Category Archives: Ohio Department of Insurance

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.