Dfs Issues 2018 Edition Of New York Consumer Guide to Health Insurers
Financial Services Superintendent
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The New York Consumer Guide to Health Insurers ranks insurers by complaints, internal and external appeals, grievances, and dispute resolution, as well as by quality of care in various categories such as child and adolescent health, women's health, adult health and behavioral health. It also includes information on health insurers' accreditation, and resources such as contact information for insurers, how to make a complaint and how to apply for health insurance offered on
The information in the guide is based on complaint, appeal and grievance information, as well as independent dispute resolution information data from 2017. The guide lists the following information:
* Rank: Each health insurance company's rank is based on the number of prompt pay complaints upheld, relative to the company's premiums. A lower number results in a higher ranking. A higher ranking means that the health insurance company had fewer complaints relative to its size.
* Total Complaints: Total number of complaints closed by DFS in 2017. Complaints typically involve issues about prompt payment, reimbursement, coverage, benefits, rates and premiums.
* Total Prompt Pay Complaints: Total number of prompt pay complaints closed by DFS in 2017. Large health insurance companies may receive more complaints because they have more members and pay more claims than smaller health insurance companies.
* Upheld Prompt Pay Complaints: Number of closed prompt pay complaints where DFS determined that the health insurance company was not processing claims in a timely manner. Prompt pay complaints upheld by DFS are used to calculate the prompt pay complaint ratio and ranking.
* Premiums: Dollar amount generated by a health insurance company in
* Prompt Pay Complaint Ratio: Number of prompt pay complaints upheld divided by the health insurance company's premiums.
For 2017, the insurers with the highest overall ranking based on the lowest number of complaints are:
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* Community Blue (Health Now)
* Delta Dental of
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* Eastern Vision Service Plan (vision coverage only)
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New Yorkers who have concerns with their health insurance company should first contact their insurer's
For issues concerning payment, reimbursement, coverage, benefits and premiums, contact:
Consumer Assistance Unit,
Phone: 800-342-3736
Online: www.dfs.ny.gov/consumer/fileacomplaint.htm
For denials of coverage of health care services because a health insurance company considers them experimental, investigational, not medically necessary, a clinical trial, a rare disease treatment, an out-of-network service or, an out-of-network referral, contact:
Phone: 800-400-8882
Email: [email protected]
For general information:
www.dfs.ny.gov/insurance/extapp/extappqa.htm
For an external appeal application:
www.dfs.ny.gov/insurance/extapp/extappl.pdf
For issues concerning HMO quality of care, contact:
Managed Care Complaint Unit
Phone: 800-206-8125
Online: www.health.ny.gov/health_care/managed_care/complaints/index.htm
For issues concerning insurance fraud, contact:
Phone: 800-342-3736
Online: www.dfs.ny.gov/consumer/scamsfraud.htm
A copy of the Consumer Guide to Health Insurers can be found here.( https://www.dfs.ny.gov/consumer/health/cg_health_2018.pdf)
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