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 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:

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!

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