HEALTH (PLAN) PROBLEMS

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Although Americans give their health plans decent grades, they nonetheless admit to having had problems with them. In a July/August 2001 study conducted by Princeton Research Associates for the Henry J. Kaiser Family Foundation and the Harvard School of Public Health, 48 percent of those surveyed — who were between the ages of 18 and 64, and had private insurance — say they had a problem in the past year. Reported difficulties generally fell into several categories: cost-related, communications-based, problems of convenience and serious medical concerns. On the serious side, 14 percent say they've had a hard time getting their plan to cover a necessary procedure or treatment, and 6 percent say they've been denied treatment outright. Less serious issues, such as insensitivity on the part of administrators and language or communication problems with staff, were reported by 10 percent and 4 percent, respectively. In terms of the major effects of the problems, slightly more than one-third say that the difficulties increased their level of stress, while 9 percent say that they brought about a decline in health.

BILLING IS A BUMMER

The No. 1 problem people report having had with their health-care plan is payment for services.

In the past 12 months, have you personally had any problems with your main health-insurance plan related to:

AMONG PRIVATELY INSURED CONSUMERS AGES 18-64 PERCENT YES
Billing or payment for services 22%
Your plan not covering a particular treatment or kind of care you needed 14%
Difficulty getting someone from the plan on the phone to answer your questions 14%
Misunderstandings over which health services your plan covers 13%
Difficulty getting an appointment with a doctor 12%
Being forced to change doctors or your doctor being dropped from the plan 11%
Difficulty selecting a doctor in the plan 10%
Administrators or other plan staff being insensitive or not helpful 10%
Source: Kaiser Foundation/Harvard School of Public Health, July/August 2001
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