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Wednesday, 18 December 2013 11:01

2013 HMO Report Cards

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OPIC's Annual HMO Reports Are Now Available

 

The Office of Public Insurance Counsel (OPIC) released its annual HMO reports Comparing Texas HMOs 2013 and Guide to Texas HMO Quality: 2013. 

Comparing Texas HMOs 2013 is OPIC’s annual Health Maintenance Organization (HMO) report card.  The report focuses on plan members’ satisfaction with various aspects of their HMOs.  It also includes information on consumer rights, an analysis of complaint data collected by the Texas Department of Insurance, and information on appeals. The report can be accessed here.  

Guide to Texas HMO Quality: 2013 compares basic services delivered by Texas HMOs addressing significant health issues such as cancer, heart disease, smoking, diabetes, the care of pregnant women, and the care of children.  OPIC produces and publishes this guide through an agreement with the Department of State Health Services’ Texas Health Care Information Collection (THCIC). The report can be accessed here.

Public Counsel Deeia Beck said that “the reports provide new and seasoned consumers the kind of detailed information essential to choosing a health plan that meets their needs.  As more consumers enter the marketplace, these reports help consumers evaluate their health care options.”

For hard copies of the reports or for additional information, contact OPIC at 512-322-4143.

               

 

 

Sunday, 18 December 2011 08:09

Comparison by Region 2012

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2012 Survey (CAHPS 4.0H)

 

Statewide Aggregrates (PDF)


Central Texas (PDF)

 

  • Includes: Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson


East Texas (PDF)

  • Includes: Anderson, Angelina, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Hardin, Harrison, Henderson, Hopkins, Houston, Jasper, Jefferson, Lamar, Marion, Morris, Nacogdoches, Newton, Orange, Panola, Polk, Rains, Red River, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Smith, Titus, Trinity, Tyler, Upshur, Van Zandt, Wood


Gulf Coast Texas (PDF)

  • Includes: Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton


North Texas (PDF)

  • Includes: Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise


Panhandle/Plains Texas (PDF)

  • Includes: Andrews, Archer, Armstrong, Bailey, Baylor, Borden, Briscoe, Brown, Callahan, Carson, Castro, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Foard, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jack, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Montague, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terrell, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Wichita, Wilbarger, Winkler, Yoakum, Young


South Texas (PDF)

  • Includes: Aransas, Atascosa, Bandera, Bee, Bexar, Brooks, Calhoun, Cameron, Comal, De Witt, Dimmitt, Duval, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Hidalgo, Jackson, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kerr, Kinney, Kleberg, La Salle, Lavaca, Live Oak, Maverick, McMullen, Medina, Nueces, Real, Refugio, San Patricio, Starr, Uvalde, Val Verde, Victoria, Webb, Willacy, Wilson, Zapata, Zavala


West Texas (PDF)

  • Includes: Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio

To open the reports found on this page you must have a copy of Adobe Acrobat Reader.  You can download a free copy of Acrobat Reader Here.

 


Thursday, 13 September 2012 16:04

UP Tip of the Month

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United Policyholders recently published some helpful advice for people shopping for disability insurance. In the group’s latest Tip of the Month, Tony Steuer discusses a few key policy provisions and provides some helpful questions to consider when shopping for disability insurance, including:

  • Are there benefit ceilings or caps that apply monthly and/or over a lifetime?
  • How is “disabled” defined under the policy?
  • Does the definition of “disabled” change or shift if you become disabled?
  • Will your benefits be offset/reduced by Social Security Disability benefits or other sources?
  • Does the policy have a “discretionary clause” or other wording that gives the insurance company too much power to decide whether or not you're disabled? Remember discretionary clauses are now prohibited in Texas, but it is still a good idea to ask and make sure your policy does not contain this type of language.  

If you are considering purchasing disability insurance please check out the entire article here.

Tuesday, 15 May 2012 09:41

PPOs and Cost Sharing

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PPOs and Cost Sharing

May 2012 

A Preferred Provider Organization (PPO) is a type of managed care health plan that contracts with physicians, hospitals, and other health care providers to create a network of preferred providers to treat members at a negotiated price. As a participant, you can obtain health care services either through those in-network preferred providers or out-of-network providers. PPOs require you to pay for part of the cost of most covered services. This “cost-sharing” includes copays, deductibles, and coinsurance. 

A copay is a set dollar amount you pay at the time you receive care. Plans often charge copays for routine doctor visits and prescriptions. For example, your plan may require you to pay $25 for an office visit or $10 to fill a prescription. Often services covered by a copay are exempt from a deductible requirement. 

A deductible is an annual dollar amount you must pay out-of-pocket before the plan will pay for covered medical services. Deductibles for in-network services are often lower than deductibles for out-of-network services. 

After meeting your deductible, you will typically pay coinsurance for the health services you receive. Coinsurance is typically expressed as a percentage of the covered cost of a service. Often you will pay a lower percentage for services by in-network providers than those by out-of-network providers. For example, a plan may require you to pay 20 percent of the cost of a procedure performed by an in-network provider, but require you to pay 50 percent if an out-of-network provider performs the procedure.

In addition to a higher coinsurance responsibility, if you elect to use an out-of-network provider you may also be responsible for any charges above the allowed amount—the maximum amount your insurance company will pay for a specific service. For example, if your policy has a 20% coinsurance fee and an in-network provider charges $100 for a covered procedure, your out-of-pocket costs will be $20. If your policy has a 50% coinsurance fee for out-of-network procedures with an allowed amount of $100 for a procedure, then your coinsurance amount for that procedure will be $50. If the out-of-network provider charges $200 for the procedure, you may also have to pay the $100 above the allowed amount. 

Your policy documents will list any copay, deductibles, or coinsurance applicable to your plan. Make sure you review this information and contact your health plan and provider to determine your estimated out-of-pocket expenses prior to receiving health care.

House Bill 1405, enacted by the Texas state legislature in 2011, expands protections for consumers enrolled in employer and individual health plans with prescription drug formularies. A prescription drug formulary lists the prescription drugs, both generic and brand name, that are available through your health insurance plan.

The new law prohibits plans from making mid-year changes to prescription drug formularies including the removal of a drug from the formulary, changes in prior authorization requirements, cost sharing increases, and changes to step therapy restrictions. Step therapy is the practice of treating a condition with safe, lower cost drugs first and progressing (or stepping) to riskier, more costly therapies if necessary.

Plans must continue to provide prescription drug benefits under an enrollee’s contracted benefit levels until the next renewal period, even if the plan changes the formulary in the middle of the year. When a plan does change the formulary, it must provide written notice to each affected group plan enrollee and individual plan policyholder at least 60 days before the contract period ends. Prior to the enactment of this law, many of these requirements applied to large-employer plans, but small-employer and individual plans were exempt.

The new law applies to policies issued, delivered, or renewed after January 1, 2012.

Sunday, 26 February 2012 18:22

2012 Resultados por Región

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Texas Central (PDF)

  • Incluye: Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson


Texas Este (PDF)

  • Incluye: Anderson, Angelina, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Hardin, Harrison, Henderson, Hopkins, Houston, Jasper, Jefferson, Lamar, Marion, Morris, Nacogdoches, Newton, Orange, Panola, Polk, Rains, Red River, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Smith, Titus, Trinity, Tyler, Upshur, Van Zandt, Wood


Costa de Texas (PDF)

  • Incluye: Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton


Texas Norte (PDF)

  • Incluye: Collin, Cooke, Dallas, Denton, Erath, Ellis, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise


Texas Panhandle/Plains (PDF)

  • Incluye: Andrews, Archer, Armstrong, Bailey, Baylor, Borden, Briscoe, Brown, Callahan, Carson, Castro, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Foard, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jack, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Montague, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terrell, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Wichita, Wilbarger, Winkler, Yoakum, Young


Texas Sur (PDF)

  • Incluye: Aransas, Atascosa, Bandera, Bee, Bexar, Brooks, Calhoun, Cameron, Comal, De Witt, Dimmitt, Duval, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Hidalgo, Jackson, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kerr, Kinney, Kleberg, La Salle, Lavaca, Live Oak, Maverick, McMullen, Medina, Nueces, Real, Refugio, San Patricio, Starr, Uvalde, Val Verde, Victoria, Webb, Willacy, Wilson, Zapata, Zavala


Texas Oeste (PDF)

  • Incluye: Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio
Tuesday, 21 February 2012 06:32

Results by Region 2006

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Results by Region 2006

2006 Survey (CAHPS™ 3.0H) Results by Region

Central Texas (PDF)

  • Includes: Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson


East Texas (PDF)

  • Includes: Anderson, Angelina, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Hardin, Harrison, Henderson, Hopkins, Houston, Jasper, Jefferson, Lamar, Marion, Morris, Nacogdoches, Newton, Orange, Panola, Polk, Rains, Red River, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Smith, Titus, Trinity, Tyler, Upshur, Van Zandt, Wood


Gulf Coast Texas (PDF)

  • Includes: Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton


North Texas (PDF)

  • Includes: Collin, Cooke, Dallas, Denton, Erath, Ellis, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise


Panhandle/Plains Texas (PDF)

  • Includes: Andrews, Archer, Armstrong, Bailey, Baylor, Borden, Briscoe, Brown, Callahan, Carson, Castro, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Foard, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jack, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Montague, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terrell, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Wichita, Wilbarger, Winkler, Yoakum, Young


South Texas (PDF)

  • Includes: Aransas, Atascosa, Bandera, Bee, Bexar, Brooks, Calhoun, Cameron, Comal, De Witt, Dimmitt, Duval, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Hidalgo, Jackson, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kerr, Kinney, Kleberg, La Salle, Lavaca, Live Oak, Maverick, McMullen, Medina, Nueces, Real, Refugio, San Patricio, Starr, Uvalde, Val Verde, Victoria, Webb, Willacy, Wilson, Zapata, Zavala


West Texas (PDF)

  • Includes: Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio

Tuesday, 21 February 2012 06:23

Comparing Texas HMOs 2006

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Comparing Texas HMOs 2006

21 hmoreportimage2

To download the entire report:(PDF)

NOTE: To view the PDF files below, you will need to download Adobe Acrobat.

About the information in the HMO Report Card

(PDF)

  • About the report
  • What to consider when choosing an HMO
  • Why does health plan quality matter?
  • How this booklet can help you
  • What are your legal rights?
  • Types of health plans
2006 Survey (CAHPS™ 3.0H)

Results by: Region and Individual Company

Complaint Data – Patient and Provider Complaints

(PDF)

State-wide Information

(PDF)

  • HMO Market Share
  • Customer Service Phone Numbers
  • Sources of financial and other information
Tuesday, 31 January 2012 20:45

Comparing Texas HMOs 2010

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Comparing Texas HMOs 2010

OPIC recently determined that due to a database input error, CAHPS® survey data for the measure labeled “Shared Decision Making” in Comparing Texas HMOs was incorrectly displayed. Corrections have been made to the on-line versions of Comparing Texas HMOs for the period 2008-10 as of 11/18/2010. We advise disregarding the “Shared Decision Making” measure for any reports downloaded or received prior to this date. OPIC regrets the error.


HMO Report Image

NOTE: To view the PDF files below, you will need to download Adobe Acrobat.

 

To download the entire report (2.5 MB): Comparing Texas HMOs 2010
About the information in the HMO Report Card

(PDF)

  • About the report
  • What to consider when choosing an HMO
  • Why does health plan quality matter?
  • How this booklet can help you
  • What are your legal rights?
  • Types of health plans
2010 Survey (CAHPS® 4.0H)

Results by: Region or Company

Complaint Data – Patient and Provider Complaints

(PDF)

State-wide Information

(PDF)

  • HMO Market Share
  • Customer Service Phone Numbers
  • Sources of financial and other information
Tuesday, 31 January 2012 20:37

Results by Company 2002

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Results by Company 2002


2002 Survey (CAHPS™ 2.0H) Results by Individual Company
  • How people rated their health plan
  • How people rated their health care
  • How people rated their doctor or nurse
  • How people rated their specialist
  • Getting care that is needed
  • Getting care without long waits
  • Handling of claims quickly and correctly
  • Efficiency and helpfulness of customer service
  • How well doctors communicate
  • Courtesy, respect, and helpfulness of office staff
  • Response rate for all plans in the survey

STATE AVERAGES (Word 2000) or (PDF)
Aetna US Healthcare, Inc. (Houston) (Word 2000) or (PDF)
Aetna US Healthcare, Inc. (San Antonio) (Word 2000) or (PDF)
Aetna US Healthcare of North Texas, Inc.(Dallas/Ft Worth) (Word 2000) or (PDF)
AmCare Health Plans of Texas, Inc. (Austin/Dallas/El Paso/Houston/San Antonio) (Word 2000) or (PDF)
Amil International, Inc. (Austin) (Word 2000) or (PDF)
CIGNA HealthCare of Texas, Inc. (Dallas) (Word 2000) or (PDF)
CIGNA HealthCare of Texas, Inc. (Houston) (Word 2000) or (PDF)
Community First Health Plans, Inc. (San Antonio) (Word 2000) or (PDF)
FIRSTCARE (Abilene) (Word 2000) or (PDF)
FIRSTCARE (Amarillo) (Word 2000) or (PDF)
FIRSTCARE (Lubbock) (Word 2000) or (PDF)
FIRSTCARE (Waco) (Word 2000) or (PDF)
Heritage Health Plans (Tyler) (Word 2000) or (PDF)
HMO Blue Texas (Abilene/Midland/San Angelo) (Word 2000) or (PDF)
HMO Blue Texas (Austin) (Word 2000) or (PDF)
HMO Blue Texas (Beaumont/Lufkin) (Word 2000) or (PDF)
HMO Blue Texas (Corpus Christi/Rio Grande/San Antonio) (Word 2000) or (PDF)
HMO Blue Texas (Dallas/Ft Worth) (Word 2000) or (PDF)
HMO Blue Texas (El Paso) (Word 2000) or (PDF)
HMO Blue Texas (Houston) (Word 2000) or (PDF)
HMO Blue Texas (Lubbock) (Word 2000) or (PDF)
HMO Blue Texas (Tyler) (Word 2000) or (PDF)
Humana Health Plan of Texas (Austin) (Word 2000) or (PDF)
Humana Health Plan of Texas (Corpus Christi) (Word 2000) or (PDF)
Humana Health Plan of Texas (Houston) (Word 2000) or (PDF)
Humana Health Plan of Texas (San Antonio) (Word 2000) or (PDF)
Mercy Health Plans (Laredo) (Word 2000) or (PDF)
MethodistCare (Southeast Texas) (Word 2000) or (PDF)
One Health Plan of Texas, Inc. (Austin) (Word 2000) or (PDF)
One Health Plan of Texas, Inc. (Dallas) (Word 2000) or (PDF)
One Health Plan of Texas, Inc. (Houston) (Word 2000) or (PDF)
PacifiCare of Texas (Austin) (Word 2000) or (PDF)
PacifiCare of Texas (Dallas) (Word 2000) or (PDF)
PacifiCare of Texas (Houston) (Word 2000) or (PDF)
PacifiCare of Texas (San Antonio) (Word 2000) or (PDF)
Parkland Community Health Plan (Northeast Texas) (Word 2000) or (PDF)
Scott and White Health Plan (Central Texas) (Word 2000) or (PDF)
Seton Health Plan (Austin) (Word 2000) or (PDF)
UnitedHealthcare of Texas, Inc. (Austin/San Antonio) (Word 2000) or (PDF)
UnitedHealthcare of Texas, Inc. (Corpus Christi/Houston) (Word 2000) or (PDF)
UnitedHealthcare of Texas, Inc. (Dallas) (Word 2000) or (PDF)
Valley Health Plans (Harlingen) (Word 2000) or (PDF)