Most People Satisfied With Health Plans, Including HMOs
August 24, 2000
People are generally pleased with their insurance plans, including enrollees in Health Maintenance Organizations (HMOs). A survey of insured adults by the Kaiser Family Foundation and Consumer Reports revealed that most were satisfied with the care under their plan with 64 percent giving the plans a grade of A or B.
- The rates rose to 74 percent for traditional insurance and fell to 55 percent for strict managed care; however none of the plans fell below 50 percent.
- Patients in poor health gave lower ratings to their health plan, regardless of type: of those in fair or poor health, 56 percent gave their plans an A or B, while 65 percent of those in excellent health gave their plans the same grades.
- While about half of the survey participants claimed to have a problem with their plans, nearly half of these problems related to billing or paperwork.
However, consumers lacked information as to the details of their plan or who regulates it. The study found 89 percent did not know what state agency regulated health plans and 40 percent did not know whether they had the right to appeal a plan decision. Only 46 percent consulted their plan information when a conflict arose.
Although at least 33 states now have an external review process, few consumers took formal action to appeal a decision by their health plan -- only 6 percent of those claiming to have a problem filed a formal appeal.
Texas is the exception to the dearth of appeals. The state's three-year-old program for outside review of plan coverage decisions has heard 1,000 appeals, 48 percent of which were decided in favor of the plans and 52 percent in favor of the patients. The success of the plan may be due to the direct participation of physicians who are allowed to be the patient's advocate.
Source: Susan J. Landers, "People Happy with HMOs - Until They're Sick," and "Patients Failing to Appeal Conflicts with Health Plans," June 26, 2000, American Medical News; and "Most People Happy with Health Plans, 51 Percent Report Problems, Survey Finds," June 12, 2000, BNA's Health Care Policy Report.
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