SAMPLE LETTER to attach to your Complaint Form

Consumer Protection Department

Texas Department of Insurance

P.O. Box 149091

Austin, TX 78714-9091

RE:     Consumer Complaint and

            Request for Investigation

Dear Sirs and Madams,

My family is insured by a group health insurance policy issued by BlueCross BlueShield of Texas (BCBS).  BCBS has consistently and precipitously increased the premiums for health coverage over the last few years claiming that increased health care costs and increased claims require increased premiums.  However, my family’s pediatrician’s group, Pediatric Associates of Austin, P.A., recently informed its patients of a drastic change in their reimbursement policy.  As the attached letter explains, as of January 1, 2005, my doctors can no longer accept BCBS insurance due to continuing and severe decreases in reimbursement amounts for patient care.  All of these actions have taken place in the same fiscal quarters that BCBS has enjoyed unprecedented and increasing profit.  BCBS is not responding to actual costs or claims, it is using its position in the market to unfairly manipulate the availability (and therefore cost) of healthcare to the workers and families in our community.

We respectfully request that TDI, and our State Legislature, investigate whether BCBS has engaged in practices that breach its duties to Texas health consumers through the actions described below, including:

1.      Systematically putting downward pressure on the healthcare market, regardless of true cost to provide those services in an area.

2. The negotiation tactics employed by BCBS are unfair to consumers.

3. BCBS is misleading the public by declaring financial need

Please provide a response as to whether any such investigation is undertaken and the results.  I appreciate your help and look forward to hearing from you.

Your name here

address

cc:       Representative Elliott Naishtat ,

Vice-Chair, House Committee on Human Services