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Home / News & IndustryManaged Care Insight and Analysis
Updated: November 24, 2009
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


  This article was taken from:
The Executive Report on Managed Care

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