Pre-certification clauses, in which the patient must get permission in advance for a given treatment, also lead to complications. Not the patient. Consumers must remember to look beyond the monthly premiums to consider overall costs, including co-payments and deductibles. But some plans have a lifetime limit on what they will pay, which can be wiped out by a major health problem. Be sure to talk with someone who is authorized to answer this type of question, like the plan administrator.
Some states keep records of how many complaints a health plan has received.
Individual companies and the National Committee for Quality Assurance, an industry group, also put out patient-satisfaction surveys, but these are not very reliable. It is one thing to ask healthy subscribers how they rate their HMO, quite another to poll those with chronic illnesses. Still, plans that have failed the NCQA certification procedure, which looks at 50 criteria, like how many plan doctors are board certified in their specialties, should be avoided. Perhaps the trickiest area to untangle in managed care, and the most vital, is the relationship between your doctor and the health-care company, because this can affect what the doctor tells you and the care you receive. Some plans compensate their primary-care providers with a set monthly fee for each enrolled patient.