Health Insurance Consumer Assistance Program,
Michigan Department of Insurance

This program provides information and assistance to consumers through its hotline, a website, and translation services.

Program Structure and Services

The Michigan Health Insurance Consumer Assistance Program (HICAP), which was established in February 2011, is housed in the state Office of Financial and Insurance Regulation. It is an expansion of the office’s long-running Consumer Services Division, which helps consumers with questions and concerns on a wide range of issues. HICAP responds to consumer inquires and complaints about health insurance benefits and coverage of health care services, answers consumer questions about internal health plan appeals, and administers the state’s external appeals process.

HICAP is staffed by between nine and 12 life and health insurance analysts who have varied areas of expertise. The program receives many inquires by phone, so in order to ensure that consumers receive expedient and personalized assistance, HICAP has established standards for its helpline: It uses live operators who answer and route callers to helpline analysts within three minutes. These analysts have a high level of expertise, so they can help consumers on a case-by-case basis without the use of scripts. Counselors help 75 percent of consumers on their first call, and they return all calls, including messages left after hours, within one business day.

HICAP also educates consumers through its website, which provides detailed answers to frequently asked questions on numerous topics. These topics include the health care options that are available to different groups of consumers, how to transition from job-based to individual insurance, self-funded plans, and the appeals process. HICAP has found that many consumers who call their hotline have consulted these resources and are therefore better prepared to seek help in specific areas.

In 2010, HICAP resolved 1,739 health insurance complaints and recovered $700,054 for Michigan health care consumers.

How Did Consumer Assistance Grant Funding Help the Michigan Health Insurance Consumer Assistance Program?

In October 2010, HICAP was awarded $1.1 million in federal grant funding. The program has invested some of these funds in improving its database so that it can collect more complete information about the consumers who call for assistance. HICAP expects that collecting data in new categories, such as demographic and geographic data, will help the program target its outreach and education efforts.

At the start of its grant, the program hired a health care resource analyst to coordinate all activities related to public education and implementation of the Affordable Care Act. These activities include creating brochures and presentations on provisions of the law for legislators and consumers, updating the health insurance section of their website with resources for consumers on new benefits and rights, and traveling throughout the state to conduct health literacy forums. These educational events provide the opportunity for consumers to talk with an insurance analyst at a local venue, which is especially important for those who can’t take advantage of the walk-in assistance that is provided at the Lansing office. The program is also in the process of hiring a data manager and an attorney, who will provide assistance to consumers during the appeals process (previously, the program was able only to answer questions about appeals and could not provide more advanced assistance).

Most recently, HICAP used its grant to purchase a translation line that offers services in 230 languages, helping the program assist consumers in their primary language. With this new capability, HICAP will be able to reach more of Michigan’s underserved communities, including the state’s large Arabic and Spanish speaking populations. The program is also working to make materials available in the state’s most prevalent languages, and it is partnering with community centers in areas where residents have limited English proficiency to encourage local organizations to refer clients with health care questions to the program’s helpline.

Consumer Story

In February 2011, HICAP was contacted by a consumer whose adult daughter lost her health coverage when she turned 25. The daughter has rheumatoid arthritis, and her monthly prescriptions and medical care cost $2,500. HICAP contacted the mother’s insurer directly to discuss the new health reform requirement that adult children be allowed to stay on their parents’ plans until age 26. As a result of the conversation, the daughter’s health coverage was reinstated.

Sources

• Interview between Cheryl Fish-Parcham and Elaine Saly, Families USA, and Cathy Kirby, Deputy Commissioner, and Karin Gyger, Health Care Resource Analyst, Consumer Services Division, Michigan Office of Financial and Insurance Regulation, June 20, 2011.
• Michigan Office of Financial and Insurance Regulation, Annual Report to Governor Rick Snyder 2010 (Lansing, MI: Michigan Office of Financial and Insurance Regulation, Fall 2011), available online at http://www.michigan.gov/documents/lara/2010_OFIR_Report_360129_7.pdf.
• Michigan Office of Financial and Insurance Regulation, Annual Report to Governor Jennifer M. Granholm 2009 (Lansing, MI: Michigan Office of Financial and Insurance Regulation, Fall 2010), available online at http://www.michigan.gov/documents/dleg/Final_2009_Annual_Report_325449_7.pdf.
• Department of Licensing and Regulatory Affairs, Michigan Office of Financial and Insurance Regulation, “Insurance Complaint Statistics,” available online at http://www.michigan.gov/lara/0,1607,7-154-10555_12902_12912---,00.html.
• The Health Insurance Information, Publications, and Frequently Asked Questions sections of the Michigan Office of Financial and Insurance Regulation website provide consumer information on a variety of health care topics at http://www.michigan.gov/lara/0,4601,7-154-10555_12902_35510---,00.html.

PDF of this profile is available.