HMOs Failing State Standards :: social issues

HMOs Failing State Standards New Yorkers may be covered by one of the nation's most comprehensive health consumer protection laws--but insurers routinely flout it, according to a report released yesterday by New York City Public Advocate Mark Green. Posing as prospective clients, Green's investigators called 12 of the region's health maintenance organizations, including some of the largest on Long Island and in Queens, to get information about their complaint records, lists of covered prescription drugs and medical procedures, and policies on confidentiality and experimental treatments. Although New York's new managed care bill of rights requires health plans to provide the information to both members and potential members, all of the HMOs flunked the test most of the time, with representatives either unwilling or unable to answer the questions. "Five out of six times the HMOs refused to tell one of our callers whether a drug was covered by the HMO," Green said. "Not to know whether the HMO you might join will cover a drug you use monthly is like a computer store refusing to tell you the memory of the computer--or an auto dealership refusing to give you the miles-per-gallon of the Pontiac." "Our callers got extremely frustrated, and their health wasn't even at risk," Greensaid. The survey was conducted in July and August, just months after the New York law went into effect in April. Kevin McGrath--a spokesman for Wellcare, the small plan that had the worst score--said that although he hasn't seen the full report, he is "suspicious" of the survey's methodology because the results were so extreme. "From the results, it looks to me that the survey may be flawed," he said. "The results are hard to believe." [CURE Comment: Not to MCL subscribers, Kevin.] Even Cigna HealthCare of New York, which scored highest on a point system devised by Green, complied with the law only one-third of the time, according to the report. Other top performers were NYLCare Health Plans of New York, which complied 15 percent of the time, and United Healthcare and Oxford, which both complied 14 percent of the time. Prudential HealthCare, MagnaCare/MagnaHealth and WellCare ranked at the bottom of the list, complying less than 5 percent of the time, Green's office said. Health Insurance Plan of Greater New York, Aetna/US Healthcare and Empire Blue Cross and Blue Shield ranked in the middle, complying 20 percent, 16 percent and 13 percent of the time, respectively.