November 13, 2002

The Michigan Office of Financial and Insurance Services (OFIS) today released the third annual health maintenance organization (HMO) Consumer Guide. The guide is available at www.michigan.gov/ofis or in hard copy by calling OFIS toll free at 877-999-6442.

“The OFIS HMO Consumer Guide continues to be an excellent resource for information about HMOs in Michigan,” said OFIS Commissioner Frank M. Fitzgerald. “The guide provides HMO quality statistics, complaint information, and links to financial information. This guide assists consumers in choosing an HMO and making important health decisions.”

The direct link to the HMO Consumer Guide is http://www.michigan.gov/cis/0,1607,7-154-10555_13222_13224-34152--,00.html. The guide is available on-line as a web-based database – consumers can choose among HMOs in their area to create a personal HMO guide. The hard copies available from OFIS by calling toll free (877-999-6442) contain information for all Michigan commercial HMOs.

The quality information in the guide is based on the Health Employer Data Information Set ® (HEDIS) and the Consumer Assessment of Health Plans ® (CAHPS) from the National Committee for Quality Assurance (NCQA). HMOs are measured on access/service, doctor communication/service, staying healthy services, and getting better/living with illness services. Additional information on the quality measurements is available at www.ncqa.org.

The HMO complaint information is based on statistics from the Patients Right to Independent Review Act (PRIRA). This act sets up a process for Michigan consumers who have received a health care claim denial from an HMO or health insurance company. The act sets up an internal appeals process with the HMO or insurance company as a first step. If the service is still denied after the internal appeals process has been completed, consumers can appeal to the state for an independent review of the claim denial. Complaint statistics from the PRIRA process are available in the OFIS HMO Consumer Guide. Directions on using PRIRA are available at www.michigan.gov/cis/0,1607,7-154-10555_12902_12907---,00.html and a summary of the first two years of PRIRA is available at www.michigan.gov/cis/0,1607,7-154-10555_13222_13250-55482--,00.html.

The HMO financial information contained in the guide tracks the solvency of Michigan HMOs from year-end 2000 through the 2nd quarter of 2002. This web site is updated with PDFs of the HMO financial reports roughly 45 days after the end of each quarter and year-end. The financial information can be directly linked at www.michigan.gov/cis/0,1607,7-154-10555_12902_18956---,00.html.

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The Michigan Office of Financial and Insurance Services (OFIS) is responsible for the regulation of Blue Cross Blue Shield, 28 HMOs, 138 banks, 281 credit unions, almost 1,500 insurance companies, 1,583 investment advisers, 2,164 securities broker-dealers, 6,000 consumer finance lenders, 89,000 insurance agents, and 120,715 securities agents. OFIS is part of the Department of Consumer and Industry Services and is primarily fee-funded, requiring minimal public tax dollars for its regulatory and consumer assistance activities. OFIS has insurance, financial institutions and securities information available online at the OFIS web site, www.michigan.gov/ofis, or at the Michigan government home page, www.michigan.gov. All information is also available through the OFIS toll free number, (877) 999-6442. If you would like to receive OFIS press releases electronically, please email ofis-info@michigan.gov.