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Insurance Companies, Plans, and How They Rate
Among Consumers &
Physicians |
Consumers and physicians deal directly with the
faults and benefits of the health insurance plans provided by employers,
sponsored by a government, or purchased independently. More often than not, despite their
brochures, published coverage policies, and stated benefits, consumers
and employers often do not have a clear understanding of their chosen
plan and how they will perform for them. Physicians, with their hearts
and minds involved in patient care, are often blindsided by plans
that suffer from poor administration and sudden changes in coverage
guidelines. There is, however, information available to help consumers
be more aware of insurance companies and their various plans.
Our goal here is to give you a sampling of this information and provide
resource links that can provide you with additional data.
According to
neurosurgical.com, health insurance in America dates as far back as the
Civil War. "The earliest ones only offered coverage against
accidents related from travel by rail or steamboat. The plans did,
however, pave the way for more comprehensive plans covering all
illnesses and injuries. The first group policy giving comprehensive
benefits was offered by Massachusetts Health Insurance of Boston in
1847. Insurance companies issued the first individual disability and
illness policies in about 1890."
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Aetna:
Founded in 1850 in the state of Connecticut as an annuity fund to
sell life insurance, the company has continuously kept growing. Today,
Aetna has an estimated 15.8 million medical members, 13 million dental
members and 10.6 million pharmacy members. They have over 793,000 health
care professionals affiliated to them, 462,000 primary care doctors and
physicians and 4,716 hospitals.
Blue Cross and Blue Shield (BCBS): BCBS is a family of
39 independent, community-based and locally operated Blue Cross and Blue
Shield companies. Blue Cross was founded in Texas in the year 1929 as a
unique nonprofit health insurance plan for teachers and from then on
spread across the United States. It is estimated that BCBS has about 99
million people in their health plans or one out of three Americans!
Together, the 39 entities represent the oldest and largest family of
health benefit companies. About 90% of hospitals and 80% of physicians
nationwide have contracts with BCBS.
CIGNA: CIGNA is the
acronym used for the oldest health insurance company in the United
States. It is a combination of two companies INA or Insurance Company of
North America and CG or Connecticut General life Insurance Company,
which were formed in the 1700s and 1800s respectively. It has 12 million
members and offers its plans throughout Canada and the US.
United Healthcare: United Healthcare is one of the
biggest health insurance companies in the United States. UHC was founded
in 1977. Today, the United Healthcare Group, along with sister company
Uprise Incorporated, serves more than 18 million Americans. The company
Oxford Health Insurance falls under the umbrella of the United
Healthcare Group. They provide quality health care from an estimated
470,000 physicians in 4,500 hospitals; they serve in all 50 states.
UniCare: UniCare is a
national organization and is one of the nation’s largest publicly traded
managed care companies, with an estimated 13 million members throughout
the United States. Founded in 1995, UniCare's parent company is
WellPoint.
WellPoint: WellPoint
Incorporated (previously known as Anthem Incorporated) was formed when
WellPoint Health Networks Incorporated and Anthem Incorporated merged in
2004. This relatively young company was founded and quickly became one
of the nation’s leaders in health benefits in terms of commercial
membership in the continental United States. The company is
headquartered in Indianapolis, Indiana and is an independent licensee of
the Blue Cross and Blue Shield Association in the states that they
serve, and in all 50 states through UniCare.
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Step Two ...........
How they rate |
There are ratings on healthcare plans and their
companies all over the net, from a variety of sources, with differing
data .... depending on the methodology used, and the agenda of the
source. However, there are some consistencies we will mention here.
Consumer Reports published the results of a survey made of 37,481
readers and their responses to their 2008 Health Plan Survey. Their
survey results, however, are proprietary so we can't give you all the
details. They require an online subscription if you want access to all
the healthcare data. I will mention that of the 41 nationwide PPO and
HMO plans sited in the results, the following were rated as
having the highest frequency of problems getting access to care:
Coventry Health Care, CIGNA, Humana, United Healthcare and Unicare.
The
Medical Group Management Association surveyed 1,700 group practice
professionals in 2009, asking for their ratings of seven payers ...
Anthem, Aetna, CIGNA, Coventry, Humana, Medicare Part B, and United
Healthcare. "Results reflect the members’ perceptions of the payer
environment in areas of payer communications, provider credentialing,
contracting, payment policies, system transparency and overall
satisfaction." In this survey, United Healthcare
consistently rated last in 4 out of 6 categories, getting
better marks in system transparency and provider credentialing. Medicare Part B and Aetna got the highest
ratings in overall satisfaction.
JD
Power & Associates published the results of a survey made of 33,000
health plan members polled between December 2008 and January 2009.
The New England ratings include those for 11 companies, including BCBS,
Aetna, CIGNA and United Healthcare. Harvard Pilgrim Health Care
was rated highest in overall satisfaction. Coming in
2nd was BCBS of Mass, Maine, and Connecticut and Tufts Associated Health
Plans. The worst ratings are shared by Aetna, CIGNA, United
Healthcare, ConnectiCare, and BCBS of Rhode Island.
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