Survey: Health Plans Satisfy Most

Are you happy with your health insurance plan?

A new survey by the Kaiser Family Foundation and Consumer Reports finds most people are. But, there are still some serious problems.

The survey of 2,500 insured adults between the ages of 18 and 64 found most problems appeared minor and easy to resolve, while a significant minority involved serious reported consequences and were difficult to settle.

CBS News Correspondent Howard Arenstein reports half of those questioned said they had problems with their health care plan, but they described the problems as minor hassles— like having to go through a number of steps to get a referral to a specialist, or having to make a number of phone calls to finally get your bill paid after you make a visit to the emergency room and find out it wasn't initially paid by your insurer.

But one in five is a serious problem, according to Larry Levitt of the Kaiser Family Foundation. "Like more money out of your pocket, decline in your health, permanent disability, lots of lost time from work or school or other activities."

However, the figures are positive, overall.

Among people who have had contact with their plan in the last year, 83 percent said their recent experiences in dealing with it have been positive. Even among those who say they have had a problem with their plan, 71 percent reported their recent experiences as positive.

In fact, most people (64 percent), when asked to give an overall view of their plan, gave their plan an "A" or "B."

But those in "strict" managed care plans (with features common in HMOs) graded their plans lower (53 percent gave an "A" or "B") than those in "loose" managed care plans (70 percent gave their plan an "A" or "B") or those remaining in traditional health insurance (of whom 74 percent gave their plan an "A" or "B").

An official with the Blue Cross, Blue Shield of Massachusetts insists the overall figures represent good news for the consumer.

However, another health official takes issue with that.

Peter Lee of the Pacific Business Group on Health says the new survey is further proof of a crisis in confidence in health care.

Lee says 3 percent reported problems with getting health care that led to a permanent or long-lasting disability. He says that might seem low, but it actually represents four million Americans with critical problems.

Of the 51 percent of insured Americans under age 65 who reported having some problem with their health plan in the last year, women in "strict" managed care plans, and those who are in fair or poor health or who have a health condition were the most likely to report problems.

And what types of problems do people have with their plans?

• Delays or denials of coverage or care (reported by 17 percent of all people and 32 percent of people with problems).
• Difficulty seeing a physician (14 percent of all people; 27 percent of people with problems).
• Billing and payment roblems (12 percent of all people; 23 percent of people with problems).
• Problems related to communication or customer service difficulties (7 percent of all people; 14 percent of people with problems).

But 43 percent of those who reported problems identified moderate overall consequences, while 18 percent (or 9 percent of all insured adults) identified more serious consequences.

Almost two in five (38 percent) of people experiencing problems (or 19 percent of all insured adults) said there was a financial consequence to the problem (i.e., they wound up paying more for treatment or services than they normally would have).

In most cases (53 percent) where there was a problem that had a financial consequence, the amount at issue was under $200. In 14 percent of these cases (5 percent of those with a problem), there was a cost of $1000 or more.

As for lost time, about one in five (21 percent) of people experiencing problems said they lost time from work, school or other major life activities as a result. While most cases involved relatively little time lost, it amounted to at least a week in 28 percent of those cases.

About one in five people (21 percent) with problems said they experienced a decline in health as a result. Most said it was “not too serious,” though a small minority (6 percent of those with a problem of any kind) said the decline resulted in a permanent or long-lasting disability.

BY DAVID LESLIE