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. The Provider's Contract 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.
This capitation can discourage a physician from ordering up tests and treatment past a certain spending level, as do special incentive plans that pay doctors a bonus to keep costs down. And according to the American Medical Association, at least a dozen HMOs, covering millions of patients, have so-called gag clauses that prevent doctors from revealing their compensation deal or discussing treatment options that are not covered by the plan. Yet it is nearly impossible for a single consumer to find out about these arrangements unless a disgruntled doctor breaks ranks. Following the lead of Massachusetts, a number of states are considering laws that would ban gag clauses in physician contracts. Barring that, an employee can try to get answers through his or her company, which has more leverage.