What Does the National Committee for Quality Assurance Do? :

When you are searching for a health insurance policy, you may run across a rating or report card on a company that has been issued by the National Committee for Quality Assurance or the NCQA. It is important to understand what this company does and who they are, to ensure that you are getting the best possible health insurance policy for your money.

First, the NCQA is a non-profit, 501( c) (3) corporation. This means that they operate for the benefit of consumers and are not likely to be biased towards specific insurance companies. They have been called the watchdog of the insurance industry in the past, particularly for managed care organizations or HMO’s. In addition, they also provide reports on individual doctors and medical groups that deal with the public.

The reason that the NCQA was formed was to increase the quality of health care for people in the United States. In the past, HMO abuses were front page news and people became leery of this type of coverage. Good HMO companies were lumped in with bad companies and the insurance industry went through a period of upheaval, which was, in a large part, deserved. However, there are many reputable and quality HMO providers in existence and the NCQA is there to bring the good companies to light while showing the public which companies are not reputable.

In addition to providing a report card or rating for an insurance company, the NCQA works with physicians and health care companies to provide information and resources, as well as feedback for the health care industry. This feedback goes a long way towards improving the quality of care for patients and insurance policyholders.

A board of directors that represent different sectors of the health care industry make up the NCQA. These people include employers, consumers, physicians, health plan representatives and policy makers. This diverse group allows a greater understanding of the health care industry as a whole and makes sure that all the important facets of the industry are understood.

The NCQA began offering accreditation for managed care companies or MCO’s in 1991. This step was in part due to the lack of available standardized information in the health care industry. Consumers were often left in the dark and had no idea about the reliability of the insurance companies they were dealing with.

This MCO program is voluntary, but the sign-up rates in the managed care industry have been high. The standards for this program are severe and offer consumers a way to easily find an accredited insurance company. To date, the NCQA has reviewed over half of all of the HMO plans in the country, which accounts for about 75% of enrollees in HMO plans.

Plans that pass the scrutiny of this program receive a seal from NCQA that ranks the company in a number of different ways, such as: Confidentiality, consumer protection, access to information, patient safety, as well as service and steps to improve the service. The seal declares that the NCQA has reviewed the insurance company, and that they are an NCQA Accredited Managed Care Organization. The seal will also include the company’s ranking, such as excellent.

If you are looking to find a new HMO plan, stop looking if you don’t see an NCQA seal. This program has been instituted to provide you with the necessary information to select a health plan that will live up not only the NCQA’s standards, but your own.

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