Missed opportunities Featured

9:50am EDT October 31, 2002
With worries increasing about the affordability and availability of quality health care, 92 percent of Americans surveyed say it is important to be more informed as health care consumers, according to a workplace survey commissioned by CIGNA HealthCare.

But as an estimated 100 million U.S. employees find themselves making their annual health plan selections, the survey shows that many are doing so without the knowledge they need to make an informed choice. And most are unaware of the latest health services and resources available from many health plans. As a result, many Americans leave these new services unused.

What's overlooked

The survey found that while most people -- nearly 90 percent -- know to ask about cost and whether they can continue to see their favorite doctors, very few know to ask about other services that may vary significantly from plan to plan. Ironically, when these services are described to them, a majority say they want them and that they would be an important consideration in their selection of a health plan.

Here are a few things consumers ought to check before choosing a health plan.

* 24-hour phone access to nurses. Find out if the health plan offers access to nurses around the clock to answer your questions or direct you to the most appropriate care. This can be particularly helpful in the middle of the night if you aren't sure what to do and need guidance or a friendly voice.

* Nurse case managers. Some plans assign a nurse case manager, who works directly with you and your family to help you understand your options, identify facilities for rehabilitative services or post-operative care, find additional financial or other resources and help with things such as filing claims.

* Personalized online health resources. Find out what kind of Web site the plan offers. A good site should let you order medications, check the status of your claims, find a participating provider, track your deductibles and copayments and get health news and information tailored just for you and your family.

* Disease management programs. Investigate whether the plan offers these programs, so if you or a covered dependent have or develop a chronic condition, you'll have support in finding out your options and managing the condition.

* Discounts on health and wellness services. Check whether the plan offers discounts on health, fitness and wellness services. Take advantage of discounts on smoking cessation programs, weight loss programs, health clubs, laser eye surgery, cosmetic dentistry and massage therapy, especially if these are programs you'd be interested in, anyway.

* Wide range of health services. Consider whether the plan covers mental health, substance abuse, dental, vision and pharmacy, all within the same company. This can be more convenient and make it easier for your health plan to help you and your doctor identify a problem, such as medications prescribed by different doctors that might not go well together.

* Quality measures. Ask if the health plan allows its programs to be reviewed and rated by an independent organization. Only about 50 percent of plans submit to this scrutiny, and experts say it is those plans that usually offer the highest quality clinical programs.

Many still think their health plan only processes doctors' bills and pays claims. If more people knew the kind of resources available through many health plans, they'd make use of them.

And since these same resources are designed to keep employees healthier -- and therefore more productive -- their availability in a health plan ought to be an important consideration for employers, too. Jeanne McCarthy is president and general manager of CIGNA HealthCare - Ohio region, headquartered in Cleveland. CIGNA HealthCare is one of the nation's leading providers of health-benefit programs, with managed care networks serving 45 states, the District of Columbia and Puerto Rico. CIGNA HealthCare provides medical coverage through managed care and indemnity programs to more than 13.3 million people, including more than 250,000 in major Ohio markets. Reach McCarthy at (800) 541-7526.