Another approach to finding out about the quality of a health insurance plan is tracking down the answers to the following questions:
- How does the plan ensure good medical care?
- Does the plan review the care provided by doctors and hospitals?
- How does the plan review its services?
- What does the plan do to correct problems?
- How does the plan resolve member complaints?
- Does the plan review the qualifications of doctors before they are included in the plan?
- Has the plan carried out surveys to assess the healthcare experiences of members? If so, ask for the report(s) of the results.
Last but not least, one can talk to current members of the plan and find out about their experiences regarding waiting for appointments and attitudes of medical staff. It is also important to know about the services offered, care received from the health insurance plan, and grievances against it, if any.
As mentioned earlier, there is a range of health insurance plans. Various agencies are responsible for accrediting these plans and maintaining lists of accredited organizations with detailed information about them.
The Joint Commission on Accreditation of Healthcare Organizations evaluates and accredits healthcare organizations, healthcare programs and plans, hospitals, home care organizations, healthcare organizations that provide long-term care, behavioral healthcare centers, laboratory services, ambulatory care services, integrated delivery networks, and managed care entities. There are about 40,000 accredited organizations.
The National Committee for Quality Assurance accredits HMOs and other managed care organizations.
The American Accreditation HealthCare/Commission/URAC accredits PPOs and other managed care networks.
The Accreditation Association for Ambulatory Health Care accredits outpatient healthcare settings including ambulatory surgery centers, radiation oncology centers, and student health centers.
The Community Health Accreditation Program accredits community, home health, and hospice programs, public health departments, and nursing centers.
The Consumer Coalition for Quality Health Care is a national, nonprofit organization of consumer groups that advocate for consumer protection and quality assurance programs and policies. It provides consumer materials on managed care as well as information on general healthcare matters, quality issues, and activities at the state level.
