Most Give Their Health Plans Passing Grades
Many of the reported problems were on the order of, "You go to the emergency room and your plan doesn't want to pay the bill, so you make a few calls and it gets paid," Levitt says. "It's ripe for dinner table conversation; it annoys people, but it's not changing lives."
"The disturbing news was that one out of five people are having serious problems, when a treatment costs money out of pocket, when delays in treatment lead to worsening of health problems," he tells WebMD. "People have to take time from daily activities to deal with problems, and then the problem doesn't resolve itself. Those are the problems we need to focus on, both to prevent them and to make sure they get resolved."
With patients' rights debates going on in Congress, "there's been lot of rhetoric," Levitt says. "Our role is to provide hard facts to cut through the rhetoric, both the good news and the bad news.
Changes already are happening in the industry, he tells WebMD. "Some health insurance plans are trying to get rid of the red tape, making it easier to see a medical specialist, beefing up customer service staff. It's already happening, not across the board but in some companies."
Creation of an independent appeals system to resolve managed care patient complaints has been debated, Levitt says. However, "the survey showed that consumers in the 33 states that have appeals systems rarely use them. Very often they just don't know how to access it. Consumers are very confused on where to find it. The problem is, [the system] is different in every single state. The place to start is with your plan, but if you're not getting satisfaction there, go to a state agency that regulates health insurance. Often it's the Department of Insurance, but not always. It can be confusing. We have to get better at helping people navigate the system."
Physicians can be very effective as patient advocates, Levitt says. "Previous surveys show that doctors can be advocates, and patients trust them. Often, doctors will intervene on your behalf, and very often, they are successful. They're dealing with the system every day and they know how to work it."