Health Insurers Slammed in Harris County Doc Survey

A new survey released by the nation's largest county medical society says six of the biggest health insurance companies in Texas are failing patients and doctors. As Houston Public Radio's Jack Williams reports, almost 500 doctors who are members of the Harris County Medical Society weighed-in, and the results weren't pretty.

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The internet survey polled doctors on a wide-range of subjects, things like preauthorization of services, getting referrals, finding in-network specialists and payment denials. Harris County Medical Society President Dr. Michael Kelly says insurance companies got slammed.

"The results were dismal at best."

The six insurance companies in the survey included Blue Cross and Blue Shield of Texas, Aetna and Cigna. About ten-percent of the Medical Society's member doctors responded, but many gave failing grades on things like customer service and the amount of paperwork involved in filing claims.

"Having results such as these for companies that are supposed to be industry leaders is just shameful. In any other field with this kind of customer service, the companies would be soon out of business. It's time for the health insurance companies to raise their standards for our patients, and for you and me." 

Medical Society officials say they commissioned the survey, done by the University of Houston-Clear Lake, because there really is no official grading system for Texas insurance companies. Dr. Kimberly Monday is the chair of the Medical Society's Managed Care Committee.

"More than 65-percent of the doctors surveyed report that they have experienced difficulties getting their patient's medical services approved. So what does this mean? In my practice, I'm a neurologist. Someone comes in with a transient neurological difficult. I know they need to have an MRI. There's no question about that, but I can't do that. I have to go to a second party, provide notes, sometimes a phone call to advocate for the physician so that I can get that paid for. And what does that mean? That may mean a week before it's done and many cases, one in our practice, it resulted in a neurological event."   

Monday says she was surprised by how bad the results were.

"Being a practicing physician I know that it's very difficult, but on many of these questions, 70 and 80-percent of physicians were having difficulty and that really handcuffs you when you're trying to take care of patients, which is what we're doing. I was a bit surprised by how bad it was, not terribly surprised, but a bit that it was to that degree."

Margaret Jarvis is with Blue Cross and Blue Shield of Texas and says the company cares a great deal about customer service and providing efficient services to physicians.  

"We're very aware of physician dissatisfaction on the issues raised in the survey and Blue Cross is investing significant time and resources in providing efficient services to all our members across the state and of course to physicians."   

In a written statement, Aetna says it takes physician satisfaction seriously, but questioned the survey's methodology and the validity of its findings. A call to Cigna was not returned. You can see results of the survey through a link on our website, KUHF. org.

 

Bio photo of Jack Williams

Jack Williams

Director of News Programming

News Director Jack Williams has been with Houston Public Radio since August of 2000. He's also a reporter and anchor for Houston Public Radio's local All Things Considered segments...