RD508 - Report of the State Corporation Commission on the Activities of the Office of the Managed Care Ombudsman - 2016

Executive Summary:
This annual report on the activities of the Office of the Managed Care Ombudsman (Office or Staff) covers the reporting period from November 1, 2015 to October 31, 2016. During this period, the Office provided informal and formal assistance to more than 712 consumers and other individuals. The Office responded to general questions and specific problems and issues with managed care and health insurance coverage provided by managed care health insurance plans (MCHIPs). The Office 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 when necessary, 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 regulatory authority of the Bureau of Insurance. Specifically, during the reporting period, the Office responded to 596 inquiries and assisted 116 consumers in filing insurance-related appeals. The Office also participated in outreach events, such as the State Fair of Virginia, and continued to monitor federal and state health insurance related legislation. Details of these and other activities are provided herein.