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Hmos Failing State Standards Essay

938 words - 4 pages

New Yorkers may be covered by one of the nation's most comprehensive health consumer protection laws--but insurers routinely flout it, according to a report released yesterday by New York City Public Advocate Mark Green.
Posing as prospective clients, Green's investigators called 12 of the region's health maintenance organizations, including some of the largest on Long Island and in Queens, to get information about their complaint records, lists of covered prescription drugs and medical procedures, and policies on confidentiality and experimental treatments. Although New York's new managed care bill of rights requires health plans to provide the information to both members and potential ...view middle of the document...

Other top performers were NYLCare Health Plans of New York, which complied 15 percent of the time, and United Healthcare and Oxford, which both complied 14 percent of the time. Prudential HealthCare, MagnaCare/MagnaHealth and WellCare ranked at the bottom of the list, complying less than 5 percent of the time, Green's office said. Health Insurance Plan of Greater New York, Aetna/US Healthcare and Empire Blue Cross and Blue Shield ranked in the middle, complying 20 percent, 16 percent and 13 percent of the time, respectively. Physicians Health Services Inc. and Healthsource Inc. both complied 14 percent of the time.Bob Hinckley, a spokesman for the state Department of Health, said the department has cited two plans--Aetna/US Healthcare and Oxford-for violations, but said the plans were not fined. [CURE Comment: That's really getting their attention, Bob.] Officials from managed care plans contacted yesterday refused to discuss the survey, saying they had not yet read the report. Amy Nacinovich, a spokeswoman for the HMO Council and Conference, an Albany-based trade association, also declined comment. According to the report, Green's investigators often faced long waits on the phone only to be told they had to submit their questions in writing, and were promised information would be mailed to them that never was. In some cases, callers were given inaccurate information, or got contradictory answers when calling the same HMO more than once. New York's Managed Care Bill of Rights is one of the nation's most comprehensive. Among other provisions, it requires disclosure of a wide range of information, from the drugs the plan will pay for to the criteria used to determine which medical procedures are covered. Green's report is based on a monthlong survey done by his...

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