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State PPOs lag behind in quality healthcare

November 18, 2010 12:00:00 AM PST
California lags behind most of the nation when it comes to quality health care. That's according to the latest report card on preferred providers from California Insurance Commissioner Steve Poizner."This is a wakeup call. Some of the results are atrocious," said Poizner Thursday.

For the 2.5 million Californians who have a preferred provider organization, or PPO, for health insurance, a new report card by the California Department of Insurance may open the door for better care and service.

None of the six companies reviewed received the highest, four stars. They were mostly in the mediocre range of two to three stars.

"It's not time for everyone to put a lot of pressure on health insurance companies. They'd better step up and improve," said Poizner.

Among the worst performers when it comes to meeting the national standard of care and providing good customer service were:

  • Anthem Blue Cross PPO
  • Blue Shield of California
  • Blue Shield Life PPO
  • Health Net of California PPO

They got a "fair" rating, with only two stars.

When it came to service, they were at the bottom, joining United Healthcare and Cigna with one star, considered a "poor" rating.

Most PPO insurance companies hadn't reviewed the report card yet, but United HealthCare and Aetna said they're committed to improving service.

We showed PPO members the ratings and they say they're consistent with their experience.

"On the phone, they ask who it is and I have to repeat everything I just said to some other girl when she transfers me to somebody else," said Wyatt Earp, a member of a PPO.

Some say they don't understand all those letters insurance companies send.

"I think the companies need to do a better job on explaining things," said PPO member Leslie Clemons. "They have all these crazy codes that you don't know what they are."

Healthcare advocates may start pushing insurance companies to be more clear.

"So that customers have better information, they have clearer standards and that they have more transparency so that they can make purchasing 0decisions when they are deciding between plans," said Anthony Wright, Health Access California.

On a positive note, the report found eight out of every 10 PPO members had a favorable experience with their plan, and that two-thirds of patients are getting the right care for their condition.


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