Health Insurance Articles
Quality Standards Your Health Insurance Company Should Measure Up To
2009-12-31
Although U.S. health care has been reputed as one of the best health care systems globally, John M. Eisenberg, M.D., and Elaine J. Power M.P.P. assert in "Transforming Insurance Coverage into Quality Health Care" that our lack of access to reasonably priced health insurance and health care policies does not at all reflect a quality system. They add that even the policies we do have access to oftentimes do not include easy access to clinics and care providers, preventive screenings and services, choice of providers, reasonable pharmacy costs, consistent care by our primary doctors or access to referrals. It is for these reasons that it is necessary for there to be standards that insurance companies must meet when offering you coverage.
To address this need, the National Committee for Quality Assurance (NCQA) is considering effective ways to enforce consistent care by primary caregivers, to prioritize care coordination, and to generate effective measurements of performance and accountability by health care professionals, institutions and health insurance. The NCQA also mentions making the best use of health information technology so that communication errors are minimized between doctor, insurance companies and hospitals.
Until a quality control system is put in place for insurance companies, American consumers need to advocate for themselves, ensuring that they receive quality, adequate health insurance coverage. Those looking for quality health insurance coverage are encouraged to ask themselves questions like, "What does my doctor or care provider say about the plan I am considering?," "Does my health care policy pay for immunizations, preventive care and screenings?" and "Are doctors and pharmacies easily accessible?" Additionally, it may benefit consumers to seek out how many patient complaints were filed in the previous year about the provider company, along with how many members dropped the plan
The Department of Labor Employee Benefits Security Administration (EBSA) offers many helpful tips about scrutinizing and selecting proper health insurance. First, they suggest familiarizing yourself with the plan you are considering. Educate yourself about exclusions on the policy, the process of switching plans if you deem it necessary, whether the plan covers preventative care and prescriptions, and their policy on pre-existing conditions. After you feel relatively comfortable in your knowledge, they also encourage you to sit down with your agent to address any concerns. This will ensure that the coverage you decide on will meet your needs appropriately and you won't find yourself with surprising out-of-pocket expenses down the road.
When it comes down to it, a government policy mandating specific standards for insurance companies would help, but it wouldn't take the consumer off the hook. It is purely up to you to understand your health insurance policy and make sure your insurer provides adequate customer service and care.
