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Insurance Sites May Untangle a Web of Choices

January 21, 2002|BENEDICT CAREY

Six California health plans announced last week that they would begin to rate hospitals and doctors on various measures, such as how "satisfied" patients are with their doctors, and publish the results. This type of information should be helpful to consumers as they try to navigate the murky world of health insurance to make informed decisions. Meantime, some health plans already are making an effort to do a better job of explaining their services. Here are a few of them:

Aetna Navigator

The Navigator is meant as an all-purpose resource for both Aetna U.S. Healthcare clients and the general public. Aetna members can, for instance, switch primary-care doctors online, refill prescriptions or replace a lost ID card. Consumers can read about dozens of Aetna insurance plans available, check whether their doctor is in a plan, and explore InteliHealth, Aetna's online consumer health information company affiliated with Harvard Medical School and the University of Pennsylvania School of Dental Medicine. What's lacking is a straight rundown of the insurance plans themselves, in plain language. Granted, specific policy information can be simplified only so much. Aetna has about a dozen different medical plans in the Los Angeles area alone, but the descriptions leave something to be desired: "Members who coordinate care through their PCP and obtain referrals to network providers pay a minimum co-payment ... can self-refer to a network doctor or hospital at a higher co-payment ... [or] seek care outside the Aetna U.S. Healthcare HMO provider network without a referral, subject to a deductible and coinsurance." This may be clear--if you're in the health benefits business. The rest of us could use a more basic explanation, without the policy mumbo jumbo.

Blue Cross of California

The Blue Cross site seems largely designed as a marketing vehicle and has none of the range or depth of consumer information available on other sites. Its "Resources" section, for instance, amounts to little more than a list of online links to government agencies and professional organizations. But you'll also find here a feature called "How to Choose a Plan," which is somewhat helpful. After working through the ad copy, you will find a few "decision points," which at least get you thinking about the differences among policies. For example, one says, "I need a more affordable plan with lower monthly premiums"; in this case the site recommends a product called PlanScape. Blue Cross also posts a sample case: a San Diego family with a 19-year-old daughter and 10-year-old son whose coverage and premiums are described. This is helpful, too, insofar as it gets consumers actually working out what specific plans will mean for them.

Blue Shield of California

Blue Shield's site has won awards for providing members with good, readable and relevant information on nutrition, fitness, prevention, as well as a library of helpful articles on illnesses and conditions. But the value here for those investigating health insurance are the Frequently Asked Questions pages for individual and group plans. These are good questions: What is the best plan for me? What kinds of plans do you offer? What is the difference between an HMO and a PPO? The answers are often refreshingly blunt and clear. But, here again, the company falls short in providing detailed examples to illustrate exactly what different policies mean for different people.

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