RD361 - Report of the State Corporation Commission on the Activities of the Office of the Managed Care Ombudsman - 2010


Executive Summary:
This annual report on the activities of the Office of the Managed Care Ombudsman (the Office) covers the period from November 1, 2009 through October 31, 2010. During this period, the Office informally and formally assisted over 897 consumers and other individuals by responding to general issues or specific problems involving a Managed Care Health Insurance Plan (an MCHIP). This assistance usually involved questions and problems regarding managed care or health insurance and other related subjects. The Office staff helped consumers understand how their health insurance works and potential ways to resolve problems, including formally assisting consumers in the internal appeal process with an MCHIP. When confronted with situations that were outside the Office’s regulatory purview, staff referred individuals to other sections within the Bureau of Insurance for assistance, or in some cases, to another regulatory agency. During this reporting period, staff closely monitored historical legislation at the federal level and state level that affect health insurance and related areas. The Office continues to provide a valuable service oriented to consumers and functions in accordance with the legislation that established the Office in 1999.