Choosing the Right Plan

The fundamental criteria that is important in choosing a good managed care plan is the

quality of service it will deliver to you. This is a bit of a challenge to determine since the

insurance companies are not too eager to provide objective data. Instead, you will need to

research this information independently, reviewing both doctors and hospitals that serve

your area.

Don’t just choose a plan because they make nice commercials; this is a fatal mistake that

captures many with good marketing and they find out the hard way when it’s time to go to

the emergency room and it turns out to be the same location as the county general ward for

indigents.

The first place to start is with your state regulator. Most states have an agency designated to

review and monitor the practices of managed care plans in their jurisdiction. This source can

provide you with both objective reports and also feedback on which insurers are doing their

job and which ones get a lot of complaints.

A second source is the insurer’s trade association. Many insurers want to maintain a sense

of premium, so they will make sure to get certified in their industry as a quality provider. This

requires them to have to meet certain standards for care, service, and customer treatment.

Seeing which players have this certification and which ones don’t can weed out some of the

undesirable plans.

Research also requires doing some investigation. Look at the way your insurer determines

which doctors to hire and what hospitals to include in its network. Are the doctors rated and

qualified by a set of factors before being hired or are they brought on with just name and

license? Is there any kind of a feedback program to monitor network service providers

regularly? Is the insurer willing to provide survey reports from its members on how it’s

doing?

Ultimately, referrals are one of the best information sources because these folks are already

in the managed care plan or were in it. They can share with you first-hand experience

specific to your region or network area. You can get valuable, inside knowledge only gained

through a member’s perspective, and possibly avoid the mistakes a past member made

without suffering in the process. You will want to focus on the service experienced, which

doctors were the best, what disadvantages were experienced, and how finances were

handled.

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