Choosing and Using a Health
Plan
Contents
Changes and
Choices
Overview
Choosing a Plan
1. What Are My Health Plan
Choices?
2. Where Do I Get These Health Plans?
3. What
Plan Benefits Are Offered?
4. What Is Most Important to
Me in a Plan?
5. How Do I Compare Health Plans?
6. How
Do I Find Out About Quality?
Using Care
7. How Can I Get the Most from My
Plan?
8. How Do I Obtain Care?
9. What if I Have to Go
to the Hospital?
10. What if I Am Not Satisfied with My
Care?
Primary Care Doctors
Pre-Existing
Conditions
Tips on Choosing a Doctor
Sources of Additional Information
General
Information
Accreditation and Quality
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Changes and Choices
Health care in
America is changing rapidly. Twenty-five years ago, most
people in the United States had indemnity insurance
coverage. A person with indemnity insurance could go to any
doctor, hospital, or other provider (which would bill for
each service given), and the insurance and the patient would
each pay part of the bill.
But today, more than half
of all Americans who have health insurance are enrolled in
some kind of managed care plan, an organized way of both
providing services and paying for them. Different types of
managed care plans work differently and include preferred
provider organizations (PPOs), health maintenance
organizations (HMOs), and point-of-service (POS) plans.
You've probably heard these terms before. But what do
they mean, and what are the differences between them? And
what do these differences mean to you?
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Overview
This booklet can help you make
sense of your choices for getting health care
insurance:
*See the questions and answers on
important things you should know when "Choosing a
Plan."
*To get the most out of the plan you choose, see
the tips in the section "Using Care."
*For more help, see
"Sources of Additional Information."
Even if you don't get to choose the health plan yourself
(for example, your employer may select the plan for your
company), you still need to understand what kind of
protection your health plan provides and what you will need
to do to get the health care that you and your family
need.
The more you learn, the more easily you'll be able to
decide what fits your personal needs and budget.
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Choosing a Plan
1. What Are My Health
Plan Choices?
Choosing between health plans is
not as easy as it once was. Although there is no one "best"
plan, there are some plans that will be better than others
for you and your family's health needs. Plans differ, both
in how much you have to pay and how easy it is to get the
services you need. Although no plan will pay for all the
costs associated with your medical care, some plans will
cover more than others.
Almost all plans today have
ways to reduce unnecessary use of health care—and keep down
the costs of health care, too. This may affect how easily
you get the care you want, but should not affect how easily
you get the care you need.
Plans change from year to year, so you should carefully
consider each plan, using the questions outlined in this
booklet. If you get health insurance where you work, you
should start with your employee benefits office. Its staff
should be able to tell you what is covered under the plans
available. You can also call plans directly to ask
questions.
Health insurance plans are usually described as either
indemnity (fee-for-service) or managed care. These types of
plans differ in important ways that are described below.
With any health plan, however, there is a basic premium,
which is how much you or your employer pay, usually monthly,
to buy health insurance coverage. In addition, there are
often other payments you must make, which will vary by plan.
In considering any plan, you should try to figure out its
total cost to you and your family, especially if someone in
the family has a chronic or serious health condition.
Indemnity and managed care plans differ in their basic
approach. Put broadly, the major differences concern choice
of providers, out-of-pocket costs for covered services, and
how bills are paid. Usually, indemnity plans offer more
choice of doctors (including specialists, such as
cardiologists and surgeons), hospitals, and other health
care providers than managed care plans. Indemnity plans pay
their share of the costs of a service only after they
receive a bill.
Managed care plans have agreements with certain doctors,
hospitals, and health care providers to give a range of
services to plan members at reduced cost. In general, you
will have less paperwork and lower out-of-pocket costs if
you select a managed care type plan and a broader choice of
health care providers if you select an indemnity-type plan.
Over time, the distinctions between these kinds of plans
have begun to blur as health plans compete for your
business. Some indemnity plans offer managed care-type
options, and some managed care plans offer members the
opportunity to use providers who are "outside" the plan.
This makes it even more important for you to understand how
your health plan works.
Besides indemnity plans, there are basically three types
of managed care plans: PPOs, HMOs, and POS plans.
Indemnity Plan
With an indemnity plan
(sometimes called fee-for-service), you can use any medical
provider (such as a doctor and hospital). You or they send
the bill to the insurance company, which pays part of it.
Usually, you have a deductible—such as $200—to pay each year
before the insurer starts paying.
Once you meet the
deductible, most indemnity plans pay a percentage of what
they consider the "Usual and Customary" charge for covered
services. The insurer generally pays 80 percent of the Usual
and Customary costs and you pay the other 20 percent, which
is known as coinsurance. If the provider charges more than
the Usual and Customary rates, you will have to pay both the
coinsurance and the difference.
The plan will pay for charges for medical tests and
prescriptions as well as from doctors and hospitals. It may
not pay for some preventive care, like checkups.
Managed Care
Preferred Provider
Organization (PPO). A PPO is a form of managed care
closest to an indemnity plan. A PPO has arrangements with
doctors, hospitals, and other providers of care who have
agreed to accept lower fees from the insurer for their
services. As a result, your cost sharing should be lower
than if you go outside the network. In addition to the PPO
doctors making referrals, plan members can refer themselves
to other doctors, including ones outside the plan.
If
you go to a doctor within the PPO network, you will pay a
copayment (a set amount you pay for certain services—say $10
for a doctor or $5 for a prescription). Your coinsurance
will be based on lower charges for PPO members.
If you choose to go outside the network, you will have to
meet the deductible and pay coinsurance based on higher
charges. In addition, you may have to pay the difference
between what the provider charges and what the plan will
pay.
Health Maintenance Organization (HMO). HMOs are
the oldest form of managed care plan. HMOs offer members a
range of health benefits, including preventive care, for a
set monthly fee. There are many kinds of HMOs. If doctors
are employees of the health plan and you visit them at
central medical offices or clinics, it is a staff or group
model HMO. Other HMOs contract with physician groups or
individual doctors who have private offices. These are
called individual practice associations (IPAs) or
networks.
HMOs will give you a list of doctors from which to choose
a primary care doctor. This doctor coordinates your care,
which means that generally you must contact him or her to be
referred to a specialist.
With some HMOs, you will pay nothing when you visit
doctors. With other HMOs there may be a copayment, like $5
or $10, for various services.
If you belong to an HMO, the plan only covers the cost of
charges for doctors in that HMO. If you go outside the HMO,
you will pay the bill. This is not the case with
point-of-service plans.
Point-of-Service (POS) Plan. Many HMOs offer an
indemnity-type option known as a POS plan. The primary care
doctors in a POS plan usually make referrals to other
providers in the plan. But in a POS plan, members can refer
themselves outside the plan and still get some coverage.
If the doctor makes a referral out of the network, the
plan pays all or most of the bill. If you refer yourself to
a provider outside the network and the service is covered by
the plan, you will have to pay coinsurance.
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Primary Care Doctors
Your primary care
doctor will serve as your regular doctor, managing your care
and working with you to make most of the medical decisions
about your care as a patient. In many plans, care by
specialists is only paid for if your are referred by your
primary care doctor.
An HMO or a POS plan will
provide you with a list of doctors from which you will
choose your primary care doctor (usually a family physician,
internists, obstetrician-gynecologist, or pedicatrician).
This could mean you might have to choose a new primary care
doctor if your current one does not belong to the plan.
PPOs allow members to use primary care doctors outside
the PPO network (at a higher cost). Indemnity plans allow
any doctor to be used.
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2. Where Do I Get These Health
Plans?
Group Policies
You may be
able to get group health coverage—either indemnity or
managed care—through your job or the job of a family member.
Many employers allow you to join or change health
plans once a year during open enrollment. But once you
choose a plan, you must keep it for a year. Discuss choices
and limits with your employee benefits office.
Individual Policies
If you are
self-employed or if your company does not offer group
policies, you may need to buy individual health insurance.
Individual policies cost more than group policies.
Some organizations—such as unions, professional
associations, or social or civic groups—offer health plans
for members. You may want to talk to an insurance broker,
who can tell you more about the indemnity and managed care
plans that are available for individuals. Some States also
provide insurance for very small groups or the
self-employed.
Medicare
Americans age 65 or older and
people with certain disabilities can be covered under
Medicare, a Federal health insurance program.
In many
parts of the country, people covered under Medicare now have
a choice between managed care and indemnity plans. They also
can switch their plans for any reason. However, they must
officially tell the plan or the local Social Security
Office, and the change may not take effect for up to 30
days. Call your local Social Security office or the State
office on aging to find out what is available in your
area.
Medicaid
Medicaid covers some low-income
people (especially children and pregnant women), and
disabled people. Medicaid is a joint Federal-State health
insurance program that is run by the States.
In some
cases, States require people covered under Medicaid to join
managed care plans. Insurance plans and State regulations
differ, so check with your State Medicaid office to learn
more.
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Pre-Existing Conditions
A pre-existing
condition is a medical condition diagnosed or treated before
joining a new plan. In the past, health care given for a
pre-existing condition often has not been covered for
someone who joins a new plan until after a waiting period.
However, a new law—called the Health Insurance Portability
and Accountability Act—changes the rules.
Under the
law, most of which goes into effect on July 1, 1997, a
pre-existing condition will be covered without a waiting
period when you join a new group plan if you have been
insured the previous 12 months. This means that if you
remain insured for 12 months or more, you will be able to go
from one job to another, and your pre-existing condition
will be covered—without additional waiting periods—even if
you have a chronic illness.
If you have a pre-existing condition and have not been
insured the previous 12 months before joining a new plan,
the longest you will have to wait before you are covered for
that condition is 12 months.
To find out how this new law affects you, check with
either your employer benefits office or your health
plan.
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3. What Plan Benefits Are Offered?
Most
plans provide basic medical coverage, but the details are
what counts. The best plan for someone else may not be the
best plan for you. For each plan you are considering, find
out how it handles:
*Physical exams and health screenings.
*Care by
specialists.
*Hospitalization and emergency
care.
*Prescription drugs.
*Vision care.
*Dental
services.
Also ask about:
*Care and counseling for mental
health.
*Services for drug and alcohol
abuse.
*Obstetrical-gynecological care and family
planning services.
*Ongoing care for chronic (long-term)
diseases, conditions, or disabilities.
*Physical therapy
and other rehabilitative care.
*Home health, nursing
home, and hospice care.
*Chiropractic or alternative
health care, such as acupuncture.
*Experimental
treatments.
Some plans offer members health education and preventive
care, but services differ. Ask questions such as:
*What preventive care is offered, such as shots for
children?
*What health screenings are given, such as
breast exams and Pap smears for women?
Does the plan help
people who want to quit smoking?
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4. What Is Most Important to Me in a
Plan?
In choosing a plan, you have to decide what
is most important to you. All plans have tradeoffs. Ask
yourself these questions:
*How comprehensive do I want coverage of health care
services to be?
*How do I feel about limits on my choice
of doctors or hospitals?
*How do I feel about a primary
care doctor referring me to specialists for additional
care?
*How convenient does my care need to be?
*How
important is the cost of services?
*How much am I willing
to spend on premiums and other health care costs?
*How do
I feel about keeping receipts and filing claims?
You might also want to think about whether the services a
plan offers meet your needs. Call the plan for details about
coverage if you have questions. Consider:
*Life changes you may be thinking about, such as starting
a family or retiring.
*Chronic health conditions or
disabilities that you or family members have.
*If you or
anyone in your family will need care for the
elderly.
*Care for family members who travel a lot,
attend college, or spend time at two homes.
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5. How Do I Compare Health Plans?
After you
review what benefits are available and decide what is
important to you, you can compare plans. Many things should
be considered. These include services offered, choice of
providers, location, and costs. The quality of care is also
a factor to think about (see section 6.).
Services
Look at the services offered by
each plan. What services are limited or not covered? Is
there a good match between what is provided and what you
think you will need? For example, if you have a chronic
disease, is there a special program for that illness? Will
the plan provide the medicines and equipment you may
need?
Find out what types of care or services the
plan won't pay for. These usually are called
exclusions.
Few indemnity and managed care plans
cover treatments that are experimental. Ask how the plan
decides what is or is not experimental. Find out what you
can do if you disagree with a plan's decision on medical
care or coverage.
Choice
What doctors, hospitals, and other
medical providers are part of the plan? Are there enough of
the kinds of doctors you want to see? Do you need to choose
a primary care doctor? If you want to see a specialist, can
you refer yourself or must your primary care doctor refer
you? Do you need approval from the plan before going into
the hospital or getting specialty care?
Location
Where will you go for care? Are
these places near where you work or live? How does the plan
handle care when you are away from home?
Costs
No health insurance plan will cover
every expense. To get a true idea of what your costs will be
under each plan, you need to look at how much you will pay
for your premium and other costs.
*Are there deductibles you must pay before the insurance
begins to help cover your costs?
*After you have met your
deductible, what part of your costs are paid by the
plan?
*Does this amount vary by the type of service,
doctor, or health facility used?
*Are there copayments
you must pay for certain services, such as doctor
visits?
*If you use doctors outside a plan's network, how
much more will you pay to get care?
*If a plan does not
cover certain services or care that you think you will need,
how much will you have to pay?
*Are there any limits to
how much you must pay in case of major illness?
*Is there
a limit on how much the plan will pay for your care in a
year or over a lifetime? A single hospital stay for a
serious condition could cost hundreds of thousands of
dollars.
You can't know in advance what your health care needs for
the coming year will be. But you can guess what services you
and your family might need. Figure out what the total costs
to your family would be for these services under each
plan.
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6. How Do I Find Out About Quality?
Quality
is hard to measure, but more and more information is
becoming available. There are certain things you can look
for and questions you can ask. Whatever kind of plan you are
considering, you can check out individual doctors and
hospitals. For doctors, see "Tips on Choosing a Doctor."
Many managed care plans are regulated by Federal and
State agencies. Indemnity plans are regulated by State
insurance commissions. Your State Department of Health or
insurance commission can tell you about any plan you are
interested in.
You can also find out if the managed care plan you are
interested in has been "accredited," meaning that it meets
certain standards of independent organizations. Some States
require accreditation if plans serve special groups, such as
people in Medicaid. Some employers will only contract with
plans that are accredited.
Several national organizations review and accredit plans
and institutions (see "Sources of Additional Information").
You can contact these organizations to see if a plan you are
considering, or an institution in the plan, is
accredited.
Another approach is to ask the plan how it ensures good
medical care. Does the plan review the qualifications of
doctors before they are added to the plan? Plans are
supposed to review the care that is given by their doctors
and hospitals. How does the plan review its own services,
and has it made changes to correct problems? How does the
plan resolve member complaints?
Some managed care plans survey members about their health
care experiences. Ask the plan for a report of the survey
results.
Some plans and independent organizations are also
beginning to produce "report cards." These reports often
include satisfaction survey results and other information on
quality, such as if a plan provides preventive care (for
example, shots for children and Pap smears for women) or if
the plan follows up on test results. Report cards may also
include information on how many members stay in or leave the
plan, how many of the plan's doctors are board certified, or
how long you may have to wait for an appointment.
Report cards can only give you an idea of how a plan
works and may not give a full picture of a plan's quality.
Ask plans if their activities have been reported in report
cards developed by outside groups (business or consumer
organizations).
Also keep any eye out for magazine articles that rate
health plans.
Finally, you can talk to current members of the plan. Ask
how they feel about their experiences, such as waiting times
for appointments, the helpfulness of medical staff, the
services offered, and the care received. If there are
programs for your particular condition, how are the patients
in it doing?
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Tips on Choosing a Doctor
Your doctor
will be your partner in care, so it is important to choose
carefully from the doctors available to you. In some managed
care plans, you will generally be limited to choosing from
only certain doctors; in other plans, some doctors may be
"preferred," which means they are part of a network and you
will pay less if you use them. Ask your plan for a list or
directory of providers. The plan may also offer other help
in choosing.
You can ask doctors you know, medical
societies, friends, family, and coworkers to recommend
doctors. You may also contact hospitals and referral
services about doctors in your area.
Once you have the names of doctors who interest you, make
sure they are accepting new patients. Here's how to check
doctors out:
*Ask plans and medical offices for information on their
doctors' training and
experience.
*Look up basic
information about doctors in the Directory of Medical
Specialists,
available at your local library. This
reference has up-to-date professional and biographic
information on about 400,000 practicing physicians.
*Use
"AMA Physician Select," which is the American Medical
Association's free service on the Internet for information
about physicians
(http://www.ama-assn.org/aps/amahg.htm).
You may also want to find out:
*Is the doctor
board certified? Although all doctors must be licensed to
practice medicine, some also are board certified. This means
the doctor has completed several years of training in a
specialty and passed an exam. Call the American Board of
Medical Specialties at 800-776-2378 for more
information.
*Have complaints been registered or
disciplinary actions taken against the doctor? To find out,
call your State Medical Licensing Board. Ask Directory
Assistance for the phone number.
*Have complaints been
registered with your State department of insurance? (Not all
departments of insurance accept complaints.) Ask Directory
Assistance for the phone number.
Once you have narrowed your search to a few doctors, you
may want to set up "get acquainted" appointments with them.
Ask what charge there might be for these visits, if any.
Such appointments give you a chance to interview the
doctors—for example, to find out if they have much
experience with any health conditions you may have.
Using Care
7. How
Can I Get the Most from My Plan?
You will get the
best care if you:
Stay Informed
*Read
your health insurance policy and member handbook. Make sure
you understand them, especially the information on benefits,
coverage, and limits. Sales materials or plan summaries
cannot give you the full picture.
*See if your plan has
a magazine or newsletter. It can be a good source of
information on how the plan works and on important policies
that affect your care.
*Talk to your health benefits
officer at work to learn more about your policy.
*Ask how
the plan will notify you of changes in the network of
providers or covered services while you are part of the
plan.
Take Charge
*Ask your doctor
about regular screenings to check your health. Discuss your
risk of getting certain conditions. What lifestyle choices
and changes might you need to make to lower your risks or
prevent illness?
*Ask questions and insist on clear
answers.
*Ask about the risks and benefits of tests and
treatments. Tell your doctor what you like and dislike about
your choices for care.
*Make sure you understand and can
follow the doctor's instructions. You may want to bring
another person along or take notes to help you remember
things.
Keep Track
*Write down your concerns. Start
a health log of symptoms to help you better explain any
health problems when you meet with your doctor.
*Set up
health files for family members at home. This will help you
to monitor care. Include health histories of shots,
illnesses, treatments, and hospital visits. Ask for copies
of lab results. Keep a list of your medicines, noting side
effects and other problems (such as other drugs and foods
that should not be taken at the same time).
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8. How Do I Obtain Care?
Learning what you can expect from your health plan and
how it works are key steps to getting the care you need. Ask
these questions:
*When are the offices open? What if I need care after
hours?
*How do I make appointments? How quickly can I
expect to be seen for illness or for routine care?
*If I
need lab tests, are they done in the doctor's office or will
I be sent to a laboratory?
*Will most of my appointments
be with the primary care doctor? Will nurse practitioners or
physician's assistants sometimes give care as well?
*Is
there an advice hotline? Some plans have toll-free phone
services that help members decide how to handle a problem
that may not require a doctor's visit.
Find out how your plan provides care outside the service
area and what you must do to get care. This is especially
important if you travel often, are away from home for long
periods, or have family members away at
school.
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9. What if I Have to Go to the Hospital?
The time to find out what rules your plan has on hospital
care is before you need it.
Planned Hospitalizations
Unless it is a
medical emergency, your health plan or primary care doctor
will probably have to give advance approval (preadmission
certification) for you to go to the hospital. Otherwise, the
cost of your hospital care may not be covered. Ask these
questions:
*What hospitals are part of the plan network?
*Is
there a limit on how long I can stay in the
hospital?
*Who decides when I am to be
discharged?
*Will needed followup care, such as nursing
home or home health care, be covered by the plan?
*If I
have a serious medical problem, will the plan provide
someone to oversee care and make sure my needs are met?
Ask how your plan handles getting a second doctor's
opinion on whether surgery or another treatment is needed.
Are second opinions encouraged or required? Who pays?
Emergency or Urgent Care
If you have a true
medical emergency, you should go to the nearest hospital as
fast as possible. It is important for you to know what kind
of medical problems are defined as emergencies and how to
arrange for ambulance service, if needed. Most plans must be
told within a certain time after emergency admission to a
hospital. If the hospital is not part of the plan network,
you may be transferred to a network hospital when your
condition is stable. Ask these questions:
*How does the plan define "emergency care?" What
conditions or injuries are considered emergencies?
*How
does the plan handle "urgent care" after normal business
hours? Urgent care is for problems that are not true
emergencies but still need quick medical attention. Check
with your plan to find out what it considers to be urgent
care. Examples may include sore throats with fever, ear
infections, and serious sprains. Call your primary care
doctor or the plan's hotline for advice about what to do.
The plan may also have urgent care centers for
members.
*How do I get urgent care or hospital care if I
am out of the area? How must I tell the plan and how soon
after I get the care?
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10. What if I Am Not Satisified with My Care?
Getting the best care and services means understanding
how your health plan works, what your rights are, and how to
complain if you need to.You have the right to get copies of
test results as well as medical information about yourself.
If you are in a managed care plan, you can ask to change
your primary care doctor if you are unhappy with the
relationship. You may also be able to switch plans during
open enrollment.
Most plans have an appeals process that both you and
your doctor may use if you disagree with the plan's
decisions. If your plan refuses to provide or pay for
services, you can complain or file a grievance about any
decision you feel is unfair—or you can appeal it.
You can contact the member services division of your plan
for more information or to complain. Use your plan's
complaint process fully before taking other action.
Be sure to keep written records of:
*All correspondence with the plan.
*Claims forms and
copies of bills.
* Phone conversations—the date and time,
the people you speak with, and the nature of each call.
If the plan does not satisfy you, you may decide to bring
the matter to the attention of your employee benefits
manager, your State insurance commissioner, your State
department of health, or the legal system. If you are a
Medicare or Medicaid beneficiary, you have additional ways
through those programs to file a grievance about the care
received from a plan or provider. For information, contact
your State's medical Peer Review Organization or State
Medicaid Program.
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Sources of Additional
Information
Many organizations have
information that can help you understand your health care
choices. Some helpful materials and contacts are listed.
General Information
"Checkup on Health
Insurance Choices"
"Questions To Ask Your Doctor Before
You Have Surgery"
AHCPR Publications
Clearinghouse
P.O. Box 8547
Silver Spring, MD
20907
800-358-9295
E-mail:
ahrqpubs@ahrq.gov
"The Consumers Guide to Health
Insurance"
Health Insurance Association of America
555
13th St. N.W., 600 East
Washington, DC
20004-1109
(202) 824-1600
"Guide to Health Insurance for People with
Medicare"
"Your Medicare Handbook"
"Managed Care
Plans"
Health Care Financing Administration
7500
Security Blvd.
Baltimore, MD
21244-1850
800-638-6833
"Putting Patients First"
National Health
Council
1730 M St., NW, Suite 500
Washington, DC
20036-4505
(202) 785-3910
"Managed Care: An AARP Guide"
American Association of
Retired Persons
611 E St., N.W.
Washington, DC
20049
(202) 434-2277
"Choosing Quality: Finding the Health Plan That's Right
for You"
National Committee for Quality Assurance
2000
L St., N.W., Suite 500
Washington, DC
20036
800-839-6487
"Consumers' Guide to Health Plans"
Consumers'
Checkbook
Center for the Study of Services
733 15th
St., N.W., Suite 820
Washington, DC 20005
(202)
347-7283
Accreditation and Quality
Accreditation
Association for Ambulatory Health Care; 9933 Lawler Ave.;
Skokie, IL 60077-3708; (847) 676-9610
Accredits outpatient health care settings such as
ambulatory surgery centers, radiation oncology centers, and
student health centers. Call for a list of accredited
organizations.
Community Health Accreditation Program; 350 Hudson St.;
New York, NY 10014; 800-669-1656, ext. 242
Accredits community, home health, and hospice programs;
public health departments; and nursing centers. Call for a
list of accredited organizations.
Consumer Coalition for Quality Health Care; 1275 K
Street, N.W.; Suite 602; Washington, DC 20005; (202)
789-3606
A national, nonprofit organization of consumer groups
advocating for consumer protections and quality assurance
programs and policies. Call with general questions about
quality issues or for consumer materials on managed care and
activities at the State level.
Joint Commission on Accreditation of Healthcare
Organizations; One Renaissance Blvd.; Oakbrook Terrace, IL
60181; (630) 792-5000
Evaluates and accredits nearly 20,000 health care
organizations and programs including almost 12,000 hospitals
and home care organizations, and more than 7,000 other
health care organizations that provide long term care,
behavioral health care, laboratory and ambulatory care
services. The Joint Commission also accredits health plans,
integrated delivery networks, and other managed care
entities. Visit Quality Check on the Joint Commission’s Web
site (http://www.jcaho.org) for information on individual
accredited organizations or for general information about
assessing the quality of health care organizations.
National Committee for Quality Assurance; 2000 L St.
N.W., Suite 500; Washington, DC 20036; 800-839-6487; Web
Site: http://www.ncqa.org
Accredits HMOs and other managed care organizations. Call
for the NCQA Accreditation Status List, Accreditation
Summary Report, publications list, or for general
information about quality.
Utilization Review Accreditation Commission; 1130
Connecticut Ave. N.W., Suite 450; Washington, DC 20036;
(202) 296-0120
Accredits PPOs and other managed care networks. Call for
a list of accredited organizations.
top
This consumer's guide was developed by the Agency for
Health Care Policy and Research, U.S. Department of Health
and Human Services, Rockville, MD, in cooperation with the
Health Insurance Association of America, Washington,
DC.
AHCPR Publication No. 97-0011
Current as of March
1997
Choosing and Using a Health Plan. AHCPR Publication No.
97-0011, March 1997. Agency for Health Care Policy and
Research, Rockville, MD, and the Health Insurance
Association of America, Washington, DC.
http://www.ahrq.gov/consumer/hlthpln1.htm