RD369 - Report of the State Corporation Commission on the Activities of the Office of the Managed Care Ombudsman - 2013


Executive Summary:
This annual report on the activities of the Office of the Managed Care Ombudsman (Office) covers the period from November 1, 2012 to October 31, 2013. During this period, the Office provided informal and formal assistance to over 538 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. The Office also formally helped consumers appeal adverse benefit determinations, and referred consumers to other sections within the Bureau of insurance for assistance, or, in some cases, to another regulatory agency when the problems involved issues outside the Office’s regulatory purview. The Office continues to promote and protect the interest of Virginia consumers in accordance with the provisions of Title 38.2, Chapter 59 of the Code of Virginia.