Insurance Complaints

Jane Nevins filed this request with the California Department of Insurance of California .
Status
Completed

Communications

From: Jane Nevins

To Whom It May Concern:

Pursuant to the California Public Records Act (California Government Code §§ 6250), I hereby request the following records:

I'd like annual data on consumer complaints filed each year including but not limited to the number of complaints, the insurance company, the reason for the complaint and the outcome of complaints.

The requested documents will be made available to the general public, and this request is not being made for commercial purposes.

In the event that there are fees, I would be grateful if you would inform me of the total charges in advance of fulfilling my request. I would prefer the request filled electronically, by e-mail attachment if available or CD-ROM if not.

Thank you in advance for your anticipated cooperation in this matter. I look forward to receiving your response to this request within 10 calendar days, as the statute requires.

Sincerely,

Jane Nevins

From: Custodian of Records

The California Department of Insurance is in receipt of your request which has been treated as a Public Records Act request. The Department will respond shortly pursuant to Government Code Section 6253(c) which states that the Department has up to ten days to respond to your request.

From: Charters, Belinda

Ms. Nevins:

On November 30, 2016, the California Department of Insurance Custodian of Records received your request for information on the above-referenced matter, which has been treated as a request pursuant to the California Public Records Act (Gov. Code § 6250 et. Seq).

Specifically, your request seeks information regarding consumer complaints.

The requested information is available on the Department's public website:

Complaint Studies - on three lines of insurance:
http://www.insurance.ca.gov/01-consumers/120-company/03-concmplt/index.cfm

Company Performance & Comparison Data --- search any insurance company for the past three years:
https://interactive.web.insurance.ca.gov/companyprofile/companyprofile

Annual report - provides the cumulative number of complaints received each year.
http://www.insurance.ca.gov/0400-news/0200-studies-reports/0700-commissioner-report/

Thank you for your consideration.

Belinda M. Charters
Senior Legal Analyst
Government Law Bureau
300 Capitol Mall, Suite 1700
Sacramento, CA 95814
Ph: 916-492-3334

From: Jane Nevins

Dear Ms. Charters,

Thank you so much for your response and list of links to the reports on consumer complaints. I appreciate your help, and I realize I should have been more specific in my request.

I am specifically looking for a data set on consumer complaints about health insurance companies in Calfornia from the Health Claims Bureau (HCB), which investigates consumer and health care provider allegations of improper claims handling by health insurers. I am interested in how consumer complaints about health insurance have changed over time.

The data I'm looking for could include the name of the companies, the date of the complaint, the type of complaint (the code), whether the DIC investigated the complaint, the results of that investigation, etc. The 2015 Annual Report of the Commissioner mentions a database that captures and tracks potential issues and summarizes the data in the report. I would like access to the data in that database as it relates to consumer complaints about health insurance providers in CA for the last 10 years.

Thank you again, and please let me know if you have any questions about this request.

Have a great week!

Sincerely,
Jane Nevins

From: Charters, Belinda

Ms. Nevins,

Thank you for your email below received today, February 3, 2017. I did not receive the emails from Dec. 20, 2016 or Jan. 4 or 19, 2017. I will open a new PRA matter and be in contact with you within the next 10 days.

Belinda M. Charters
Senior Legal Analyst
Government Law Bureau
300 Capitol Mall, Suite 1700
Sacramento, CA 95814
Ph: 916-492-3334

From: Charters, Belinda

Ms. Nevins:

On February 3, 2017, the California Department of Insurance ("Department") Custodian of Records received your request for information on the above-referenced matter, which has been treated as a request pursuant to the California Public Records Act (Gov. Code § 6250 et. seq).

Your request seeks a data set on consumer complaints about health insurance companies in California from the Health Claims Bureau.

The details contained in the Department database is not publically available. However, when it comes to health, the Department has two types of information currently available:

1. Independent Medical Review Program statistics since 2011 are located at the following link: https://interactive.web.insurance.ca.gov/IMR/faces/search?_afrLoop=337085265104066&_afrWindowMode=0&_adf.ctrl-state=4bq5j1qyk_4 . This is limited to cases that have gone through the IMR process but provides expanded info on complaints, such as diagnosis, treatment, outcome of the IMR, age/gender, etc. and the name of the company for cases closed after July 1, 2015.

2. Complaint study for the last 3 years for health within the CDI jurisdiction: https://interactive.web.insurance.ca.gov/companyprofile/companyprofile. You need to provide the name of the insurer one by one to obtain the summary results. For example, if you type in "Anthem Blue Cross," it will take you to Anthem's page https://interactive.web.insurance.ca.gov/companyprofile/companyprofile?event=companyComplaintEvent&doFunction=getCompanyPerformance&eid=7008 . From there, you need to click on Company Performance & Comparison Data on the LHS of the screen, which will display the summary of the company's performance for the last 3 years. This is the only info that's publically available

Thank you for your consideration.

Belinda M. Charters
Senior Legal Analyst
Government Law Bureau
300 Capitol Mall, Suite 1700
Sacramento, CA 95814
Ph: 916-492-3334

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