Low Customer Service Marks for California PPOs…

Today, the California Department of Insurance released a new report card, showing Californians giving poor grades to their PPOs in key areas such as customer service.

Health Access attended the release of the 2nd annual PPO report card today, (see picture; Insurance Commissioner Steve Poizner is not in the frame). The new report card has two improvement over last year: includes all of the “big six” insurers, including Blue Shield which did not participate in last year’s ratings; and it includes customer satisfaction ratings for the first time. This complements a long-time annual report card on HMOs provided by California’s Department of Managed Health Care (DMHC) and the Office of Patient Advocate since 2001.

According to the California Department of Insurance (CDI), while other states collect similar data for PPOs, California is the only state to analyze it, and offer it in a consumer-friendly, interactive format that includes summary ratings as well as the more detailed underlying measurements.

As reported by CDI, none of the six PPOs on the report card received the highest four-star rating, but Aetna, CIGNA HealthCare of California and UnitedHealthcare (California) each received three stars overall for delivering quality clinical care. Anthem Blue Cross, Blue Shield of California and Health Net each received two stars overall in that category. Rating criteria included asthma care, checking for cancer, diabetes care and treatment of children. The ratings are based on a set of standard measures developed by the National Committee on Quality Assurance.

These first round of grades on customer satisfaction is startling. All PPOs got the mediocre 2-3 star ratings for getting care easily; all insurers except Aetna received the lowest, single-star rating for plan service: helpful customer service, getting information about your costs, and paying claims.

California insurers need to shape up in a big way. PPOs typically provide a greater range of access to providers, but too many Californians don’t feel they are getting good service and information about what is covered, what they have to pay, and what their options are. When people are sick, the last thing they want is the hassle of dealing with an insurance company. For an industry that spent $86 million against health reform, insurers have a lot of reforming they need to do, from answering the phone quicker, to providing better information about payment.

Usually these customer satisfaction ratings reflect more favorably for insurers, because most people haven’t need major care in a given year, and thus report being satified with the security of having an insurance card in their wallet. For insurers to get such poor grades, they really needed to have earned them.

These grades also show the need for additional transparency and oversight for insurers. We need to require these types of report cards that measure several areas of delivery of health care to consumers in the midst of significant change in the marketplace.

As we implement federal health reform in California, we need to ensure that purchasers and consumers have information like this at the time they are making a purchasing decision–something that we hope the new health insurance exchange will do. We need to institute the reforms needed to standardize the market, set high expectations for insurers, and make it easy for consumers to understand their benefits and their options. Our goal should be to have insurers compete on price, quality, and customer service, rather than simply on how deftly they can avoid paying the claims of sick patients. Right now, insurers really don’t compete on quality or customer service, which is why they get away with such grades.

Health Access California promotes quality, affordable health care for all Californians.

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