A Review of Michigan's Insurance Complaint System

With the passage of Michigan Public Act 251, the Patient's Right to Independent Review Act, the state's residents gained access to an external appeals process for resolving disputes over covered health insurance benefits. This study examines the new review process and the results of cases brought to it during the first 16 months of the program which began in October 2000.

Under the program, Michigan residents who believe their claims have been incorrectly rejected by health insurers can request that the disputed claims be sent to an independent review organization for an objective decision. The study's analysis of data obtained through the Freedom of Information Act finds that complaints filed by residents have a 46 percent chance of being reversed. Nonetheless, the number of residents taking advantage of the new program has remained fairly small - an average of less than 20 a month - suggesting a lack of public knowledge about it.

The report was prepared by Susan L. Silberman, Ph.D., of AARP Knowledge Management. (7 pages)