Tag Archives: Ohio Department of Insurance

2018 Rate Review Observations

Anthem is the only insurer right now in 19 Ohio counties, and in 2018 they will be exiting the Ohio individual market, except for one teeny tiny county, Pike, for a non-exchange plan that probably has 5 members, just so they can keep their foot in the door and not be banned for five years in case they want to come back. Awe.

Anthem has about 18% of the individual market in Ohio, and they insure millions of Ohio corporate and state workers. 40,000 individuals are presently covered by Anthem, and 10,000 people may not be offered any individual plan next year as a result.

In Toledo, Anthem has the worst, smallest provider network, and it was 66% inaccurate. It is highly expensive, and went up quite a bit last year.

Anthem more than tripled their premiums in seven years, just like Medical Mutual did, who left hanging an estimated 100,000 people covered by their PPO plans, completely exiting  and extinguishing the sale of PPO’s in the individual market,  thus eliminating the only national network plan sold to individuals in Ohio. Last year two insurers covered nearly 50% of the Ohio individual market, and now they are gone.

Also gone this year is United Healthcare and Aetna, so just like that, our four largest insurers of the individual market are gone from the individual market, and Ohio let them, even rewarding the insurers with our state employee insurance business. Ohio either has no business sense, or our state really doesn’t care whether or not 300,000 Ohioans can buy insurance in the individual market.

Four things that Ohio can do to mitigate this healthcare crisis:

1.

Ohio should do what New York is doing this year, and ban insurers who leave the exchange from any future participation in public programs such as Medicaid.

Governor Cuomo announces aggressive actions to protect access to quality affordable health care for all New Yorkers  New York State website
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2.

Ohio should propose a Medicaid buy-in for anyone in the state, like the plan that Nevada’s legislature just passed for it’s citizens. After all, our commercial insurers in the individual market (Anthem, Medical Mutual, United Healthcare, Aetna) have been replaced by Medicaid insurers (Buckeye Ambetter, CareSource, Molina), and since all of Ohio is covered for Medicaid, it makes sense that these insurers can also cover all of Ohio for the individual market, and with great ease.

Nevada’s legislature just passed a radical plan to let anybody sign up for Medicaid  VOX
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VOX

3.

Ohio should pass an emergency “any willing provider” law so that citizens can take their insurance dollars to any provider willing to accept them and the payment. At an average of 80% inaccuracies in our provider networks, have the worst that have been reported in the entire country! It’s only civilized that Ohio gives us an”any willing provider” law.

4.

Oscar Insurance Corporation of Ohio, a new insurer for Ohio this year, should cover all the counties that Anthem has left hanging.

But they won’t be covering even one of them. It comes to Ohio to set up shop with Cleveland Clinic in the five counties around Cleveland.

It’s a perfect example to show why market-driven health insurance does not jive with societal needs, and it never will.

Click the photo to visit Oscar’s News page

(Dream on, hoping for a private, for-profit insurance industry to voluntarily go into 19 counties for the business of a mere 10,000 people who won’t otherwise have insurance, when the company can get the same business by simply marketing to the east side of Cleveland. But for some reason, the for-profit, so called “free market” health insurance model persists. And it has nothing to do with what is best for our country.)

5.

Here’s something the federal government can do: Open up the D.C. Exchange to people without an option, as per U.S. Senator Claire McCaskill’s proposal.

McCaskill proposes expansion of DC exchange Columbia Daily Tribune, May 18, 2017
Check out this video clip on McCaskill’s Facebook page from June 9, where she asks the Senate for a hearing on the secret health insurance plan that the Republicans are going to impose on Americans without any discussion with Democrats or the public!

The D.C. Exchange sells insurance for everyone in the country, that is, everyone who is a member of Congress or their staff. I have researched the plans and found that they are really inexpensive compared to what is sold in Ohio. Moreover, it’s quality PPO insurance with national provider networks.

At one time, the ACA was going to have just one exchange for the entire country, like this exchange in D.C. But then the insurers got their mitts on the shaping of the ACA. They sliced it up into hundreds of different state and county plans. Four short years later, insurers are leaving, and hundreds of counties will have no insurance option. It seems logical to open up the D.C. exchange, for everyone. What would be wrong with doing that?

Click on the photo to visit the DC Health Link

On a final note, the chart below shows the three largest insurers in Ohio, from a report made to the state of Ohio by the actuarial company, Milliman, in 2011. I added to the original chart in light blue, to show the individual rate increases since 2010. (The dark blue along with the red and green show the 2010 rates.)

With the withdrawal of Anthem, none will be in the individual market next year! Our three biggest insurers in the individual market in 2010, gone!

It’s no wonder, because our regulators let their rates go up over 300% in 7 years, while the rates for the group plans went up only a total of 30%. Wow. You’d think that all the new members of these plans had leprosy. I hope they are cured, at least.

Divide, divide, divide. Divide and subtract some more! The huge free market health insurance system is so close to knocking off those 23 million people who just don’t fit in their money-making calculations.

Provider Network Complaints Get Buried

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The good news is, I finally received some of the provider network consumer complaints that I asked for from the Ohio Department of Insurance.

The bad news is, for many of the complaints, we don’t get to know the outcome because the Ohio Department of Insurance kicks the complaint over to another department, and they make it confidential. The following are paragraphs from the Ohio insurance department’s closing letters for various provider network complaints:

Due to this error we are referring our findings to another division within the Department for further review. Please be aware that investigations by this division and the records pertaining to these investigations are confidential by law. Consequently, the Department will not be able to provide you with any information as to whether an active case investigation will be opened on the matter or if an active case investigation is opened and the status of the investigation.
Based upon our review of the facts and circumstances presented, we determined that CareSource provided you inaccurate information regarding their provider network. The Department is also concerned about the likelihood that additional members have received inaccurate network information as well. Therefore, this matter has been referred to another division in our agency for investigation.
Due to incorrect information provided to you by Buckeye, we have forwarded our findings to another division within the Department for further review. Please be aware that investigations by this division are confidential by law. Consequently, the Department will not be able to provide you with any information as to whether an active case investigation will be open on the matter you reported or if an active case investigation is opened and the status of the investigation.
Caresource did not initially administer the claim in accordance with the terms of your policy; therefore, we have forwarded our findings to another division within our Department for further review. Please be aware that investigations by this division and the records pertaining to these investigations are confidential by law. Consequently, the Department will not be able to provide you with any information as to whether an active case investigation will be opened on the matter you reported or if an active case investigation is opened and the status of any investigation.
We have forwarded our findings to another division within our Department for further review. Please be aware that investigations by this division are confidential by law. Consequently, the Department will not be able to provide you with any information as to whether an active case investigation will be opened on the matter you reported, or the status if an investigation is opened.

What is the law that they claim prevents them from revealing the status or results of the investigation? The new provider network rules they put into place this year. They wrote in a clause that gives them the power to keep investigations confidential.

http://codes.ohio.gov/oac/3901-8-16

(2) All documents provided to the superintendent under paragraph (G) of this rule shall be considered work papers of the superintendent that are subject to section 3901.48 of the Revised Code and are confidential and privileged and shall not be considered a public record, as defined in section 149.43 of the Revised Code. The original documents and any copies of them shall not be subject to subpoena and shall not be made public by the superintendent or any other person, except as otherwise provided in section 3901.48 of the Revised Code.

Clever!  So all of our provider network complaints get buried. Companies get to keep doing this, because the Ohio Department of Insurance doesn’t care. They reward them instead, with confidentiality. And after two years, they destroy the original complaint, buried, burned, deleted.

I told you they are run by the insurance guy!

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Related: Ohio Citizen Rate Review Provider Network Survey, Summer 2016

Related: Passing the Buck: My letter to complaint examiner

Complaint No. CSD0039402 CareSource provider network

Two out of 50 Indians

Here’s my public complaint to the Ohio Department of Insurance about CareSource’s inaccurate provider network directory:

Complaint No. CSD0039402, filed online on April 18, 2016.

SUMMARY: CareSource’s “Just 4 Me” published online provider list is highly inaccurate. 96% of the 52 ProMedica internal medicine and family practice primary care doctors on their list for zip code 43615, 15 mile radius, listed as accepting new patients are actually NOT accepting new patients. I informed CareSource about this discrepancy in November, 2015, and I gave them a detailed list (including one doctor who is retired) and still they have not corrected it.

I expect the Ohio Department of Insurance to investigate this fraud and correct it.


See, here, my December 2015 post about this experience.

See here, my struggle to obtain public records from the Ohio Department of Insurance regarding provider networks.

Should the public be allowed to know about public complaints like this one?

Yes, of course the public should be allowed to know, but if you try to find out, you’ll be going down the rabbit hole.

See more here.

See the end result of complaints like this here.

Medical Mutual Complaint, Example 6 – Accountability

"0" Premium before tax credit. November 27, 2015 credit shown for $62,000 income
$0 Premium before tax credit. Sign me up!

During last week’s preview week on healthcare.gov, Medical Mutual  offered duplicate plans, same name but one serial number off from other plans, that cost nothing. Zilch. $0. And then I couldn’t believe how much my premium was going up on the mirrored plan that was not $0. What a great deal – those $0 plans! So I called Medical Mutual to ask more details about the $0 Premium before tax credit offerings on healthcare.gov, because the $0 plan was clearly offered to me. These are direct quotes from Naomi in the Medical Mutual sales department on October 27:

You have to talk to the Marketplace. I don’t see the plan. I can’t look it up by plan number. You just popped up on the line and I answered your call.

I cannot look up plans by plan number, you have to go back to the Marketplace. Marketplace is administrating the plan.

Your premium went up because the federal government regulates that and they increased everyone’s premium.

You’re asking me to look up a plan on a different company’s website that I can’t see.

You want me to have all the answers as to why there is a free plan on the healthcare.gov website and it is offered to you.

We don’t have info on the plans offered on healthcare.gov, you have to go to them. It’s a different entity.

I can’t give you false information. I can but I’m not going to do that.

I cannot look up a policy that we do not offer.

It’s federally facilitated, different from Medical Mutual.

I can’t answer your questions because they are offered through healthcare.gov.

Sounds like it’s for medicaid.

We have no information on it. Nobody answers questions about plans on healthcare.gov. It’s through the government. You need to contact healthcare.gov because it’s offered through healthcare.gov. For this plan you have to call healthcare.gov.


When I spoke to Stacey at healthcare.gov on October 27, he duplicated everything I did on his screen and came up with the same results I was getting and these are his direct quotes:

I thought that was their job. (He said when I told him Medical Mutual told me I had to ask healthcare.gov about their plans.)

I would think that, and I’m putting them side by side, they are identical.

I don’t know why it says “child” because it covers adults and children.

This plan has costs and this doesn’t. I don’t understand, I really think that Medical Mutual should have been able to tell you some basic information.

I see this plan and all the details that it consists of, and it would seem you would pay “0” dollars.

This seems like the one to get, and when its says premium before tax credit is “0” you don’t even need a tax credit.

It’s like a trick, like smoke and mirrors.

It is very bizarre. They are nearly identical to the other plan, they are only one number off in the plan ID so I understand your concern.

I have never really experienced this in this way.

It seems as if it is supposed to be “0” dollars, or it is a trick.

It’s ridiculous, it’s their plan, it’s their company and they won’t talk to you about it.

Here’s a phone number you can call, Ohio Department of Insurance, let them know what is going on. Let them know what we discussed, that I see the same thing you see.


So I took healthcare.gov’s advice, and after speaking with the Ohio Department of Insurance, I filed a consumer complaint against Medical Mutual for pricing and accountability and false advertising.

Page one of my consumer complaint, no. CSD-0034217
Page one of my consumer complaint, no. CSD-0034217

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