Did you know that the Oklahoma State Department of Health licenses
and regulates health maintenance organizations (HMOs)? Many people
don't, so help spread the word.
What you should know if you or your family members have a complaint
about an HMO:
- First, contact the HMO's member service department. Each HMO
is required to have a formal process for solving member's
problems. The phone number is on your ID card.
- Sometime the problem is with the doctor or clinic's staff and
the HMO doesn't know about it. This might happen if your
primary care physician refuses to refer you to a specialist or
if a bill has not been paid.
- If the HMO's staff is not able to solve the problem with a phone
call, you should send your complaint to the HMO in writing.
- If the HMO's complaint process does not solve the problem to
your satisfaction, you can call the Oklahoma State Department
of Health at 1-800-811-4552. This number is an answering
machine, but someone will return your call within 24 hours.
- You can also call 405/271-6868 and ask to speak with someone in
Managed Care.
What can the Oklahoma State Department of Health do to an HMO? They
can revoke or suspend an HMO's license to operate. If you are having
problems, the health department wants to know about it. It is contact
with the public that helps them in monitoring the quality of services
provided by HMO's.