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Press Office

IMMEDIATE, Friday September 26, 2003


Fifth Annual Guide Helps Consumers, Ensures Access to Quality Health Care

Governor George E. Pataki today announced that the State’s fifth annual edition of the New York Consumer Guide to Health Insurers is now available. The Guide allows New Yorkers to compare insurers when choosing the health insurance coverage that is best for themselves and their families.

The comprehensive Guide, produced in conjunction with National Committee for Quality Assurance (NCQA) and Consumers Union, publisher of Consumer Reports, furnishes New York State insurance consumers with key facts to compare and choose health insurers. Health plans are compared on major quality of care indicators and consumer service factors.

"Making an educated choice about health insurance is one of the most important decisions a family can make," Governor Pataki said. "The Consumer Guide to Health Insurers contains a wealth of helpful and easy-to-use information to assist New Yorkers in comparing different plans and making an informed choice about their health care coverage."

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 External Review Law and gives results of the 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. HMOs are ranked separately from non-profit insurers and commercial insurers.

"With five million New Yorkers getting their health insurance through HMOs and with millions more obtaining coverage through non-profit indemnity insurers and commercial insurers, this complaint ranking is an important tool for evaluating one’s health insurance needs," said Superintendent of Insurance Gregory V. Serio. "The guide makes it easy to find your health insurer and compare it to other insurers in the marketplace."

Important information from the Department of Health about HMOs is also included. The information allows consumers to compare HMOs in terms of quality-of-care indicators, such as well-child visits, cholesterol screenings after a cardiovascular event, specific treatments after a heart attack, chlamydia screenings, and antidepressant medication management. In addition, consumer survey results are included that convey the opinions of HMO members with respect to physician quality, access to care, and their overall ratings of their HMOs.

State Health Commissioner Antonia C. Novello, M.D., M.P.H., Dr.P.H., said, "This new health insurer guide, coupled with the State Health Department’s annual report on Managed Care Performance in New York State, are providing New Yorkers with the information they need to make informed decisions when choosing a health plan. Strengthened consumer access to managed care quality indicators and marked improvements in the care provided by managed care plans statewide clearly demonstrate Governor Pataki’s commitment to making sure that each and every New Yorker has access to the best health care in the nation."

The information gathered in the consumer guide and its related findings will be used to help achieve Governor Pataki’s health goals for New York, which include: reducing the burden of asthma attacks among children; increasing immunization for children; significantly reducing teenage smoking; and eliminating the transmission of HIV disease from mothers to newborns.

The five HMOs with the best complaint ratios in 2002 were: Empire HealthChoice, Capital District Physicians’ Health Plan (CDPHP), Vytra, Excellus Health Plan, and Independent Health Association (IHA). Three of these HMOs — Excellus, Empire, and IHA — were also among the top five in the previous year. (Note: the Excellus Health Plan operates under the following names: Finger Lakes HMO, Upstate HMO, and Univera Healthcare HMO).

The HMOs with the worst complaint ratios in 2002 are: Atlantis Health Plan,Inc., MDNY, CIGNA, Health Net of New York and UnitedHealthcare of NY.

Only four large non-profit indemnity insurers wrote sufficient premium to qualify for inclusion in the 2002 non-profit complaint ranking. Of the four insurers, Vytra Health Services and Excellus Health Plan Inc. both posted better than average results. The same two insurers were also above-average performers the previous year.

Of commercial insurers writing traditional health insurance, Empire HealthChoice Assurance was the top finisher. In the previous year, Empire was also the best finisher among commercial carriers writing traditional health insurance products.

Enacting meaningful and practical health insurance reforms for New Yorkers has been a key priority of Governor Pataki. Among the landmark laws that have been enacted in recent years are the following: the Women’s Health & Wellness Act of 2002; the Health Care Reform Act of 2000, which established the Healthy NY Program for New York’s working uninsured; the Women’s Health and Cancer Rights Act of 1997; the Managed Care Reform Act of 1996; the Point-of-Service Law of 1995; the Child Health Plus insurance program expansion; and the 1998 External Review Law which guarantees consumers a right to external review of health insurance coverage decisions.

The report can be accessed on the State Insurance Department’s Web site at in the consumer section or by calling the consumer hotline at 1-800-342-3736. Consumers may also access the State Health Department’s annual report on Managed Care performance at

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