Category Archives: Letters

Just give us what you have. We promise not to pee in the pool.

Dear Penny

Thank you for taking the time to write me with your concerns regarding reforms to our nation’s health care system. It is good to hear from you.

As you know, members of the House of Representatives recently passed a bill to repeal and replace the Affordable Care Act, otherwise known as Obamacare. This bill, the American Health Care Act (AHCA), replaces Obamacare with aand makes significant changes to the Medicaid program. Since the AHCA has passed in the House, it now comes to the Senate for debate.

I have already made clear that I do not support the House bill as it is currently constructed. My concerns that the AHCA does not do enough to protect Ohio’s Medicaid expansion population, especially those who are receiving treatment for heroin and prescription drug abuse, remain unchanged. We have an opioid epidemic in this country, and I will continue to work with my colleagues on solutions that will ensure those who are caught in the grips of this epidemic can continue to get the treatment they need.

This said, we must not lose sight of the fact that, for many Ohioans,Individuals and families continue to face higher health care costs and fewer choices for health care providers. Insurance companies,continue to pull their health plans from the individual market across the State. Small businesses continue to pay more money for insurance premiums that could have otherwise been used to hire more employees or provide better pay for those they already employ. Congress must provide solutions to these problems, and I look forward to working with my colleagues to do so.

Afterand decreasing choices under the Affordable Care Act, it is clear that the current course of our health care system is unsustainable. Ohio families who are struggling to pay for health care need relief soon. Our nation’sand while changing such a large and complicated system is no easy task, I believe that such change is necessary to ensure affordable access to high quality care for Ohioans and Americans across the country for years to come.

Sincerely,

Rob Portman
U.S. Senator

Dear Bob Latta

Dear Representative Latta,

Thank you for your letter dated April 28 in reply to my letter dated March 7 in regard to healthcare reform. You state that “we need to empower states to deliver health care solutions that lower costs, increase quality, and improve coverage.” Here is why that will never work in Ohio:

The special interests of the health insurance industry are even more cozy with the state of Ohio than it seems they are with Congress, if that could even be possible. It is the lobbyists who control everything in Ohio, from educational luncheons with our legislators, to the wording of laws that are written to control them, to the actual running of the insurance department. It’s so crowded in Columbus with special interests, that there is no room left for the interests of the people who live in Ohio.

I have written to you about these issues several times in the past year, in fact I made an entire website based on these issues, OhioCitizenRateReview.Info.

In case you never read my website, this is what the state of Ohio has done with their empowerment that they’ve had in the past seven years:

1. Ohio lets every rate hike go through no matter what. Every rate hike the insurers want, the insurers get, regardless of how unrealistic it is for the economy of Ohioans.

2. Ohio does this in secret, without “Effective Rate Review”, a “check and balance” that was provided for in the ACA law. With several million dollar grants from the CMS, Ohio was supposed to have set up a transparent system for citizens to be informed and have open discussions about the annual rate hikes the insurers ask for every year. But they don’t. They keep everything as secret as they possibly can.

3. In secret, and without properly addressing my 2015 complaint, Ohio allowed Medical Mutual to eliminate their PPO insurance in the individual market, after granting Medical Mutual rate hikes of 373% over seven years. About 100,000 Ohioans were personally affected by this elimination of Medical Mutual’s PPO, which was the only national network insurance available in Ohio to individuals. This was probably the biggest market share, but Ohio let them do it, without any fanfare, without any discussion, and at the same time, while rewarding Medical Mutual with the state of Ohio’s employee insurance business. Ohio employees get Medical Mutual PPOs, but not the individuals of Ohio.

4. Complaints made to the Ohio department of insurance get buried. So that Ohioans who have problems with insurance companies in the state of Ohio have absolutely no voice and their problems have no resolution.

5. Our provider networks in Ohio are unacceptably inaccurate. This falls under the jurisdiction of Ohio laws as well as federal laws. A new state law was passed last year that was supposed to ensure their accuracy, but Ohio won’t enforce it. Last summer I called all the PCP doctors in the ACA networks in Toledo listed as accepting new patients, 308 doctors, and only 20% were actually accepting new patients. 10% in the “affordable” plans. I informed you, you did nothing. I informed my state representatives, they did nothing. The New York Times reported on it in December. Not a peep from you, but your colleague in Lima, Jim Jordan, spoke out in favor of the flawed directories, saying “It should surprise no one that the Ohio Department of Insurance’s physician directories are so flawed, considering how flawed the Affordable Care Act (ACA) is.”

And now you want to give the state even more control so that they can further pervert our healthcare system for their own personal greedy purpose.

You were elected, Bob Latta, to represent us in Congress. It’s your responsibility to look out for us on a federal level. We didn’t elect you for you to skirt your responsibility and send it back to the states.

We need healthcare to be thought of as a public good, and not a Wall Street money machine. We have a democracy, not a monarchy. Money is not king. You were elected by the people, not appointed by lobbyists who crown you with their favors.

As I wrote in my previous letter, you should be addressing the problems of healthcare costs instead of letting them grow and grow.

It’s absolutely a lie for you to say in your letter that the AHCA will lower premiums by 10% and allow us to keep our doctors. Premiums for those over 50 will go up five times as much as it will cost others, and millions of people will not be able to keep their doctor because they will not be able to afford insurance anymore.

If you can’t give us what we need, or at least enforce the laws that can fix the problems with the ACA, then just leave it alone, so that we can vote you out of office, and elect a Congress who will give us what we need.

Sincerely,

Penny Gentieu

Medicare for All NOW!

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Click on this image to see the Kaiser Foundation’s Interactive Map of Tax Credits under the Affordable Care Act vs. the American Health Care Act, sure to make you very sick when you see what our House of Representatives has been up to in the past two months.

My call to Rep. Latta and follow-up letter on March 7.  Please call too — 202-225-6405

Dear Representative Latta,

How is it right that this country further discriminates against certain groups of Americans when it comes to healthcare?

Why aren’t you addressing the real problem which is the amount of money we spend on healthcare and the rate in which it’s going up each year, at an unsustainable rate which has grown to be 18% of the GNP and is actually estimated to be 30% in 2040?

Why are pharmaceutical companies allowed to price-fix generic drugs to jack up prices by 8,000%?  Why are they granted orphan status which permits extremely high prices on mainstream popular drugs like Abilify, Crestor, and Humira, the best-selling medicine in the world?

What about all the hospital mergers, and the secret prices with no transparency, and the double-digit premium price hikes? What about the skinny provider networks with 80% inaccuracies? What about families plagued with medical bankruptcies?

Since everybody needs healthcare at one time or another, why don’t you treat it like a utility that we all need that is publicly regulated, or like the fire department that is paid-for through taxes?

Instead, the House of Representatives does nothing to address any of these problems. You come out with this extremely regressive, insulting, age-discriminating bandaid to the current Affordable Care Act and call it the American Health Care Act.

Under this law, is it fair that people in their fifties and sixties will be paying five times more than others?  Do you think we really have the money to pay that, when health insurance has already gone up for us 350% in the past ten years?

When the median family income in Lucas County is $41,777, how can you think it’s okay for health insurance to cost $25,000?  Or do you think that healthcare is something only for the rich? Of course the average family can’t afford it. So what do you do but take the subsidies that were income based, and you make them age based, across the board, to everyone regardless of their wealth, to continue this medical industry corporate welfare.

Don’t you think that the underlying costs that make health insurance so expensive should be put in check? Have you considered that the high administration costs, adding up to be at least 30% of our total healthcare costs, could be kept down to 5% if we didn’t have hundreds of insurance companies trying to manage our healthcare, instead of just one manager, such as Medicare?

Do you really think that in 2017, Americans do not deserve healthcare? All Americans deserve affordable healthcare, and it will be affordable when people are put first, before special interests. We demand Medicare for ALL.

Sincerely,

Penny Gentieu

“Yes Ms. Gentieu, you really do live in Russia.”

pg24-25After nearly nine months since I made a query with the Ohio Inspector General to look into certain issues at the Ohio Department of Insurance, I received an email response on March 8, posted below. Coming one day after the unveiling of the utterly regressive Republican answer to our healthcare problems, it’s like they are trying to tell me something.  

“Yes Ms. Gentieu, you really do live in Russia.”

But we live in America and we were promised a better, less expensive healthcare plan that wouldn’t leave people dying in the streets.

(Related: Letter to Rep. Latta)

JUNE 29, 2016
Dear Ohio Inspector General:
  1. The Ohio Department of Insurance is granting double-digit rate hikes without any public review, without lowering the hikes. They are basically working for the insurance companies at the expense of millions of Ohioans, including me, whose insurance went up 373% in 7 years, same company.
  2.  The Ohio Department of Insurance is not releasing public documents to me about consumer complaints.
  3. The Ohio Department of Insurance is not releasing rate review justifications for the public to participate in “effective rate review” — with the 5 million dollars in CMS grants meant for this purpose. Other states save their people millions — even a billion — using public rate review, but not Ohio.
  4. The Ohio Department of Insurance has no problem with health insurance companies advertising phony provider networks. There’s no fine or punishment for lying to the public or to the enrollees, so health insurance companies are allowed to rip us off blind!

None of this seems right; or good in the least for the citizens of Ohio, me included. Please investigate.

Ever since I’ve lived in Ohio, my Medical Mutual health insurance rates have gone up double-digits every year. I’ve had the same, or essentially the same health insurance plan with Medical Mutual. I’m a small business person, so I buy individual insurance. The year the plan went on the Marketplace, in 2014, my Medical Mutual premiums went up 224%! The price of my 2016 Medical Mutual insurance is now 373% more than my Medical Mutual insurance was in 2009! In just seven years it went up 373%! The benefits, including the provider networks, of the Medical Mutual insurance in 2009 through 2016 are basically the same.

All of these rate increases were approved by the Ohio Department of Insurance. I found out recently that the state of Ohio received huge multi-million dollar grants from the HHR to assist in the transparency of health insurance rate reviews, and to assist in the containment of rate hikes. The most recent grant was given to Ohio just this month. What does Ohio do with these grants? Other states have saved their citizens at least a billion dollars in rate hikes by using these funds for “effective rate review.” But not in Ohio. The state of Ohio grants rate hikes just as much as the insurance companies ask them for. Double-digit rate hikes, no problem! And Ohio keeps the process secret from their citizens, who they do not engage in “effective rate review.”

I’m not only robbed of my rights, I’m made to be a stooge to the Ohio health insurance industry, an industry that seems to have the Ohio Department of Insurance wrapped around its finger.

I’m just one person getting robbed, in the company of millions of other people getting robbed too – people facing double-digit health insurance rate increases year after year, whether or not health insurance is a part of their employment or they buy it individually. Unsustainable rate increases are happening to everyone in Ohio. Because in Ohio, whatever the insurance companies want, the insurance companies get.

Have you seen lately how we rank as a state? Ohio is the most expensive state for health insurance, see this April 2016 Department of Health and Human Services Brief, Table 4, page 9.

Not surprisingly, not only is the insurance way too expensive, the quality is questionable. A big problem exists with phony provider networks. I made two complaints to the ODI about this issue (see, CareSource complaint here). I wanted to see what other complaints have been made. I requested public records of health insurance complaints, but my efforts were completely thwarted by the Records Custodian at the Ohio Department of Insurance. After six weeks of hassle with them, they gave me a list of 50 complaint numbers and ODI employees the complaints were assigned to, with no other information — not even the the names of the insurance companies that were complained about!

No doubt a problem exists with phony provider networks, because Ohio has no regulation allowing for a punishment or fine for health insurance companies that have phony provider networks. That wouldn’t be something the insurance companies would want, so the Ohio Department of Insurance doesn’t impose such regulation.

Recently, the Ohio Department of Insurance secretly approved the merger of Aetna and Humana, burying the document deep in their website. It didn’t matter to the ODI that the Ohio legislative Insurance committees requested an investigation and public hearing. It didn’t matter to the ODI that consumer groups requested an investigation and public hearing. The ODI went right ahead and gave the insurance companies exactly what
they wanted, without any consideration to what the public and the elected officials asked for — an investigation and public hearing. A simple investigation and public hearing to consider the pros and cons of a merger between two companies representing such a
huge percentage of the market, and how that would affect Ohioans. Hmmmm……

There’s no other way to put it — it’s like we live in Russia.

It is appalling – the lack of transparency in this state!   And that’s not all.

Is it too much to ask from Ohio for the state insurance department to look after the best interests of its citizens when it comes to healthcare, instead of entirely, quite blatantly, enabling the health insurance industry to take utter advantage of us, and strip away any value to what they are selling, as well?

It’s killing us.

I hope you will consider the issues that I have brought up, and help in these ways:

The Ohio Department of Insurance should release public records upon request. Consumer complaints should be searchable on their website, similar to how they are on the Ohio Attorney General’s website, or better yet, like they are on the Texas Department of Insurance’s website. The ODI should do something constructive with the complaints that consumers make, and not just treat them like hot potatoes that they can’t throw far enough fast enough, that they completely erase after only TWO YEARS!

The ODI should create an effective rate review program like many other states have, such as Vermont. The ODI should not grant every rate hike the insurance companies ask for, rather, they should make the process public, and have public hearings about rate increases, in an effort to keep the annual rate hikes down.

It seems obvious, but the Ohio Department of Insurance needs to start serving the needs of Ohioans.

And finally, the ODI should tell me why they allowed Medical Mutual to raise my rate 224% the year it went on the Marketplace and 373% since 2009. (consumer complaint no. CSD-0034217.)

Their response, nearly nine months later:

Screen Shot 2017-03-08 at 1.37.28 PM

Email to Governor’s Office of Health Transformations

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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

Barbara,

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.

Rep Fedor

Sent from my iPhone

On Sep 13, 2016, at 11:17 AM, Sears, Barbara <Barbara.Sears@governor.ohio.gov> wrote:

Teresa –

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

Barbara R. Sears
Assistant Director
Governor’s Office of Health Transformation
614-752-5024 (Office)
614-325-2500 (Cell)

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 <penny@babystock.com>; Jen.Stack@ohiohouse.gov
Subject: Fwd: Major errors in provider network directories

Dear Barbara,

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.

Sincerely,

Rep. Teresa Fedor

Sent from my iPhone

Begin forwarded message:

From: “Penny Gentieu” <penny@babystock.com>
Date: September 12, 2016 at 7:59:14 PM EDT
To: Barbara.Sears@governor.ohio.gov
Subject: Major errors in provider network directories
Reply-To: penny@babystock.com

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:
http://ohiocitizenratereview.info/provider-networks/letters-to-insurers/

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.

Sincerely,

Penny Gentieu

Penny Gentieu
718-788-0570

Insurers’ Flawed Directories Leave Patients Scrambling

Letter to U.S. Senator Sherrod Brown

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Dear Senator Sherrod Brown,

Thank you for June 10th letter, confirming that Ohio is a state that is required to publicly post rate increase justifications, to provide more transparency to the public. You said that I should share my concerns with the Ohio Department of Insurance.  I did in fact contact the Ohio Department of Insurance before I wrote to you last month. The Ohio Department of Insurance told me that they do not release the rate justifications until they are finalized.

We have a problem in Ohio with the Ohio Department of Insurance interfering in the public’s right to obtain public records.

The Ohio Department of Insurance has also withheld my April request for public records of health insurance complaints, specifically, complaints about provider networks. And I recently found out that the department shreds complaints they receive after they image them, then erase them after only two years from the date the complaint was decided on.  So already they have destroyed two months worth of complaints while they are stalling out the inevitable release of the public records, public records that I am and have been completely entitled to.

I wonder what records the Ohio Department of Insurance has destroyed in those two months during the time I had a right to see them. Why is it they are is such a big hurry to destroy public records of health insurance complaints, with a short, two-year retention schedule? Two years is hardly any time at all, to show trends, to help Ohioans understand the problems and help them solve those problems.

Continue reading Letter to U.S. Senator Sherrod Brown

Letter to Governor Kasich

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Dear Governor Kasich,

This letter is to give you feedback about the Ohio Department of Insurance and ask for your help.

I’m a constituent. Ever since I’ve lived in Ohio, my Medical Mutual health insurance rates have gone up double-digits every year. I’ve had the same, or essentially the same health insurance plan with Medical Mutual. I’m a small business person, so I buy individual insurance.

The year the plan went on the Marketplace, in 2014, my Medical Mutual premiums went up 224%!

The price of my 2016 Medical Mutual insurance is now 373% more than my Medical Mutual insurance was in 2009! In just seven years it went up 373%! Even though the benefits, including the provider networks, of the Medical Mutual insurance from 2009 through 2016 have been basically the same.

All of these rate increases were approved by the Ohio Department of Insurance.

I found out recently that the state of Ohio received huge multi-million dollar grants from the HHR to assist in the transparency of health insurance rate reviews, and to assist in the containment of rate hikes. The most recent grant was given to Ohio just this month.

What does Ohio do with these grants? Other states have saved their citizens at least a billion dollars in rate hikes by using these funds for “effective rate review.” But not in Ohio. The state of Ohio grants rate hikes just as much as the insurance companies ask them for. Double-digit rate hikes, no problem! And Ohio keeps the process secret from their citizens, who they do not engage in “effective rate review.”

I’m not only robbed of my rights, I’m made to be a stooge to the Ohio health insurance industry, an industry that seems to have the Ohio Department of Insurance wrapped around its finger.

I’m just one person getting robbed, in the company of millions of other people getting robbed too – people facing double-digit health insurance rate increases year after year, whether or not health insurance is a part of their employment or they buy it individually. Unsustainable rate increases are happening to everyone in Ohio. Because in Ohio, whatever the insurance companies want, the insurance companies get.

Have you seen lately how we rank as a state? Ohio is the most expensive state for health insurance, see this April 2016 Department of Health and Human Services Brief, Table 4, page 9.

Not surprisingly, not only is the insurance way too expensive, the quality is questionable. A big problem exists with phony provider networks. I made two complaints to the ODI about this issue (see, CareSource complaint here). I wanted to see what other complaints have been made. I requested public records of health insurance complaints, but my efforts were completely thwarted by the Records Custodian at the Ohio Department of Insurance. After six weeks of hassle with them, they gave me a list of 50 complaint numbers and ODI employees the complaints were assigned to, with no other information — not even the the names of the insurance companies that were complained about!

No doubt a problem exists with phony provider networks, because Ohio has no regulation allowing for a punishment or fine for health insurance companies that have phony provider networks. That wouldn’t be something the insurance companies would want, so the Ohio Department of Insurance doesn’t impose such regulation.

Recently, the Ohio Department of Insurance secretly approved the merger of Aetna and Humana, burying the document deep in their website. It didn’t matter to the ODI that the Ohio legislative Insurance committees requested an investigation and public hearing. It didn’t matter to the ODI that consumer groups requested an investigation and public hearing. The ODI went right ahead and gave the insurance companies exactly what they wanted, without any consideration to what the public and the elected officials asked for — an investigation and public hearing. A simple investigation and public hearing to consider the pros and cons of a merger between two companies representing such a huge percentage of the market, and how that would affect Ohioans.  Hmmmm……

There’s no other way to put it — it’s like we live in Russia.

It is appalling – the lack of transparency in this state!

Is it too much to ask from Ohio for the state insurance department to look after the best interests of its citizens when it comes to healthcare, instead of entirely, quite blatantly, enabling the health insurance industry to take utter advantage of us, and strip away any value to what they are selling, as well?

I hope you will consider the issues that I have brought up, and help in these ways:

The Ohio Department of Insurance should release public records upon request. Consumer complaints should be searchable on their website, similar to how they are on the Ohio Attorney General’s website, or better yet, like they are on the Texas Department of Insurance’s website. The ODI should do something constructive with the complaints that consumers make, and not just treat them like hot potatoes that they can’t throw far enough fast enough, that they completely destroy after only TWO YEARS!

The ODI should create an effective rate review program like many other states have, such as Vermont. The ODI should not grant every rate hike the insurance companies ask for, rather, they should make the process public, and have public hearings about rate increases, in an effort to keep the annual rate hikes down.

It seems obvious, but the Ohio Department of Insurance needs to start serving the needs of Ohioans.

And finally, the ODI should tell me why they allowed Medical Mutual  to raise my rate 224% the year it went on the Marketplace and 373% since 2009. (consumer complaint no. CSD-0034217.)

Thank you for your time.

Sincerely,

Penny Gentieu

My email to ProMedica

PG204309-Edit

Dear Dr. Cassavar,

With Open Enrollment of the Marketplace upon us, and many Toledoans having to change insurance plans because our premiums went up so much, many of us have to find new doctors, too. But ProMedica sure isn’t making it easy to for us make an intelligent decision.

In your role as President of ProMedica Physicians, could you kindly make some changes in your doctors’ current lax custom they have of rarely updating their insurance “panel” statuses?

I know for a fact that four years ago, Dr. McAlear’s entire office of physicians was not accepting new patients, because I had a doctor in that group who left to work at the Veteran’s Hospital, and not one doctor in the group could take me. Yet, four years later, those doctors are still listed as accepting new patients!

Last week I called 50 ProMedica doctors on the CareSource network who are advertised as accepting new patients, but actually only two doctors are really accepting new patients. That does not show very good odds for the honesty and consideration of the doctors to the community that they serve.

I looked up these same 50 ProMedica doctors on the Medical Mutual SuperMed PPO network, and I found 47 on this network, and of those 47, 17 are listed as closed, but 30 are listed as accepting new patients when actually only two of those 30 are accepting new patients.

I lived in New York for 27 years, and I never had a problem finding a doctor. Doctors in New York are required to update their status within 15 days of a change. Michigan has similar rules and there is no problem there, either.

I’m sure there is some law that applies to this problem in Toledo, even if Ohio may not have a regulation like that, which I don’t know, but I assume that is the reasoning. I’m not a lawyer, just a Toledoan who has been hurt by this process, and I’m talking to other people who have been hurt too, and I’m trying to make a change for the better.

Couldn’t ProMedica doctors take the lead in our community by providing accurate information on your website and on insurance network lists for your community members? It can’t be that much effort and it sure would go a long way. In a city where ProMedica is building new buildings and has such a big name, ProMedica could show Toledoans that you are listening to their concerns and that you want to help make a better Toledo. You are Toledo’s doctors, but you are also our neighbors and our friends too.

When I hear things like, “It’s been going on for years” from doctors’ offices that will not accept new patients even when they are listed as doing so, I have to think, what does that say about our community, and what is that teaching our kids? It’s got to stop. Please, take the lead, Dr. Cassavar and ProMedica Physicians.

Thank you for your time. I appreciate your consideration.

An open letter to CareNet and Toledo’s leaders and philanthropists.

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An open letter to Carenet, ProMedica, Mercy, United Way, The Stranahan Foundation, Susan G. Komen for the Cure, Lucas County Commissioners, University of Toledo, Buckeye Cable System, UAW, The Kroger Company, the Andersons, the Mancinis, the Blacks, the Blocks, the Petersons, Toledo Community Foundation, Ms. Barbara Steele, and all the other generous Toledo’s civic-minded families, leaders and philanthropists, too many to list,

Did you know that 60-70% of Toledoans receive Medicaid or Medicare? That’s a lot of people.  And  many other people in Toledo have incomes that are between 139% and 400% of the Federal Poverty Level. The price of health insurance has gone up so much – doubling and tripling in just seven years – most people cannot afford $25k per year average premium for a family of four. Even if the median household income in Ohio is $49k – they just can’t manage it. They’ve got kids, they’ve got rent, they’ve got food and car expenses too. Don’t you wonder why health insurance costs more than half of most Americans’ incomes? These people need the tax credit subsidy of the Affordable Care Act. (Until this country can come up with a better idea.)

But, the affordable health plans available to them on the Marketplace include hardly any Toledo doctors accepting the affordable insurance and/or that are accepting new patients, even when they are listed all over the internet as accepting new patients.

There are perhaps 200 insurance plans marketed to Toledoans. But 90% of them are priced way out of the stratosphere for most of Toledo, even for Toledo’s ever-shrinking upper-middle class. (Remember that quaint term, “the upper-middle class?” we don’t hear it much any more in Toledo.)

It’s shocking, but it is true. that the affordable plans, the ones that are affordable according to the ACA law, are few, have extremely limited networks, if in fact any of the doctors listed on the plans’ networks even do accept new patients.

The price we are forced to pay for these far inferior plans, as consumers, as taxpayers, is actually double what we used to pay for our quality Medical Mutual PPO national-network health insurance just three years ago. Double the price! And they are being sold to lower-income Toledoans with no regard to the veracity of the network, with no respect for the quality of care that lower-income Toledoans deserve — after all — it sure is expensive!

How can we pay the insurance industry twice the price of a quality policy that actually costs half as much three years ago, and not get any value out of it? It just doesn’t make sense.

Toledo used to be an industrial town where glass was its biggest industry. Now the biggest industry is ProMedica; it is building new additions at the Toledo Hospital, a big ambulatory medical center in Sylvania, new headquarters and the renovation of the historic steam plant on the riverfront in downtown Toledo. It’s all so wonderful for Toledoans — an infusion of city income tax dollars from the workers, and I’m sure there are other benefits.

Our hospitals and health systems are here in Toledo, and obviously their purpose is to serve Toledo. To serve Toledo within the economics of the Toledo market, not at Beverly Hills prices, that maybe only .1% of Toledoans can really afford. But those 243 people go elsewhere for serious healthcare.

Why don’t more doctors at ProMedica accept the affordable health insurance, like Ambetter, HealthSpan or CareSource? Is it because these insurance companies don’t pay? Doesn’t a new insurance that costs two times as much as a similar but quality insurance cost three years ago have the same reimbursement rate as a long-standing insurance plan? If not, please let us know.

That would be a good start.

200 health insurance plans (just guessing), a consolidated health system in Toledo, yet each doctor is responsible for signing contracts with so many different health insurances, and gee-wiz, it is so much trouble to keep up with their internet profiles. Maybe ProMedica should simplify this for all of their doctors and simply accept all 200 insurances, which should be paying all the same after all, and ProMedica, etc. like Mercy and Toledo Clinic, should be responsible for keeping up internet profiles of doctors in their ever-growing universe. Or maybe advocate for some health insurance that is more universal if they think this system is too difficult. Because we the citizens of Toledo, Ohio, find it very difficult too.
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