RD354 - Report of the State Corporation Commission on the Activities of the Office of the Managed Care Ombudsman - 2012

Executive Summary:
This annual report on the activities of the Office of the Managed Care Ombudsman (Office) covers the period from November 1, 2011 to October 31, 2012. During this period, the Office provided informal and formal assistance to over 395 consumers and other individuals by responding to general questions and specific problems with managed care and health insurance coverage provided by a managed care health insurance plan (MCHIP). The Office staff helped consumers understand how their health insurance works, the importance of reading and understanding coverage documents, and methods to solve problems. When requested, the Office formally helped consumers appeal adverse benefit determinations. When confronted with problems outside the Office’s regulatory purview, staff referred consumers to other sections within the Bureau of Insurance for assistance, or, in some cases, to another regulatory agency. The Office continues to provide a valuable service to consumers, and functions in accordance with the legislation that established the Office in 1999.