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    Health Care Reform:

    Health Insurance & Affordable Care Act

    Most Give Their Health Plans Passing Grades


    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.

    "We look at the physician as being key to decisions of medical necessity, determining medical necessity, and appropriateness," Trachtman tells WebMD. "The study shows that nearly one-fifth of individuals report delays in coverage. So the physicians making that determination would be the arbiters of what should and shouldn't be covered within the workings of the plan. It's possible that some of these things that were denied were correctly denied. But we have to make sure the decision is made with a firm medical basis rather than cost or other considerations."

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