Immediate Release: Contact: Jennifer Snyder, 713-524-4267, ext. 244
Dec. 5, 2007
Health Plans Are Failing Patients, Businesses and Physicians,Say Doctors
• Survey Result Graphs
• Health Plan Survey Report
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(Houston, TX….) All six of the major health insurance companies operating in Harris County are failing patients when it comes to patient care, payment and customer service, said physicians in a survey conducted by the Harris County Medical Society and the University of Houston-Clear Lake (UHCL) Master’s Program in Healthcare Administration.
“We asked the physicians of Harris County to evaluate the health plans, and the results were dismal,” said HCMS President Michael V. Kelly II, MD. “The survey shows that the six largest health insurance companies are providing mostly mediocre service to our patients. Frankly, this is unacceptable. They’re failing our patients, they’re failing physicians and they’re failing the businesses that pay big dollars every year for their products.”
Dr. Kelly said the survey results should be a wake-up call to Harris County’s major health insurance companies. For many years, the Harris County Medical Society has been meeting regularly with health insurance companies to resolve patient and physician issues.
“Through our current meeting process, we do not get information on the overall performance of the companies or on the processes that are functioning well,” said Dr. Kelly. “Therefore, our physician members decided to rate the six largest health insurance companies in Harris and surrounding counties. Our initial goal with the survey was to recognize the areas of good performance and uncover issues that need to be addressed by the health insurance companies.”
“Additionally, we are hoping thatthis information will assist our physicians and the business community in making their contracting decisions, since there is no formal rating of health insurance companies in our area,” said Dr. Kelly.
Four hundred eighty-seven Harris County Medical Society-member physicians responded to the survey, which evaluated Aetna, Blue Cross and Blue Shield of Texas, CIGNA, Humana, Unicare, and United Healthcare. Results of the survey were compiled by UHCL. Harris County Medical Society distributed the survey to 5,708 of its member physicians in July. The survey respondents came from all areas of the medical profession throughout Harris County: primary care, hospital based, medical subspecialties, surgical, and surgical subspecialties from solo practices, single specialty groups, and multispecialty groups.
The survey results show:
Patient Care
- The largest health insurers are failing the public when it comes to preauthorizing medical services for Houston patients. More than 65 percent of the doctors surveyed reported they have experienced difficulty getting their patients’ medical services approved. (Q: 2.1)
- Even more alarming, the six major health insurers in Harris County were reported as denying payment for medically necessary care. Seventy percent of doctors surveyed said that health insurers denied payment of medically necessary care.(Q: 2.4)
- Seventy-four percent of physicians reported that the major health insurers used prescription lists that limited the medications a doctor could prescribe for treatment. (Q: 2.5)
- While Texas struggles to improve its immunization rates, only 15 percent of the physicians surveyed reported that the major health plans always pay for the cost of immunizations. (Q: 2.15)
Payment
- In 2003, the state legislature passed a law requiring health insurers to pay doctors in a timelier manner. However, according to survey results, 69 percent of the doctor respondents still have problems with the largest health insurers paying them on time. (Q: 2.10) Sixty-four percent of the doctors surveyed said they are paid less than their contracted rates with the health insurance companies.
(Q: 2.11)
Customer Service
- One of the most glaring realities of the survey is that the six major health plans are failing to educate their customers about the coverage they have. Fifty-nine percent of the physicians surveyed said that their patients rarely or never understand the benefits, co-pays, deductibles, and limitations of their coverage. (Q: 2.27)
- It is widely accepted that activities focused on general wellness are some of the best ways to lower health care costs. However, this is one area the major health plans are failing dramatically. Sixty-seven percent of the physician respondents stated that their patients rarely or never understood the preventative services, care coordination and other lifestyle modification services available to them. (Q: 2.28)
- Health insurers are forcing doctors to employ more staff to handle the extra paperwork that comes with filing claims with the health plans. In fact, 83 percent of Harris County doctors surveyed said they had to hire one or more full-time employees per doctor just to deal with the extra paperwork. (Q: 2.18)
- When health plans deny coverage for a procedure or a prescription medication, physicians have to spend time advocating on behalf of their patients. However, the major health insurers do not respond promptly to telephone calls, the survey showed. Only 29 percent of the doctors surveyed said the major health plans frequently responded to a phone call promptly. (Q: 2.20) Even worse, the survey stated that there was very little chance that issues, questions and complaints could be resolved with just one call. Fifty-six percent of the doctors surveyed said they never or rarely resolved an issue with one call. (Q: 2.21)
- Only 24 percent of the doctors surveyed said it was easy to find important information on the major health insurers’ Web sites. (Q: 2:25)
“Far too often, the health insurance companies impede medically necessary care for our patients by denying payment and preauthorization of services,” Dr. Kelly said. “If the plans offer wellness services, neither our offices nor our patients know about them. Payments are wrong or late or both. The plans expect physicians to absorb far too much of the cost of providing care. And their customer service is intolerable.”
“Having results such as these for companies that are supposed to be industry leaders is shameful,” said Dr. Kelly. “In any other field, with this kind of customer service, the company would soon be out of business. It’s time the health insurance companies raise their standards for our patients. As physicians, we take an oath to first, do no harm. I would like these health insurance companies to follow along our [physicians’] guidelines of care. Hopefully, through this survey the Medical Society physicians can begin a dialogue with the health insurance companies on areas to transform. We would like to work together to provide the best health care possible for our patients and start lowering the cost of health care that is crippling many businesses.”
The Harris County Medical Society, established in 1903, is the professional organization for physicians in Harris County. It is the largest county medical society in the nation with a membership of more than 10,000 physicians and medical students. Its mission is be the leading advocate for member physicians, their patients and the community, in promoting the highest standards of ethical medical practice, access to quality medical care, medical education, research and community health.
(Q=Survey questions in the Harris County Medical Society Analysis of Payor Survey.)
Confidence level of survey +/- 5.5 percent.