HARTFORD, Conn., Dec. 28, 2005 (PRIMEZONE) -- Getting and keeping healthcare coverage once again tops the list of concerns for Connecticut residents, according to the 2005 Survey of Managed Care Consumers, released today by State Healthcare Advocate Kevin Lembo. The study, designed to collect input on satisfaction, problem resolution and service awareness from a sampling of the millions of CT residents in managed care plans, revealed several significant issues.
The Center for Research & Public Policy of Trumbull conducted the survey on behalf of the Healthcare Advocate. The Center utilized a super random digit sampling procedure to identify and conduct interviews with 400 Connecticut residents who belong to private managed care plans. The survey has a margin of error of +/- 5% at a 95% confidence level.
"High prices, a changing insurance marketplace, and more complicated financing mechanisms have added to the anxiety CT residents are feeling about their healthcare," Lembo pointed out. "Once consumers are able to access health insurance, either individually or through their employer, most understand how their co-pay, deductibles and prescription coverage work. The majority also understands their rights and responsibilities."
He added, "Overall satisfaction with the health plans has increased dramatically. The insurance providers should be commended for the 7 point jump in consumer satisfaction over 2002, when this survey was last conducted."
Highlights of the Survey:
-- Seventy-nine percent of respondents in private managed care
plans expressed concerns about healthcare -- ahead of taxes,
education, crime, terrorism and employment.
-- Seventy-three percent of respondents said they had used
their health insurance within the past 3 months.
-- Eighty-nine percent (89 percent) used their coverage for
primary care and 72 percent for routine dental -- this is
great news for prevention. Hospital and Emergency Room
care were down slightly from 2002.
-- The lowest levels of awareness were centered on "COBRA"
benefits and mental health coverage (although, awareness
about mental health coverage rose 8 points from 2002).
-- The percentage of people who have read and understand their
rights within their plan grew from 43.9 percent in 2002,
to 57.8 percent in 2005.
-- Only 6 percent of respondents have had a problem with their
health insurance plan in the last year.
-- 87 percent are satisfied with their health insurance plan,
overall.
-- Consumers responded that their health insurance plans do a
good job in: processing claims and explaining benefits.
-- The number of respondents who are "dissatisfied" with their
health insurance plan dropped from 6.9 percent in 2002,
to 3 percent in 2005.
-- Almost 1 in 5 people surveyed said that their insurance
company had changed a treatment plan or objected to
needed care.
Interesting to the Office of the Healthcare Advocate is the information related to "who" appeals, and the ultimate outcome of that process, Lembo added. "Barriers to the legal right of consumers to appeal health plan decisions must be addressed immediately," he said. "Whether these barriers are real or perceived doesn't matter when the end result is that consumers lose their rights."
-- The lowest insurance plan satisfaction scores were reserved
for the quality and accessibility of informational material
produced by the insurance company.
-- While almost 20 percent had had a test, treatment, prescription
or procedure denied, only about half of those consumers
appealed the health insurance plan's decision (down slightly
from 2002).
-- For those who did appeal, the number of consumer successes
rose from 65.4 percent in 2002, to 84.8 percent -- a
significant increase.
-- African-Americans had the highest incidence of plan
denials (23 percent), but only 3.8 percent appealed the
health insurance plan's decision (compared with 12.1 percent
for whites, and 13.3 percent for Hispanics).
-- Only half of Hispanics who appealed their health insurance
plan's decision were successful in having it overturned
compared to 84 percent of the Whites and 100 percent of the
African-Americans surveyed.
Insurance Department sponsored legislation, passed in 2005, requires health insurers to advise consumers about their right to an external appeal following a final denial of service. Lembo will consult with the Insurance Commissioner, Leadership of the General Assembly's Insurance Committee, and representatives of the health plans to develop strategies for removing other barriers to access that may exist.
The Office of the Healthcare Advocate (OHA) is an independent agency of Connecticut State Government. The Office, created as the Managed Care Ombudsman in 1999 as part of the Managed Care Accountability Act, works to educate consumers about their rights and responsibilities in their health insurance plan. OHA also assists consumers through the appeal process when a health insurance company denies treatment or reimbursement. For more information on the OHA, go to http://www.ct.gov/oha .