Why is it important to resolve member complaints?
Medical care and health insurance can be complicated. The rules and responsibilities can be confusing. Sometimes there are mistakes and misunderstandings, so it is important that your HMO helps you when problems occur.
What can HMOs do to resolve complaints?
Highly rated HMOs solve your problems quickly by having well-trained staff and good business systems. These HMOs have knowledgeable, respectful staff. They also have systems and clear rules to quickly troubleshoot your complaints and to help settle any disagreements.
What do the stars mean?
The scores show the percentage of health plan members who reported that they were satisfied with the HMO’s handling of a problem when they called or wrote to the plan. The higher score means more members highly rated their plan on handling member complaints.
The scores are based on information from a survey of a sample of at least 100 HMO members in 2015.
Data Disclaimer
The data source for data for the Report Cards is Quality Compass® 2024 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass® 2024 includes Healthcare Effectiveness Data and Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors. NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass and HEDIS are registered trademarks of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
Users of the data shall not have the right to alter, enhance, or otherwise modify the data. Anyone who wants to use or reproduce the data without modification for a noncommercial purpose may do so without obtaining any approval from NCQA. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. Use by healthcare providers in connection with their own practices is not commercial use. A "commercial use" refers to any sale, license, or distribution of the data for commercial gain, or incorporation of the data into any product or service that is sold, licensed, or distributed for commercial gain, even if there is no actual charge for inclusion of the data. ©2004-2024 National Committee for Quality Assurance, all rights reserved.