Health Plan Complaint Form Gives Voice to Academy Members

A good idea just got better. On Feb. 1, the Academy launched its own version of an online health plan complaint form that gives members an avenue to report insurance company hassles.

Since October 2002, Academy members have had access to a similar system available through the AMA. The decision to move to an AAFP-maintained form sprang directly from substitute resolution No. 304 (Members Only; PDF file: 17 pages / 65 KB. More about PDFs.) passed by the 2005 AAFP Congress of Delegates. The resolution, considered by the Reference Committee on Health Care Services, asks the Academy to strengthen advocacy efforts and promote health plan accountability in reimbursement practices.

"Members wanted the Academy to have its own health plan clearinghouse where they could log their complaints concerning health plans," said Trevor Stone, AAFP's manager of private sector advocacy.

Ownership of data proved to be a major factor in the decision. "The Academy will now own the data that our members provide," said Stone. "Under the previous system, the online form completed by members went directly back to the AMA for tabulation, and then those results were submitted quarterly to the Academy."

In addition, Stone said there was a general feeling that Academy members would be more comfortable completing a form within their own specialty society.

When a member goes to the site to submit a complaint, he or she will first enter his or her AAFP ID number, which allows the Academy's member database to automatically fill in the member's name, city and state. The member will be asked to supply health plan information and then proceed to the final section, where specific complaints about issues such as customer service, claims processing and coding can be recorded. All information provided on the form will be de-identified, meaning privacy will be maintained, said Stone.

Accessing the "View complaints received" link will give members a look at problems their colleagues have reported. "Members will be able to see completed complaint forms," said Stone, emphasizing that the entire system is dependent on member feedback. "This project is only as good as the numbers and data that members input."

Stone said the data gathered from the logged complaints would highlight members' frustrations with health plans. In turn, that information will allow the Academy to better communicate -- on members' behalf -- with health plans.

"This system is not a means for the AAFP to take complaints to health plans on a member-by-member basis, but it will help assist the Academy in tracking trends to align its advocacy efforts with members' needs," said Stone.