|
|
Overall %
Responding Often/ Always |
|
BCBS TX |
Cigna |
Humana |
Medicare |
|
Unicare |
United HC |
|
|
|
|
|
|
|
|
|
|
|
|
My
practice has experienced difficulties with Preauthorization for services from
this payor. |
24.4% |
|
|
|
|
|
|
|
|
|
My
practices has experiences difficulties obtaining referrals for patients. |
18.1% |
|
|
|
|
|
|
|
|
|
I
have experienced difficulty finding a specialist in the payor's
network. |
9.9% |
|
|
|
|
|
|
|
|
|
Payment
denials for medically necessary care are a problem with this payor. |
35.3% |
|
|
|
|
|
|
|
|
|
The
formulary for this payor limits the medications I
need to prescribe for treatment |
24.6% |
|
|
|
|
|
|
|
|
|
My
practice experiences an excessive amount of requests for prescription drug preauthorizations with this payor. |
22.5% |
|
|
|
|
|
|
|
|
|
My
practice has experienced problems related to filing electronic claims. |
16.4% |
|
|
|
|
|
|
|
|
|
My
practice has experienced problems related to filing paper claims. |
21.5% |
|
|
|
|
|
|
|
|
|
My
practice has experienced problems related to the timeliness of reimbursement. |
29.2% |
|
|
|
|
|
|
|
|
|
My
practice has experienced issues with payments that are less than the
contracted rate. |
18.3% |
|
|
|
|
|
|
|
|
|
My
practice has experienced problems related to recoupments.
(Recoupments meaning the health plan asking or
taking reimbursements from you after they have already paid.) |
12.0% |
|
|
|
|
|
|
|
|
|
How
often in the past 12 months have your reimbursement been discounted by an
entity that is associated with the payor, but whom
you are unfamiliar (silent PPO's). |
12.4% |
|
|
|
|
|
|
|
|
|
Does
the payor required your time and services for which
they do not reimburse for before issuing benefits to the patients (i.e. precerts, preauths, peer to
peer review, literature searches, letters of medical necessity, etc.) |
46.5% |
|
|
|
|
|
|
|
|
Indicates the health plan is performing
statistically better than the mean. Indicates the health
plan is not statistically different from the mean.
Indicates
the health plan is performing statistically worse than the mean.
|
|
Overall % in
Never/Rarely Category |
|
BCBS TX |
Cigna |
Humana |
Medicare |
|
Unicare |
United
HC |
|
My
practice is aware of the lifestyle modification services (preventive
services, care coordination, etc.) available with this payor. |
34.1% |
|
|
|
|
|
|
|
|
|
The
payor reimburses for the cost of in-office lab
services |
38.5% |
|
|
|
|
|
|
|
|
|
The
payor reimburses for the cost of immunizations. |
22.6% |
|
|
|
|
|
|
|
|
|
The
payor is prompt in responding to my phone calls. |
35.0% |
|
|
|
|
|
|
|
|
|
My
complaint, issue or question is often resolved with one phone call. |
50.2% |
|
|
|
|
|
|
|
|
|
The
payor routinely notifies my practice of updates to
formularies, coding, procedural changes, fee schedule changes, etc. |
35.3% |
|
|
|
|
|
|
|
|
|
The
payor's credentialing process is completed within
three months. |
28.9% |
|
|
|
|
|
|
|
|
|
Patients
generally understand their insurance coverage, benefits, co-pays, and deductibles,
and benefit limitations. |
53.4% |
|
|
|
|
|
|
|
|
|
Patients
understand the preventative services, care coordination and other lifestyle
modification services available to them. |
71.6% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Overall % in Not
Helpful Category |
|
|
|
|
|
|
|
|
|
Please
rate the helpfulness of the payor's representatives
in answering your questions and resolving issues. |
18.6% |
|
|
|
|
|
|
|
|
|
|
Overall % in Not
Easy Category |
|
|
|
|
|
|
|
|
|
Please
rate the ease of use the payor's website to help
you find the information you need. |
17.9% |
|
|
|
|
|
|
|
|
|
|
Overall % in No
Category |
|
|
|
|
|
|
|
|
|
Can
your office communicate with the payor via email. |
62.70% |
|
|
|
|
|
|
|
|
Indicates the health plan is performing
statistically better than the mean. Indicates the health
plan is not statistically different from the mean.
Indicates
the health plan is performing statistically worse than the mean.
