Insurance commissioner seeks change in authority over HMOs

OKLAHOMA CITY -- The phones at the State Insurance Department ring dozens of times each day relaying complaints about health maintenance organizations.

But the agency in charge of monitoring Oklahoma's insurance agencies can't do anything to help -- unless Insurance Commissioner Carroll Fisher's proposal to change the law prevails.

Fisher suggested Tuesday at a public hearing that he take over the regulation of HMOs, which are not insurance companies according to state law and fall under the supervision of the state Health Department. The current setup confuses many HMO clients, he said.

People having trouble filing a claim or getting their HMO to pay a bill don't know they should be calling the health department instead of the insurance commissioner, he said.

Fisher's office, which oversees all other Oklahoma insurance companies, is better equipped to handle the problems, he said. The insurance department's staff has expertise handling claims, explaining coverage and working as a liaison between insurance companies and clients. Also, the department could protect people whose health organizations went bankrupt, making sure their claims were paid, officials said.

"We're good at it," said Bart Bates, legislative liaison for the insurance department. "We're probably the best at it in the state."

Jim Smith, a Community Care customer, said it's obvious HMOs are insurance companies.

"If it looks like a duck and it walks like a duck and it sounds like a duck, it's a duck," the senior said. "A health maintenance organization is, to Jim Smith, an insurance company."

But not everybody is convinced.

The health department, for one, is opposed to transferring its authority.

"The state statute made it quite clear that an HMO was not an insurance product," said Dr. Jay Gregory, president of the Oklahoma State Board of Health. "The state Legislature was very wise when it made that decision."

Gregory said citizens' health would be compromised because the insurance commissioner would always side with the insurance company. At the health department, a board of directors -- not just one commissioner -- makes decisions.

"That's just wrong when you have an issue that deals with health," he said.

Gregory said a group of HMOs that has sued the health department to block a recent state law allowing citizens to take health organizations to court is behind the insurance commissioner's proposal.

"It's political," he said. "It's motivated by money. There should be an outrage of the Oklahoma citizenry."

But Fisher claimed he has no "hidden agenda."

"It doesn't make any difference to us," the commissioner said. "That's our whole agenda -- to take care of the consumer. There's no rush to glory here."

HMOs are taking a neutral position.

"Our belief is we don't care who regulates HMOs," said Jimmy Durant, executive director of the Oklahoma Association of Health Plans. "We just believe the citizens of Oklahoma need to be protected."

Several who attended the public hearing said they don't care who regulates the health organizations. They just want better service.

"The politicians and the lawyers are fouling up the whole works," said Pat Miller, a senior and HMO client.

Health care professionals said their biggest problem is not receiving payments from HMOs.

Bill Atkins, a representative of Oklahoma City's nonprofit Community Counseling Center, said the center had to lay off 15 people and cancel a program for abused children because payments from HMOs did not arrive on time.

"These problems with not getting paid have had a very real impact on us," Atkins said.

"Whatever system is in place now doesn't seem to be working."

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