NCPA - National Center for Policy Analysis

HMOs Paying More Attention To Patient Complaints

November 30, 1998

Some large Health Maintenance Organizations (HMOs) are taking steps to address problems that have enraged and frustrated their members. Their executives have recognized that it is a lot cheaper and easier to fix mundane service problems than to change the basic rules of managed care.

A recent report by Health Rights Hotline -- a nonprofit assistance program for managed-care consumers in four California counties -- studied the complaints of 2,400 people during the past year.

  • Denial of care was the leading complaint -- affecting 17 percent of those surveyed.
  • Inappropriate care was cited by 14 percent, as was poor customer service.
  • Disputes over payments concerned 11 percent, and 10 percent cited the unmet need for specialty care.
  • Other glitches involved delays in getting care and problems with obtaining prescription drugs.

Observers say that HMOs' efforts to streamline the system have involved instituting three-way conference calls between patients, HMO representatives and doctors. Another solution being tried is referring care denials to an outside reviewer for a binding decision. Simply answering phone calls promptly is another policy aimed at reducing patient frustration.

Source: Rhonda L. Rundle, "Under Attack, HMOs Address Patients' Gripes," Wall Street Journal, November 27, 1998.


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