Rate of Formal Complaints Against HMOs Reviewed by DMHC
Any HMO member, by law, can contact DMHC if they are not satisfied with the 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 reports on the HMO members’ formal complaints filed against their HMO. A plan member can make a formal complaint with DMHC if they are not satisfied with their HMO’s response through its grievance-appeals process. DMHC reviews these complaints and decides whether a plan’s decision is legal or if it must be reversed.
What do the stars mean?
The score shows the rate of HMO members who filed a formal complaint against their health plan and had it reviewed by DMHC. The formal complaints are a subset of all the inquiries and complaints described in the Rate of Inquiries and Complaints About HMOs Received by DMHC chart. A longer bar means that a greater percentage of that HMO’s members filed formal complaints with DMHC.
What Is the Source?
The data sources for this average rate came from DMHC’s 2013 Independent Medical Review by Health Plan 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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