Category Archives: Ohio Department of Insurance

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.

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 left hanging an estimated 100,000 people covered by their PPO plans, completely exiting  and extinguishing the sale of PPO’s in the individual market,  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 After all, our commercial insurers in the individual market (Anthem, Medical Mutual, United Healthcare, Aetna) have been replaced by Medicaid insurers (Buckeye Ambetter, CareSource, Molina), and since all of Ohio is covered for Medicaid, it makes sense that these insurers can also cover all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.

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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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.