Table Of Content

UMASS/AMHERST 2066 0367 3188 5 Your 0 APR 2 2008 Guide to LA'V I Managed Care Massachusetts in January 2007 Devai L. Patrick Governor JudyAnn Bigby, M.D. SecretaryofHealth and Human Services Commonwealth ofMassachusetts MASS2 KFM2587.H4 Y68 2007 Your guide to managed care in Massachusetts. DATE DUE This item may be kept DAYS 14 IT MAY BE RENEWED ONLY ONCE Table of Contents About this Guide • 3 Quality IVIatters • 4 Quality Indicators Health Plans, Managed Care, and You • 5 Types of Healtin Plans Table 1 : Comparison of Popular Health Plan Types Health Care Savings Accounts Table 2: Comparison of Tax-favored Accounts for Health Care Costs Fraudulent Plans Choosing a Health Plan • 11 Quality of Care and Service Table 3: Massachusetts Health Plan Profiles Provider Choice Health Benefits Plan Costs Living Healthy and Staying Healthy '15 Figure 1 : Testing for Colorectal Cancer Figure 2: Flu Shots Figure 3: Discussion of Ways to Stop Smoking Figure 4: Controlling High Blood Pressure Women's Health • 17 Figure 5: Testing for Breast Cancer Figure 6: Testing for Cervical Cancer Figure 7: Testing for Chlamydia Figure 8: Care Given to Women after Childbirth Children's Health • 19 Figure 9; Immunizations for Children Figure 10: Routine Check-ups for Children Figure 1 1 : Good Treatmentfor Children with Asthma Adolescent Health • 21 Figure 12: Immunizations forAdolescents Figure 1 3: Routine Check-ups forAdolescents Figure 14: Good Treatment forAdolescents with Asthma Diabetes Care • 23 Figure 15: Controlling Blood Sugar Figure 16: Controlling Cholesterol 1 Digitized by tlie Internet Arcliive 2015 in https://arcliive.org/details/yourguidetomanagOOnnass Table of Contents Figure 1 7: Monitoring for Eye Problems Figure 18: Monitoring for Kidney Problems Mental and Behavioral Health • 25 Figure 19: Good Antidepressant Medication Management - 3 Months Figure 20: Good Contact with Health Care Provider Figure 21 Good Antidepressant Medication Management - 6 Months : Figure 22: Follow-up after Hospitalization for Mental Illness Plan Members' Satisfaction Ratings • 27 Appeals and Complaints • 30 If Your Health Plan Is Self-funded... IfYour Health Plan Is Fully Insured... How Do File an Internal Grievance? I If Your Plan is a Fully-Insured Fee-for-Service Plan Not Subject to Managed Care Regulation... IfYour Plan is a MassHealth (or Medicaid) Plan... If Your Plan is a Medicare Plan... Government Employees... Additional Resources • 33 Glossary • 35 Endnotes • 38 Acknowledgments and Production Notes • 41 2 About Guide this Massachusetts Residents, Your Guide to Managed Care in Massachusetts will be of interest to more people now that Massachusetts requires all of its residents to have health insurance byJuly 1, 2007. For information on purchasing a state approved health insurance policy for which you may be eligible to receive finaiicial assitance call 1-877-623-6765 (see the "Additional Resources" section on page 33). This Guide can be helpful regardless ofthe health insruance policy you buy although different sections will be relevant to different people.. Clicking on a topic in the table of contents will take you directly to that section. The Massachusetts Division of Health Care Finance and Policy (DHCFP) and the Massachusetts Office of Patient Protection (OPP) are pleased to provide you with the sixth annual edition of Your Guide to Managed Care in Massachusetts. The purpose of this guide is to give you information that will help you: • Learn the differences between different types of health insurance and how those differences affect you, • Choose a health plan that best meets your needs, • File an appeal or complaint with your health plan if the need arises, and • Find additional information on health plans. This guide presents information, for comparison purposes, of eleven commercial health plans that are licensed to operate in Massachusetts. Health plans offered by Medicare, MassHealth/ Medicaid, and self-funded/ERISA plans are not covered here. Please .see the "Additional Resources" section on page 33 for contact information to find out more about plans not covered in this Guide. The information that compares health plans' performance is based on the most objective sources possible and organized into the following areas: • Living and Staying Healthy • Women's Health • Child and Adolescent Health • Diabetes Care • Mental and Behavioral Health • Members' Satisfaction Ratings of their Health Plan