November 13, 2001
Menlo Park, CA and Yonkers, NY – Today a free online consumer guide about handling health plan disputes was launched by the Kaiser Family Foundation and Consumers Union, the publisher of Consumer Reports magazine. A Consumer Guide to Handling Disputes With Your Private or Employer Health Plan provides practical information to plan enrollees who are seeking a way to resolve a dispute with their health plan or to better understand their coverage before a problem arises.
With the vast majority of Americans getting their healthcare through some form of managed care plan, understanding those plans and how to resolve disputes is critical. Today, 40 states plus the District of Columbia have legislated procedures for resolving disputes outside the health plan through “external review” systems, yet studies show these systems are not well utilized. This guide will help consumers navigate their plan’s internal grievance procedure, as well as their state’s external review process.
“Disputes with health plans range from simple communication problems to delays or denial of coverage or care, and it is critical that consumers have the tools they need to navigate the dispute resolution process,” said Drew Altman, Ph.D., president of the Kaiser Family Foundation. “Health disputes left unresolved can have a major impact on people’s lives.”
A recent survey by the Kaiser Family Foundation and Harvard University School of Public Health found that almost half (48%) of privately insured adults under age 65 had a problem with their health plan in the last year with a range of consequences from hassles, to paying more, to adverse effects on their health.
“Consumers must be vigilant in monitoring the decisions made by health plans,” said Trudy Lieberman, director of The Center for Consumer Health Choices at Consumers Union. “Many disputes arise because people don’t know their coverage. By becoming familiar with coverage, benefits and grievance procedures, a dispute that occurs can be resolved more easily.”
How to Access the Consumer Guide:
Visit the Kaiser Family Foundation website at www.kff.org/consumerguide/, or the health section of the Consumers Union. In addition, a link to the Consumer Guide is posted in the free consumer advice section of the Consumer Reports magazine website, www.consumerreports.org.
The guide includes sections that will help people understand their health plan’s rules and coverage, its internal review process, and the external review process in the states that have one. It was developed under a partnership between The Center for Consumer Health Choices at Consumers Union and the Kaiser Family Foundation.
The Kaiser Family Foundation is an independent, national health philanthropy dedicated to providing information and analysis on health issues to policymakers, the media, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.
Consumers Union is an independent, nonprofit testing and information-gathering organization, serving only the consumer. It is a comprehensive source of unbiased advice about products and services, personal finance, health, nutrition, and other consumer concerns. Since 1936, Consumers Union’s mission has been to test products, inform the public, and protect consumers.
The Henry J. Kaiser Family Foundation
2400 Sand Hill Road
Menlo Park CA 94025
Tel 650 854-9400
Fax 650 854-4800
101 Truman Avenue
Yonkers, NY 10703-1057
Tel 914 378-2000
Fax 914 378-2900