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Third Annual Guide Enables NYers to Evaluate Health Insurance Providers

Governor George E. Pataki today announced that the State’s third annual edition of the New York Consumer Guide to Health Insurers is now available.

The new, comprehensive Guide, produced in conjunction with National Committee for Quality Assurance (NCQA) and Consumers Union, publisher of Consumer Reports, provides New York State consumers access to key facts about choosing and comparing health insurers.

"It is important to know the facts when evaluating and choosing a health care plan for you and your family," Governor Pataki said. "The New York Consumer Guide to Health Insurers puts vital information in the hands of New Yorkers, enabling them to make sound, informed decisions about health insurance for themselves and their families."

The Guide allows consumers to compare plans based on the number of complaints, grievances, and utilization review appeals. It also explains how consumers can appeal adverse utilization review decisions under the State’s two-year old External Review Law and gives results of the new law by all types of health insurers.

Also included is the State Insurance Department’s annual ranking of health insurers according to the number of consumer complaints. Complaint ratios are determined by the number of upheld complaints in proportion to the plan’s size.

The HMOs with the best complaint ratios are:

1. Rochester Area HMO (Preferred Care) -0.000

2. Managed Health -0.000

3. Metroplus -0.000

4. Finger Lakes HMO/HMO Blue -0.009

5. Univera Healthcare of CNY -0.020

The HMOs with the worst complaint ratios are:

19. PHS (Health Net) -0.484

20. Oxford -0.620

21. Vytra -0.775

22. MDNY -0.794

23. CIGNA -1.369

Important information provided by the Department of Health is also included, such as certain rates of treatment, health plan enrollee primary care visit rates, and other indicators of a health plan’s quality of care. In addition, consumers are offered a comprehensive review and a comparison of the major quality-of-care indicators and other performance measures for HMOs, not-for-profit insurers and commercial insurers. Standard indicators that are measured include mammography screenings, child immunizations and prenatal care.

Additionally, an HMO-only guide will soon be available, as well as a new interactive version of the guide on the Insurance Department’s Web site.

"This Guide is important for consumers because it highlights real differences in performance among the plans and presents the information in a standard and easy-to-understand format," said Insurance Superintendent Gregory V. Serio. "I am pleased to offer this updated resource so individuals know how health insurers are treating their customers, how they handle complaints, grievances, and appeals and what quality of care they provide."

It has been a top priority to enact meaningful and practical health insurance reform for New Yorkers. Landmark legislation such as the Heath Care Reform Act of 2000 establishing the Healthy NY Program covering New York’s working uninsured, Point-of-Service Law of 1995, the Managed Care Reform Act of 1996, the Women’s Health and Cancer Rights Act of 1997, the Child Health Plus insurance program expansion, and 1998 legislation guaranteeing consumer a right to external review of health insurance coverage decisions are examples of major health insurance initiatives signed into law by the Governor.

The report can be accessed on the Insurance Department’s Web site at in the consumer section or by calling the consumer hotline at 1-800-342-3736.


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