My email is at the bottom of the page, that I sent to Barbara Sears, the former State Representative for my neighboring town of Sylvania, (which was included in my provider network survey), who is now the Assistant Director of the Governor’s Office of Health Transformation. I thought she’d be concerned and would help. I cc’d it to my State Representative, Rep. Teresa Fedor, who then wrote to Barbara Sears, and this is their email exchange.
The stated goal of the Office of Health Transformation is for Ohio to be the healthiest place to live, work, and raise a family. Wouldn’t any state want the best for their citizens? But there’s a double standard here. Barbara Sears is saying that if our emergency problem has to do with health insurance, the Office of Health Transformation won’t provide a position on this issue, let alone provide any help to make sure Ohioans who buy health insurance will get healthcare under the conditions I have uncovered, with 80% average inaccuracies in the provider network directories. The issues I brought up in my email didn’t faze her in the least.
Ironic, isn’t it. Barbara Sears, in charge of the Governor’s Office of Health Transformation, simply has no opinion whatsoever about the 80% provider network inaccuracies uncovered in Toledo. Nor does Barbara Sears have any concern for the welfare of her neighbors and former constituents who voted her in as their State Representative. I bet they are sorry now.
Re: Major errors in provider network directories
Sep 13, 2016, at 9:29pm
It’s unfortunate the Governor’s Health Transformation would not want knowledge of this emergency for millions of Ohioans. I hope that you will be able to share this issue with him and make recommendations to move it forward to be dealt with in short order otherwise our citizens will suffer.
Sent from my iPhone
On Sep 13, 2016, at 11:17 AM, Sears, Barbara <Barbara.Sears@governor.ohio.gov> wrote:
Thank you for your email. I am not involved with the Department of Insurance in my position in the Governor’s Office of Health Transformation (OHT) and cannot speak for the Governor, the Department of Insurance or provide a position from OHT on these issues.
Barbara R. Sears
Governor’s Office of Health Transformation
This message and any response to it may constitute a public record and thus may be publicly available to anyone who requests it.
From: Teresa Fedor
Sent: Monday, September 12, 2016 11:23 PM
To: Sears, Barbara <Barbara.Sears@governor.ohio.gov>
Cc: Penny Gentieu <email@example.com>; Jen.Stack@ohiohouse.gov
Subject: Fwd: Major errors in provider network directories
Hello. Penny has been in contact with me for quite some time now alerting me about a very serious issue she has expertly researched and outline. I ask that Penny and others she is working with meet with you as soon as possible to address this serious issue and work on compliance measures and a plan to fix it in order to help individuals and families access critical medical needs. I am confident you can help the millions of citizens counting on the Governor’ administration to get this right. At this juncture, it rises to the level of an emergency for again millions of Ohioans. I’ll make myself available and Penny will as well.
I look forward to your quick response and a plan to address this as soon as possible.
Rep. Teresa Fedor
Sent from my iPhone
Begin forwarded message:
From: “Penny Gentieu” <firstname.lastname@example.org>
Date: September 12, 2016 at 7:59:14 PM EDT
Subject: Major errors in provider network directories
Dear Ms. Sears,
I live in Toledo, Sylvania Township. I have a website, ohiocitizenratereview.info, which I started last year to bring awareness to the severe problems we have in this city, in this state, in regard to health insurance. I’m writing to ask for your help as the Assistant Director of the Office of Health Transformation, and as a neighbor.
I’ve conducted a survey of 308 primary care provider physicians listed on six provider networks who are all listed as accepting new patients. I called the doctors, and about 80% are NOT accepting new patients. The provider networks are for individual health insurance plans sold by Anthem Blue Cross Blue Shield, Paramount, Medical Mutual, Molina, CareSource, and Buckeye Community Health. These are ALL of the plans available to individuals.
Here is a link to the survey, http://ohiocitizenratereview.info/provider-networks/ and here’s a link about the survey, http://ohiocitizenratereview.info/provider-networks/description/, and here is a link to the letters I sent to the insurers along with detailed lists, asking them to please correct their provider network directories before November 1 when Open Enrollment begins for 2017 enrollment:
I created this survey because I wanted to find a primary care physician in Toledo and couldn’t find one, a problem I’ve had since I moved to Toledo seven years ago. I actually have to drive to Ann Arbor in order to see a doctor. But my good PPO health insurance is apparently being fazed out by Medical Mutual, as they transition to their extremely narrow network plans, with their 85% provider network directory inaccuracy rate of doctors listed as accepting new patients.
The ACA law forces Toledoans to buy health insurance or face a sizable federal fine. With 65% to 90% inaccuracies, Toledoans are given 5 to 1 odds that we won’t be able to find a doctor. This can’t be the intention of the state of Ohio, for their citizens to have to pay dearly, to gamble on the likelihood that they will be able to get healthcare when they need it.
Unfortunately, the Ohio Department of Insurance has not been any help, which could be why my survey shows an 80% error rate, which is much worse than the California provider network scandal of 2014-2015, which you can read about here: http://ohiocitizenratereview.info/outrageous-health-insurance-rate-increases/if-other-states-can-do-it-why-cant-we/
Times are hard for Ohioans, especially for Toledoans, whose median family income dropped 17.3% in a 10 year period, when health insurance premiums more than doubled. In fact for me, premiums went up 373% in that time period, just so I could hang on to my quality Medical Mutual PPO to see a doctor in Ann Arbor, since I could never find a doctor in Toledo, due to the extremely inaccurate provider network directories. It’s really crazy that in November, chances are we Toledoans will continue having to paying out the biggest budgeted monthly expense, for health insurance that is based on a fraudulent dishonest system, where issuers are allowed to misrepresent their products and nobody does a thing about it.
Is it possible that you could look into this, and put into motion some emergency measures so that come November, hardworking Toledoans can get actually get a fair shake, and not get duped again.
I’m happy to send you the detailed list of doctors that I sent to the insurers, if you can be of help.
Thank you for your time.
Insurers’ Flawed Directories Leave Patients Scrambling