Managed Care News   

                           Connecticut Survey on Managed Care

(HARTFORD, CT, June 12, 2002) –  The State of Connecticut’s Office of Healthcare Advocate (OHA) surveyed residents who belong to managed care health plans.  Conducted in May 2002 by The Center for Research & Public Policy in Trumbull, affiliated with Sacred Heart University, the telephone survey focused on consumer understanding and satisfaction with their health plan.

In summary, 74% of Connecticut residents described themselves as a satisfied managed care customer and an additional 17% considered themselves as either loyal or advocates of their health plan.  This positive feedback was further supported by the fact that more than 80% stated that they were very or somewhat aware of specific plan rules such as co-pays, deductibles, prescription coverage and how to obtain referrals.  One goal of "The Office of the Healthcare Advocate" is to assist the consumers in understanding how to select a health plan and how to understand their coverage. An informed consumer will generally be more satisfied and encounter less problems.

According to this survey, 9% of Connecticut residents have experienced a problem with their health plan in the past year.  Some of these problems were related to bills not getting paid, prescriptions not being covered or coverage changing, limited coverage, problems due to pre-existing conditions and slow process-related issues.  Nearly a quarter of the respondents reported that their health plan had changed coverage restrictions or denied coverage for a medical procedure, treatment, prescription or service.  When asked if they had ever appealed a decision, 13% said they had.  Of this group, two thirds stated that their appeal was successful.

Respondents were asked to rate the customer service they receive from their health plan.  Overall, the scores were moderate, but results varied by health plan. For instance, 72% rated the courtesy of the customer service personnel as 1-4 on a 10-point scale with 1 being excellent and 10 being poor.  However, the distribution across plans ranged from 48% to 91%.  Another example involved the speed in which the plan responded to the member.  Aggregately, 66% rated 1-4 on the same 10-point scale; however, results ranged from 38% to 79% when looking at each health plan.

A significant finding of the survey was that only 64% of the respondents were aware of coverage for mental health services.  During first quarter 2002, 13% of OHA cases were related to issues with consumers accessing and receiving mental health care.  It needs to be determined if people have the benefit and are having difficulties or if they may not be offered this benefit as part of their health plan.  Although Connecticut has a state law for mental health parity, this law applies to the approximately 60% of citizens covered by a state-licensed (fully insured) plan opposed to a federal or self-funded plan.

Results from this survey will assist The Office of the Healthcare Advocate in determining the areas to focus their educational efforts.   The office helps people understand their existing rights, health plan benefits and options in receiving quality health care services that are medically necessary.  The Office of the Healthcare Advocate was created by the Connecticut General Assembly to assist consumers with issues or concerns with their managed care health plans.  Consumers with questions can call toll free, 1-866-HMO-4446 or visit the web site, www.ct.gov/OHA.