New York - Superintendent of Financial Services Linda A. Lacewell today announced that the Department of Financial Services (DFS) has released the 2019 edition of the New York Consumer Guide to Health Insurers, an annual guide that is part of DFS’s ongoing efforts to protect New Yorkers, help them make informed choices about health insurance providers, and ensure that New York State’s health insurance market remains strong.

“DFS remains committed to empowering New York consumers by providing objective information they can use to make the best decisions when choosing a health insurance company,” said Superintendent Lacewell. “The 2019 guide is a comprehensive resource, providing data in a variety of significant categories, including complaints and quality of care.”

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 New York’s health insurance marketplace.

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: This represents the total number of complaints closed by DFS in 2018. Complaints typically involve issues about prompt payment, reimbursement, coverage, network adequacy, benefits, rates and premiums.
• Total Prompt Pay Complaints: This is the total number of prompt pay complaints closed by DFS in 2018. 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: This ranking represents the dollar amount generated by a health insurance company in New York State during 2018. Premiums are used to calculate the prompt pay complaint ratio so that health insurance companies of different sizes can be compared fairly. Premium data exclude Medicare and Medicaid.
• Prompt Pay Complaint Ratio: Number of prompt pay complaints upheld divided by the health insurance company’s premiums.

If you have a problem with your health insurer, first contact your insurer’s Member Services Department.  If the problem is not resolved to your satisfaction, call the appropriate state agency for assistance.

For issues concerning payment, reimbursement, coverage, network adequacy, benefits and premiums, contact:

New York State Department of Financial Services

Consumer Assistance Unit

Phone: 800-342-3736

Email: [email protected] 

Online: www.dfs.ny.gov/complaint

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:

New York State Department of Financial Services

New York State External Appeal Division

Phone: 800-400-8882

Email: [email protected]

Online: www.dfs.ny.gov/complaints/file_external_appeal

For issues concerning HMO quality of care, contact:

New York State Department of Health

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: 

New York State Department of Financial Services

Insurance Frauds Bureau

Phone: 888-FRAUDNY | 888-372-8369

Online: www.dfs.ny.gov/complaints/report_fraud

Under federal law, if you receive health coverage through a self-insured plan covered by ERISA, New York consumer protections and insurance laws do not apply. If you have a complaint regarding a self-insured plan, contact:

United States Department of Labor

Employee Benefits Security Administration

200 Constitution Avenue, NW

Washington, DC 20210

Phone: 202-693-8700 | 866-444-EBSA

Online: www.dol.gov/agencies/ebsa

A copy of the 2019 Consumer Guide to Health Insurers can be found on the DFS website.

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