THE GOING RATE: Health providers were not satisfied in general with the reimbursement rates paid by insurers, as shown by the percentage of responses that were "very good" or "good" in terms of rate adequacy from the three commercial insurers in Rhode Island, Blue Cross & Blue Shield of Rhode Island, UnitedHealthcare of New England and Tufts Health Plan. Results were broken down by type of health care provider.
PROVIDENCE – Rhode Island medical providers voiced general dissatisfaction with commercial insurance carriers across a spectrum of issues, including fair treatment of providers, promotion of affordability and quality of health care, according to the results of a survey released on Feb. 15 by the R.I. Office of the Health Insurance Commissioner.
The 2011 survey, which was sent to all Rhode Island physicians with an active email address, had an overall response rate of 20 percent from physicians who were eligible.
The survey findings reported that “distinctions” remain between the three commercial carriers – Blue Cross & Blue Shield of Rhode Island, UnitedHealthcare of New England, and Tufts Health Plan of Rhode Island. “Providers were generally dissatisfied with United on all metrics, with greater than 54 percent of respondents indicating ‘poor’ or ‘very poor performance in most categories (except claims processing accuracy and simplicity),” according to OHIC’s findings.
The survey found that providers were more satisfied with Blue Cross than United’s or Tufts’ performance, and that primary care providers were more satisfied with Blue Cross on issues such as rate adequacy, general provider services, and health systems improvement than were non-primary care providers.
In turn, the survey found that provider satisfaction with Tufts varied across the metrics, with a higher percentage of respondents satisfied with rate adequacy and claims processing accuracy and simplicity, but providers were unsatisfied with additional payments and delivery system improvements.
While providers who responded found improvements by all three carriers regarding additional payments over time, particularly with Blue Cross’s addition payment strategies, with more than 60 percent of respondents indicated “very good” or “good” performance, most physicians said that their rate of reimbursement by the health plans were “poor” or “very poor,” according to the survey. Overall, the survey report said, “Blue Cross’s rates of reimbursement are perceived more positively than United’s or Tufts’ rates of reimbursement.”
In terms of total “covered lives” – the technical term used by commercial health insurers – there are 605,000 covered lives in Rhode Island, according to the most recent data provided by the insurers to OHIC. Blue Cross has 397,000, United has 147,000, and Tufts has 15,000 (5,000 are Rhode Island residents who work in Massachusetts). An additional 46,000 covered lives were attributed to purchases of commercial health insurance from out-of-state insurers that Rhode Island doesn’t regulate.
To view the complete survey report, go to click here.
christopher f. koller,
r.i. office of the health insurance commissioner,
health insurance carriers,
blue cross & blue shield of rhode island,
unitedhealthcare of new england,
tufts health plan