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HEALTH INSURANCE

Blue Cross receives highest ratings in OHIC providers survey

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PROVIDENCE – The R.I. Office of the Health Insurance Commissioner released the results of its annual survey of Rhode Island providers on Oct. 12, which found Blue Cross & Blue Shield of Rhode Island scoring higher than its two commercial health insurance competitors, UnitedHealthcare and Tufts Health Plan in the three categories measured.

The results were based upon an e-mail survey sent to providers using a R.I. Department of Health list on May 14 of this year, with OHIC receiving 426 responses, both partial and complete, for a response rate of 19.7 percent.

OHIC called the survey “a tool for translating provider experience into public knowledge,” but said the survey was not designed to draw robust statistical inferences about the provider community, nor to scientifically uncover differences in treatment of providers by the three commercial health insurers.

Under “General Provider Experience,” 30 percent of respondents rated payment reimbursements as “Good” or “Very Good” for Blue Cross, compared to 11 percent for UnitedHealthcare and 21 percent for Tufts. In that same category, under satisfaction with provider services, Blue Cross received 38 percent in “Good” or “Very Good”; by comparison, UnitedHealthcare received 9 percent and Tufts 18 percent.

Under “Gauging Administrative Burden,” Blue Cross once again received higher responses in “Good” and “Very Good” categories, compared to UnitedHealthcare and Tufts, according to the survey.

Overall, providers reported spending more than 30 percent of their time on insurer administrative work. In addition, 62 percent of respondents reported that the commercial health insurers later approve more than 40 percent of initially denied claims, indicating that most denials are the due to administrative errors, according to OHIC.

“We will use the results of the OHIC survey constructively to improve our services and relationships with providers,” said Tufts spokeswoman Sonya Hagopian. “We will also continue to work collaboratively with Rhode Island providers on our shared commitment to nationally-recognized, high-quality care.”

UnitedHealthcare spokesman Benjamin J. Goldstein said that the health insurer’s number one goal is “to expand access to affordable health care for all Americans.” Relationships with physicians and hospitals, he continued, were “a key component of meeting that goal, which is why we have taken steps to improve how we work with them on a daily basis.”

The best and most credible validation for UnitedHealthcare’s improved service to providers comes from various external groups and comprehensive data analysis, according to Goldstein, who noted OHIC’s 19.7 percent response rate. Goldstein cited the American Medical Association’s annual National Health Insurer Report Card, released in June 2012, which rated UnitedHealthcare number one on two key accuracy metrics: contracted fee schedule match rate – 98.79 percent, and electronic remittance accuracy – 98.32 percent.

OHIC, R.I. Office of the Health Insurance Commissioner, BCBSRI, blue Cross, Blue cross & blue shield of rhode island, tufts health plan, unitedhealthcare

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