Paramount’s Inaccurate Provider Network Directory
Dr. ____ is a primary care physician listed on the Paramount provider network as accepting new patients. I recently called for an appointment. The doctor requires a yearly membership payment of $1,650 from the patient, along with regular billing to the insurance. The office said that they no longer accept Paramount, that Paramount cancelled his contract, maybe because of the membership fee, over a year ago. But does Paramount take him off the provider network list? No!
To think that Paramount keeps this doctor on their provider network directory as a PCP accepting new patients, even after Paramount told the doctor that he’s no longer with them and can no longer accept Paramount insurance.
But Dr. ____ is not the only doctor they’ve got wrong on their list. Paramount has only 31 PCP Doctors accepting new patients on a provider network list that shows 89 PCP doctors accepting new patients. 50 doctors on the yes list are not accepting new patients, with another eight names that are duplicated. This summer, I called them all, which you can read about here: Ohio Citizen Rate Review Provider Network Survey, Summer, 2016.
Why is Paramount’s provider list so inaccurate? It is 65% inaccurate! Perhaps it looks better this way to the CMS when the CMS issues their first-ever provider network “breadth” ratings this summer.
What will the CMS do about that situation, with all of the gross inaccuracies that I have documented? We will soon find out. If it’s merely fines they impose, then that is far too easy for the billion dollar health industry to pay them off. We the people would be totally cheated, if all the insurance companies have to do, for grossly misrepresenting their networks, is to pay a fine, without the imposition of real punishment and the correction of this corruption for good.
Paramount Rate Review
Paramount projects 4,224 members in 2017, thereby having the largest share of the approximately 10,000 Marketplace enrollees. Some of the 4,224 may be sign-ups through insurance agents. Paramount is eliminating all county areas other than 1 and 6, which is Northwest Ohio, and it apparently intends to pick up some of the slack from the eliminated Medical Mutual PPOs.
Paramount is asking for a 9.88% average increase in rates this year. They claim it will be no more than 13% for some. With the age factor factored in, one’s rate can go up another 2 or 3%. That, and a little raise on the area rate that they snuck in, could make a 16% hike for the unlucky ones.
The ACA law allows for 20% of the premium to be spent on administration and profit, like a commission. I doubt if Paramount will be taking any less than that, so for 2017, they’ll be making a hefty 10% increase just for their overhead. Since Paramount is in Toledo, maybe it will trickle down to the community somehow. Perhaps they could hire someone to be in charge of monitoring the provider network and updating the database, so it’s accurate.
What could be better, knowing that you can simply sit back and passively expand your operating revenue on account of medical expenses going up, and the money just keeps rolling in. But what is the incentive to keep costs down, when it is obviously not in a company’s favor to do so? Paramount is owned by the medical megalopolis, ProMedica, so it is in an especially fortuitous sweet spot.