What are private rating firms?
What should I do if I have a dispute with my health insurance carrier?
What if my self-help efforts fail?
How do I file a complaint with OFIR?
Does OFIR keep track of consumer complaints?
What are the most frequent consumer complaints about health coverage?
Complaint comparison

What are private rating firms?
Several private firms specialize in evaluating the finances and services of insurance or managed care carriers. Each of these agencies has its own methods and standards and gives grades to the companies based on their judgment of how well the company is doing.

• The phone numbers and web site addresses below will connect you with some of the most popular rating firms.
• You may be charged for insurance company reports you get.
• Before you rely on any report, make sure you understand the rating system because each firm has its own grading system. For example, one firm may use "A+" as its top grade, while another may go all the way up to "A+++."

A.M. Best Company
Phone: (908) 439-2200
Web site: www.ambest.com

Fitch Investor's Service
Phone: 1-800-853-4824
Web site: www.fitchibca.com

Moody's Investor Service
Phone: (212) 553-0377
Web site: www.moodys.com

Standard & Poor's
Phone: (212) 438-1000
Web site: www.standardandpoors.com

Several of these rating firms publish books with their ratings, so you may also be able to find what you need at your local library.

What should I do if I have a dispute with my health insurance carrier?
You do not need a lawyer to resolve most disputes with an insurance agent or a health carrier. Start with contacting your health carrier's customer services office. Most companies have toll-free telephone numbers for quick service. If you do not receive satisfaction, ask about the health carrier's procedures for appealing decisions. For information on appeals go here: http://www.michigan.gov/cis/0,1607,7-154-10555_12902_35510_35694---,00.html

What if my self-help efforts fail?
If working directly with the health carrier doesn't satisfy your concerns, you should contact the Office of Financial and Insurance Regulation at 1-877-999-6442.

How do I file a complaint with OFIR?
You can obtain a complaint form and instructions for filing a written complaint from our web site at http://www.michigan.gov/documents/cis_ofis_comp_all_25074_7.pdf or by calling OFIR toll free at 1-877-999-6442. We will send the health carrier a copy of your complaint and ask them to explain its position. - Health carriers are required by law to respond to OFIR and most health carriers are very cooperative in resolving complaints. We will review all of the facts to make sure the health carrier has followed its contract with you, and that it has also complied with insurance rules and laws.

Does OFIR keep track of consumer complaints?
Yes. In 2003, OFIR received more than 4,000 complaints regarding health coverage. If your complaint raises questions requiring us to contact the health carrier, we will record it as a "complaint." A complaint represents a consumer who has been unhappy with the health carrier. It does not necessarily mean the health carrier has broken the law or done anything wrong.

What are the most frequent consumer complaints about health coverage?

• Claim denial
• Claim handling delay
• Unsatisfactory settlement offer
• Coverage question

Complaint comparisons
To obtain complaint information on individual health insurance carriers and BCBSM, visit the ofis web site at http://www.michigan.gov/cis/0,1607,7-154-10555_12902_12916---,00.html.
The "Complaint Ratio" column is designed to help make "apples-to-apples" comparisons easier.

To obtain complaint information on HMOs, visit the ofis web site at http://www.michigan.gov/documents/cis_ofis_compinfo_28032_7.html

Please visit the following pages on the OFIR web site to obtain specific complaint information:

Health Insurance Company Complaint Ratios - http://www.michigan.gov/cis/0,1607,7-154-10555_12902_12916---,00.html
Health Insurance Company Complaint Statistics - http://www.michigan.gov/cis/0,1607,7-154-10555_12902_12912---,00.html
Health Insurance Company Financial Information - http://www.naic.org/cis/ (NAIC web site, see financial information section)
HMO Complaint Information - http://www.michigan.gov/documents/cis_ofis_compinfo_28032_7.html
HMO Financial Information - http://www.michigan.gov/cis/0,1607,7-154-10555_12902_18956-93711--,00.html
BCBSM Complaint Ratios - http://www.michigan.gov/cis/0,1607,7-154-10555_12902_12916-100476--,00.html