[MOL] Picking an HMO, Ins. Series Part 7 [00730] Medicine On Line

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[MOL] Picking an HMO, Ins. Series Part 7

      So it’s time again to pick an HMO, and you’ve got brochures and forms strewn all over the dining room table. All the glossy pictures of grateful patients beaming at their beneficent doctors are nice, but they don’t really tell you what you want to know: Which plan actually delivers? Or maybe you’ve already run afoul of one of your health plan’s restrictions and want to find out how to fight it. Where to turn?
      Try the Internet. While it's true that consumers navigating the health-care system are working largely without map or compass, there are some sites (including this one, of course) that help light the way. And as the market slowly responds to the huge thirst for information about how to take control of our care, the Internet will be one of the first places where that information will become available.
      At this point, Web browsing is the easiest way to access HMO and hospital report cards, detailed information about Medicare and advice from consumer groups about handling disputes. You can even find places to compare notes with other users of managed care, some of whom are quite disgruntled indeed. For instance, there's the militant anti-managed-care message at the Health Administration Responsibility Project, which includes detailed information about the legal battle over whether patients should be able to sue their health plans. This is a good site if you're in the midst of a dispute with your plan and need legal ammunition.
      For less ideology and more straight consumer information, try the Web site of the Center for Patient Advocacy. Look under "insurance problems" for detailed information on HMOs as well as contacts for state insurance and health departments that regulate HMOs. The site also offers detailed instructions about how to take on your HMO and a helpful glossary of terms and acronyms.
      While the center is a non-profit organization, there are other patient advocates who will help you for a price. One of them is Patient Advocacy Services. Check out the site to find out more about the company, which will help you resolve claims disputes with an insurer or set up a structured payment plan.
      Another organization that does something similar is American Medical Consumers, which is kind of a hybrid between an advocacy group and a business. You can buy advice from the organization's founder, Dr. Vincent Riccardi, for $20 a session or buy a year's package for $135. AMC is also putting together a medical consumer empowerment kit, including tips for being an assertive medical consumer, recognizing the negatives in a health plan and getting your medical records (might be a good stocking stuffer!). Find out more at AMC's Web site.
      Some unique consumer information is available at the site for Citizens for the Right to Know, an advocacy group that pushes for full disclosure of the terms of health insurance policies. The group's site includes tips on choosing a plan and fighting it if there's a problem. Plus, there's a useful bonus for Californians: a database of the drug formularies for most of the HMOs in the state. The formulary is the list of prescription drugs that a plan will pay for, and it's a good place to check before you sign on for a plan, especially if you regularly take an expensive brand-name drug.
      Other fact-filled sites, believe it or not, are offered by the federal government. A must-read for Medicare beneficiaries is that program's site, which includes everything from the basic, such as how much you'll be paying in premiums and co-pays for traditional Medicare coverage, to a comprehensive listing of the health plans that offer Medicare managed care plans. Also, check out the sections on fraud to find out what you can do when you suspect your doctor may be overbilling the program, and on nursing homes. There's also a tool called Medicare Compare, which lets you see the details on various Medicare managed care plans side-by-side. Be sure to look at the Medicare site rather than its parent site, www.hcfa.gov, which is primarily an abundance of bureaucratic detail meant for health plan executives and other unfortunate souls who are required to deal with the Health Care Financing Administration.
      The Internet is especially useful for looking up what limited information is available for assessing health plan quality. The most advanced is available only to consumers in California: The Pacific Business Group on Health, a business coalition, offers information on health plans, hospitals and doctor groups that are evaluated on a limited number of topics, such as consumer satisfaction. Go directly to that database at www.healthscope.org/core.htm. Two other organizations offer some information which may be of value to you. One, the National Committee for Quality Assurance, assesses health plans in a voluntary program and its site will tell you in broad terms how a plan performed in that accreditation process.
      If you're checking out a hospital, try the Joint Commission on the Accreditation of Healthcare Organizations, to locate the latest accreditation report. Keep digging down to get the hospital's performance report, where you can ultimately see the scores it received in specific areas such as medication use and evaluating employees, and whether those problems were resolved. While the information may seem technical to the layperson, it can give you the chance to ask a hospital questions about its weaknesses before you decide to deliver your baby there or check in for elective surgery.
      A couple of national magazines have culled several sources of quality information about health plans and put it together for you. Check out U.S. News and World Report's most recent effort. Newsweek did one too.
      It's also a good idea to keep bookmarked the Web site for your health plan. Some of the big national HMOs have extensive sites that include lists of their doctors, information on how to stay healthy, and measurements of their own quality, though keep in mind that they've picked that information out themselves. These include Kaiser Permanente, Group Health Cooperative and PacifiCare Health Systems

Warmly, lillian
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