COVERAGE: Just the Facts Ma'am

Fifty-five percent of insured people don’t understand the “critical details” of their health policies, a new survey tells us. We ask ourselves: who are the 45 percent who do understand them?

We worry about this because we have begun a national dialogue this year about health care reform. And it’s really easy to scare off the public if they don’t understand what they’ve got today, let alone what they will or won’t have under the various reforms being proposed.

Bloomberg reports on a J.D. Power & Associates survey that found that 55 percent did not understand their insurance including prescription benefits, how to find the right doctor and appeal-coverage denials. Additionally, consumers ranked health plans lower in customer satisfaction than hospitals and pharmacies.

"Health care is very complicated in our country, and the process of accessing it is very complicated," David Stefan, executive director of J.D. Power's health-care practice, told Bloomberg. “When you get materials from a plan, they're written to be complete and, in some cases, almost legal-like agreements, and they can be very hard for members to understand." Nonprofit health plans, including regional Blue Cross/Blue Shield organizations, more frequently scored highest on overall satisfaction (though that wasn’t uniformly true in all regions).

We understand why health plans need the legalese. But we’d love a version in clear and simple English as well. Yet another reason for national health reform where everyone is covered in a system where the rules of the insurance game are fair – and clear – and people know and understand what they are getting. Complexity and confusion was one of the reasons (OK one of many, many reasons) that health reform died in the early 90s. We hope everyone speaks more clearly this time around.

PS: We figure the uninsured understand what they’ve got: Too little. Too late. Too expensive.