Letters to Insurers

img_4867-3An ominous dark cloud looms over Toledo, Sept. 2016. What will November bring?

Dear Insurers: Please correct your provider network directories!

On September 9, I mailed the following letters to the six insurers of health insurance sold on the individual Marketplace in Lucas County. These insurers are the subject of my provider network survey. With each letter, I enclosed a copy of the provider network directory that I downloaded on July 16, plus a detailed and lengthy list of the doctors that the insurer has listed as accepting new patients but when I called them, they weren’t accepting new patients. Read about the survey here.

Will the doctors and insurance companies correct their networks before Open Enrollment begins on November 1? These are our only health insurance choices, and they range from bad to worse. We are forced to buy a plan from one of these insurers, or else we’ll have to pay a huge federal fine for not having health insurance.  The provider network lists are on average 80% incorrect, but the government rewards the insurers for their incompetence by making us pay for this blatant corruption. Health insurance is the most expensive monthly budgeted item burdening Toledoans. All that money and for what? For an insurance card in our wallet giving us 5 to 1 odds that we won’t get health care. We get a 20% chance of finding a doctor! Doctors, who are our neighbors, relatives and friends, along with the insurers, the state of Ohio and CMS have worked in concert to allow this to happen.

If we want fairness, it seems to be up to us — we, the people who are being harmed, and we the people who see our community members being harmed — to ask insurers to please sell us legitimate, honest, quality health insurance products, and to start by correcting their provider network directories by November 1.

Correcting the directories should be an easy thing for them to do, especially since they make more and more money from us every year just on their administration costs — an annual bonus they give themselves for charging us higher premiums. Shouldn’t they put some of our money toward keeping accurate provider network directories? That’s the very least they can do. I gave my time for free because it is my civic duty to report these outrageously unacceptable inaccuracies to them. I gave each insurer a detailed list of doctors they have listed as accepting new patients but when I called, they were not accepting new patients.  I sorted the lists by physician groups: ProMedica, University of Toledo, Mercy, Toledo Clinic, etc, to make it so easy for them to correct, that they just can’t not do it.

See my 2017 provider network-rate reviews of Toledo insurers here:
MedMutual-ProMedica Buckeye Ambetter Paramount
Anthem CareSource Just4me Molina

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LETTERS TO HEALTH INSURERS

Frank Bloomquist
Vice President of Sales, Northwest Region
Medical Mutual

Dear Mr. Bloomquist,

Because you are vice president of sales in the Toledo area, I’d like to make you aware that the product you are selling is highly misleading. I conducted a survey this summer of the Medical Mutual provider networks, from the online directories downloaded on July 16, and a huge percentage of the doctors you have listed as accepting new patients, were actually not accepting new patients when I called them.

I called all 136 primary care physicians on the Med-Mutual-ProMedica list, the 136 who were listed as accepting new patients, and only 20 were actually accepting new patients! 20 doctors only! And 116 were not!

I called 197 of the 264 primary care physicians on the SuperMed PPO list downloaded on July 16, among those who were listed as accepting new patients, and out of the 197 primary care physicians, only 61 doctors were actually accepting new patients, and 136 were not. 61 doctors only and 136 were not!

As the annual Open Enrollment is right around the corner, and I am right down the street, I’m writing this letter to ask that Medical Mutual to be a good neighbor to us. Kindly clean up this horrific misrepresentation of your provider network before open enrollment begins on November 1, so that we, your potential customers, will not be duped again.

Thank you for your time.

Sincerely,
Penny Gentieu

Encl: July 16, 2016 provider network directories, detailed list of doctors who are incorrectly listed as accepting new patients

(See, here, Mr. Bloomquist’s reply.)

Nancy Martin
Vice President, Quality and Population Health
Medical Mutual

Dear Ms. Martin,

Because you are vice president of Quality and Population Health, I’d like to make you aware that the quality of the population in Toledo has been highly compromised by Medical Mutual. I conducted a survey this summer of the Medical Mutual provider networks, from the online directories downloaded on July 16, and a huge percentage of the doctors you have listed as accepting new patients, were actually not accepting new patients when I called them.

I called all 136 primary care physicians on the Med- Mutual-ProMedica list, the 136 who were listed as accepting new patients, and only 20 were actually accepting new patients! 20 doctors only! And 116 were not!

I called 197 of the 264 primary care physicians on the SuperMed PPO list downloaded on July 16, among those who were listed as accepting new patients, and out of the 197 primary care physicians, only 61 doctors were actually accepting new patients, and 136 were not. 61 doctors only and 136 were not!

As the annual Open Enrollment is right around the corner, I’m writing this letter to ask that Medical Mutual help our population by fulfilling your promise of quantified quality choices. Kindly clean up this horrific misrepresentation of your provider network before open enrollment begins on November 1, so that we, your population, will not be duped again.

Thank you for your time.

Sincerely,
Penny Gentieu

Encl: July 16, 2016 provider network directories, detailed list of doctors who are incorrectly listed as accepting new patients

Richard Wallack
Vice President, Government Business Unit
Medical Mutual

Dear Mr. Wallack,

Because you are vice president of the Government Business Unit, I’d like to make you aware that your Marketplace-plan provider network directories are extremely inaccurate. I conducted a survey this summer of the Medical Mutual provider networks, from the online directories downloaded on July 16, and a huge percentage of the doctors you have listed as accepting new patients, were actually not accepting new patients when I called them.

I called all 136 primary care physicians on the Med-Mutual- ProMedica list, the 136 who were listed as accepting new patients, and only 20 were actually accepting new patients! 20 doctors only! And 116 were not!

I called 197 of the 264 primary care physicians on the SuperMed PPO list downloaded on July 16, among those who were listed as accepting new patients, and out of the 197 primary care physicians, only 61 doctors were actually accepting new patients, and 136 were not. 61 doctors only and 136 were not!

As the annual Open Enrollment is right around the corner, I’m writing this letter to ask that Medical Mutual clean up this horrific misrepresentation of your provider network before open enrollment begins on November 1, so that we will not be duped again.

Thank you for your time.

Sincerely,
Penny Gentieu

Encl: July 16, 2016 provider network directories, detailed list of doctors who are incorrectly listed as accepting new patients

Erin Hoeflinger
President
Anthem Blue Cross & Blue Shield of Ohio

Dear Ms. Hoeflinger,

I’d like to make you aware that your Marketplace-plan provider network directory for Toledo is extremely inaccurate. I conducted a survey this summer of the Anthem Blue Cross Blue Shield “Pathway X” provider network from the online directory downloaded on July 16. Out of your micro-narrow network that is way too small for our area to begin with, a full two-thirds of the primary care doctors you list as accepting new patients, were actually not accepting new patients when I called them. Some were not even primary care doctors, but specialists in fields such as pediatrics, geriatrics, and endocrinology.

Out of your meager list of 39 PCP doctors, which is actually only 36 doctors, with three duplications, only 13 doctors were actually accepting new patients! 13 doctors only!

As the annual Open Enrollment is right around the corner, I’m writing this letter to ask that Anthem Blue Cross Blue Shield clean up this horrific misrepresentation of your provider network before open enrollment begins on November 1, so that we will not be duped again.

Thank you for your time.

Sincerely,
Penny Gentieu

Encl: July 16, 2016 provider network directory, detailed list of doctors who are incorrectly listed as accepting new patients

Michelle Stoughton
Senior Director, Government Relations
Anthem Blue Cross & Blue Shield of Ohio

Dear Ms. Stoughton,

I’d like to make you aware that your Marketplace-plan provider network directory for Toledo is extremely inaccurate. I conducted a survey this summer of the Anthem Blue Cross Blue Shield “Pathway X” provider network from the online directory downloaded on July 16. Out of your micro-narrow network that is way too small for our area to begin with, a full two-thirds of the primary care doctors you list as accepting new patients, were actually not accepting new patients when I called them. Some were not even primary care doctors, but specialists in fields such as pediatrics, geriatrics, and endocrinology.

Out of your meager list of 39 PCP doctors, which is actually only 36 doctors, with three duplications, only 13 doctors were actually accepting new patients! 13 doctors only!

As the annual Open Enrollment is right around the corner, I’m writing this letter to ask that Anthem Blue Cross Blue Shield clean up this horrific misrepresentation of your provider network before open enrollment begins on November 1, so that we will not be duped again.

Thank you for your time.

Sincerely,
Penny Gentieu

Encl: July 16, 2016 provider network directory, detailed list of doctors who are incorrectly listed as accepting new patients

Lynn A. Lyon
Director of Compliance
Buckeye Health Plan

Dear Ms. Lyon,

I’d like to make you aware that your Marketplace-plan Ambetter provider network directory for Toledo is extremely inaccurate. I conducted a survey this summer of the Ambetter provider network directory, which I downloaded on July 16. Out of your seemingly generous network of 98 listings of primary care doctors accepting new patients in this area, 90% were actually not accepting new patients when I called them! Some do not even accept Ambetter!

Out of your list of 98 PCP doctors, which is actually only 92 doctors after the duplications are subtracted, only 10 doctors were actually accepting new patients! 10 doctors only, out of 98! Wow!

As the annual Open Enrollment is right around the corner, I’m writing this letter to ask that Buckeye Health Plan clean up this horrific misrepresentation of your provider network before open enrollment begins on November 1, so that we will not be duped again.

Thank you for your time.

Sincerely,
Penny Gentieu

Encl: July 16, 2016 provider network directory, detailed list of doctors who are incorrectly listed as accepting new patients

Steve Ringel
President, Ohio Market
CareSource

Dear Mr. Ringel,

I’d like to make you aware that your Marketplace-plan Just4Me provider network directory for Toledo is extremely inaccurate. I conducted a survey this summer of the CareSource Just4Me provider network directory, which I downloaded on July 16. Out of your seemingly generous network of 166 listings of primary care doctors accepting new patients in this area, 90% were actually not accepting new patients when I called them! Some do not even accept CareSource!

Out of your list of 166 doctors, which is actually only 115 doctors after the duplications are subtracted, only 17 doctors were actually accepting new patients! 17 doctors only, out of 166! Wow!

As the annual Open Enrollment is right around the corner, I’m writing this letter to ask that CareSource clean up this horrific misrepresentation of your provider network before open enrollment begins on November 1, so that we will not be duped again.

Thank you for your time.

Sincerely,
Penny Gentieu

Encl: July 16, 2016 provider network directory, detailed list of doctors who are incorrectly listed as accepting new patients

Rhonda Price
Regulatory Affairs Manager
CareSource

Dear Ms. Price,

I’d like to make you aware that your Marketplace-plan Just4Me provider network directory for Toledo is extremely inaccurate. I conducted a survey this summer of the CareSource Just4Me provider network directory, which I downloaded on July 16. Out of your seemingly generous network of 166 listings of primary care doctors accepting new patients in this area, 90% were actually not accepting new patients when I called them! Some do not even accept CareSource!

Out of your list of 166 doctors, which is actually only 115 doctors after the duplications are subtracted, only 17 doctors were actually accepting new patients! 17 doctors only, out of 166! Wow!

As the annual Open Enrollment is right around the corner, I’m writing this letter to ask that CareSource clean up this horrific misrepresentation of your provider network before open enrollment begins on November 1, so that we will not be duped again.

Thank you for your time.

Sincerely,
Penny Gentieu

Encl: July 16, 2016 provider network directory, detailed list of doctors who are incorrectly listed as accepting new patients

Jack Randolph
President
Paramount Health Care

Dear Mr. Randolph,

I’d like to make you aware that your Marketplace-plan provider network directory for Toledo is extremely inaccurate. I conducted a survey this summer of the Paramount provider network directory, which I downloaded on July 16. Out of your seemingly generous network of 81 listings of primary care doctors accepting new patients in this area, 65% were actually not accepting new patients when I called them!

Out of your list of 89 PCP doctors, which is actually only 81 doctors after the duplications are subtracted, only 31 doctors were actually accepting new patients! 31 doctors only, out of 89!

As the annual Open Enrollment is right around the corner, I’m writing this letter to ask that Paramount clean up this horrific misrepresentation of your provider network before open enrollment begins on November 1, so that we will not be duped again.

Thank you for your time.

Sincerely,
Penny Gentieu

Encl: July 16, 2016 provider network directory, detailed list of doctors who are incorrectly listed as accepting new patients

Denise Cousino
Regulatory Compliance Coordinator
Paramount Health Care

Dear Ms. Cousino,

I’d like to make you aware that your Marketplace-plan provider network directory for Toledo is extremely inaccurate. I conducted a survey this summer of the Paramount provider network directory, which I downloaded on July 16. Out of your seemingly generous network of 81 listings of primary care doctors accepting new patients in this area, 65% were actually not accepting new patients when I called them!

Out of your list of 89 PCP doctors, which is actually only 81 doctors after the duplications are subtracted, only 31 doctors were actually accepting new patients! 31 doctors only, out of 89!

As the annual Open Enrollment is right around the corner, I’m writing this letter to ask that Paramount clean up this horrific misrepresentation of your provider network before open enrollment begins on November 1, so that we will not be duped again.

Thank you for your time.

Sincerely,
Penny Gentieu

Encl: July 16, 2016 provider network directory, detailed list of doctors who are incorrectly listed as accepting new patients