Experience Survey We’re sorry you decided to leave your Peoples Health plan. Thank you for taking a moment to complete this survey about your experience.1. You recently changed your Medicare coverage. Which health plan did you enroll in, or did you return to Original Medicare coverage?SelectAetnaAARPBlue Cross/Blue Shield of LouisianaEmployer planHumanaOriginal MedicareUnitedHealthcareVA/TRICAREWellCareOtherDon’t know or do not wish to sayNone 2. What is the reason or reasons you chose to leave your Peoples Health plan? Please check all that apply.2. What is the reason or reasons you chose to leave your Peoples Health plan? Leave plan reason: Doctors or hospitals checkbox Doctors or hospitals Doctors or hospitals explanation checkboxesPlease explain. My doctor or clinic is not with Peoples Health or is no longer with Peoples Health My hospital is not with Peoples Health Hard to get a doctor’s appointment Other Which doctor or clinic is not or is no longer with Peoples Health? Which hospital is not with Peoples Health? Which doctor is it hard to get an appointment with? Please describe if you selected "Other."2. What is the reason or reasons you chose to leave your Peoples Health plan? Leave plan reason: Benefits or costs for medical care checkbox Benefits or costs for medical care Benefits or costs for medical care explanation checkboxesPlease explain. Authorizations for services Didn’t offer a benefit I wanted or cover a service I needed Costs (copay, coinsurance) too high Other Please describe the benefit(s) or service(s). Please describe if you selected "Other."2. What is the reason or reasons you chose to leave your Peoples Health plan? Leave plan reason: Benefits or costs for prescription drugs checkbox Benefits or costs for prescription drugs Benefits or costs for prescription drugs explanation checkboxesPlease explain. Authorizations for drugs Didn’t cover a drug my doctor ordered Costs (copay, coinsurance) too high Other Please describe, and include the drug name(s) if available. Please describe if you selected "Other."2. What is the reason or reasons you chose to leave your Peoples Health plan? Leave plan reason: An experience you had checkbox An experience you had If you would you like to share more details, please describe the experience.2. What is the reason or reasons you chose to leave your Peoples Health plan? Leave plan reason: Something you heard about us checkbox Something you heard about us If you would you like to share more details, please describe what you heard.2. What is the reason or reasons you chose to leave your Peoples Health plan? Leave plan reason: Don't want to share reason checkbox No reason, or don’t want to share reason 3. What could we have done to make your experience better?4. How long were you a Peoples Health member? Less than 1 year 1 year to less than 2 years 2 years to less than 3 years 3 years or more 5. Would you like to provide your name as part of this feedback? Yes No Name First Last Would you like to be contacted? If so, please provide your phone number.CommentsThis field is for validation purposes and should be left unchanged. Version: 3-4-20
