Member Complaints Summary
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Member Complaints Summary 2014 Edition

Medical care and health insurance are very complex businesses. The rules and responsibilities are confusing to patients and professionals — misunderstandings and mistakes are common.

The best PPOs solve their members' problems by having well-trained staff and good business systems. These PPOs have knowledgeable, respectful staff; systems and clear rules to quickly troubleshoot member complaints and to clear up confusion or settle a disagreement.

What do the scores mean?

A clear signal about an PPO's service and care is how well the plan handles members' concerns or complaints. Members are surveyed to see if they were satisfied with how the PPO solved a problem after they contacted the plan.