| Survey: PPOs Have Problems With Member Satisfaction Issues
PPOs have fallen from grace in terms of costs and member satisfaction issues found a new survey by Consumer Reports.
In terms of costs, survey participants who were in HMOs
paid less for premiums than members in PPOs – $1,466 compared
with $2,003 – and less out of pocket on their medical bills, the
survey found.
Worse, among PPO members who were seriously ill, 69
percent paid $1,000 or more on bills. By comparison 47 percent of
seriously ill people in HMOs spent that much.
Consumers Union noted that in past years, HMO members
who were seriously ill had more trouble getting access to care, but
this time there was little difference: Of HMO members who were ill, 15
percent had problems getting care, compared with 14 percent of PPO
members.
The majority of survey participants – 84 percent
of the 37,481 health plan members who reported their experiences over
the course of a year – were in an employer-based plan.
The median annual out-of-pocket costs for premiums
increased for survey participants by 38 percent during the past two
years, and 64 percent of those surveyed were "Very" or "Completely"
satisfied with their current health insurance plan.
"That’s a lukewarm response and a slight drop from
the 67 percent in our 2007 report," said Mandy Walker, senior project
editor for Consumer Reports. "In terms of services we rate, that puts
satisfaction with health insurance above satisfaction with cable TV, a
perennial whipping post, but below pharmacies and real-estate agents."
Out-Of-Pocket Costs Soar
The survey found that annual out-of-pocket plan premium
costs were up 38 percent from two years ago for both those in HMOs and
PPOs. Survey participants reported a median premium cost of $1,829, an
increase of about $500 since 2006.
Resolving problems with claims was another issue studied
by the survey which found that members in PPOs had more trouble with
their bills. Some 24 percent of people in PPOs had a billing problem,
while just 11 percent of HMO members reported similar issues.
Thirty-three percent of PPO members who reported having a serious
illness had billing problems compared to just 14 percent of seriously
ill HMO patients.
Customer satisfaction was also studied. Consumers Union
found that 20 percent of PPO members said they had trouble with
telephone customer support and were more likely to contact the plan
several times to get a problem solved, compared to only 12 percent of
members in HMOs.
Overall, the survey found that among HMOs, Group Health
Cooperative and Health Alliance Plan topped the list when
‘rating’ health plans. Both plans were also in the top 10
in Consumer Reports’ 2007 survey. Members of the two plans
reported fewer problems getting care they needed, and HAP members were
more satisfied with their choice of doctors and the care they received.
Also among the top rated HMOs were several Kaiser
Permanente plans around the country; Preferred Care; Harvard Pilgrim
Health Care; and Independent Health.
Oxford Health Plan and Aetna Health HMO members gave
those plans lower ratings for choice of providers, the survey report
said. Oxford members also reported more problems getting the care they
needed, while Aetna plan members reported more problems getting access
to doctors, the report noted.
Anthem Blue Cross and Blue Shield of Connecticut was
among the top-rated PPOs, as it has been in past surveys. Other
top-rated PPO plans were Blue Cross and Blue Shield (Alabama, Illinois,
and Massachusetts), Excellus Blue Cross Blue Shield (New York), and
Independence Blue Cross (Pennsylvania). Group Health Inc., Great-West
Healthcare and Health Net members rated choice of doctors in those
plans worse than other PPOs.
The survey was conducted by the Consumer Reports National Research Center
Full ratings and side-by-side comparisons of 35 HMOs and
41 PPOs are available in the September issue of Consumer Reports and
online at www.ConsumerReportsHealth.org
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