First Comprehensive Catalog of Health Care Ombudsman Programs and Technical Guide for Establishing Them

Cataloging, surveying and reporting about health care ombudsman programs

From 2000 to 2001, staff from the Families USA Foundation produced the first comprehensive, nationwide catalog of health care ombudsman programs, and a guide to the key technical and design issues involved in establishing such programs.

Health ombudsman programs provide consumers with information, counseling and support in resolving grievances and pursuing appeals in non-litigation settings with insurance companies and health plans.

Key Results

  • Project staff produced the first comprehensive, nationwide catalog of health care ombudsman programs, listing nearly 2,400 organizations.
  • Project staff surveyed all 2,400 ombudsman programs identified in the first part of the project and compiled the results into a report entitled Consumer Health Assistance Programs: Report on a National Survey.
  • Project staff produced a guide to the key technical and design issues involved in establishing an ombudsman program, entitled Designing a Consumer Health Assistance Program, targeted at states considering creating ombudsman programs.
  • Project staff developed a feasibility plan for a national technical assistance support center to ombudsman programs.

Key Recommendations

Recommendations in the guide Designing a Consumer Health Assistance Program include:

  • A consumer health assistance program should be broad in scope but should have staff with distinct areas of expertise, including private insurance coverage, self-insured plans, Medicare, Medicaid, and coverage and service options for the uninsured.
  • An adequate portion of the program's budget should be devoted to training.
  • Programs should offer information referrals to consumers, give them advice on how to appeal, and represent them in grievance reviews and administrative appeals.