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Data Shows Consumers Win Appeals More Than Half the Time

Superintendent Neil D. Levin today announced that the state’s first comprehensive Consumer Guide to Health Insurers is now available to all New Yorkers. The new 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.

"With the open enrollment season upon us for health insurance, it is a perfect time for consumers to use our new Guide as many New Yorkers are changing or switching their health coverage," said Levin. "When making health care decisions it is critical that individuals know how health insurers are treating their customers, how they handle complaints and grievances, and the quality of care that they provide. Health insurers are accountable to their customers and this guide will show consumers how the plans stack up."

The new Guide gives consumers 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. In addition, consumers can compare plans based on the number of complaints, grievances and utilization review appeals. The Guide tells consumers how to contact health insurers and how they can appeal adverse utilization review decisions under the State’s new External Review law.

In addition to providing comparative data, the Guide includes explanations of each measure to help consumers understand why it is important, and how the information can be used when selecting a health insurer. This year’s Guide also contains the Department’s traditional ranking of health insurers according to the number of consumer complaints. Complaint ratios are determined by the number of upheld complaints in proportion the plans’ size.

The HMOs with the best complaint ratios are:

1. Excellus
2. Preferred Care
3. Empire Blue Cross/Blue Shield/Healthnet
4. Health Care Plan
5. Community Blue

The HMOs with the worst complaint ratios are:

22. Oxford
23. Prudential
24. Cigna
25. HUM
26. Wellcare

"This Guide is important for consumers because it highlights real differences in performance among the plans and presents the information in a standard format that is easy-to-understand," said Levin. "It is clear from our findings that consumers are taking full advantage of their rights under New York’s managed care reform laws."

Consumers may request a copy of the Guide by calling the Department’s toll free number at 1-800-342-3736 or by visiting the Department’s Web site at

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