Rate of Inquiries and Complaints About HMOs Received by DMHC
Any HMO member, by law, can contact DMHC if they are not satisfied with decisions made by their HMO about their medical care or insurance. The rate at which HMO members contact DMHC with information inquiries and complaints is one measure of how well HMOs meet their members’ needs and solve problems when they happen.
This chart shows the plans’ overall effectiveness in communicating with members. It reports informational inquiries, formal complaints and requests for IMRs filed with DMHC’s Help Center. Members’ informational inquiries include questions about a health plan’s grievance and appeals process, coverage, claims or billing, enrollment, or customer service issues.
What do the scores mean?
The score is shown as the rate by which HMO members make information inquiries, file complaints, or file IMRs with the Department of Managed Health Care (DMHC). Longer bars mean that a greater percentage of that HMO’s members contacted DMHC to make inquiries about their health plan.
What Is the Source?
This data came from the DMHC’s 2013 Independent Medical Review and Complaint Results report. For further information about the data on this page, please go to About the HMO Independent Medical Review and Complaint Ratings.
*Rates for Anthem Blue Cross and Blue Shield include aggregated data for both their HMO and PPO health plan products that are regulated by the Department of Managed Health Care.
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