Consumer Complaints

PG203129Does the public have the right to see the consumer complaints filed with the Ohio Department of Insurance?

Consumer complaints are public records in Ohio and other states, but in Ohio they keep them close to their chest. Not so in other states, check out Texas. Texans made 6,593 health insurance complaints in 2015. You can access 13 fields of information in this online database that you can download from their state insurance website.

I’ve asked the Ohio Department of Insurance for consumer complaints about provider networks and provider network directories, but they are not easy to get.

I’m just an ordinary Ohio citizen who has to buy health insurance. I happen to be concerned about inaccurate provider network directories. I made two complaints about inaccurate provider network directories, myself. See, here, and here. I’d like to know how many complaints have been made by others. If there are a lot of complaints, I’d like to know what companies are the worst, because I want to avoid those companies. And I’d like to know what the Ohio Department of Insurance is doing about it. That shouldn’t be too much to ask.

But it took seven emails, a letter to the attorney general, a letter to the governor, and a complaint to the inspector general before they sent me the complaints, when finally, after three long and determined months, I received SOME of what I asked for.

What I found out is that provider network complaints get buried. They get shoved over to a department where BY LAW (Ohio Department of Insurance’s own convenient rule) the investigations and results, and even the fact of whether or not there is an investigation at all, is completely confidential.

The new law in Ohio regarding provider directories was written so that the state requires very little from the insurer — the insurer is only obligated to update their directory if a provider or facility lets them know of a change, or else if they see something come in, like an out-of-network bill, that might tip them off that their directory needs updating. The insurer is leaving it up to the doctors, and they are blaming it on the doctors. The insurer is not required to do anything proactive to verify the correctness of their provider network directories, not even once a year. The insurers are completely off the hook — and even if enrollees tell them, well, technically the law says that the insurers have to be informed by the doctors themselves.

In the unlikely event that the insurer is found to be in violation, there is no fine. Therefore, there is no incentive to follow the law.

Furthermore, if there is an investigation within the Ohio Department of Insurance that is brought about due to this law, the Superintendent can keep all the documents secret from the public — nothing is a public record — they call it privileged work product.

So no wonder I discovered an aggregated average of 80% INACCURACIES in my Ohio Citizen Provider Network Survey, Summer 2016.

In California, the citizens, legislators, regulators and watchdogs do not allow this to go on. In November 2015, California fined Anthem and Blue Shield $250,000 and $350,000 respectively for “unacceptable inaccuracies” in their provider directories, and they will be paying millions of dollars in damages to the members hurt by the misleading directories as well. We have Anthem here, and my survey shows major flaws with Anthem’s provider directory, in fact with the same characteristic flaws found in California. Did the California scandal even faze Anthem in Ohio? Hell no, because Ohio buries their provider network complaints under the shrouding of secrecy so that Anthem and all the rest can keep doing what they are doing, and who is going to tell them they can’t?