The Secret Culling of Healthcare


The Issuers received my letters. Will they be making corrections to their highly inaccurate lists of PCP doctors, that I so laboriously brought to their attention?

Will the CMS do anything with the information I worked so hard to get to them through my Congressmen and through a direct conversation with a CMS Health Insurance Specialist?

The provider network directories in Lucas County do not accurately reflect the fact that doctors have been secretly culled from the insurers’ lists of doctors they claim are accepting new patients. When you call the doctors, their availability is noticeably missing.

When listed PCP doctors are 77% to 90% inaccurate, what exactly is the insurance company selling us? If they claim that they only pay the bills, they don’t provide the healthcare, in some convoluted indemnity clause agreement they have with health systems that they use as their excuse for their 80% average provider network directory errors, then why do they have provider networks at all?

Hospitals and practices have merged and health systems are collaborating with health insurance companies. When ProMedica lost their lawsuit over the ownership of St. Luke’s Hospital last year on monopolistic grounds, the point was that the merger would have raised prices for Toledoans. But look at ProMedica now, in a collaboration with Medical Mutual that completely wipes out health insurance as the majority of Ohioans have known it, since 1934, as Medical Mutual is the oldest health insurance company in Ohio, with their broad local PPO network with an even broader national network, being replaced by a narrow network not even a 10th of the size, which is so misrepresented by being called “MedMutual-ProMedica” when in actuality the plan had no more than 1 ProMedica PCP doctor accepting new patients when I called this summer. One ProMedica PCP doctor they had only, against a facade that looks like they have 53 available ProMedica PCP doctors accepting new patients BECAUSE THAT IS WHAT THE PROVIDER NETWORK DIRECTORY SAYS!

This is what should happen:  The directories should be made truthful by November 1, Open Enrollment.  If they don’t have enough doctors, an emergency law should PG20208547-4be passed so that their members can go to any doctor of their choosing, who will accept them, who will accept the terms of the insurer’s payments. And insurers should have to pay damages (like in California) to all of their members who have been hurt by the highly unacceptable inaccuracies of their provider network directories.

If the purpose of health insurance is to pay the bills, not to provide healthcare, it cannot restrict access to healthcare with highly inaccurate provider directories on narrow networks where “covered lives” have a 1-in-7 chance of finding healthcare, the healthcare that the provider network itself advertises and is supposed to be serving up.

Get rid of provider networks and give us a transparent payment system with health providers and health insurers so we can know what each insurer pays to providers, so that we can comparison-shop.