HEHS-98-119 HMO Complaints and Appeals: Most Key Procedures in Place, but Others Valued by Consumers Largely Absent

Many people experience difficulties with their HMOs. This report examines: (1) what elements are considered important to a system for processing HMO member complaints and appeals; (2) the extent to which HMOs complaint and appeal systems contain these elements; (3) what concerns consumers have regarding HMO complaint and appeal systems; (4) what information is available on the number and types of complaints and appeals HMOs receive from their members; and (5) how HMOs use their complaint and appeal data. Assesses whether the policies and procedures contain the features recommended by regulatory, industry, and consumer groups.