State finds many valid complaints against health insurers

Anthem Blue Cross and Blue Shield, Ambetter of Peach State, and Humana had high levels of consumer complaints last year that the state determined to be justified, according to newly released figures.

Georgia Insurance Commissioner Jim Beck and his staff recently posted complaint data for all health insurers in 2018. The complaints were fielded by the department’s Consumer Services Division.


JoAnne Oni, director of consumer services, said this week that other states compile similar data. This is the first time the Georgia agency has made the information public, she said.

Other complaint categories center on automobile, life and homeowner insurance companies. Each complaint is investigated by department staff, Oni added.

“We will continue to fulfill our promises of transparency, consumer protection, and defending against fraud as we carry out the department’s vital mission. This is just the beginning,” Beck said in a statement.

(Here is a link to the complaint figures. On the dropdown menu, click “Health Insurance.’’)

The health insurance complaint information is presented in two major categories. One is the ratio of complaints to the insurer’s 2018 premium revenue. The second is the level of confirmed complaints. Any ratio above 1.00 in either category is considered unfavorable, with higher numbers indicating worse records.

A confirmed complaint means the insurance department has determined that the insurer committed a violation, or that the complaint and the company’s response indicate the insurer was in error.

The complaint data do not include large employer health plans that are self-insured, according to Oni.

Georgia’s largest health insurer, Indianapolis-based Anthem Blue Cross, reported premium revenue in 2018 of $2.4 billion for its Blue Cross Healthcare Plan of Georgia. It recorded the largest number of complaints, 579, for an “All Complaints Ratio’’ of 1.50. Of those complaints, 81 were confirmed, for a confirmed ratio of 1.87. An Anthem spokeswoman said Tuesday that the company was reviewing the data.

Ambetter of Peach State had total complaint and confirmed complaint ratios of 1.81 and 1.31, respectively. Two Humana health plans had confirmed complaint ratios of 1.42 and 1.40.

A spokesman for Kentucky-based Humana declined to comment Tuesday. Ambetter’s parent company, St. Louis-based Centene, could not be reached for comment.

The Georgia Association of Health Plans said in a statement Tuesday that member insurers “are still evaluating the data. We look forward to continuing to work with Commissioner Beck and the insurance department to find ways to better serve our Georgia customers.”

The complaint list includes dozens of companies, ranging from Blue Cross, with its huge volume of business, to Reliable Life Insurance Company, which had just $33 in premium revenue.

Of the 21 companies with more than $100 million in revenue, 11 had at least one unfavorable complaint ratio.

“This information may be helpful to some very diligent insurance shoppers who want to know which insurance companies are best at keeping their customers happy before making a final decision about where to spend their money,’’ said Laura Colbert of the consumer advocacy group Georgians for a Healthy Future.

“The greater value of this information,” she said, “is for the Georgia Department of Insurance, which can use it to take action against insurers who consistently receive poor marks or reward insurers who consistently prioritize consumers, and for the insurance companies who may be inclined to better prioritize the needs of their customers as they see where they stack up against their competition.’’