Many California PPOs Earn Low Grades in Latest Report Card
Many of California's major PPOs received low ratings for various quality measures, particularly in providing customer service, according to a new report card released by the state Department of Insurance, the Los Angeles Times reports (Helfand, Los Angeles Times, 11/19).
The report card graded the state's six largest PPOs on a four-star scale for various quality measures. Combined, the insurers provide coverage for about 2.2 million of California's 2.6 million PPO members.
For meeting national standards of care guidelines, three insurers received three-star ratings:
- Cigna; and
The remaining three insurers received two-star ratings:
- Anthem Blue Cross;
- Blue Shield of California; and
- Health Net (Calvan, Sacramento Bee, 11/19).
For ease of obtaining care, all of the insurers received a two-star rating, except UnitedHealthcare, which received a three-star rating.
For customer service, all of the insurers received a one-star rating, except Aetna, which received a two-star rating (Los Angeles Times, 11/19). Some of the customer service complaints related to difficulties in:
- Reaching someone on the phone;
- Obtaining cost information; and
- Securing payment for claims.
No insurer received the top four-star rating for any of the quality indicators (Sacramento Bee, 11/19).
State, Insurer Comments
California Insurance Commissioner Steve Poizner (R) called the report's findings "atrocious" and urged insurers to improve the quality of their health care services.
Several of the insurers highlighted their positive ratings and described ongoing initiatives to improve care quality and customer service.
Aetna and Health Net said the report card would help them better customize their services and provide more efficient care (Los Angeles Times, 11/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.