Category Archives: Ohio Department of Insurance

UHCAN’T Find a Doctor

An Open Letter to the Board Members and Partners of Ohio’s UHCAN (Universal Health Care Action Network):

All of Ohio can thank UHCAN (http://uhcanohio.org) for sabotaging our healthcare in the individual market. UHCAN is our watchdog, they get grants to advocate for us, and shame on them for not doing their job.

We have an opioid epidemic in this country and Ohio ranks first. Could Ohio’s 90% inaccurate health insurance provider networks have anything to do with it?

It was recently reported that 715,000 Ohioans gained coverage through the ACA expanded Medicaid, and that 215,000 of them are seeking treatment for opioid addiction. Wow. One third.

We can assume that a good percentage of the Marketplace consumers are also in need of treatment. But when they are faced with a brick wall finding a doctor, after they have signed up for a plan, they are unable to get treatment, so they continue to use, and some of them die.

One year ago, last July, I went to a lot of trouble, all on my own time, to call every PCP doctor listed on every plan sold in my city, Toledo, doctors listed by the insurers as accepting new patients. 308 doctors in total. I discovered that the plans being sold are grossly inadequate, and average of 80% inaccuracies, two in fact had 90% inaccuracies! I made complaints to the insurers, to my elected representatives, to UHCAN, to the Ohio Department of Insurance.

It was a story big enough for the New York Times to report, on December 3, 2016.

Kathleen Gmeiner, a lawyer at UHCAN, was all set to send my complaints to an important contact she had at CMS. Even though she was aware of my complaint for several months, she waited the entire Fall, and then, ready to send the info in December, she was told by the director, Steve Wagner not to bother after all.

She didn’t send it, she tells me now in an email, because:

Once Donald Trump took office it became clear that the new administration was giving states a lot of flexibility and it would be unlikely anyone in the new CMS would aggressively require Ohio to take more steps around network adequacy.

Depression over the newly elected president?

Or was it depression because UHCAN’s grants were about to dry up?

UHCAN couldn’t even do that one thing that I presented to them on a silver platter.

No administration would allow insurance companies to have 90% provider network inaccuracies. To take our healthcare money and squander it away, especially when we have an opioid crisis in Ohio, is not anything the CMS would condone.

How presumptive of UHCAN to decide on their own that our nation’s overseers of medical spending and the administration of Medicaid and Medicare would not care that Americans are getting ripped off by inadequate and misleading, highly inaccurate provider networks. For UHCAN to withhold my information from the CMS is outrageous, unacceptable, and disgusting. And what a waste of grant money!

No wonder Ohio has the worst statistics for drug addiction. Our entire state, including UHCAN is sick. What drugs are they on at UHCAN, that makes them so heartless, that they can’t advocate for the people of Ohio, the sole reason for their existence?  90% inaccurate provider networks; people dying in the streets.

Yet another example of mis-used grant money.  Grants SHOULD be cut going to UHCAN Ohio. Because after all, UHCAN’T even do this one little thing to help Ohioans get healthcare after they buy health insurance!

UHCAN’T find a doctor on provider networks, and here we have an opioid epidemic!

You CAN, and you MUST, do better than this!

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Steve Wagner, director of UHCAN Ohio, on the UHCAN Ohio Facebook page, June 29, 2017, and my comment.

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UHCAN'T be serious, your mission is to achieve high quality, accessible, affordable health care for all Ohioans? Really?

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UHCAN's partners

Look who is UHCAN’s partner — CareSource, with their 90% inaccurate provider networks! Conflict of interest, to say the least.

2018 Rate Review Observations

Anthem is the only insurer right now in 19 Ohio counties, and in 2018 they will be exiting the Ohio individual market, except for one teeny tiny county, Pike, for a non-exchange plan that probably has 5 members, just so they can keep their foot in the door and not be banned for five years in case they want to come back. Awe.

Isn’t a market-driven health care system great.

Anthem has about 18% of the individual market in Ohio, and they insure millions of Ohio corporate and state workers. 40,000 individuals are presently covered by Anthem, and 10,000 people may not be offered any individual plan next year as a result.

In Toledo, Anthem has the worst, smallest provider network, and it was 66% inaccurate. It is highly expensive, and went up quite a bit last year.

Anthem more than tripled their premiums in seven years, just like Medical Mutual did, who removed themselves just this year from insuring an estimated 100,000 covered lives with their PPO plans, thus eliminating the only national network plan sold to individuals in Ohio. Last year two insurers covered nearly 50% of the Ohio individual market, and now they are gone.

Also gone this year is United Healthcare and Aetna, so just like that, our four largest insurers of the individual market are gone from the individual market, and Ohio let them, even rewarding the insurers with our state employee insurance business. Ohio either has no business sense, or our state really doesn’t care whether or not 300,000 Ohioans can buy insurance in the individual market.

Four things that Ohio can do to mitigate this healthcare crisis:

1.

Ohio should do what New York is doing this year, and ban insurers who leave the exchange from any future participation in public programs such as Medicaid.

Governor Cuomo announces aggressive actions to protect access to quality affordable health care for all New Yorkers  New York State website
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2.

Ohio should propose a Medicaid buy-in for anyone in the state, like the plan that Nevada’s legislature just passed for it’s citizens. After all, our commercial insurers in the individual market (Anthem, Medical Mutual, United Healthcare, Aetna) have been replaced by Medicaid insurers (Buckeye Ambetter, CareSource, Molina), and since all of Ohio is covered for Medicaid, it makes sense that these insurers can also cover all of Ohio for the individual market, and with great ease.

Nevada’s legislature just passed a radical plan to let anybody sign up for Medicaid  VOX
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VOX

3.

Ohio should pass an emergency “any willing provider” law so that citizens can take their insurance dollars to any provider willing to accept them and the payment. At an average of 80% inaccuracies in our provider networks, have the worst that have been reported in the entire country! It’s only civilized that Ohio gives us an”any willing provider” law.

4.

Oscar Insurance Corporation of Ohio, a new insurer for Ohio this year, should cover all the counties that Anthem has left hanging.

But they won’t be covering even one of them. It comes to Ohio to set up shop with Cleveland Clinic in the five counties around Cleveland.

It’s a perfect example to show why market-driven health insurance does not jive with societal needs, and it never will.

Click the photo to visit Oscar’s News page

(Dream on, hoping for a private, for-profit insurance industry to voluntarily go into 19 counties for the business of a mere 10,000 people who won’t otherwise have insurance, when the company can get the same business by simply marketing to the east side of Cleveland. But for some reason, the for-profit, so called “free market” health insurance model persists. And it has nothing to do with what is best for our country.)

5.

Here’s something the federal government can do: Open up the D.C. Exchange to people without an option, as per U.S. Senator Claire McCaskill’s proposal.

McCaskill proposes expansion of DC exchange Columbia Daily Tribune, May 18, 2017
Check out this video clip on McCaskill’s Facebook page from June 9, where she asks the Senate for a hearing on the secret health insurance plan that the Republicans are going to impose on Americans without any discussion with Democrats or the public!

The D.C. Exchange sells insurance for everyone in the country, that is, everyone who is a member of Congress or their staff. I have researched the plans and found that they are really inexpensive compared to what is sold in Ohio. Moreover, it’s quality PPO insurance with national provider networks.

At one time, the ACA was going to have just one exchange for the entire country, like this exchange in D.C. But then the insurers got their mitts on the shaping of the ACA. They sliced it up into hundreds of different state and county plans. Four short years later, insurers are leaving, and hundreds of counties will have no insurance option. It seems logical to open up the D.C. exchange, for everyone. What would be wrong with doing that?

Click on the photo to visit the DC Health Link

On a final note, the chart below shows the three largest insurers in Ohio, from a report made to the state of Ohio by the actuarial company, Milliman, in 2011. I added to the original chart in light blue, to show the individual rate increases since 2010. (The dark blue along with the red and green show the 2010 rates.)

With the withdrawal of Anthem, none will be in the individual market next year! Our three biggest insurers in the individual market in 2010, gone!

It’s no wonder, because our regulators let their rates go up over 300% in 7 years, while the rates for the group plans went up only a total of 30%. Wow. You’d think that all the new members of these plans had leprosy. I hope they are cured, at least.

Divide, divide, divide. Divide and subtract some more! The huge free market health insurance system is so close to knocking off those 23 million people who just don’t fit in their money-making calculations.

Click on the chart for an analysis of seven-year rate hikes

See this page for directions on how to research Ohio insurance rate filings and submit comments.  http://ohiocitizenratereview.info/rate-reviews/how-to-make-comments/

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

Healthcare Insecurity

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The brand-new barrier that Ohio and Medical Mutual have put between patients and healthcare: the elimination of PPOs in the individual market.

While ProMedica doctors survey their patients’ “Food Insecurity,” (ones who can get in to see ProMedica docs, because when you call them from the insurers’  lists of accepting new patients, they actually really are NOT accepting new patients) I’m experiencing “Healthcare Insecurity.”

Medical Mutual eliminated our “real insurance” PPO plan on December 31, 2016. In 2013, their PPO was the only kind of insurance they offered to individuals, and there were 101,380 of us covered by their PPO insurance, more than 25% of the entire Ohio individual market and the biggest market share of any insurer in the state and it remained like that through 2015, but in 2017, Medical Mutual , after raising our rates more than 300% during those three short years, is putting us all out on the street.

No more PPOs anymore for the individuals of Ohio who buy their own health insurance — only skinny, extremely inaccurate provider networks for us.

We must either resign ourselves to our fate, that can we no longer have the best healthcare, like the people have who work for the state of Ohio or for big corporations, or we must marry for health insurance, simply so we can have a chance for decent healthcare along with everyone else.

To think that Mary Taylor and the state of Ohio did not look out for us when Medical Mutual withdrew PPO insurance from the individuals. Not a peep about the pending doom, and my complaint got buried.

Yet the state of Ohio gives themselves Medical Mutual’s PPO as the state employees’ health insurance. In fact, in the past nine years, Medical Mutual made an average of $192,000,000 per year insuring Ohio state workers.

Shouldn’t the state of Ohio have said to Medical Mutual, if they were going to eliminate PPOs for individuals, thereby hurting 100,000 Ohioans directly and damaging the options of all Ohioans, then they will no longer be getting Ohio’s state employee insurance business?

The state of Ohio and Medical Mutual are working in concert to snuff out individuals. Are they stupid or are they sly foxes? What’s next — the state using grant money to give themselves an art show called “After Hours”?

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Advice to Shoppers

pg245841We get the shaft: we’re the tiny percentage of the American population who must buy Obamacare health insurance, because we don’t get health insurance from an employer, whether it be a large corporation or the state or federal government, nor do we qualify for Medicare or Medicaid which together cover 50% of the population.

For us, the individual health insurance market, a mere 5% of the population, Obamacare is highly fragmented, with about 600 risk pools and 300 different carriers — shouldn’t we have just one?  We would not only be able to have an honest choice of providers, we’d have bargaining power as well, and we could save 50% just on administration costs because providers wouldn’t have to spend half their time on the phone with so many insurers. We could endeavor to attain the highest standard of health, as is our right as human beings, right along side the rest of the U.S. population, right along side our neighbors with the employment and the government PPOs.

However, we, the individuals who have to buy our own insurance, are forced to choose from several packs of lies in the current, discriminatory, Obamacare system. We are forced to pay more than double for less than half of what we got just three years ago before the “Marketplace.” We get only inadequate and inaccurate provider networks to choose from, because PPOs have been taken away from us, replaced by tiny newly-invented networks that are on average 80% inaccurate. None of the networks are adequate according to the standards issued by the CMS.

Our representatives and regulators know all too well about the inaccuracies but they do not care enough to demand that the insurers fix it. Consumer law apparently doesn’t count with health insurance, which is many households’ largest monthly budgeted item, as well as almost one-fifth of the entire U.S. economy. Only state insurance regulators, along with the CMS, can demand corrections. But they don’t either, because as we all know, insurance companies run the show and run the legislature. Corruption abounds. We the people all suckers to the health industry must accept our situation, because we have no voice. Buyer beware and carefully consider your options.

Make sure to have a doctor in the plan before buying a plan. Good luck.flyer-11-10

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.

Unfinished

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Today is the day that the Ohio Department of Insurance said that they would have an answer on my appeal of their complete denial of any wrong-doing by Medical Mutual brought up in my complaint dated October 27, 2015, consumer complaint no. CSD-0034217.

I asked them to specifically look again at the issues of pricing and inaccurate provider network directory. Why did our plan jump 224% when it went on the Marketplace? And their otherwise double-digit rate hikes for years besides that.

I know what to expect, because I know who they work for. So I just want to get this on the page now, before I am completely depressed.

On Monday, I received a phone message from Kaylee (no last name, no phone number) at Medical Mutual, who said that we are paying $134.63 less a month than the actual amount we are paying. She said if I have any questions, to call healthcare.gov.

That was weird. $134.63 less. Hmmm…..

Then I received this letter from Medical Mutual, that had no contact information at all, no email address or phone number, just that I should call the Marketplace about a case number*:

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So I called healthcare.gov to ask them about that case number. I spoke to Felicia on a long phone call, who found nothing, and she had her supervisor research it, who found nothing, as well. The case number does not exist.*

I called Medical Mutual, but I was not permitted to talk to Douglas J. Bennett. From my call, I’m not even sure he exists.*

It wasn’t the first time Medical Mutual pawned things off on healthcare.gov. See, this, about their $0 premium mirror plans.

Here is a chart showing how much my Medical Mutual health insurance premiums have gone up:

2009 2010 2011 2012 2013 2014 2015 2016 2017
$413 $454 $425* $476 $560 $1,255 $1,355 $1,542 $?,???

How is that good? I’ve written more about rate increases and affordability on the page, Medical Mutual 7-year rate increases.

Enclosed in the Ohio Department of Insurance’s February 24 closing package (meaning, they were finished with my complaint) was Medical Mutual’s reply letter to my complaint, specifically this justification:

“All of our rates are filed, reviewed and approved by the Ohio Department of Insurance (ODI), so we are confident that this process assures us and our members the rates they are being charged are valid.”

That was all that was needed for the Ohio Department of Insurance to dismiss my pricing complaint.

Does the Ohio Department of Insurance exist for the citizens of Ohio or does it exist only for the wealth of the health insurance industry?

to be continued…

UPDATE AUGUST 23:
  • *The Ohio Department of Insurance’s explanation: “The company goes on to state that HICS E1604930964 was not a fraudulent case number and Mr. Bennett does not work in their Customer Care Center; therefore, he does not take calls.”

And there you have it!  That is simply all it takes — They are the billion dollar boss! Their billion dollar words carry so much weight, they don’t even have to say much of anything at all. A couple of words will suffice! And I will never know why they said on the phone message that my premiums are $134.63 less than what they actually are — they skipped over that little issue — or why my premiums jumped 224% in 2014 because their answer to that is rock-solid:

  • All of our rates are filed, reviewed and approved by the Ohio Department of Insurance (ODI), so we are confident that this process assures us and our members the rates they are being charged are valid.

As for the ghastly provider network inaccuracies, the ODI explains:

  • At the time of the occurrence there are no Ohio Revised Code that specifies requirements for provider list information and maintenance.

Are you sure? But what about now, I asked….

  • 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.
  • 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.

139 doctors on their list marked as accepting new patients, but when you call them, they aren’t….okay, great, thanks….and I have to pay good money for this?

  • Your public records request to the Department for Medical Mutual’s 2014 actuarial information and initial rate filings for exchange plans has been forwarded for review and fulfillment. Please understand that some records may not be available due to state retention schedules.

Cool. Hope to get to figure out the actuarial reason why my premiums jumped 224% in 2014 before you burn the evidence.

More about my thwarted complaint.

Public Records request for rate filings

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I submitted this request to the Ohio Department of Insurance for 2017 rate review filing public records on May 16:

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Their response on May 23:

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My reply on May 23:

Dear Ms. Washburn,

What do you mean by HIC? When will you approve the rate filings? Doesn’t Ohio have an “Effective Rate Review” where the public can contribute to the rate review process? If so, then I would like to see the filings. According to the CMS, Ohio has an “Effective Rate Review” process. I would appreciate your prompt relpy. If you could please note what law you are relying on to deny me access to these records at this time, I would appreciate knowing that, too. Additionally, Medical Mutual does sell on the Exchange.

No answer to that.

My first request on April 21 below:


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Would you think they would lie about something as important and serious as the public’s right to see the actuarial memorandums and rate justifications before the rates are approved?


The link they gave me to access approved filings was on a 2013 press release webpage:

http://insurance.ohio.gov/Newsroom/Pages/06062013ACAProposedRates.aspx

Then you have to follow the links through the press release:

But you won’t get in like that. You have to go back to their 2013 press release about how much more health insurance was going to be in 2014 on the Marketplace. For some funny reason, they put the link there. That’s the secret way in!

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Error message you get when you don’t know the secret passageway.

Here, you will find the corresponding highly redacted documents, that should not be highly redacted, because all the information is crossed out that is meant to mathematically substantiate why the rates are going up so much, but we need to see those numbers and double-check the math. I don’t know for sure, but I will take an educated guess that Ohio could, but they don’t, require these issuers to disclose all those important numbers on the redacted-for-trade-secrets version of their rate filings. The numbers, naturally, are very basic public information — the reasons why, are not trade secret!!  Obviously, CMS requirements exist for this disclosure, since it’s the fundamental principle of effective rate review.