Provider Network and Rate Reviews

Ohio Citizen Rate Review Provider Network Survey, Summer 2016

chase exec with watchman 7-85Provider network reviews and rate reviews for Lucas County Marketplace health insurance plans for 2017:


  • Buckeye Ambetter (by Centene)    The rates are going down next year, and so will our tax credits. It is Lucas County’s current SLCSP, which I discuss in detail. It has a 90% inaccuracy rate in its primary care doctor provider network directory that encompasses all of Toledo and surrounding areas. But it’s cheap!
  • Molina   Molina has the most primary care doctors taking new patients in Toledo, thanks to Mercy Health. Still, at 77% inaccuracies in the provider network directory, there’s plenty of room for improvement, but we’ll take what we can get.
  • CareSource   Their provider network online database is 90% inaccurate, and no complaints to the Ohio Department of Insurance can change anything. I’m not the only one making complaints, either.
  • MedMutual-ProMedica    Medical Mutual’s PPO appears to be eliminated and replaced by MedMutual-ProMedica HMO. But the HMO will never fill the shoes of the PPO, and if its horrendously misleading provider network directory with its 85% inaccuracies is not corrected, it will never walk.
  • Paramount    They plan on having more Toledo enrollees next year. With 65% inaccuracies in their provider network online database, they must make the online provider list accurate immediately.
  • Anthem BCBS     A discussion on narrow networks, the “any willing provider” clause, the Orwellian control of utilization, medical bankruptcies, truth in advertising, and the government. The priciest and largest insurer in Ohio has the smallest network of all, with only 13 out of 36 PCP doctors accepting new patients.
  • Aetna    The shifting Aetna landscape. Aetna pulled out of the Marketplace on August 16 to teach the Department of Justice a lesson for disapproving of their monopolistic merger with Humana. What are we missing? Here is my 2017 rate review for Aetna, RIP. Some companies can just never get enough.

The “breadth” of this year’s inaccurate, misleading, falsely represented, untruthful, and wrongfully advertised provider networks is summarized on this chart:

Overview of the Toledo Marketplace provider network market:

provider-network-chartThe pale colors indicate the breadth of the inaccuracies of the provider networks we are offered, here in zip code 43615.

Details here:

Ohio Citizen Rate Review Provider Network Survey, Summer 2016



An overview of insurers in the Toledo Marketplace:
2015 2016 2017
Ambetter Ambetter Ambetter
CareSource CareSource Molina
HealthSpan Molina CareSource
Paramount Medical Mutual Medical Mutual
Aetna Paramount Paramount
Molina United Healthcare Aetna
In Health Aetna  Anthem BCBS
Medical Mutual HealthSpan
Anthem Anthem
United Healthcare In Health


Questions for Lt. Gov. and insurance department director, Mary Taylor:
  • Why does the Ohio Department of Insurance allow insurers to maintain provider network directories with 90% inaccuracies? See, CareSource screenshot for September 15.
  • What do you do to insurers with unacceptable inaccuracies in their network directories?
  • Will you enforce any emergency regulations to correct the provider network directory problem before Open Enrollment begins in November?

link to the Ohio SERFF filings: