Health Plans: Score cards: Turnaround is fair play

February 1, 2008

While there's all sorts of talk in the medical community about health plans rating doctors, Houston-area physicians have decided to turn the tables.

While there's all sorts of talk in the medical community about health plans rating doctors, Houston-area physicians have decided to turn the tables. With the help of the Harris County Medical Society, they rated the six-largest health plans in their area on patient care, payment, and customer services. The results of the survey "were dismal," said HCMS President Michael V. Kelly II, MD. For instance, nearly two-thirds of the 487 physicians who responded said they've had a tough time getting approval for patients' medical services. Almost 70 percent reported they're having trouble with prompt payment, and 64 percent said they're being paid less than the contracted rate for some services. "Payments are wrong or late or both," Kelly said.

The survey, which was done in conjunction with the University of Houston-Clear Lake's master's program in healthcare administration, evaluated Aetna, Blue Cross and Blue Shield of Texas, CIGNA, Humana, Unicare, and United Healthcare.