All posts by pennygentieu

Medical Mutual

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MedMutual-ProMedica provider network

You would think, from the name of this new HMO, that it would have a network of ProMedica doctors. But there is exactly one ProMedica primary care physician accepting new patients, in a sea of 54 falsely advertised ProMedica PCP doctors listed on the healthcare.gov-linked provider network directory as accepting new patients.

Besides that, the provider network lists a total of 136 PCP doctors accepting new patients, but in fact only 20 of the 136 are actually accepting new patients when you call them and ask. You’ll be hard-pressed to identify those very few doctors on the list, but here’s a hint: they are mostly Toledo Clinic doctors, a Mercy doctor, a doctor at a mental health facility, and a couple of independents.

Two out of 50 Indians-2

I called ProMedica’s one doctor accepting new patients in July for an appointment. I was told that he was booking in October, and to call back in one month to get an appointment, because his calendar was not yet available to make appointments. So even that one ProMedica doctor accepting new patients is a mirage, until an appointment can actually be made!

Only 20 doctors are accepting new patients, including only one Promedica doctor, on a provider network list of 136 doctors listed as accepting new patients, makes 85% of the list extremely misleading, falsely advertising the plan’s product and breadth of provider network, and why?

None of the 22 Promedica PCP physicians at the new Health and Wellness Center will be your new doctor –– not one!

doctors-

The cross-outs in these photos taken at the new ProMedica Health and Wellness Center are 22 of ProMedica’s 53 doctors that listed on the provider network databases as accepting new patients, but when you call them, they are not accepting new patients. See: Ohio Citizen Rate Review Provider Network Survey, Summer 2016

MedMutual SuperMed PPO provider network

Meanwhile, the Medical Mutual SuperMed PPO local provider network for the insurance I now have is also very inaccurate. I have made detailed complaints to the Ohio Department of Insurance about the inaccuracies I found in the provider network directory. They ignored it initially,  so I asked them to look again. This is their final determination, after 10 months:

Under current regulations the network directory is required to be updated at least quarterly. The directory information is self-reported by the provider to the insurer. When updates are received the insurer updates the directory, however it is the providers’ responsibility to provide accurate information, such as if they are accepting new patients.

 Really? 70% inaccurate is okay with you?

In this case we have applied the Ohio insurance regulations to the information parties have provided and found no evidence that the company has acted improperly.
Blame it on the doctors.

How can Medical Mutual and the Ohio Department of Insurance honestly put the onus on the doctors, considering what the doctors offices shared with me, during my research for the Ohio Citizen Rate Review Provider Network Survey, Summer, 2016? Here are some of the things the doctors offices told me, ones who are listed on the Medical Mutual SuperMed PPO provider network as accepting new patients, when I asked them why they were on the provider list as accepting new patients, when they were not accepting new patients:

Seven said they keep calling to have the list changed but they don’t update, one moved to Arizona, one moved to California, one moved to Oak Harbor, one moved to Bowling Green three years ago, two are retired, one isn’t practicing anymore, two you must pay an additional annual membership fee of $1,650 and they still take your insurance,  two are geriatrics only, two more only see patients in the nursing home, one more only sees patients in Hospice, two only see mental health patients, five said they have no control over the lists, one only sees Owens Corning employees and asked twice to be taken off the list, eight screen for age, address, state of health and doctors you’ve seen and then decide if they are accepting new patients or not, 11 do not accept new patients but their residents do, 12 do not accept new patients but their nurse practitioners do, one is not practicing medicine anymore, two are not PCPs, one only sees addiction program patients, one is a hospitalist, one is a hematologist, one is a sleep doctor, one sees only adolescents, three are sports doctors, six were not locatable, one said they put doctors on the list without asking and they never update them, one said they haven’t accepted new patients for 30 years, etc., etc., etc….

Bait and switch

Can Chrysler sell you a car with only one wheel, not four? You can’t get very far with one wheel.  But that’s what they gave you, after you signed on the bottom line. You complain to the state attorney general, but your complaint goes on deaf ears?

You buy an expensive insurance plan with a network of doctors, only to find out that they lied about the provider network — using the doctors’ good names, they baited you with doctors and switch you to registered nurses and residents. Or nobody at all. That wasn’t the deal.

Our Ohio Department of Insurance, which seems to exist for the insurance companies and not for the people, does nothing about it. The Ohio Department of Insurance puts complaints about provider networks behind closed doors, shrouded in secrecy, nobody is allowed to know anything about anything, ever…. and the Ohio Department of Insurance claims to be allowed to do that by law.

But that does not make phony provider network directories fair or right.

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Your money or your life!

What else is new?

For 2017, Ohio’s insurer since 1934 has eliminated its “real insurance” SuperMed PPO that includes a national network, including the expansive and expert network of accurately listed Ann Arbor doctors and providers who are actually available to patients — imagine that — and gives us a narrow-to-nothing, dishonestly advertised, joke of a network HMO — the MedMutual-Promedica HMO described above, which was new in 2016 and is projected to have 3,320 members in 2017, all in the Toledo area, up from 1,152 in 2016, apparently taking up the slack from the discontinued PPO. It will be going up 1.88%, 2.24% over-all, which means it’s more like 10% more for the oldest members.

They also have a MedMutual-Mercy HMO version, which they priced quite a bit higher than the Promedica — is that to manipulate the Toledo market and create more monopoly than they have already? The Mercy HMO, for our alternative hospital system, the venerable “gray nuns” known for their charity care in Toledo, has an average rate hike of 15% for 2017, and is projected to have 401 members, up from 2 members in 2016. The Mercy plan has obviously been priced to fail. How convenient.

Thanks so much for taking away my doctor and real medical care, Medical Mutual, and replacing it with this imitation of a plan, that costs more than double what my insurance cost in 2013.

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What it looks like to me.

It looks like Medical Mutual has successfully replaced real insurance with this toy insurance HMO. Good if your are a child, and just pretending to buy health insurance. Ironically, there’s no need anymore for the strangely priced “$0 premium before tax credit” so-called “Child Only” mirror plans that always seemed suspicious to me, and made me wonder how they figured into the extreme rate hike I experienced in 2014 with my same insurance plan when it went on the Marketplace and my premium rose in price by 224%.

Whatever their master plan was, it’s over in 2017, and the children are being mapped to these lousy plans. Three years was all that it took to complete the transformation from good and somewhat affordable to bad and expensive and dumb.

Medical Mutual will not be selling any plans for child-only priced $0 premium before tax credit in 2017, like they did in 2014, 2015, and 2016. Maybe my consumer complaint to the Ohio Department of Insurance had something to do with it, but more likely it was part of their master plan to juvenilize their offerings. They blamed healthcare.gov for the problems I brought up with the Child Only “$0” cost plans, but Medical Mutual always passes the buck to the Feds, assured that the Republicans at the Ohio Department of Insurance will praise them for doing so.

That’s what they would both have us believe. The real truth is that just any old excuse will do, they don’t even need one, because they make their own rules, and the insurance guy and the insurance regulator have each other’s back, in fact they are each other’s back.

Why not just blame it on the doctors.

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See, here, about the Medical Mutual Child-only plans on the Exchange healthcare.gov: Medical Mutual Complaint Example 6: Accountability

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Noted that Promedica network HMO, which was sold under the company name of  “Medical Health Insuring Company of Ohio” has switched over to “Consumers Life Insurance Company” which is Medical Mutual’s company that sells life and disability insurance.

The Demise of the PPObaby-head-row

Why did my rates go up 373% in seven years?

I suspect why: it was a strategic plan so that Medical Mutual could completely eliminate PPOs in the entire individual market by 2017, which is not fair and discriminates against the individual, while still keeping PPOs for the large employer market and the large share they have of the State of Ohio employee insurance, making the attainment of the best healthcare no longer possible for the entrepreneur, the artist, the small business owner, the individual. Is that the goal? The folks at Medical Mutual ought to make sure that when their own kids grow up, they leave the state, because in their greed, they have ruined it here. All Ohioans will suffer greatly by this denial of equal access to healthcare through Medical Mutual’s prejudicial elimination of PPOs in the individual market.

State-approved rate increase by year

Premium

Actual Increase

2009

No information available

413.33

2010

454.30

10%

2011

7.50%

*425.09

-9%

2012

13.70%

476.42

12%

2013

15.40%

559.66

18%

2014

17% on non-marketplace

1,255.00

224%

2015

15.70%

1,355.00

8%

2016

16.99%

1,542.00

14%

*increased deductible to lower the rate in 2011

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My Medical Mutual insurance went up 373% in seven years, during a 10-year span of time when the median family income in Toledo dropped 17.3%. And now, for 2017, PPO insurance has been eliminated, and Medical Mutual is in business with ProMedica, with their falsely advertised doctors accepting new patients, the biggest reason why we can’t find a doctor in Toledo, Ohio.

Molina

PG231667Last summer, a woman in Dayton, Ohio made a complaint to the Ohio Attorney General that she and her husband bought a Molina Marketplace plan because their doctors were listed on it, but when they tried to schedule appointments, the doctors didn’t actually take Molina. Molina had in fact issued her a card with those doctors names on it. She asked the Molina call center to help her find a doctor, and the customer service representative called all the doctors in her area, and couldn’t find her one doctor in the Molina network. She faced having to pay for this insurance for an entire year – $10,034 for absolutely nothing!

“They baited us into choosing this insurance plan by listing doctors who do not accept their marketplace insurance product and we are now stuck until the next open enrollment period.”

Bait with doctors and switch to nothing.

Here is how Molina’s advertised provider network of primary care doctors stacks up to other Marketplace provider networks in Toledo, downloaded on July 16, 2016. 13 out of 57 doctors on Molina’s Internal Medicine list are listed a total of 25 more times on the list with one doctor listed 7 times. The duplications nearly double the apparent size of the network, which shows 57 internal medicine primary care doctors.

Ohio Citizen Rate Review Provider Network Survey, Summer, 2016
Ohio Citizen Rate Review Provider Network Survey, Summer 2016

Only one of the seven Toledo Clinic doctors on the Molina provider list actually accepts Molina insurance.

But only thanks to the Mercy Health providers, Molina actually has the most primary care doctors available to accept new patients. See, my Ohio Citizen Rate Review Provider Network Survey, Summer 2016. Molina has a mere 77% rate of inaccuracies; 59% inaccurate if you subtract all the duplications. Although that’s nothing to brag about, it was refreshing to hear that many yeses in a sea of so many no’s.

Ohio Citizen Rate Review Provider Network Survey, Summer 2016
Ohio Citizen Rate Review Provider Network Survey, Summer 2016

Molina currently has 10,878 members, and their projected membership for 2017 is 19,083. The Toledo area has 556 members in 2016, up from 383 in 2015. Molina projects next year’s Toledo membership to nearly double, expecting a 10%+ market share of the area healthcare.gov sales.

Molina covers 325,000 Ohioans in Medicaid and Medicare plans. They serve 3.5 million members in 11 states and Puerto Rico. The Molina CEO’s compensation was 11.9 million in 2013.

Molina anticipates a 5.9% increase in unit cost (4.8%) and utilization (1.1%). Molina calculated a medical loss ratio (MLR) for 2017 of 88.1%, itemizing about 2% on “quality improving activities” and about 78% on incurred claims. Molina expects their new members to be healthier, with nearly the same age mix as in 2016.

Molina expects prescription drugs to cost 6% more next year, with a 2.5% increase in the use of the drugs.

A Wakely Consulting Risk Survey that Molina participated in estimated a risk transfer receivable of $67.03.

Molina is asking for an aggregate .9% decrease in rates next year. The range of the rate change will be from -6.1% to +9.7%.

Look out, Ambetter by Centene! Molina’s coming after you for the SLCSP benchmark plan. I wonder, does the government give a bonus to Centene (and Ambetter) or Molina for reducing their rates (which lowers the tax credit / subsidy the government pays) as a backdrop for the other insurance offerings to raise their rates by double-digits, rates so high, they become more than half the median household income? Is this in the grand master plan, to get everyone out of “real” insurance? Do the provider network inaccuracies matter little, in the government’s scheme of things? We may be lucky in Toledo, but think of the woman in Dayton last year.

Molina is a giant managed care organization for Medicaid and Medicare, making megabucks from the U. S. government, like Centene’s Ambetter. Both are now competing for the Marketplace market. According to my provider network survey, Molina has the most potential for integrity. If only Molina could do a little bit better.

Aetna

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The health insurance industry at the Wynn this summer, the ritziest casino hotel in Las Vegas. Busy guys going from one seminar to another seminar brainstorming new schemes to improve health care quality for members while keeping patients away from providers in order to reduce utilization.

Aetna wants to merge with Humana this year. It’s just fine with the Ohio Department of Insurance, even though Ohio legislators and consumer groups requested to first have an investigation and public hearings about the merger. See this letter, and this article. Thankfully, the U.S. Department of Justice may put a stop to it; the DOJ filed a lawsuit on July 21 and will conduct an investigation. The Ohio Attorney General is joining in with the DOJ to challenge the merger, in an interesting turn of events.

Aetna, whose CEO made 15.1 million in 2014, broke off with the health insurance lobbying group AHIP this year, because they are so darn big. Aetna has 23,670,000 medical health insurance members. Humana, (whose CEO made 10.2 million in 2014), has about 10 million members with an additional 4.4 million Medicare members. Together, they would have 38.07 million members, which is about half the total number of Americans on Medicaid.

Aetna’s stock went up 525% in the past seven years.

Aetna is asking for a rate hike of 12.97% average, ranging from 7.9% to 22.7% for their PPO PD (pediatric dental) plans, and an 11.37% average increase, ranging from 3.3% to 22.8% increases for their PPO plans.

Humana is asking for a 39.3% rate increase, ranging from 20.6% to 42.3% increases. Humana services the Dayton and Cincinnati areas, and will affect 5,178 individuals. (Which is about half the total number of individuals in Toledo who buy any plan on the Marketplace.)

Humana is estimating the combined cost and utilization trend to be 7.7% annually, or 16.1% for two years.

Aetna expects medical costs to go up 7.6%, because providers raised their prices and members get more medical care. Aetna expects drug prices to go up by 10%.

Aetna has 20,771 members in the state of Ohio, which is about 8% of the market, and 660 members in Area 1, which includes Toledo. It expects to gain 152 more members from Area 1 in 2017.

The average age of the membership is 50.

Aetna projects an average premium of $451.82, with an index rate of 488.68 before the age factor is applied.

The Aetna product with the pediatric dental will be going up an average of 2.4% more than the plan without, so families with kids will get hit harder with rate increases. Clever. 15% of the covered members are 21 or younger, however 25% buy the plan with pediatric dental.

If you can afford it, you may be one of the lucky few who can actually keep their doctor, since Aetna claims to have the biggest of all Toledo provider networks.

This year Aetna serves as the second lowest cost silver plan in Rating Area 13, which is Youngstown, where it insures about 2,200 people.

Insurance regulators, reject unreasonable, unsustainable rate hikes. Please have some understanding of our economy.

WAIT! –– AETNA HAS PULLED OUT, JUST THIS AUGUST 16! In what appears to be a knee-jerk reaction to the DOJ investigation, but they say it’s over the high price of drugs! What a giant corporate bully!

http://big.assets.huffingtonpost.com/AetnaDOJletter.pdf  The “smoking gun”

Can you imagine if you were to do it, in your small business, suddenly back out of a contract and long-time commitments, how weird and unprofessional that would be, and here we have hundreds of thousands of individuals in 11 states affected by this –– what is going on?

Postscript:

LA TIMES January 23, 2017: U.S. judge finds that Aetna deceived the public about its reasons for quitting Obamacare

Buckeye Ambetter by Centene

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A chart from Ambetter’s 2017 rate filings for Toledo’s current and likely to be next year’s second lowest cost silver plan. They crossed everything out so we can’t know!

What are they covering up?

All we get to know about Ambetter’s 2017 rate review filings is NOTHING!

It doesn’t much matter that CMS gave Ohio millions of dollars to set up
EFFECTIVE RATE REVIEW

(shhhhh!!!)

THEY THINK OHIOANS DON’T COUNT

AND CAN’T READ!PG189950

Buckeye Ambetter is owned by Centene, one of the biggest managed care companies for Medicaid and Medicare. Centene has 5.1 million members. The CEO is one of the highest paid of all health insurance CEOs, reeling in 44 million dollars worth of compensation last year.

Ambetter is the benchmark SLCSP (second lowest cost silver plan) in Lucas County. Ambetter’s plan controls the amount of the tax credit that the 80-90% people receive on healthcare.gov.

In 2014, the Toledo area had only 61 Ambetter enrollees, which was 10% of the entire state membership of 616. In 2015, the first year as the SLCSP, it had 345 local enrollees in the SLCSP plan, called Ambetter Balance Care 1, and 600 local enrollees in Ambetter Balance Care 2, the first lowest cost silver plan. For 2016, it estimated 1,784 local members in total for all their plans, including the SLCSP in the Toledo area. I hope I got it right, because it’s difficult to decipher anything from their extremely redacted rate filings.

Ohioans have the highest average premium after tax credit than any other state on the Marketplace. (This, according to the Department of Health and Human Services Office of the Assistant Secretary for Planning and EvaluationASPE ISSUE BRIEF, HEALTH INSURANCE MARKETPLACE PREMIUMS AFTER SHOPPING, SWITCHING, AND PREMIUM TAX CREDITS, 2015–2016, April 12, 2016, page 9, Table 4, second column to the right, Average Monthly Premium after APTC [Advance Premium Tax Credits. ])

Amidst competing plans on the Marketplace that are going up double digits next year, Ambetter’s rates for 2017 are actually going down by an average of 1% in 2017.  Is that because their provider network directory for their primary care physicians is 90% inaccurate, and people die first before they can find a doctor? Or do they just attract younger, healthier Toledoans — ones who never see a doctor? Or is it both?

Below is a chart representing the breadth of inaccuracies I discovered contained in Ambetter’s online provider directory from my survey, linked here: Ohio Citizen Rate Review Provider Network Survey, Summer, 2016. 90% inaccurate. Wow.

Ohio Citizen Rate Review Provider Network Survey, Summer, 2016
Ohio Citizen Rate Review Provider Network Survey, Summer, 2016

It makes you wonder, how can anything be so inaccurate! It makes you wonder if it could be an Orwellian scheme to keep the government subsidies down while controlling utilization! Whatever it is, Ambetter has been the second lowest cost silver plan (SLCSP) sold in Toledo for the past two years, and it has more weirdness to it than simply the weirdness of its grossly inaccurate provider network.

Complicated, complicated stuff.

Because Ambetter’s rates are going down next year, the tax credit for Toledoans will go down as well. That will make a much larger rate increase for the other plans Toledoans can buy, contrary to what the U.S. Health and Human Services department is telling reporters.

The Toledo Blade reported in August in a typical article that tows the line, Fewer choices, higher prices in Lucas County for Obamacare:

The federal officials stressed that the tax credits, which many consumers are eligible for, are designed to protect against rate increases. If rates go up, so do the tax credits.

Not so! Do the math! I wonder, does Ambetter by Centene get a government bonus for reducing their rates, thereby reducing the tax credit? Or are they just racking up brownie points for the inevitable end result? Not only does Ambetter’s rate reduction lower the tax credit, but something else is going on with Ambetter that makes the tax credit even smaller, that  I describe below. Our tax credit this year is actually equal to the first lowest cost silver plan, not the second lowest cost silver plan! And why is that?

So so very complicated. I’ve been searching for an answer since November, 2013, and no one knows.

The implosion of the Jeep Administration Building, Toledo, Ohio
The implosion of the Jeep Administration Building, Toledo, Ohio, 1979

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Ohioans have the highest average premium after tax credit than any other state on the Marketplace, and the SLCSP discrepancy must be one big piece of the puzzle as to why.

It’s just so complicated, that if you make it so very complicated, we won’t ever be able to understand!  But please tell us anyway because it’s really very simple — Why aren’t Ohioans getting an honest second lowest cost silver plan tax credit that is equal to the second lowest cost silver plan that we can actually buy?

And back to that 90% inaccurate provider network.
This from the horse’s mouth:
"Our approach to developing and managing the provider network begins with a thorough analysis and evaluation of the state Department of Health and Human Services (HHS) network adequacy requirements for the managed care organization networks. We will develop and maintain a network of qualified providers in sufficient numbers and locations. Providers will be adequate and reasonable in number, in specialty type and in geographic distribution to meet the medical needs of members, both adults and children, without excessive travel requirements, and will be in compliance with HHS access and availability requirements."

https://ambetter.buckeyehealthplan.com/content/dam/centene/Buckeye/Ambetter/PDFs/OH_ProviderNewsletter_Fall2015.pdf

Promises, promises, promises. All they sell are broken promises.

CareSource

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Waste King down the drain, just like the poison algae blooms of Lake Erie. Wasted opportunities for healthcare; our money and our health down the drain.

CareSource Provider Network Review

In 2014, CareSource charged too much for their premiums, and had to send rebate checks in 2015. However, according to complaints made to the Ohio Attorney General’s office, the checks were worthless because they had an incorrect routing number on them.

There are many complaints about members being unable to find doctors. Here is mine, that I first made to CareSource, and then made to the Ohio Department of Insurance:

November 2015:

Three weeks into the 2015 Open Enrollment, I called the offices of 50 ProMedica primary care physicians who were listed on the CareSource Just4Me network of Lucas County PCPs as accepting new patients, marked with a definitive YES. CareSource is one of the two, maybe three, affordable plans on healthcare.gov. CareSource also administers Medicaid plans. Only two out of 50 ProMedica PCPs on their network listed as YES actually were accepting new patients. I called CareSource. I spoke to a customer service representative and to the press relations department. I was actually impressed with their responsiveness — the concern they expressed and the actions they said they were going to take, and I thought maybe CareSource might be okay, after all. From their reactions — how sorry they were, how they took all the details, how the head of the public relations/press relations department called me back the next day with another person on the line, saying that they were going to fix this, that they were going to get someone up here immediately to talk to ProMedica, and that CareSource would be correcting their listings – I thought, this is a refreshing change from what I’m used to encountering with health insurance. But it’s been a week, and there are only two weeks left for Open Enrollment, and misrepresentation like that isn’t corrected immediately when the buyers of health insurance are under such a deadline is just not acceptable.

And guess what, the doctors are still listed as accepting new patients nine months later; only one has been corrected. I called the entire list of internal medicine and family practice primary care physicians this summer for my Ohio Citizen Rate Review Provider Network Survey. CareSource listed 166 doctors accepting new patients, when, according to the doctors themselves, only 17 are accepting new patients, and CareSource has 51 duplications of names on their list.

CareSource doesn’t care. Why haven’t they fixed this? 90% is inaccurate, for gosh sakes!

My November complaint to CareSource and my April complaint to the Ohio Department of Insurance hasn’t changed a thing! It’s not hard to make corrections, so it must be something else that keeps CareSource from telling the truth about these doctors’ panel statuses. False advertising! Is it the CMS audit?

May 10:

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July 29:Screen Shot 2016-08-16 at 3.00.52 PMScreen-Shot-2016-08-16-at-3.01.19-PM2

The Ohio Department of Insurance may or may not correct it, and we will never know if they are investigating it or not, because they made that little rule for themselves. How convenient.

These matters have NOT been properly addressed.

No corrections to their provider network database after all this time, and why is that?

Two sets of books, as the saying goes?

Whatever it takes to get their CMS rating, and the heck with the patients?

Patients don’t get invited to the party?

Is this not fraud on a very high level?

90% WRONG!

Ohio Citizen Rate Review Provider Network Survey, Summer, 2016
Ohio Citizen Rate Review Provider Network Survey, Summer, 2016

There can be no excuse for not correcting this immediately, let alone allowing it sit like that for 10 months!

August 16:

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Only three family practice doctor listings have been removed since my survey, in the past month. Progress?

September 15:

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Here it is on September 15, 2016 — only one family practice doctor listing has been removed in the past month. Progress? What seems to be the problem, CareSource and Ohio Department of Insurance’s director, Mary Taylor?

CareSource 2017 Rate Review

CareSource is asking for a 13.53% increase — that’s the average increase from last year — the actual increases vary, estimated by me to be between 5% and 30%. The 30% if you are unlucky enough to be in your fifties or sixties. You don’t get to check the math, because they crossed out all the numbers (not that they are allowed to)…..

Below are screenshots of CareSource’s 2016 Actuarial Memorandum for their Marketplace plans – with all the details redacted, so we don’t get to know!


Screen Shot 2016-07-01 at 5.36.19 PMScreen Shot 2016-07-01 at 5.28.04 PMScreen Shot 2016-07-01 at 5.31.29 PMScreen Shot 2016-07-01 at 5.51.53 PMScreen Shot 2016-07-01 at 5.31.37 PMScreen Shot 2016-07-01 at 5.32.01 PM  Screen Shot 2016-07-01 at 5.32.46 PMScreen Shot 2016-07-01 at 5.32.35 PMScreen Shot 2016-07-01 at 5.33.20 PMScreen Shot 2016-07-01 at 5.34.30 PMScreen Shot 2016-07-01 at 5.34.18 PMScreen Shot 2016-07-01 at 5.33.52 PMScreen Shot 2016-07-01 at 5.35.07 PM Screen Shot 2016-07-01 at 5.34.46 PM    Screen Shot 2016-07-01 at 5.33.38 PMScreen Shot 2016-07-01 at 5.33.03 PM   Screen Shot 2016-07-01 at 5.32.22 PM      Screen Shot 2016-07-01 at 5.25.29 PM Screen Shot 2016-07-01 at 5.24.57 PM Screen Shot 2016-07-01 at 5.24.44 PM Screen Shot 2016-07-01 at 5.24.09 PM

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And who am I supposed to ask? You have no contact info on your website!

Complaint No. CSD0039402 CareSource provider network

Two out of 50 Indians

Here’s my public complaint to the Ohio Department of Insurance about CareSource’s inaccurate provider network directory:

Complaint No. CSD0039402, filed online on April 18, 2016.

SUMMARY: CareSource’s “Just 4 Me” published online provider list is highly inaccurate. 96% of the 52 ProMedica internal medicine and family practice primary care doctors on their list for zip code 43615, 15 mile radius, listed as accepting new patients are actually NOT accepting new patients. I informed CareSource about this discrepancy in November, 2015, and I gave them a detailed list (including one doctor who is retired) and still they have not corrected it.

I expect the Ohio Department of Insurance to investigate this fraud and correct it.


See, here, my December 2015 post about this experience.

See here, my struggle to obtain public records from the Ohio Department of Insurance regarding provider networks.

Should the public be allowed to know about public complaints like this one?

Yes, of course the public should be allowed to know, but if you try to find out, you’ll be going down the rabbit hole.

See more here.

See the end result of complaints like this here.

Medical Mutual Complaint, Example 6 – Accountability

"0" Premium before tax credit. November 27, 2015 credit shown for $62,000 income
$0 Premium before tax credit. Sign me up!

During last week’s preview week on healthcare.gov, Medical Mutual  offered duplicate plans, same name but one serial number off from other plans, that cost nothing. Zilch. $0. And then I couldn’t believe how much my premium was going up on the mirrored plan that was not $0. What a great deal – those $0 plans! So I called Medical Mutual to ask more details about the $0 Premium before tax credit offerings on healthcare.gov, because the $0 plan was clearly offered to me. These are direct quotes from Naomi in the Medical Mutual sales department on October 27:

You have to talk to the Marketplace. I don’t see the plan. I can’t look it up by plan number. You just popped up on the line and I answered your call.

I cannot look up plans by plan number, you have to go back to the Marketplace. Marketplace is administrating the plan.

Your premium went up because the federal government regulates that and they increased everyone’s premium.

You’re asking me to look up a plan on a different company’s website that I can’t see.

You want me to have all the answers as to why there is a free plan on the healthcare.gov website and it is offered to you.

We don’t have info on the plans offered on healthcare.gov, you have to go to them. It’s a different entity.

I can’t give you false information. I can but I’m not going to do that.

I cannot look up a policy that we do not offer.

It’s federally facilitated, different from Medical Mutual.

I can’t answer your questions because they are offered through healthcare.gov.

Sounds like it’s for medicaid.

We have no information on it. Nobody answers questions about plans on healthcare.gov. It’s through the government. You need to contact healthcare.gov because it’s offered through healthcare.gov. For this plan you have to call healthcare.gov.


When I spoke to Stacey at healthcare.gov on October 27, he duplicated everything I did on his screen and came up with the same results I was getting and these are his direct quotes:

I thought that was their job. (He said when I told him Medical Mutual told me I had to ask healthcare.gov about their plans.)

I would think that, and I’m putting them side by side, they are identical.

I don’t know why it says “child” because it covers adults and children.

This plan has costs and this doesn’t. I don’t understand, I really think that Medical Mutual should have been able to tell you some basic information.

I see this plan and all the details that it consists of, and it would seem you would pay “0” dollars.

This seems like the one to get, and when its says premium before tax credit is “0” you don’t even need a tax credit.

It’s like a trick, like smoke and mirrors.

It is very bizarre. They are nearly identical to the other plan, they are only one number off in the plan ID so I understand your concern.

I have never really experienced this in this way.

It seems as if it is supposed to be “0” dollars, or it is a trick.

It’s ridiculous, it’s their plan, it’s their company and they won’t talk to you about it.

Here’s a phone number you can call, Ohio Department of Insurance, let them know what is going on. Let them know what we discussed, that I see the same thing you see.


So I took healthcare.gov’s advice, and after speaking with the Ohio Department of Insurance, I filed a consumer complaint against Medical Mutual for pricing and accountability and false advertising.

Page one of my consumer complaint, no. CSD-0034217
Page one of my consumer complaint, no. CSD-0034217

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