AP/Detroit News Examines Increased Number of Tiered Health Plans Nationwide
The AP/Detroit News on Friday examined some health insurers' offering of tiered health plans that base member copayments on health care providers' quality and cost information. Under such plans, member copayments are highest for physicians and hospitals that health insurers say provide more costly care.
According to the AP/News, UnitedHealth Group and Medica have begun pilot programs in which members who see a doctor not included in the preferred tier pay between 10% and 30% of the cost of services. Tiered plans are marketed as a "cost-saver" to employers, who typically pay a greater share of health insurance premiums.
However, tiered plans "are already raising anger and concerns among health care providers and patients," the AP/News reports. Doctors critical of tiered plans say that quality care could be compromised if doctors are sorted based on the cost of treatment. In addition, some hospital systems have said they will eliminate contracts with health insurers unless the tiered plans are revised, and some patients have voiced opposition to plans that have required them to change physicians to avoid higher copays, the AP/News reports.
Al Eldendary, president of the St. Louis Metropolitan Medical Society, questioned insurers' ranking methods, saying UnitedHealth's system uses billing records instead of medical records and the data is inaccurate.
Lewis Sandy, head of clinical strategy at UnitedHealthcare, emphasized the quality-ranking system of the plans based on claims and survey data but acknowledged that some doctors receive a lower ranking because of cost (Freed, AP/Detroit News, 5/20).