PG231667Last summer, a woman in Dayton, Ohio made a complaint to the Ohio Attorney General that she and her husband bought a Molina Marketplace plan because their doctors were listed on it, but when they tried to schedule appointments, the doctors didn’t actually take Molina. Molina had in fact issued her a card with those doctors names on it. She asked the Molina call center to help her find a doctor, and the customer service representative called all the doctors in her area, and couldn’t find her one doctor in the Molina network. She faced having to pay for this insurance for an entire year – $10,034 for absolutely nothing!

“They baited us into choosing this insurance plan by listing doctors who do not accept their marketplace insurance product and we are now stuck until the next open enrollment period.”

Bait with doctors and switch to nothing.

Here is how Molina’s advertised provider network of primary care doctors stacks up to other Marketplace provider networks in Toledo, downloaded on July 16, 2016. 13 out of 57 doctors on Molina’s Internal Medicine list are listed a total of 25 more times on the list with one doctor listed 7 times. The duplications nearly double the apparent size of the network, which shows 57 internal medicine primary care doctors.

Ohio Citizen Rate Review Provider Network Survey, Summer, 2016
Ohio Citizen Rate Review Provider Network Survey, Summer 2016

Only one of the seven Toledo Clinic doctors on the Molina provider list actually accepts Molina insurance.

But only thanks to the Mercy Health providers, Molina actually has the most primary care doctors available to accept new patients. See, my Ohio Citizen Rate Review Provider Network Survey, Summer 2016. Molina has a mere 77% rate of inaccuracies; 59% inaccurate if you subtract all the duplications. Although that’s nothing to brag about, it was refreshing to hear that many yeses in a sea of so many no’s.

Ohio Citizen Rate Review Provider Network Survey, Summer 2016
Ohio Citizen Rate Review Provider Network Survey, Summer 2016

Molina currently has 10,878 members, and their projected membership for 2017 is 19,083. The Toledo area has 556 members in 2016, up from 383 in 2015. Molina projects next year’s Toledo membership to nearly double, expecting a 10%+ market share of the area sales.

Molina covers 325,000 Ohioans in Medicaid and Medicare plans. They serve 3.5 million members in 11 states and Puerto Rico. The Molina CEO’s compensation was 11.9 million in 2013.

Molina anticipates a 5.9% increase in unit cost (4.8%) and utilization (1.1%). Molina calculated a medical loss ratio (MLR) for 2017 of 88.1%, itemizing about 2% on “quality improving activities” and about 78% on incurred claims. Molina expects their new members to be healthier, with nearly the same age mix as in 2016.

Molina expects prescription drugs to cost 6% more next year, with a 2.5% increase in the use of the drugs.

A Wakely Consulting Risk Survey that Molina participated in estimated a risk transfer receivable of $67.03.

Molina is asking for an aggregate .9% decrease in rates next year. The range of the rate change will be from -6.1% to +9.7%.

Look out, Ambetter by Centene! Molina’s coming after you for the SLCSP benchmark plan. I wonder, does the government give a bonus to Centene (and Ambetter) or Molina for reducing their rates (which lowers the tax credit / subsidy the government pays) as a backdrop for the other insurance offerings to raise their rates by double-digits, rates so high, they become more than half the median household income? Is this in the grand master plan, to get everyone out of “real” insurance? Do the provider network inaccuracies matter little, in the government’s scheme of things? We may be lucky in Toledo, but think of the woman in Dayton last year.

Molina is a giant managed care organization for Medicaid and Medicare, making megabucks from the U. S. government, like Centene’s Ambetter. Both are now competing for the Marketplace market. According to my provider network survey, Molina has the most potential for integrity. If only Molina could do a little bit better.