Consumer group finds HMOs deny benefit info
The number of health maintenance organizations (HMOs) in California that provide consumers with easy access to benefit coverage information is up but still has room for improvement, says a recent survey by the advocacy group Citizens for the Right to Know in Sacramento.
The follow-up survey is a replication of one conducted last year that found millions of health care consumers were unable to access any information about the drugs covered by their own or prospective HMOs. The advocacy group contacted customer service representatives at 48 HMOs, which provide services to almost all of California's 14 million managed care enrollees, and requested copies of their formulary lists. Some of the more important results include:
o 26% of the HMOs had no one available to answer simple yes or no availability questions, down from 35% in last year's survey.
o 17% of HMO representatives said the drug lists were proprietary and could only be given to doctors, employers, or members, down from 23% last year.
o 4% of HMO representatives didn't know what a formulary list was, down from 10% last year.
o 9% of HMOs said their plan covers anything a doctor prescribes, leaving no need for a formulary, up from fewer than 8% last year.
o 4% of HMOs said they contract out their formularies and had no access to their own coverage information. That represents no change from last year.