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by Maureen Thompson
Before making a purchase-whether it's a dishwasher, computer, or car-we comparison shop. We gather a great deal of information and create a report card of sorts so that our decision will be an informed one.
But how many of us comparison shop for our own health insurance based on the plan's coverage of audiology and speech-language pathology services? Do you know how your health plan rates on coverage of the services you provide when compared with others? If not, ASHA has done the comparison shopping for you and developed tools to assist you in rating your own health plan as well as those of your patients, family, and friends.
Why Develop a Health Plan Report Card?
Generally speaking, health plan report cards are an outgrowth of market pressure for greater accountability in managed care. They allow for fair comparisons of what health plans deliver. Health plans are often rated and compared to other plans with respect to quality of care, access to care, and patient satisfaction. Armed with this information, consumers can make more informed purchasing decisions. This, in turn, is intended to drive health plans to improve their performance and provide better services.
The only information most consumers receive from their health plan concerns plan costs and benefit information-language so vague that consumers are never quite sure what services will or won't be covered. In an environment where consumers are paying a greater share of health care costs, they have a right to know exactly what services they will receive for their dollars.
Despite the plethora of health plan report cards-rating such coverage areas as mental health, obesity, and diabetes care-none rated audiology and speech-language pathology benefits.
What Does the Report Card Tell Me?
ASHA's 2003 Audiology and Speech-Language Pathology Report Card presents a comprehensive picture of a variety of health plans by providing information on four major benefit categories:
- coverage of audiology services
- coverage of speech-language pathology services
- limitations to coverage
- provider accessibility
Each category is then further subdivided to provide additional informat ion. For example, the coverage category includes the percentage of coverage, out-of- pocket expenses, and the amount of the annual plan deductible. ASHA's model benefits for speech-language pathology and audiology were used as a benchmark against which each health plan was rated.
The health plans represented in the report card are those of small, medium, and large organizations, as well as unions, military, Medicare, and national fee-for service plans available through the Federal Employee Health Benefit Program. The health plans in the report card represent plans that were judged good, fair, and poor. Health plans were downgraded for withholding information or not reporting coverage information to discourage case-by-case decision-making.
Detailed coverage information for each plan can be found on ASHA's Web site. Note that the coverage data represent a snapshot of a particular contract, not the only coverage offered by the health plan. A glossary is included to help you navigate the maze of health care terminology.
How Do I Evaluate the Information?
How you evaluate a health plan's coverage of audiology and speech-language pathology services will vary depending on your needs or the needs of a particular patient. Comprehensive coverage means different things to different people. Let's look at an imaginary health plan:
- Provides speech and language treatment due to accident, illness, or injury up to 50 visits per year; no coverage for developmental delays.
- Offers a $2,000 hearing aid allowance per ear every two years for children up to the age of 18; no hearing aid coverage for adults.
The plan would rate poorly if the patient is a child with an articulation delay or an adult needing hearing aids, yet would rate well if the patient is a child with a bilateral hearing loss or an adult who needed speech-language services after an auto accident.
Report cards will continue to improve their usefulness and availability to consumers. Consumers do use report cards to increase awareness of their own health plan, not just in making a decision to switch plans. Ultimately, the real benefit of report cards is that health care will improve as plans compete for quality.
Maureen Thompson is ASHA's director of private health plans advocacy. Contact her at mthompson@asha.org.
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