| Health
insurance is recognized at every level of government as involving an important
public interest. At the Federal level, there are a number of important statutes
applicable to health care insurance. The McCarren-Ferguson Act provides
that even though the insuring or provision of health care may be national
in scope the regulation of insurance is left to the states. Likewise,
the Health Maintenance Organization (HMO) Act provides that HMO's or health
service plans are regulated by the states. As a result of these two Federal statutes,
much of the task of health insurance regulation is left to the states.
Regulatory practices
vary from state to state. For instance, in California health
insurers are regulated by the Department of Insurance and HMO's and health
service plans are regulated by the Department of Corporations. In
addition, the Federal Old Age, Survivors and Disability Insurance Benefits
laws (Medicare) provide that the Health Care Financing Administration (HCFA)
of the Federal Department of Health and Human Services oversees grievances involving
Medicare recipients. As a result of the foregoing, if a consumer has a complaint
about an insurance company, they can contact their state's Department of
Insurance, if they have a complaint against an HMO or health service
plan, they can contact either the Department of Insurance, the Department
of Corporations, or in some states, the Department of Health. If the insured
or plan member is a Medicare recipient and is not satisfied with the insurer
or plan action, he or she can contact the federal agency, in addition to the applicable
state agency. If the consumer complaint involves medical negligence or malpractice,
in addition to the foregoing, the consumer can contact the state's medical governing
board in addition to the insurance, corporations or health departments. |
