FOR IMMEDIATE RELEASE:
June 8, 2006
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Lynda Tran 202-898-3349
A Case of the Blues?
NEW STUDY: Blue Cross Blue Shield Received Most Complaints of Any Insurer in Texas
Consumer complaints against state's largest health insurer on the rise; decreasing among all insurers
HOUSTON - A new study of complaints against Texas health insurers shows Blue Cross Blue Shield of Texas (Blue Cross of Texas) is leading the market in consumer complaints and could be driving down overall quality among all state health insurance companies. Last year consumers and doctors filed two and a half times more complaints per policyholder against Blue Cross of Texas--the state's largest health insurer-than against the average Texas health insurer. Consumers alone filed three times more complaints against Blue Cross of Texas.
Furthermore, the study shows that consumers and doctors are increasingly dissatisfied with Blue Cross of Texas. While consumer complaints against all Texas health insurers are decreasing, complaints against Blue Cross of Texas are going up. With a 28 percent market share, Blue Cross of Texas is the largest health insurer in the state, according to Standard and Poor's.
"As the state's largest health insurance company, Blue Cross Blue Shield of Texas sets the pace for other health insurers," said Chris Schwartz, Research Director for SEIU, who issued the report. "Blue Cross should lead the insurance market in services-not complaints."
The findings are the result of a new study into complaints filed by consumers and health care providers with the Texas Department of Insurance. Conducted by the nation's largest union, SEIU (Service Employees International Union), the study found that:
Blue Cross of Texas received more complaints from consumers and doctors than any other Texas HMO in 2005.
- Consumers, doctors, and other health care providers filed 2,218 complaints against Blue Cross of Texas in 2005 alone.
- Blue Cross of Texas has received more consumer complaints than any other HMO in Southeast Texas every year for the last five years.
Consumer complaints against Blue Cross of Texas are up compared with other insurers.
- Both consumers and health care providers can file complaints against an insurance company. At Blue Cross of Texas, the proportion of all complaints filed by consumers has increased by 33 percent at the same time that consumers' share of complaints at other Texas insurance companies declined by 50 percent.
- In Southeast Texas, the consumer share of complaints has risen even faster-from 12 percent in 2003 to 78 percent in early 2006.
Blue Cross of Texas received more "justified" consumer complaints than any other Texas HMO in 2005.
- A complaint is determined by the Texas Department of Insurance to be justified when it finds "an apparent violation of a policy provision, contract provision, rule or statute, or there is a valid concern that a prudent layperson would regard as a practice or service that is below customary business or medical practice." Last year, there were 4.6 times as many "justified" complaints filed against Blue Cross of Texas in Texas as against the average Texas health insurer.
- Statewide, more than half of consumer complaints against Blue Cross of Texas's HMO operations were determined to be justified by the Texas Department of Insurance, compared to an average of one-third of the complaints filed against all health insurers. Similar results were found in Southeast Texas.
Other study findings include Blue Cross of Texas leading the state in complaints involving access to health care and mishandled claims as well as a high turnover rate among physicians who are part of the Blue Cross of Texas HMO network.
With more than 1.8 million members, SEIU is the nation's largest union and the largest union of health care providers. In Texas, SEIU represents more than 14,000 workers, including janitors and public employees. In the last ten years, SEIU has helped hundreds of thousands of workers win access to affordable health insurance on the job.