Who Rates HMO Plans?

Sorting through the extensive information on HMO coverage and exclusions is exhausting, yet it may still fall short of telling you which plans actually deliver on their promises. Many people wonder if there is a reliable source that rates HMOs.

The Internet has made it much easier to access

HMO and hospital report cards. Although they can be a little difficult to sift through, the most useful consumer-oriented sites are those offered by the federal and state governments. Each state has a department of insurance and a Web site. For a full list of all 50 states' Web sites, go to the Council of Insurance Agents and Brokers. This site lists both the federal and state agencies that regulate insurance.

The National Committee for Quality Assurance (NCQA) also offers consumer information on health plans. NCQA allows you to search by plan name to find out its ranking. If you want to evaluate a hospital, the best source is the Joint Commission on the Accreditation of Health Care Organizations. You may find the language and format of its reports difficult to understand, but they should give you an idea of the kinds of inquiries to make.

For a nonprofessionals' assessment of health plans, try U.S. News and World Report or Newsweek. Both magazines cover the managed care industry and publish annual reports and surveys on HMO quality.

Finally, don't forget to check out your own HMO's Web site, particularly if it is a national HMO. While company sites are not unbiased, these sites often publish favorable reviews by evaluators.

In the event of a legal dispute, contact the Center for Patient Advocacy for detailed information on HMOs and HMO regulations. The site provides detailed instructions about your rights and the procedures for fighting your HMO legally.