Medical Mutual

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MedMutual-ProMedica provider network

You would think, from the name of this new HMO, that it would have a network of ProMedica doctors. But there is exactly one ProMedica primary care physician accepting new patients, in a sea of 54 falsely advertised ProMedica PCP doctors listed on the healthcare.gov-linked provider network directory as accepting new patients.

Besides that, the provider network lists a total of 136 PCP doctors accepting new patients, but in fact only 20 of the 136 are actually accepting new patients when you call them and ask. You’ll be hard-pressed to identify those very few doctors on the list, but here’s a hint: they are mostly Toledo Clinic doctors, a Mercy doctor, a doctor at a mental health facility, and a couple of independents.

Two out of 50 Indians-2

I called ProMedica’s one doctor accepting new patients in July for an appointment. I was told that he was booking in October, and to call back in one month to get an appointment, because his calendar was not yet available to make appointments. So even that one ProMedica doctor accepting new patients is a mirage, until an appointment can actually be made!

Only 20 doctors are accepting new patients, including only one Promedica doctor, on a provider network list of 136 doctors listed as accepting new patients, makes 85% of the list extremely misleading, falsely advertising the plan’s product and breadth of provider network, and why?

None of the 22 Promedica PCP physicians at the new Health and Wellness Center will be your new doctor –– not one!

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The cross-outs in these photos taken at the new ProMedica Health and Wellness Center are 22 of ProMedica’s 53 doctors that listed on the provider network databases as accepting new patients, but when you call them, they are not accepting new patients. See: Ohio Citizen Rate Review Provider Network Survey, Summer 2016

MedMutual SuperMed PPO provider network

Meanwhile, the Medical Mutual SuperMed PPO local provider network for the insurance I now have is also very inaccurate. I have made detailed complaints to the Ohio Department of Insurance about the inaccuracies I found in the provider network directory. They ignored it initially,  so I asked them to look again. This is their final determination, after 10 months:

Under current regulations the network directory is required to be updated at least quarterly. 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.

 Really? 70% inaccurate is okay with you?

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.
Blame it on the doctors.

How can Medical Mutual and the Ohio Department of Insurance honestly put the onus on the doctors, considering what the doctors offices shared with me, during my research for the Ohio Citizen Rate Review Provider Network Survey, Summer, 2016? Here are some of the things the doctors offices told me, ones who are listed on the Medical Mutual SuperMed PPO provider network as accepting new patients, when I asked them why they were on the provider list as accepting new patients, when they were not accepting new patients:

Seven said they keep calling to have the list changed but they don’t update, one moved to Arizona, one moved to California, one moved to Oak Harbor, one moved to Bowling Green three years ago, two are retired, one isn’t practicing anymore, two you must pay an additional annual membership fee of $1,650 and they still take your insurance,  two are geriatrics only, two more only see patients in the nursing home, one more only sees patients in Hospice, two only see mental health patients, five said they have no control over the lists, one only sees Owens Corning employees and asked twice to be taken off the list, eight screen for age, address, state of health and doctors you’ve seen and then decide if they are accepting new patients or not, 11 do not accept new patients but their residents do, 12 do not accept new patients but their nurse practitioners do, one is not practicing medicine anymore, two are not PCPs, one only sees addiction program patients, one is a hospitalist, one is a hematologist, one is a sleep doctor, one sees only adolescents, three are sports doctors, six were not locatable, one said they put doctors on the list without asking and they never update them, one said they haven’t accepted new patients for 30 years, etc., etc., etc….

Bait and switch

Can Chrysler sell you a car with only one wheel, not four? You can’t get very far with one wheel.  But that’s what they gave you, after you signed on the bottom line. You complain to the state attorney general, but your complaint goes on deaf ears?

You buy an expensive insurance plan with a network of doctors, only to find out that they lied about the provider network — using the doctors’ good names, they baited you with doctors and switch you to registered nurses and residents. Or nobody at all. That wasn’t the deal.

Our Ohio Department of Insurance, which seems to exist for the insurance companies and not for the people, does nothing about it. The Ohio Department of Insurance puts complaints about provider networks behind closed doors, shrouded in secrecy, nobody is allowed to know anything about anything, ever…. and the Ohio Department of Insurance claims to be allowed to do that by law.

But that does not make phony provider network directories fair or right.

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Your money or your life!

What else is new?

For 2017, Ohio’s insurer since 1934 has eliminated its “real insurance” SuperMed PPO that includes a national network, including the expansive and expert network of accurately listed Ann Arbor doctors and providers who are actually available to patients — imagine that — and gives us a narrow-to-nothing, dishonestly advertised, joke of a network HMO — the MedMutual-Promedica HMO described above, which was new in 2016 and is projected to have 3,320 members in 2017, all in the Toledo area, up from 1,152 in 2016, apparently taking up the slack from the discontinued PPO. It will be going up 1.88%, 2.24% over-all, which means it’s more like 10% more for the oldest members.

They also have a MedMutual-Mercy HMO version, which they priced quite a bit higher than the Promedica — is that to manipulate the Toledo market and create more monopoly than they have already? The Mercy HMO, for our alternative hospital system, the venerable “gray nuns” known for their charity care in Toledo, has an average rate hike of 15% for 2017, and is projected to have 401 members, up from 2 members in 2016. The Mercy plan has obviously been priced to fail. How convenient.

Thanks so much for taking away my doctor and real medical care, Medical Mutual, and replacing it with this imitation of a plan, that costs more than double what my insurance cost in 2013.

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What it looks like to me.

It looks like Medical Mutual has successfully replaced real insurance with this toy insurance HMO. Good if your are a child, and just pretending to buy health insurance. Ironically, there’s no need anymore for the strangely priced “$0 premium before tax credit” so-called “Child Only” mirror plans that always seemed suspicious to me, and made me wonder how they figured into the extreme rate hike I experienced in 2014 with my same insurance plan when it went on the Marketplace and my premium rose in price by 224%.

Whatever their master plan was, it’s over in 2017, and the children are being mapped to these lousy plans. Three years was all that it took to complete the transformation from good and somewhat affordable to bad and expensive and dumb.

Medical Mutual will not be selling any plans for child-only priced $0 premium before tax credit in 2017, like they did in 2014, 2015, and 2016. Maybe my consumer complaint to the Ohio Department of Insurance had something to do with it, but more likely it was part of their master plan to juvenilize their offerings. They blamed healthcare.gov for the problems I brought up with the Child Only “$0” cost plans, but Medical Mutual always passes the buck to the Feds, assured that the Republicans at the Ohio Department of Insurance will give them a gold star for doing so.

That’s what they would both have us believe. The real truth is that just any old excuse will do, they don’t even need one, because they make their own rules, and the insurance guy and the insurance regulator have each other’s back.

Why not just blame it on the doctors.

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See, here, about the Medical Mutual Child-only plans on the Exchange healthcare.gov: Medical Mutual Complaint Example 6: Accountability

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Noted that Promedica network HMO, which was sold under the company name of  “Medical Health Insuring Company of Ohio” has switched over to “Consumers Life Insurance Company” which is Medical Mutual’s company that sells life and disability insurance.

The Demise of the PPObaby-head-row

Why did my rates go up 373% in seven years?

I suspect why: it was a strategic plan so that Medical Mutual could completely eliminate PPOs in the entire individual market by 2017, which is not fair and discriminates against the individual, while still keeping PPOs for the large employer market and the large share they have of the State of Ohio employee insurance, making the attainment of the best healthcare no longer possible for the entrepreneur, the artist, the small business owner, the individual. Is that the goal? The folks at Medical Mutual ought to make sure that when their own kids grow up, they leave the state, because in their greed, they have ruined it here. All Ohioans will suffer greatly by this denial of equal access to healthcare through Medical Mutual’s prejudicial elimination of PPOs in the individual market.

State-approved rate increase by year

Premium

Actual Increase

2009

No information available

413.33

2010

454.30

10%

2011

7.50%

*425.09

-9%

2012

13.70%

476.42

12%

2013

15.40%

559.66

18%

2014

17% on non-marketplace

1,255.00

224%

2015

15.70%

1,355.00

8%

2016

16.99%

1,542.00

14%

*increased deductible to lower the rate in 2011

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My Medical Mutual insurance went up 373% in seven years, during a 10-year span of time when the median family income in Toledo dropped 17.3%. And now, for 2017, PPO insurance has been eliminated, and Medical Mutual is in business with ProMedica, with their falsely advertised doctors accepting new patients, the biggest reason why we can’t find a doctor in Toledo, Ohio.