Consumer Reports
Choose Your State Below For Approved
InsuranceSalesman.com
Auto Financing
|
Using Consumer Reports' Health Plan Ratings
By: Tony Novak
It has always been difficult for consumers
who purchase health insurance
to find meaningful data on the quality of the available plans. It
has been even more difficult, I think, for a health insurance buyer
to translate the published data into conclusions relevant to their
own purchasing situation since most individual and small business
purchasers have different concerns than the majority of employees
of larger corporations. Much of the available data just is not relevant
to individuals and small businesses. But now the "king of all
ratings" - Consumer Reports Magazine - has spoken on the issue
of health insurance plans, I think it makes sense to defer to them
and consider how this well-known rating system might be useful for
buyers of health plans.
Consumer Reports published a review of Health
Maintenance Organizations (HMO) and Preferred Provided Organizations
(PPO) health plans in their October 2001 issue. The report is available
free online. Like most other CR reports, you have to be knowledgeable
in the subject material and really read between the lines to get
the true value of the ratings report.
Since my company MedSave.com doesn't handle
HMOs and I personally don't like them, I skipped that section. The
report on PPOs is likely to be much more interesting to most individual
or small businesses buyers of health
insurance. Certainly HMOs are the right answer – or even
the only answer - in some situations, but I just think that “quality
shopping for a HMO” is an oxymoron. But the flexible design
of PPO plans in today’s market makes it is more likely that
a shopper will find an attractive value in a PPO plan rather than
in an HMO.
Six of the seven top-ranked PPO networks
are operated by local Blue Cross associations. This is good news
unless you happen to be among of the majority of Americans who does
not live in one of these six geographic service regions, or you
can't afford the generally high costs that come with a premium Blue
Cross/Blue Shield health plan. This is the most significant result
of the CR report: Blue Cross PPO networks are doing a good job satisfying
their members. Certainly these are premium-care, premium-cost plans.
Unfortunately, with average family premiums well above $700 per
month, many individual and small business buyers simply cannot afford
the cost of these plans.
The highest-ranking private national PPO
plan was Private Healthcare Systems (PHCS). This was great to see
because I've always recommended PHCS and personally felt they were
the best option for the largest group of buyers, but I had no hard
evidence to back up this opinion.
PHCS health plans are available in some form
to everyone in all 50 states through a variety of
insurance plans and uninsured plans. The insurance plans are
available to perhaps 80% of small businesses and 50% of healthy
individuals, but individuals with health problems will have trouble
finding one of these plans. Beware of the uninsured “discount
plans”. The concept is good, but the price is not. It is highly
unlikely that this is a good financial deal for any buyer. Unfortunately
these plans are hyped on the Web and junk e-mail to the point where
we cannot seem to get away from them.
The most attractive feature of the PHSC health
network plans is that they often can be combined with other cost-saving
plan design features like preferred-risk and preferred-industry
discounts, high deductible plans and Medical Savings Accounts. With
high deductible plans, keep in mind that you still benefit from
direct in-network claims processing and substantial provider discounts
even if your bill is lower than the policy deductible. A benefits
consultant can design a plan to fit almost any budget simply by
adjusting the levels of insurance coverage.
Most health plans today offer a variety of
PPO network choices, and it is often possible to use more than one
PPO network within a single health insurance plan. In some locations
a small local PPO may be strong choice, but might not even be listed
in the CR rating system due to its size. Often an individual or
small business located in a rural area may wisely select a PPO based
solely on the participation of the dominant hospital system in their
own community despite a lower rating in the CR survey.
In any event, I think that most of us would
agree that "more news is good news" when it comes to providing
public information about the quality of our nation's health
insurance plans
You can find more Health
Insurance Information here
|
