Politics & policy

Insight into federal and state health care legislation & CMS regulation

N.H. Governor Proposes Bill To Curb Rising HMO Complaints

New Hampshire Insurance Commissioner Charles Blossom estimates that his office will receive more than 9,000 consumer complaints against managed care companies this year, a 44-percent increase from 1997.

Though Blossom says the state has resolved about 70 percent of complaints against HMOs accused of failing to provide promised coverage or of violating state regulations, Gov. Jeanne Shaheen has proposed an HMO Accountability Act. The governor's proposal would streamline rules for challenging denials of benefits, with an expedited appeals process in life-threatening cases. Managed care organizations say that Shaheen's bill is unneeded and costly.

As plans have lost money in recent months, the number of disputes over coverage denials has risen. HMOs in the state have lost more than $30 million in the first six months of 1998, with Blue Cross and Blue Shield of New Hampshire accounting for nearly half of that. The company blames competitive pressures, higher outpatient costs and increased use of prescription drugs. The insurer plans to raise premium rates by up to 20 percent next year to try to stem the losses.

Other New Hampshire plans that lost money in the first half of the year include Aetna U.S. Healthcare, Healthsource New Hampshire, Harvard Pilgrim Health Care, Oxford Health Plans and Tufts Health Plan.

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