What Was Measured?

Why Is It Important?

Medical care and health insurance are very complex businesses. The rules and responsibilities are confusing to patients and professionals — misunderstandings and mistakes are common.

The best HMOs solve their members’ problems by having well-trained staff and good business systems. These HMOs have knowledgeable, respectful staff; systems and clear rules to quickly troubleshoot member complaints and to clear up confusion or settle a disagreement.

Member Complaints Summary 2012 Edition

A clear signal about an HMO’s service and care is how well the plan handles members’ concerns or complaints. Members are surveyed to see if they were satisfied with how the HMO solved a problem after they contacted the plan.