The result for best health insurance companies in California is out. PPO quality summary ratings is undertaken every year by California Department of Insurance. It is a bellwether survey which rates the larger PPO health insurance companies. About 7 million Californians are covered under PPO health insurance.
For 2013 edition the report card covers the six largest health insurance companies in California. These companies are Aetna PPO, Anthem Blue Cross PPO, Blue Shield of California/Blue Shield Life PPO, CIGNA PPO, Health Net PPO, and UnitedHealthcare Insurance. Smaller PPOs are not covered because they do not publicly report their quality reports.
Overview of The Rating Process
To find the best health insurance company in California the Department of Insurance rates participating carriers under two broad categories.
1. PPO Provides Recommended Care?
Health insurance companies are rated for giving the right care for important health conditions. Members are randomly selected from each PPO and their medical records are reviewed. The care received be sample is benchmarked against national standards for recommended care. This rating done by a team of experts.
2. Rating from Patients
The second part of the rating process is done by patients. Patients rate their PPO under two heads – getting easy care and PPO helps members get answers.
Getting easy care as the name suggests rates health insurance companies on the ease with which members receive health care. For example a PPO where members get quicker appointments with doctors will get higher ratings.
The second head – PPO helps members get answers – rates PPO on parameters like quality of customer service help, accuracy of information on how much a care or treatment will cost, and getting accurate claim payment information.
Best Health Insurance Companies in California
Now coming to the meat of the topic. Here is a list of best health insurance companies in California on different parameters. The rating is absolute. The rating is on a scale of 1-4.
- 1 – Poor
- 2 – Fair
- 3 – Good
- 4 – Excellent
Best Health Insurance Company in California as Per Patients
The table below shows how patients have rated health insurance carriers. Note that not one carrier has been rated excellent.
|Carrier||Getting Easy Care||PPO Helps Members Get Answers|
|Anthem Blue Cross PPO||Good||Fair|
|Blue Shield of California/Blue Shield Life PPO||Good||Poor|
|UnitedHealthcare Insurance Co., Inc.||Fair||Fair|
|Health Net PPO||Poor||Poor|
As per the patients Anthem Blue Cross PPO is the best health insurance company in California. It has been rated good for getting easy care and fair for helping members get answers. Blue Cross of California/Blue Shield Life PPO is at number two. CIGNA PPO and UnitedHealthcare are jointly at number three. Aetna PPO and Health Net PPO are at the bottom of the ladder.
Except for the first two, the performance of the remaining carriers is disappointing. Health Net PPO’s rating are especially bad. If you are a member of this PPO then getting easy care is difficult. The PPO does not even help members to get answers in a timely manner.
Best Health Insurance Companies in California – Analysis of Medical Records
As per the analysis of patient’s medical records the rating given to health insurance companies is as under. It is interesting to note that again no PPO has been rated excellent
|Health Insurance Carrier||Rating on 4 Point Scale|
|UnitedHealthcare Insurance Co., Inc.||Good|
|Anthem Blue Cross PPO||Fair|
|Blue Shield of California/Blue Shield Life PPO||Fair|
|Health Net PPO||Fair|
Lets see how the carriers fare for important health care and treatment items. The rating in the table above is an aggregation of the items below.
Rating For Asthma and Lung Disease Care
|Health Insurance Carrier||Overall Rating||Medicine for Adults/Adolescents||Medicine for Children||Testing Lung Disease||Treating Lung Disease||Treating Bronchitis|
|Anthem Blue Cross PPO||Fair||89%||96%||37%||68%||30%|
|Blue Shield of California/ Blue Shield Life PPO||Fair||90%||96%||34%||75%||23%|
|Health Net PPO||Fair||87%||99%||38%||Too few patients||23%|
|Score for top health plans nationwide||93%||99%||49%||87%||29%|
As far as care for asthma and lung diseases is concerned the California PPO health insurance ratings are not good. Most of the score are significantly (more than 4%) lower than national average. PPOs have done extremely poor in testing lung diseases. With number of valley fever cases on the rise this is a bad sign.
Best Health Insurance Carrier for Cancer Screening
Good PPO health insurance plans and their doctors should regularly screen members for cancer. Members should be regularly screened for breast, cervix, and colon cancers. Cancer if found early is curable or containable. This is how the best health insurance companies in California fared this test.
|Health Insurance Carrier||Overall Rating||Breast Cancer Screening||Cervical Cancer Screening|
|Anthem Blue Cross PPO||Fair||65%||75%|
|Blue Shield of California/ Blue Shield Life PPO||Fair||65%||75%|
|Health Net PPO||Poor||63%||74%|
|Score for top health plans nationwide||72%||79%|
Health Net PPO is the worst when it comes to cancer screening. For both breast cancer and cervical cancer its score is more than 4% lower than national average. Infact breast cancer screening is poor for all the top six health insurance companies. This table should be a cause of worry for members. If cancer is not detected early then it can lead to life threatening conditions. At the very least it will cause financial distress. Over all UnitedHealthcare and Aetna are the best health insurance companies in California for preventive cancer screening.
Best Health Insurance Company in California for Diabetes Care
Diabetes is a serious medical condition. Diabetic patients also suffer from a number of other medical conditions. Here is how the best health insurance companies in California fare when it comes to treating diabetes.
|Health Insurance Carrier||Overall Rating||Eye Exam||Blood Sugar Test||Controlling Blood Sugar||Testing Cholesterol||Controlling Cholesterol||Testing Kidney Function||Controlling Blood Pressure|
|Anthem Blue Cross PPO||Fair||41%||85%||54%||82%||44%||78%||64%|
|Blue Shield of California/ Blue Shield Life PPO||Poor||44%||81%||48%||76%||41%||78%||49%|
|Health Net PPO||Fair||54%||84%||65%||78%||49%||76%||65%|
|Score for top health plans nationwide||61%||92%||66%||87%||51%||85%||70%|
UnitedHealthcare is the best health insurance company in California for diabetic health care. Cigna PPO and Blue Shield of California/Blue Shield PPO are the worst by a big margin. All health carrier have performed poorly on eye care for diabetic patients. Aetna PPO which has the best score of 55% in this category is a good 6% lower than national average of 61%.
|Health Insurance Carrier||Overall Rating||Controlling High BP||Testing Cholesterol||Controlling Cholesterol||Heart Attack Medication||Aspirin Use Counseling|
|Anthem Blue Cross PPO||Good||63%||88%||62%||71%||50%|
|Blue Shield of California/ Blue Shield Life PPO||Poor||53%||76%||38%||72%||49%|
|Health Net PPO||Excellent||69%||89%||73%||88%||47%|
|Score for top health plans nationwide||68%||90%||66%||86%||58%|
A big surprise here. Health Net PPO is the best health insurance company in California for heart care. All ratings except one are higher than or close to national average. Best health insurance companies in california for heart care are Health Net PPO, UnitedHealthcare and Aetna PPO.
Best Health Insurance Companies in California for Maternity Care
All companies except Anthem Blue Cross PPO and Blue Shield of California are rated good for maternity care.
|Health Insurance Carrier||Overall Rating||Visits During Pregnancy||Visits After Giving Birth|
|Anthem Blue Cross PPO||Fair||94%||74%|
|Blue Shield of California/ Blue Shield Life PPO||Fair||82%||76%|
|Health Net PPO||Good||99%||83%|
|Score for top health plans nationwide||97%||88%|
Aetna PPO, CIGNA PPO, Health Net PPO, and UnitedHealthcare are the best health insurance companies in California for maternity care.