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Official complaints against Indiana insurers drop this year
e-Reports, July 25, 2011
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If you have not resolved a disputed claim or a claim passes 90 days without payment, you can file a complaint with the insurance department – thanks to efforts of the ISMA Untitled document

If you filed a complaint with the Indiana Department of Insurance (IDOI) about a health insurers’ action – or inaction – in 2010, you contributed to the Accident Health 2010 Complaint Index. If you’ve never filed a complaint, you should know that this course of action is open to you.

Complaints were down for last calendar year, 1,265 in 2010, compared with 1,506 filed in 2009.

About the 2010 index

Total complaints filed in the past five years
2010 1,265
2009 1,506
2008 1,623
2007 1,563
2006 1,239

The complaint index is based on the statewide premium total for each company and the number of closed complaints IDOI receives on a company. A complaint index of 1.00 means the insurer’s share of all complaints received is equal to its share of all the business it writes in Indiana. An index of 2.00 means the insurer’s share of complaints equals twice its share of business.

The insurers with the most premiums are Anthem ($3,257,350,848) and UnitedHealthcare ($1,002,763,057). This year, Anthem had 337 complaints with an index of 0.77; UnitedHealthcare logged 108 complaints with an index of 0.80.

Find this year’s complete index here.

IDOI reverses decision on threshold
ISMA Reports previously reported on computer system failures that plagued Anthem/Wellpoint for 18 months, starting in the fall of 2007. To fully investigate the problem, ISMA staff spent significant time and resources researching complaints by reviewing records at the IDOI. A product of this research was the discovery that the IDOI had established a $250 threshold for filing a complaint.

After reviewing more than 1,000 complaints, ISMA staff had multiple meetings with current IDOI Commissioner Steve Robertson.

“Commissioner Robertson was satisfied with information presented by the ISMA and removed the threshold amount – as long as complaints are valid and do not involve a self-funded plan,” said Mike Rinebold, ISMA director of Government Relations.

“I found Commissioner Robertson to be fair in his decision to remove the threshold amount,” continued Rinebold. “He listened to our reasoning about why the threshold was a barrier to complaint filing, for health care providers and patients.”

Self-funded insurance plans fall under federal jurisdiction as a result of the Employee Retirement Income Security Act (ERISA). Complaints regarding ERISA plans are not included in the IDOI complaint index. The IDOI now encourages you to include a copy of the patient’s insurance card with a complaint filing to prove it does not involve a self-funded plan.

Filing a complaint
The IDOI can investigate the facts about your complaint on a claim. If efforts to solve a problem with a health insurer are unsuccessful and/or if more than 90 days pass before payment of a clean claim, you can file a complaint and ask for assistance.

Find a complaint form on the IDOI website. Attach a copy of the patient’s insurance card and a cover letter, if needed, to further explain your complaint. For more information, call the IDOI at (317) 232-2395.

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