If you had to buy health insurance, where would you go to get it? How hard would it be to get straight answers about plan options and rates?
To answer those questions, I used a three-step process.
Step 1: Find insurance providers serving Central Pennsylvania. To do that, I used three tools: a list of insurance providers serving Central Pennsylvania, a phone and an Internet connection. The key resource was the Business Journal's Oct. 1 list of the region's top health-insurance providers. It contained seven companies. A round of phone calls weeded out two of the companies; neither AmeriHealth Mercy Health Plan nor Cigna HealthCare of Pennsylvania Inc. sells individual coverage here. A third - HealthAmerica Pennsylvania Inc./HealthAssurance Pennsylvania Inc.- is rolling out individual coverage in January after having left that niche market seven years ago.
That left four options: Highmark Blue Shield, Capital BlueCross, Aetna Inc. and Geisinger Health Plan. All four offer a variety of coverage, ranging from managed care to point-of-service plans. Some even have high-deductible plans that are compatible with health savings accounts. HSAs pair an account an employee can use for health-care expenses with a high-deductible health-insurance plan designed to cover catastrophic events.
Step 2: I graded the companies on two key factors: Web site and customer service. The assessments follow in the chart on page 17, and the companies are listed alphabetically.
Step 3: After making that initial contact, I gathered materials and created a chart so I could compare the various low-cost options. See page 20. (Table Omitted)
After I completed the assessment, I called official representatives of the insurance companies to explain what I had done and to tell them how I had made out.
Aetna spokesman Wait Cherniak was pleased to hear that his company offered some of the most affordable health-care options.
"For us, it's all about price points," he said. "If you can't make it affordable, then you're wasting your time."
I acknowledged I was a little in the dark over some of the plans, which might have frustrated the customerservice representative. He said the representatives are used to dealing primarily with brokers, who have a firm grasp of the industry.
Geisinger has about 240,000 members, 15,000 of them individual policy holders. Despite the relatively small number of individual plans, the Danville-based company intends to stay in the market.
"This kind of business is risky for an insurer, but there's certainly a need for it out there," said Lisa Hartman, a Geisinger spokeswoman. "What we do to minimize our risk is conduct health screenings. We don't take every single person who applies. That helps from a financial perspective."
In April, Geisinger will replace its managed-care plan for individuals with a high-deductible plan designed to make consumers more aware of the true cost of care.
"We need to make consumers a little more aware of what those costs are," Hartman said. "It's part of the solution. Not the solution, but we're starting to see more of it, and we'll soon begin to see how it works."
The PPO-style plan also will be less costly than Geisingers managed-care model.
Highmark spokesman Leilyn Perri could not say what percentage of the insurer's policy holders are individuals. Highmark primarily serves large and mid-size groups, he acknowledged.
He said the company does not post rate information on its Web site because it considers that to be proprietary information.
Even if the company did post rates, he said, any quotes would merely be guideposts without knowing details about the applicant.
"When you ask for a rate over the phone, I'm assuming I don't know you," he said.
A Capital BlueCross spokesman could not be reached for comment.
STEP 2:
Companies were graded on two key factors:
WEB SITE
How easy was it to navigate the site? What was the quality and quantity of information available online?
CUSTOMER SERVICE
How simple was it to use the voice-mail system? How knowledgeable and helpful were the customer-service representatives?
Aetna Inc.
WEB SITE
Aetna's site is easy to navigate and is the most comprehensive. A "Members & Consumers" link leads to a "Products for Individuals" link that gave me an option of choosing coverage information based on my state. There is a "Get a Quick Quote Now" link that users have to register for first. It was free, but I skipped that step and went right to a list of downtoadable documents. There are maps of Aetna's various coverage areas in Pennsylvania, detailed breakdowns of its HMO, PPO and HSA-compatible plans and rate sheets for those plans.
CUSTOMER SERVICE
Caroline was a bit terse and slightly impatient with my questions. The plans have names such as HMO 15 and PPO 40. 1 asked her if the numbers corresponded to the co-pays. She said yes, but that there was much more to it than that. She declined to elaborate. I asked her if Aetna offered a lowcost, high-deductible plan, and her answer was restricted to, "That's what a PPO is, sir." When I probed her for rate information, she said she could tell me nothing unless I gave her my name, address, date of birth and other details. I asked her if she could give me a quote based solely on sex and age, but she balked.
The call ended with her outlining how the process would work if I ended up choosing to do business with Aetna. I would have to choose a plan, fill out an application and mail a check for the first month's payment. The approval process would be three weeks.
Capital BlueCross
WEB SITE
The site isn't intuitive, but the layout is basic enough. A link labeled "Products" goes to a page that includes seven additional choices, one of which is "For Individuals." BlueCross lists its various plans, provides overviews and details about deductibles and co-pays and, best of all, the estimated price I could expect to pay for coverage. There are monthly rates for single people, a parent with a child or children, husband and wife, and family. There also is an application that can be downloaded and mailed in.
CUSTOMER SERVIE
Here's where things broke down a little. The toll-free number funneled me into a voice-mail system where the choices were limited to 'Press 1 for members" and "Press 2 for providers." I went with option 1, which transferred me to a representative. The woman was knowledgeable about the various plans, but I felt like she assumed I knew more about insurance than I really did. I had a hard time following her industry jargon. When I asked her to point out a basic, affordable plan, she told me, "It would be presumptuous of me to make a recommendation."
Geisinger Health Plan
WEB SITE
It was a simple site to use. On the main page is a link for "individuals and families" that takes you right to a quote page. All I had to do was type in my sex and age, what type of plan I was interested in (Individual, Subscriber & Spouse, Subscriber & Child, Subscriber & Children or Family) and whether I wanted to include prescription-drug coverage in my quote.
I got a quote for $181.30 a month, which I assume is a rough estimate since the software did not ask about medical history. Quote in hand, I was given the option of filling out an application online or calling an 800 number.
CUSTOMER SERVICE
Again, it was very easy to navigate. The voice-mail system includes an option for individual-coverage questions, and I was quickly connected to a representative who identified herself as Ann. She took my address and said a packet of information would be mailed to me immediately. I mentioned how easy the online quote system was to use. "We try to update it as often as possible," she said. The packet arrived within a week.
Highmark Blue Shield
WEB SITE
Finding the initial information was simple. A link to "Individual Benefits" is readily identifiable on the right-hand side of the main page. Each plan option - seven in all is linked to a short synopsis of the plan. That's the extent of the information, however. I was prompted to call an 800 number if I had questions.
CUSTOMER SERVICE
The staff was affable and professional. Nick took note of my name and address and said a packet of plan options, rates and an application should arrive in four to five business days. The information packet arrived in the mail within three days. When I asked him if rate information could be found online, he said the site "should have them, yes sir."
An exhaustive search of the site revealed no obvious references to plan pricing. I made a second call, this time getting Sharon, who put me on hold before transferring me to the Web department. Finally, Timothy told me that if I wanted quotes or other financial information, I would have to call the toll-free number that I already had called twice.
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