Shopping for Health Insurance on the Web.

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Author: Conhaim, Wallys W. wconhaim@conhaim.comPage, Loraine

Perspectives

Selecting the right health plan has become more complicated as insurers offer more choices and employers allow workers to customize their benefits.

Our need to understand health insurance has never been greater. Many of us are experiencing radical changes as premiums rise, employers reduce the share of health costs they're willing to pay, and the government changes the rules. Selecting the right plan has become more complicated as insurers offer more choices and employers allow workers to customize their benefits.

The Internet is a key resource for tackling these issues. According to the California HealthCare Foundation, nearly 10 million people shopped for health insurance on the Web in 2002. Since the early days of consumer information services more than a decade ago, insurance companies have aggressively used interactive communications to help the public match policy features to their needs as well as to collect sales leads and customer-interest profiles. Thus, insurance shoppers and those trying to understand their current coverage now have access to mature, sophisticated services from individual companies and industry sources.

Insurance sites are also becoming important customer-service assets. Industry studies show that customers want more control over their healthcare dollars. Rather than shop for new providers, some opt for new options at renewal time, such as raising a deductible in exchange for lowering a premium.

It helps to get a general overview of the industry, what it has to offer, and the issues it faces.

One good place to start is "Navigating the Health Care Maze" on HealthCareCoach.com, a project of the nonprofit California-based National Health Law Program. This site features a pop-up glossary for such terms as HMO, POS, and PPO and offers clear explanations of managed care, tiered health plans, and other concepts.

Other succinct but comprehensive resources include the Agency for Healthcare Research and Quality's "Choosing and Using a Health Plan" (http://www.ahrq.gov/consumer/hlthpln1.htm) and "Checkup on Health Insurance Choices" (http://www.ahrq.gov/consumer/insuranc.htm).

These straightforward fact sheets answer all the questions you may have on various types of programs, matching services to your needs, and how health insurance works. The rest of the AHRQ Consumers and Patients site (http://www.ahrq.gov/consumer/index.html#plans)is well worth a lengthy visit, as it's packed with information on how to be a savvy healthcare consumer.

Because health insurance is regulated by each state, it's useful to know how yours handles health-plan admission, coverage for pre-existing conditions, and financial assistance or affordable health insurance. With funding from private foundations, the Georgetown University Health Policy Institute has assembled helpful "Consumer Guides for Getting and Keeping Health Insurance" for each of the 50 states (http://www.healthinsuranceinfo.net). To directly reach your state's insurance commissioner with a question or a concern, see the Commissioners Quick List on About.com's Personal Insurance page (http://personalinsure.about.com). It includes phone numbers as well as links to Web sites.

Major insurers are well-represented by extensive Web sites (some are listed in the sidebar). But these are not necessarily the best sites for serious shoppers to consult. Just as the brick-and-mortar investment brokerage industry has spawned Internet-only marketing vehicles, so has the insurance industry.

Prominent among the newcomers that take full advantage of the Internet's customization and near real-time communications capabilities are Insure.com (http://www.insure.com), which now provides quotes from 114 health insurers, and eHealthinsurance.com (http://www.ehealthinsurance.com), which represents more than 140 companies.

Insure.com offers renters, dental, travel, auto, life, and home insurance and features a database of more than 3,000 advice articles. eHealthInsurance claims its online application process is 50-percent faster than others because many of its carriers accept electronic signatures. In addition, it claims to offer carrier-direct rates with the lowest possible premiums.

InsWeb (http://www.insweb.com), 4-FreeQuotes (http://www.4freequotes.com), HealthInsuranceFinders (http://www.healthinsurancefinders.com), and All Quotes Insurance (http://www.allquotesinsurance.com) are among the other established sites that allow users to make side-by-side comparisons and solicit quotes from a number of vendors simultaneously.

For the most part, the insurance quote services are geared to individuals, families, and small businesses, and many offer more than just health insurance. Some automatically put customers in touch with an agent for the final transaction, while others give them the option. Some services handle the transaction online using secure servers.

Price isn't everything when it comes to a health insurance plan. When you really need the insurance, it's performance that counts. You'll want to check on a plan's accreditation by searching for its "report card" at the National Committee of Quality Assurance (http://www.ncqa.org), one of the most respected evaluators of medical quality. You can also see if any complaints have been filed against the company in the National Association of Insurance Commissioners' Consumer Information Source database (http://www.naic.org/cis). A.M. Best (http://www.ambest.com/ratings/guide.html) rates insurance companies' financial strength.

A healthcare plan is only as good as the providers and institutions it covers. Thus, another approach to exploring health insurance is to work backwards, starting with an evaluation of hospitals and/or physicians.

In many parts of the country, one hospital or clinic is known as the place to go for a particular condition. A physician might be geographically convenient as well as have a good reputation. Or perhaps you want to consider a physician who has been highly recommended by a friend.

City magazines, such as New York (http://www.newyorkmetro.com/bestdocthrs/articles/02Thestdoctors/index.htm), Chicago (http://www.chicagomag.com), and Minneapolis/St. Paul (http://www.mspmag.com), have annual issues that list the best physicians in each specialty, chosen by a panel of their peers.

Several national Web sites take you from your desired physician or clinic to the plan that would cover their services. This is especially important if you're searching for an HMO that includes a specific group of clinics and hospitals. WebMD's database of physicians (http://my.webmd.com/pages/dir/toc.asp) allows you to see if a doctor is in a particular insurance program or practices in a hospital that's covered.

Consumers who adopt this approach to choosing a health plan will soon benefit from federal government initiatives that seek to standardize quality-care measurement at hospitals. In addition, there's an industry initiative to voluntarily submit to standardized quality surveys. The Institute of Medicine (http://www.iom.edu), an arm of the National Academy of Sciences, issued recommendations for such unified health quality standards in an October 2002 report.

The Center for Medicare and Medicaid Services has already launched initiatives (http://www.cms.hhs.gov/quality) that are directed toward rewarding high-quality home health as well as hospital and nursing home services. A doctors' office project is in the early planning stages. These efforts will deliver higher Medicare reimbursements to those facilities that provide high-quality care to patients. Other insurers, such as Blue Cross/Blue Shield in some states, are already beginning to follow suit. These initiatives ultimately benefit consumers by creating an environment that rewards quality care.

California is ahead of the game: It's the first state to go beyond hospitals and health plans to rate physician performance. In late 2002, it began to distribute report cards on the top 10 HMOs and top 81 physician groups in the state. These ratings, which are printed in several languages, are available at Walgreens drug stores.

The Internet has become an integral part of health coverage itself. Leading-edge insurers are beginning to cover such online services as e-mail consultations with doctors and "information prescriptions" in which physicians assign online health reading to patients.

In addition, many insurers allow enrollees to check on benefits, track a bill, make a claim, or order a new ID card online via secure sites. Some give customers lists of prescriptions that have been filled, along with detailed descriptions and the actual costs of the medications. Other plans allow doctors to check preferred drug lists online. These services are still underutilized, but usage is growing, according to industry sources.

Insurance is not everything. Just because you're insured, take advantage of the benefits to get regular checkups, and visit doctors when you're ill doesn't mean you can afford to be complacent about your health. A Rand Health study issued in June 2003 (http://www.rand.org/news/press.03/06.25fact.html) found that haying insurance does not guarantee quality healthcare. Its conclusions pointed out a tremendous gap between treatments that are known to work and treatments that patients are actually getting. The study found that thousands of deaths annually are actually preventable. It recommends that physicians take greater advantage of automated checklists and patient notification reminders.

Until such communications are more universal, patients are well-advised not only to use the Internet to shop for appropriate health insurance but also to avail themselves of the wonderful health information available from WebMD (http://www.webmd.com), the Mayo Clinic (http://www.mayoclinic.com), university medical schools, the National Library of Medicine (http://www.nlm.nih.gov/hinfo.html), and from their own insurer, hospital, and physician Web sites.

Now that the Information Age has given us the tools for easily researching insurance options, we must realize that we're rapidly moving into an era in which the Internet is a valued partner in our increasing self-care responsibility.

Evaluating Doctors, Hospitals, and Health Plans

American Association of Retired Persons
http://www.aarp.org

Best Doctors
http://www.bestdoctors.com

Consumers' CHECKBOOK Guides
to Health Plans, Doctors, and Top Doctors
http://www.checkbook.org

Consumers' CHECKBOOK License
and Disciplinary Action Information by State
http://www.checkbook.org/doctors/discipline.cfm

HealthGrades
http://www.healthgrades.com

Health Pages
http://www.thehealthpages.com

Joint Commission on Accreditation of Healthcare Resources
http://www.jcaho.org

U.S. News & World Report: Best Hospitals Rankings 2003
http://www.usnews.com/usnews/nycu/health/hosptl/tophosp.htm

Major Health Insurers

Aetna
http://www.aetna.com/index.htm

BlueCross BlueShield Association
http://www.bluecares.com

Cigna Health
http://www.cigna.com/consumer/services/healthcare/index.html

Humana
http://www.humana.com

UnitedHealth Group
http://www.unitedhealthgroup.com

Wellpoint Health Networks
http://www.wellpoint.com

Specialized Health Insurance Providers

Alternative Health Benefit Services
http://www.alternativeinsurance.com

American Dental Association's
FAQ on Dental Benefits and Insurance
http://www.ada.org/public/topics/insurance%5ffaq.asp

American Specialty Health
(national alternative health insurance provider)
http://www.ashplans.com

Health Insurance Association of America's
Guide to Long-Term Care Insurance
http://membership.hiaa.org/pdfs/2002LTCGuide.pdf

Insure Kids Now
http://www.insurekidsnow.gov

Medibroker's International and Expatriate
Medical & Healthcare Insurance
http://www.medibroker.com

Medical Information for Americans Abroad
http://travel.state.gov/medical.html

Medicare
http://www.medicare.gov

The Dental Consumer Advisor
http://www.toothinfo.com

Veterinary Pet Insurance
http://www.petinsurance.com

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By Wallys W. Conhaim

Edited by Loraine Page

Wallys W. Conhaim is a strategic planner, researcher and analyst who specializes in interactive services. Her e-mail address is wconhaim@conhaim.com