Smart Benefits: How RI Physicians Rate Local Insurers

Monday, October 22, 2012

Amy Gallagher, GoLocalProv Business/Health Expert

There’s an obvious friction between physicians and health insurers – and employers and employees are at the center of the issue. Employers put pressure on health plans to control rising healthcare costs, but still provide high quality plans. Employees expect affordable healthcare, but don't want health insurers to come between them and their doctors. The result? Doctors get paid less.

How much does this fact impact physicians’ opinions of Rhode Island insurers? In the recently released 2012 Provider Survey, courtesy of the Office the Health Insurance Commissioner, providers were asked to describe their administrative burden and rate their experience with provider relations, payment adequacy, and administrative simplicity with BCBS-RI, Tufts Health Plan and UnitedHealthcare.

Following are some key highlights of the results:

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• General Experience. In terms of overall experience, physicians ranked BCBSRI tops, followed by Tufts, then UHC. While the scores were on the low side overall, they represented the best scores for all three carriers since the survey began in 2009.

• Payment. Just 22 percent of physicians rated their satisfaction with payment as good or very good. On this question, they were more satisfied with BCBSRI (30 percent said payment was good or very good) followed by Tufts at 20 percent and UHC at 11 percent.

• Claims Processing. Physicians felt the carriers were better with the accuracy than the simplicity of claims processing. Again, BCBSRI rated tops, followed by Tufts and UHC.

• Administrative Burden. Sixty-two percent of providers reported that the carriers later approved claims they initially denied – more than 40 percent of the time.

• Health System Improvements. When it comes to the insurers’ efforts to promote improvements in the state’s healthcare system, BCBSRI received the best score, followed by Tufts then United.

Want to read more provider feedback? Visit www.ohic.ri.gov for the full survey results.

Amy Gallagher has over 19 years of healthcare industry experience. As Vice President at Cornerstone Group, she advises large employers on long-term cost-containment strategies, consumer-driven solutions and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, is a member of local organizations like the Rhode Island Business Group on Health, HRM-RI, SHRM, WELCOA, and the Rhode Island Business Healthcare Advisory Council, and participates in the Lieutenant Governor’s Health Benefits Exchange work group of the Health Care Reform Commission.

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