Consumer Reports Rates Health Insurance Plans

YONKERS, N.Y., Aug. 9 /U.S. Newswire/ -- As we approach the annual open enrollment period, when millions of people who purchase health care insurance through their employer will have the opportunity to switch plans, Consumer Reports' (CR) September story, "Weighing your health plan choices," helps consumers choose a plan that's right for them.



Consumers' choice of managed-care plan can make a big difference in the quality of medical treatment they receive. CR rates 35 HMOs and 41 PPOs, based on a survey of roughly 35,000 readers, to help consumers make this difficult and important decision.



For patients who believe that their health plan is denying them needed care and want to appeal that decision, CR offers a free Web resource, "A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan," available at http://www.ConsumersUnion.org/health/hmo-review and http://www.kff.org/consumerguide. Developed and updated by the Consumers Union Center for Consumer Health Choices and the Kaiser Family Foundation (The Henry J. Kaiser Family Foundation is a non-profit, private operating foundation that is not associated with Kaiser Permanente or Kaiser Industries), the Guide explains how to resolve problems with managed-care plans and helps patients figure out if they are eligible for external review programs that are available in 43 states and D.C. The updated Guide is an especially useful tool because a 2004 study by the Center and the Foundation found that patients are often making mistakes appealing disputes with their health insurance plan, which can lead to a rejection of the case.



In CR's reader survey, only 64 percent of readers said that they were "completely satisfied" or "very satisfied" with their plan. HMOs, which pay almost all expenses for patients who stick to providers within a network, scored slightly higher in overall satisfaction than PPOs, which cost more, but allow more choice of doctors. Respondents were happier with their plan if they paid less for their coverage, which is one reason why less-expensive HMOs scored slightly higher in overall satisfaction than PPOs.



People in HMOs had more trouble getting care than members of PPOs. Among those who suffered serious medical problems in the last year, 29 percent of survey respondents and their family members in HMOs and 23 percent in PPOs said they had difficulty obtaining the care they needed. Seventeen percent of HMO members said they had difficulty seeing doctors but only 12 percent of PPO members reported such a problem.



Among those who had a serious illness, satisfaction varied widely between those enrolled in the top third and bottom third of the plans CR rated. In the top-rated HMOs, 25 percent said they had trouble getting care. In the lower-rated plans, the share of people complaining jumped to 37 percent.



Nearly one-third of all PPO members reported billing problems, nearly three times the rate for people in HMOs.



CR Ratings and Recommendations:



-- For HMOs, Kaiser Permanente, Northwest (Ore., Wash.), and Capital District Physicians Health Plan (N.Y.) topped CR's charts in this report as well as in 2003 and received consistently high marks for billing and customer service.



-- For PPOs, Blue Cross Blue Shield plans dominate the top 10 as they did in 2003. Most of these plans had very good scores for choice of doctors.



This report also discusses various problems in the health-care industry, including:



-- Prices continue to increase. Since 2000, annual premiums for family coverage have risen 59 percent, six times the rate of inflation.



-- Employers continue to pass more of those higher costs on to consumers.



-- The health care system remains plagued by enormous quality gaps.



-- Managed care companies are not feeling the pain: They are poised for another year of gains in 2005, with total revenues projected to increase 10 percent.



-- Increasingly, Americans are willing to limit their choice of physicians and hospitals to reduce their medical costs.



Some tips to help consumers choose a plan include:



-- Start by learning the basic differences between HMOs and PPOs.



-- Search out the news: Business news about providers you are considering can be telling.



-- Ask to see the plan's list of doctors to make sure your current doctors are plan providers.



-- Call your state department of insurance to see whether it has received complaints about the plan. Once you have signed up with a plan, don't hesitate to report problems to your employer. Sometimes a call from the folks who are carrying most of the freight can solve the problem.



"Weighing your health plan choices" is available free at http://www.ConsumerReports.org