Thanks to Benefitslink.com for the pointer to this press release: “HEALTH PLANS FAIL TO DISCLOSE REQUIRED COVERAGE INFORMATION: New Report Shows HMOs Do Not Adequately Comply with State Law.” According to the press release, Attorney General Eliot Spitzer today released a report with a survey showing that health plans in New York State are failing to disclose required information that could help consumers obtain coverage for medically necessary treatments. Apparently, members of Spitzer’s staff posed as prospective enrollees of a health plan and wrote five letters to each of 22 health plans requesting information on the standards used to determine whether or not a treatment for five different conditions was medically necessary and therefore covered by insurance. Spitzer’s staff analyzed the responses from the health plans and assigned grades to the plans based on the number of satisfactory responses:
Out of 22 plans studied, half (11) received an “F” for compliance, seven plans received a “D,” three plans received a “C,” and only one plan got a “B.” No plan received an “A.” Twenty-six percent of the 110 letters received no response from the plans at all.
Spitzer has said that “when health plans fail to respond to such information requests they may discourage chronically ill New Yorkers from enrolling in their plans and thwart the state’s commitment to making insurance accessible to all without regard to health status.”
The Attorney General’s office has sent letters to each of the plans surveyed detailing particular violations and requesting that each plan take immediate measures to comply with the law and set a meeting date to discuss permanent compliance measures. The press release indicates that plans that repeatedly fail to comply with the law could face legal action.