How Other States Do It

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This page is for a collection of quick notes and links to what we can learn from other states about rate review and their state regulators. Our insurance regulators should not be our adversaries, they should be our partners.

California

California did this about insufficient and inaccurate provider directories:
  • November 2014: FINAL REPORT NON-ROUTINE SURVEY OF ANTHEM BLUE CROSS,  Department of Managed Health Care:
  • [May 2014]...The Department then conducted a telephonic survey of a statistically valid, randomly selected sample of physicians taken from the online directory. The purpose of the telephonic survey was to obtain confirmation of the physicians’ contracting status and availability to take new patients. The survey was designed to duplicate the consumer experience...
  • Consumer watchdog sues two more insurers over narrow networks
  • This week, Consumer Watchdog filed two lawsuits alleging that Cigna and Blue Shield of California misled consumers who enrolled in their health plans about the size their provider networks, Kaiser Health News' "Capsules" reports
  • January 2015: Bill would require insurers to improve provider network lists
  • Several California insurers have been sued over inadequate networks. In addition, a Department of Managed Health Care report in November 2014 said that Anthem Blue Cross and Blue Shield of California violated state law by misleading consumers about the size of their provider networks (California Healthline, 11/19/14).
  • Anthony Wright, executive director of Health Access California, said the findings are "deeply troubling," adding that DMHC should "impose fines and more importantly corrective action plans on insurers that can't keep their most basic commitment to consumers to have accurate and adequate networks and access to care"
Dear Legislature,
 Please do something about health insurers' inaccurate provider directories and the sneaky practice of charging patients for out-of-network services at in-network hospitals. Like, now.
 Sincerely,
 The Times' editorial board.
  • Summer 2015 survey reported July 2016: Inaccurate Provider Lists A Major Barrier To Care, Study Finds
  • About 10 percent of the time, the providers either were no longer with the medical group listed in the directory or never had been.
    
    In about 30 percent of cases, the callers were told that the doctor had a different specialty than the one listed in the directory. Roughly 20 percent of the time, the callers were unable to reach the doctors at the numbers listed in the directories — despite repeated attempts — because the lines were disconnected, messages weren’t returned, or for other reasons. In about 10 percent of the cases, the doctors did not accept new patients.
  • October 2015: Anthem enfactions: 1446568488109.pdf

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  • November 2015: Anthem and Blues Shield were fined $250,000 and $350,000 respectively, for having “unacceptable inaccuracies.”  DMHC/ newsroom/ 2015/ pr110315
  • “An important element of access is ensuring enrollees have accurate provider directories,” said DMHC Director Shelley Rouillard. “The DMHC has taken enforcement action and fined Blue Shield and Anthem due to unacceptable inaccuracies in their directories. These inaccuracies limited enrollee access to care that resulted in an unacceptable consumer experience and must be fixed.”
  • Study finds access to health insurance does not ensure timely appointments
  • “Although the accuracy of network listings is a separate issue from adequacy, the network is only as adequate as the information it contains is accurate,” Mukamel said. “Network listing accuracy impacts both a patient’s ability to access providers and the regulator’s ability to assess adequacy.”
  • Directory Assistance: Maintaining Reliable Provider Directories for Health Plan Shoppers

Pennsylvania

Public hearing rate reviews

Vermont

Vermont is consumer oriented.

Vermont takes affordability into account for the good of the people.

Insurance needs to be affordable, and healthcare needs to fit in to the reality of the economy of the people they serve.

My insurance went up 373% in seven years, when during those same seven years, the median income in Toledo, Ohio went down 11%. How am I supposed to pay for it, and if I can’t, do the insurers take government money to pay for it? Do they expect an endless supply of taxpayer money while naming the price? Health insurance is so expensive today that 50% of the population are on Medicaid or Medicare. And now ACA subsidies cover about 80% of healthcare.gov total sales. Yet hospitals are becoming conglomerates and raising prices through the roof, and pharmaceuticals are out of control, and costs are expected to go up every year so that in the year 2025, we will be spending over $17,000 per person per year in the United States, x 300 million people = $5,100,000,000,000! It’s already 20% of our gross domestic product. Soon it will be 30%, then 40%, then 50%, then 60%….

Here’s an example of how we could set up our rate review page.

Here’s a good website: Vermont Workers Center.

Here is Vermont’s rate review public hearing process in action: Advocates tell Regulators: Reject Blue Cross price increase

Oregon
  • Oregon used some of its federal grant money to contract with a consumer advocacy group, the Oregon State Public Interest Research Group Foundation (OSPIRG), to analyze proposed rates.
  • “We’re not going to have the same resources as the insurance companies, but the grant has been a really significant help in devoting resources to doing analysis and getting more people involved in the process, says Laura Etherton, OSPIRG Foundation Health Care Advocate.
  • Accountability in action – rate review cuts over 24 million waste 2015 health insurance
Colorado
New York
Iowa
Washington
  • Search rate increases interactive webpage, where you can search, and leave comments, and see others’ comments. Search health insurance rate increases
  • Here’s a page where you can compare details of insurance companies:
  • Welcome to Insurance Commissioner Mike Kreidler’s Health Carrier Financial Information Page.
    
    This page was created as a result of legislation Commissioner Kreidler requested in 2006. Its purpose is to help consumers understand and compare the efficiency and financial condition of each health carrier in Washington....
    
    ...This page allows you to compare up to three carriers at a time. A comparison will show a variety of information including:
    • Medical loss ratio – how much a carrier pays out in benefits compared to the amount of premium they take in.
    • Administrative costs – this includes the total amount of general administrative costs as well as the five largest non-medical expenses.
    • Average monthly premium for each of the carrier’s plans
    • Amount of surplus
    • Profit margins
Wisconsin
CMS The Center for Consumer Information & Insurance Oversight Regulations and Guidance

Question for Lt. Gov. and Director of the Ohio Department of Insurance: Why don’t we have any of this?

Here is the NAIC website for complaints, a few are listed here: https://eapps.naic.org/cis/