Tiered Ratings for Physicians and Hospitals – What do they mean?
November 28, 2011 in Member Stories
My family has just gone through the annual open enrollment process for health care. Although I am a pediatrician, we get our health insurance through my husband’s company. This year they were offering premiums at approximately half price if we signed up for the plans which base co-pays and deductibles on whichever tier the physician or hospital is rated. Intriguing.
Approaching my decision from a health care consumer standpoint, I started my research with three basic questions in mind: What tier(s) are the primary care physicians, specialists and hospitals that my family has used? What would happen if different physicians within the same office were rated differently? Would this “half” priced premium save me money over the year? After over 8 hours of internet research and conversations with the Human Resources Department at my husband’s company, I was left with more questions than answers.
The information was difficult to find, incomplete and seemingly meaningless. We were offered the choice of four different insurance companies. In order to find out about tiering levels, I had to visit each of the four company’s web sites-there was not a central location to plug in a specific name and get the tiering level for each physician/hospital. So now I have many more questions: If my primary care physician is rated Tier 1 for one company, Tier 2 for another, Tier 3 for a third (and the fourth company did not seem to post their ratings) what could these tiers possibly mean? The ratings for hospitals was similarly varied. On what are the ratings based? I could only assume that each company was using different measures to rate the physicians – so how am I to know which doctors are most cost efficient? Does cost efficiency have anything to do with how well a doctor will diagnose and treat my family?
As a pediatrician, I am worried about how others will interpret this information when choosing their insurance. Despite my time consuming research I could not decipher this information in any meaningful way. Armed with the additional knowledge that as a pediatrician I had never been given a list from any insurance company telling me what I was being measured on, I had to conclude that that it is too premature and risky to choose one of these new options. I would be thrilled to know if you have any answers to my questions or if anyone else has any other insights.