Second Opinion: Time to switch plans?
If you have questions about the practices of your managed-care coverage, ask the experts at the state Department of Managed Health Care.
My employer offers a couple of different health plan options to choose from, and we can change plans once a year around this time. I know my current health plan pretty well, but how do I know if I should switch plans?
– R. Brown, Sacramento
When deciding whether to switch plans or stay with what you have, the decision will most likely be reached based on a combination of factors. For many consumers, cost is a primary factor. For others, the ability to see a specific doctor or the type of benefits received is more important.
Fortunately, there are resources available that can help make your decision easier. The first resource is to talk with your co-workers and ask them about their experience with their health plan. This is a good place to start because it's more than likely that if you switched to that plan, your benefits would be structured identically.
If you have a new option and you are unfamiliar with the health plan, you can contact the plan itself and ask about the services they provide and about how you would access care if you joined. This can be especially important if you are switching from an HMO to a PPO or vice versa.
Finally, the state Office of the Patient Advocate, or OPA, is a great resource for those looking into switching plans. Each year, the OPA publishes a report card on the major health plans in California. The report card reflects how each plan measures up to national standards of care and how the plan's members rate their satisfaction with the plan.
Additionally, if you or someone in your family has a specific medical condition, such as asthma or diabetes, and you want to know if a health plan provides good care for that condition, the report card measures certain conditions as well. You can find this information on the OPA Web site, www.opa.ca.gov.
If you have questions or concerns about your health plan, please contact the DMHC at (888) 466-2219 or visit www.healthhelp.ca. gov for more information. If you'd like to submit a question for Second Opinion, go to: www.sacbee.com/ qna/forum/insurance/index.html.