Elders Push For Data On Health Plans

Should consumers receive complete and understandable basic information on the differences between managed care health plans so they can make intelligent buying decisions?

A broad coalition led by seniors is demanding an answer to that question in a bill that requires providers of a bewildering array of competing managed care plans in Washington to furnish basic, standard information.

The bill (SB 5883) also directs the State Insurance Commissioner to use information disclosed to prepare a “Comparative Shoppers Guide” for managed care.

This is not a money bill, its supporters stress. It wouldn’t cost anybody anything.

“Health insurers already have the information, or should have it,” says Ruth Scarborough of Vancouver, a volunteer lobbyist for the American Association of Retired Persons. “If passed, this bill would simply make information available to consumers in usable form.

“As things stand now, consumers can dig out much or most of the information they need from various sources, then try to piece together a comparison of sorts,” she said. “But you must know how to do it. And you must be very determined.

“It takes a lot of time, calling and writing insurance companies,” says Scarborough. “This can be terribly trying. And it’s completely unnecessary.”

Most people are too overwhelmed at the outset even to try, while others experience so much frustration and aggravation in the process of gathering the information needed to make valid comparisons that they become defeated. They buy what appears to be the cheapest thing that meets their needs, only to find out too late that they got less than they bargained for, according to advocates of reform.

Under the measure being advanced, health care insurance carriers, contractors, and health maintenance organizations (HMOs) would be required to provide the state insurance commissioner information on:

Basic services and benefits covered and not covered.

Restrictions on prescriptions.

Out-of-pocket costs to consumers.

How to select primary care and specialty care providers, and change them if so desired.

Emergency room reimbursement.

Actions people can take if dissatisfied with the care they are receiving.

Steps people can take if a claim is denied.

Doctors’ credentials.

How plans select doctors.

How patients are referred to other doctors.

How medical facilities are selected.

Ratio of patients to physicians.

Washington Citizens Action, which calls itself the state’s largest grassroots consumer watchdog organization, reports that some of the above information currently is simply not accessible. “For example,” says Eleanor Hamburger, health policy director, “we tried to get information, under this state’s existing disclosure laws, on certain grievance and appeals processes.

“We failed,” she said. “Ultimately, we turned to the Association of Washington Health Plans for help in securing information on their own member plans. We are still trying to gather the information. Now, how far would the average consumer get trying to secure vital information of this nature?”

The Senate Health & Long Term Care Committee has scheduled a hearing on the proposed legislation for Feb. 4 at 7 p.m. in Olympia. “We are working to get it reported out of committee to the Senate floor with a do-pass recommendation,” AARP lobbyist Scarborough said.

Sen. Alex Deccio, R-Yakima, chair of the committee, which has the power of life and death over the bill, abruptly canceled hearings on an identical measure last year. AARP, which spearheaded those earlier efforts, vowed to bring the measure back again this session.

Voters who feel this is important legislation can help it along, Scarborough said, by contacting their state lawmakers via the Olympia Legislative Hotline - 1-800-562-6000.

, DataTimes MEMO: Associate Editor Frank Bartel writes on retirement issues each Sunday. He can be reached with ideas for future columns at 459-5467 or fax 459-5482.

The following fields overflowed: CREDIT = Frank Bartel The Spokesman-Review