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Health Insurance & Affordable Care Act

Most Give Their Health Plans Passing Grades


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."

The data will add fuel to the Patients' Bill of Rights fire, says John Newman, PhD, associate professor of health administration in the Robinson College of Business at Georgia State University. "Every [insurance] plan is different, every company is different," he tells WebMD. "You have 50 different health care plans that have 50 different ways of internally resolving a problem. Some are easier to deal with than others."

What's the key to success? "Persistence, persistence, persistence," says Newman, a former Blue Cross-Blue Shield administrator. "I truly mean it. You start at one level and keep going to higher levels. What the proposed legislation is about is to provide a more consistent framework for health plans."

The legislation also has a provision for patients to sue the managed care plan. "That's the major speaking point," Newman says. "It's all very emotional. Some of the arguments are fact-based and some are not. Surveys like this give more facts to the scenario. We're finding that most don't know where to go when they have problem with their health plan. It can be confusing. [Many] may not know they have the right to appeal."

"It highlights the need for a national policy through federal legislation to protect patients. You have a variety of experiences but there should be a consistency of protections that apply equally to all individuals," says Rich Trachtman, a spokesman for the American College of Physicians-American Society of Internal Medicine.

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