Information about DC area health plans

It is now open season (at least, for UMCP employees). Time to change your health care plans or live with your current choice for the next 15 months.

Normally, you get very little in the way of information that you really need to know about how to choose a health plan. Simply knowing what the monthly fee is and how much the co-payment is isn't enough. You also need to know whether or not your HMO will deny you the safest, most effective and cheapest care (ours did), and whether they will make you spend hours and hours running around town in order to save them a few dollars (ours did).

Although the information here doesn't tell you everything you might want to know, it is the best information I've been able to come up with. I'm also putting together stories and experiences that people have had with their health care plans. Please send me other pointers or stories about your experiences and I'll add them to the list.

Bill Pugh

Resources

  • US News 1998 rating of HMO's.
  • National Committee for Quality Assurance assesses HMO's.
  • CareData - A company that, for a $12.95 fee, will give you a report on a health plan.
  • Empower! The Managed Care Patient Advocate
  • January 1996 Time magazine cover story about HMO horror stories
  • January 1996 Time magazine article on picking a health plan
  • Washingtonian magazine article on Top DC doctors
  • Health information from Consumer's checkbook - Not much information on line, but you can order consumers' guides from them.

    Alternative names

    Some HMO/POS plans don't appear to be listed under listings such as the US News and the NCQA report, but are actually listed under other names. Some of these are previous names, some are just alternatives: Here are some of the alternative names you will see:

    FAQ's

    What is capitation?
    Many HMO's pay doctors via capitation. The way this works is that a doctor gets a fixed amount of money per year per patient. Any time or expenses incurred actually dealing with a patient comes straight out of the doctor's profit. A number of people have noted that is payment method puts the doctor's and the patient's best interests at odds.

    Web pages for Health Plans

    Contact People

    If you are having difficulty with a Health Plan, it can be very difficult to get past the people who answer the phones and get to people who have any real authority or responsibility. Here are the (hard won) names (and phone numbers) of some people with real authority.

    Experiences with HMO's