HEAU Appeals and Grievances Cases - Maryland Attorney General

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Table of Contents I. Executive Summary.......................................................1 II. Overview of the Appeals and Grievances Process.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 III. Carrier Internal Grievances Process...........................................3 Carrier Statistics FY 2007............................................4 IV. Maryland Insurance Administration. .........................................5 MIA Statistics FY 2007..............................................6 V. The Health Education and Advocacy Unit......................................7 HEAU Statistics FY 2007............................................8
VI. Appendix...............................................................9 Carrier Grievance Data Grievances Reported by Carriers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Grievances Filed Eight Year Comparison. . . . . . . . . . . . . . . . . . . . . . . . . 12 Outcomes of Internal Grievances................................13 Outcomes of Internal Grievances– ThreeYear Comparison. . . . . . . . . . . 13 Type of Service Involved in Grievances. . . . . . . . . . . . . . . . . . . . . . . . . . 14 Outcomes of Grievances by Type of Service.. . . . . . . . . . . . . . . . . . . . . . 14 Percentages of Grievances Overturned or Modified Three Year Comparison ................................................15 Adverse Decisions compared to Grievances Filed.. . . . . . . . . . . . . . . . . . 16 MIA Complaint Data Complaints Listed by Carrier...................................17 Complaints Reviewed by Appeals and Grievances Unit. . . . . . . . . . . . . . 19 Disposition of Complaints.....................................20 Results of MIA Orders........................................21 Type of Service Involved in Complaints. . . . . . . . . . . . . . . . . . . . . . . . . . 22 HEAU Case Data Cases Listed by Carrier. ......................................23 Who Are Cases Filed Against?.................................27 Disposition of Cases. ........................................28 Who Filed Case?............................................29 Outcomes Based Upon Who Filed Case. . . . . . . . . . . . . . . . . . . . . . . . . . 29 Timing of Adverse Decision...................................30 Outcomes Based Upon Timing of Adverse Decision. . . . . . . . . . . . . . . . 30 Type of Service Involved in Cases.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Outcomes of Cases by Type of Service. . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Types of Carrier.............................................32 Outcomes of Cases by Regulatory Authority.. . . . . . . . . . . . . . . . . . . . . . 32 Outcomes of Cases by Decision Type .. . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Page 1: State of Maryland OFFICE OF THE ATT
Page 5 and 6: II. Overview of the Appeals and Gri
Page 7 and 8: HEAU’s 2003 Annual Report contain
Page 9 and 10: MIA Statistics FY 2007 In addition
Page 11 and 12: HEAU Statistics FY 2007 In addition
Page 13: Carrier Data Reported by Carriers F
Page 16 and 17: This chart describes the outcomes o
Page 18 and 19: This chart compares the percentage
Page 20: MIA Appeals and Grievances Complain
Page 23 and 24: During FY 2007, MIA determined that
Page 25 and 26: MIA Appeals and Grievances Complain
Page 30 and 31: The HEAU mediates several types of
Page 32 and 33: Cases may be filed on behalf of pat
Page 34 and 35: HEAU Appeals and Grievances Cases T
Page 36: The above chart identifies the perc

HEAU Appeals and Grievances Cases - Maryland Attorney General

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