Tag Archives: Ohio Department of Insurance

UHCAN’T Find a Doctor

An Open Letter to the Board Members and Partners of Ohio’s UHCAN (Universal Health Care Action Network):

All of Ohio can thank UHCAN (http://uhcanohio.org) for sabotaging our healthcare in the individual market. UHCAN is our watchdog, they get grants to advocate for us, and shame on them for not doing their job.

We have an opioid epidemic in this country and Ohio ranks first. Could Ohio’s 90% inaccurate health insurance provider networks have anything to do with it?

It was recently reported that 715,000 Ohioans gained coverage through the ACA expanded Medicaid, and that 215,000 of them are seeking treatment for opioid addiction. Wow. One third.

We can assume that a good percentage of the Marketplace consumers are also in need of treatment. But when they are faced with a brick wall finding a doctor, after they have signed up for a plan, they are unable to get treatment, so they continue to use, and some of them die.

One year ago, last July, I went to a lot of trouble, all on my own time, to call every PCP doctor listed on every plan sold in my city, Toledo, doctors listed by the insurers as accepting new patients. 308 doctors in total. I discovered that the plans being sold are grossly inadequate, and average of 80% inaccuracies, two in fact had 90% inaccuracies! I made complaints to the insurers, to my elected representatives, to UHCAN, to the Ohio Department of Insurance.

It was a story big enough for the New York Times to report, on December 3, 2016.

Kathleen Gmeiner, a lawyer at UHCAN, was all set to send my complaints to an important contact she had at CMS. Even though she was aware of my complaint for several months, she waited the entire Fall, and then, ready to send the info in December, she was told by the director, Steve Wagner not to bother after all.

She didn’t send it, she tells me now in an email, because:

Once Donald Trump took office it became clear that the new administration was giving states a lot of flexibility and it would be unlikely anyone in the new CMS would aggressively require Ohio to take more steps around network adequacy.

Depression over the newly elected president?

Or was it depression because UHCAN’s grants were about to dry up?

UHCAN couldn’t even do that one thing that I presented to them on a silver platter.

No administration would allow insurance companies to have 90% provider network inaccuracies. To take our healthcare money and squander it away, especially when we have an opioid crisis in Ohio, is not anything the CMS would condone.

How presumptive of UHCAN to decide on their own that our nation’s overseers of medical spending and the administration of Medicaid and Medicare would not care that Americans are getting ripped off by inadequate and misleading, highly inaccurate provider networks. For UHCAN to withhold my information from the CMS is outrageous, unacceptable, and disgusting. And what a waste of grant money!

No wonder Ohio has the worst statistics for drug addiction. Our entire state, including UHCAN is sick. What drugs are they on at UHCAN, that makes them so heartless, that they can’t advocate for the people of Ohio, the sole reason for their existence?  90% inaccurate provider networks; people dying in the streets.

Yet another example of mis-used grant money.  Grants SHOULD be cut going to UHCAN Ohio. Because after all, UHCAN’T even do this one little thing to help Ohioans get healthcare after they buy health insurance!

UHCAN’T find a doctor on provider networks, and here we have an opioid epidemic!

You CAN, and you MUST, do better than this!

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Steve Wagner, director of UHCAN Ohio, on the UHCAN Ohio Facebook page, June 29, 2017, and my comment.

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UHCAN'T be serious, your mission is to achieve high quality, accessible, affordable health care for all Ohioans? Really?

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UHCAN's partners

Look who is UHCAN’s partner — CareSource, with their 90% inaccurate provider networks! Conflict of interest, to say the least.

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.

Isn’t a market-driven health care system great.

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 removed themselves just this year from insuring an estimated 100,000 covered lives with their PPO plans, 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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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.

Click on the chart for an analysis of seven-year rate hikes

See this page for directions on how to research Ohio insurance rate filings and submit comments.  http://ohiocitizenratereview.info/rate-reviews/how-to-make-comments/

Dear Bob Latta

Dear Representative Latta,

Thank you for your letter dated April 28 in reply to my letter dated March 7 in regard to healthcare reform. You state that “we need to empower states to deliver health care solutions that lower costs, increase quality, and improve coverage.” Here is why that will never work in Ohio:

The special interests of the health insurance industry are even more cozy with the state of Ohio than it seems they are with Congress, if that could even be possible. It is the lobbyists who control everything in Ohio, from educational luncheons with our legislators, to the wording of laws that are written to control them, to the actual running of the insurance department. It’s so crowded in Columbus with special interests, that there is no room left for the interests of the people who live in Ohio.

I have written to you about these issues several times in the past year, in fact I made an entire website based on these issues, OhioCitizenRateReview.Info.

In case you never read my website, this is what the state of Ohio has done with their empowerment that they’ve had in the past seven years:

1. Ohio lets every rate hike go through no matter what. Every rate hike the insurers want, the insurers get, regardless of how unrealistic it is for the economy of Ohioans.

2. Ohio does this in secret, without “Effective Rate Review”, a “check and balance” that was provided for in the ACA law. With several million dollar grants from the CMS, Ohio was supposed to have set up a transparent system for citizens to be informed and have open discussions about the annual rate hikes the insurers ask for every year. But they don’t. They keep everything as secret as they possibly can.

3. In secret, and without properly addressing my 2015 complaint, Ohio allowed Medical Mutual to eliminate their PPO insurance in the individual market, after granting Medical Mutual rate hikes of 373% over seven years. About 100,000 Ohioans were personally affected by this elimination of Medical Mutual’s PPO, which was the only national network insurance available in Ohio to individuals. This was probably the biggest market share, but Ohio let them do it, without any fanfare, without any discussion, and at the same time, while rewarding Medical Mutual with the state of Ohio’s employee insurance business. Ohio employees get Medical Mutual PPOs, but not the individuals of Ohio.

4. Complaints made to the Ohio department of insurance get buried. So that Ohioans who have problems with insurance companies in the state of Ohio have absolutely no voice and their problems have no resolution.

5. Our provider networks in Ohio are unacceptably inaccurate. This falls under the jurisdiction of Ohio laws as well as federal laws. A new state law was passed last year that was supposed to ensure their accuracy, but Ohio won’t enforce it. Last summer I called all the PCP doctors in the ACA networks in Toledo listed as accepting new patients, 308 doctors, and only 20% were actually accepting new patients. 10% in the “affordable” plans. I informed you, you did nothing. I informed my state representatives, they did nothing. The New York Times reported on it in December. Not a peep from you, but your colleague in Lima, Jim Jordan, spoke out in favor of the flawed directories, saying “It should surprise no one that the Ohio Department of Insurance’s physician directories are so flawed, considering how flawed the Affordable Care Act (ACA) is.”

And now you want to give the state even more control so that they can further pervert our healthcare system for their own personal greedy purpose.

You were elected, Bob Latta, to represent us in Congress. It’s your responsibility to look out for us on a federal level. We didn’t elect you for you to skirt your responsibility and send it back to the states.

We need healthcare to be thought of as a public good, and not a Wall Street money machine. We have a democracy, not a monarchy. Money is not king. You were elected by the people, not appointed by lobbyists who crown you with their favors.

As I wrote in my previous letter, you should be addressing the problems of healthcare costs instead of letting them grow and grow.

It’s absolutely a lie for you to say in your letter that the AHCA will lower premiums by 10% and allow us to keep our doctors. Premiums for those over 50 will go up five times as much as it will cost others, and millions of people will not be able to keep their doctor because they will not be able to afford insurance anymore.

If you can’t give us what we need, or at least enforce the laws that can fix the problems with the ACA, then just leave it alone, so that we can vote you out of office, and elect a Congress who will give us what we need.

Sincerely,

Penny Gentieu

Noblesse Oblige

My Northwest Ohio federal and state senators and representatives, governor, with the lieutenant governor who is also the director of the insurance department, and the state Medicaid director.

We elected these people but King Moola rules.

Please can they throw us some crumbs.

Click on the crowns to read about my representatives. I’m deeply disappointed that they won’t fix the problems that are completely in their control to fix right now, like the highly inaccurate provider networks, and the transparency that the ACA provided for that they won’t abide by, and that they won’t pass an emergency “any willing provider” law so I can take my insurance dollars to my own doctor, and I’m shocked that when they say they are going to give us something better than the ACA, that they only think of the insurance industry, still putting profits over people. King Moola rules. Please, mini Moolas, please please throw us some crumbs!

If you are going to let yourself be crowned by the lobbyists, at least understand the concept of noblesse oblige. It’s like this: the masters must be responsible for those they tame.

“Yes Ms. Gentieu, you really do live in Russia.”

pg24-25After nearly nine months since I made a query with the Ohio Inspector General to look into certain issues at the Ohio Department of Insurance, I received an email response on March 8, posted below. Coming one day after the unveiling of the utterly regressive Republican answer to our healthcare problems, it’s like they are trying to tell me something.  

“Yes Ms. Gentieu, you really do live in Russia.”

But we live in America and we were promised a better, less expensive healthcare plan that wouldn’t leave people dying in the streets.

(Related: Letter to Rep. Latta)

JUNE 29, 2016
Dear Ohio Inspector General:
  1. The Ohio Department of Insurance is granting double-digit rate hikes without any public review, without lowering the hikes. They are basically working for the insurance companies at the expense of millions of Ohioans, including me, whose insurance went up 373% in 7 years, same company.
  2.  The Ohio Department of Insurance is not releasing public documents to me about consumer complaints.
  3. The Ohio Department of Insurance is not releasing rate review justifications for the public to participate in “effective rate review” — with the 5 million dollars in CMS grants meant for this purpose. Other states save their people millions — even a billion — using public rate review, but not Ohio.
  4. The Ohio Department of Insurance has no problem with health insurance companies advertising phony provider networks. There’s no fine or punishment for lying to the public or to the enrollees, so health insurance companies are allowed to rip us off blind!

None of this seems right; or good in the least for the citizens of Ohio, me included. Please investigate.

Ever since I’ve lived in Ohio, my Medical Mutual health insurance rates have gone up double-digits every year. I’ve had the same, or essentially the same health insurance plan with Medical Mutual. I’m a small business person, so I buy individual insurance. The year the plan went on the Marketplace, in 2014, my Medical Mutual premiums went up 224%! The price of my 2016 Medical Mutual insurance is now 373% more than my Medical Mutual insurance was in 2009! In just seven years it went up 373%! The benefits, including the provider networks, of the Medical Mutual insurance in 2009 through 2016 are basically the same.

All of these rate increases were approved by the Ohio Department of Insurance. I found out recently that the state of Ohio received huge multi-million dollar grants from the HHR to assist in the transparency of health insurance rate reviews, and to assist in the containment of rate hikes. The most recent grant was given to Ohio just this month. What does Ohio do with these grants? Other states have saved their citizens at least a billion dollars in rate hikes by using these funds for “effective rate review.” But not in Ohio. The state of Ohio grants rate hikes just as much as the insurance companies ask them for. Double-digit rate hikes, no problem! And Ohio keeps the process secret from their citizens, who they do not engage in “effective rate review.”

I’m not only robbed of my rights, I’m made to be a stooge to the Ohio health insurance industry, an industry that seems to have the Ohio Department of Insurance wrapped around its finger.

I’m just one person getting robbed, in the company of millions of other people getting robbed too – people facing double-digit health insurance rate increases year after year, whether or not health insurance is a part of their employment or they buy it individually. Unsustainable rate increases are happening to everyone in Ohio. Because in Ohio, whatever the insurance companies want, the insurance companies get.

Have you seen lately how we rank as a state? Ohio is the most expensive state for health insurance, see this April 2016 Department of Health and Human Services Brief, Table 4, page 9.

Not surprisingly, not only is the insurance way too expensive, the quality is questionable. A big problem exists with phony provider networks. I made two complaints to the ODI about this issue (see, CareSource complaint here). I wanted to see what other complaints have been made. I requested public records of health insurance complaints, but my efforts were completely thwarted by the Records Custodian at the Ohio Department of Insurance. After six weeks of hassle with them, they gave me a list of 50 complaint numbers and ODI employees the complaints were assigned to, with no other information — not even the the names of the insurance companies that were complained about!

No doubt a problem exists with phony provider networks, because Ohio has no regulation allowing for a punishment or fine for health insurance companies that have phony provider networks. That wouldn’t be something the insurance companies would want, so the Ohio Department of Insurance doesn’t impose such regulation.

Recently, the Ohio Department of Insurance secretly approved the merger of Aetna and Humana, burying the document deep in their website. It didn’t matter to the ODI that the Ohio legislative Insurance committees requested an investigation and public hearing. It didn’t matter to the ODI that consumer groups requested an investigation and public hearing. The ODI went right ahead and gave the insurance companies exactly what
they wanted, without any consideration to what the public and the elected officials asked for — an investigation and public hearing. A simple investigation and public hearing to consider the pros and cons of a merger between two companies representing such a
huge percentage of the market, and how that would affect Ohioans. Hmmmm……

There’s no other way to put it — it’s like we live in Russia.

It is appalling – the lack of transparency in this state!   And that’s not all.

Is it too much to ask from Ohio for the state insurance department to look after the best interests of its citizens when it comes to healthcare, instead of entirely, quite blatantly, enabling the health insurance industry to take utter advantage of us, and strip away any value to what they are selling, as well?

It’s killing us.

I hope you will consider the issues that I have brought up, and help in these ways:

The Ohio Department of Insurance should release public records upon request. Consumer complaints should be searchable on their website, similar to how they are on the Ohio Attorney General’s website, or better yet, like they are on the Texas Department of Insurance’s website. The ODI should do something constructive with the complaints that consumers make, and not just treat them like hot potatoes that they can’t throw far enough fast enough, that they completely erase after only TWO YEARS!

The ODI should create an effective rate review program like many other states have, such as Vermont. The ODI should not grant every rate hike the insurance companies ask for, rather, they should make the process public, and have public hearings about rate increases, in an effort to keep the annual rate hikes down.

It seems obvious, but the Ohio Department of Insurance needs to start serving the needs of Ohioans.

And finally, the ODI should tell me why they allowed Medical Mutual to raise my rate 224% the year it went on the Marketplace and 373% since 2009. (consumer complaint no. CSD-0034217.)

Their response, nearly nine months later:

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The Price I Have to Pay

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Lisa Iannotta
Office of the Ohio Attorney General
Collections Enforcement Section 150 E. Gay St.
Columbus, OH 43215

Dear Ms. Iannotta,

I reluctantly enclose a check for $10.05, the price I have to pay to get to see public records about provider network insurance complaints, only to find out that the Ohio Department of Insurance buries our complaints.

I resent having to pay anything to find out what a poor job the Ohio Department of Insurance is doing in regard to protecting Ohioans. The Ohio Department of Insurance should have to pay me, for all the time and trouble I had to go through, to learn the true fate of the complaints made by the citizens of Ohio, which is straight to the graveyard in the middle of the night.

The Ohio Department of Insurance should do their job, and that means they should clean up the provider network directories that Ohioans are complaining about, and not to make our complaints secret and delete them completely after only two years.

I resent that the Ohio Department of Insurance made this comment to the New York Times reporter, in the enclosed December 4, 2016 article in the New York Times, Insurers’ Flawed Directories Leave Patients Scrambling:

Enforcing [directory-accuracy rules] is “consumer-driven,” said David Hopcraft, a spokesman for the Ohio Insurance Department. The state does not check the lists until consumers report inaccuracies, one doctor at a time.

But the Ohio Department of Insurance doesn’t even do that much. The Ohio Department of Insurance makes provider network complaints confidential, shuffling them to a different office (the department undertaker) where they claim everything must be confidential by law. Then they bury them in secret — our provider network complaints are buried without a funeral or even a wake — we are never told what happened to our complaints, but we know for sure that they never saw the light of day.

Sincerely,

Penny Gentieu

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Penny Gentieu found many health insurance directories to be outdated and inaccurate.
Penny Gentieu found many health insurance directories to be outdated and inaccurate.

Response to Findlay’s Mary Taylor article

The Courier, January 12, 2017   Lt. gov. says Obamacare not working

I’m sorry for Findlay losing their major insurer, Medical Mutual and their PPO. We lost them in Toledo too, in fact, all over the state, they are gone. It is a tragedy that Medical Mutual has been allowed to withdraw their long-standing PPO from the individual market, the only insurance they ever offered Ohioans before 2016, and they have been Ohio’s largest insurer since 1934. This is discrimination against a whole class of people, since Medical Mutual still insures Ohio state workers and corporate employees with their PPO, but they no longer offer individuals “real insurance”.  Why was there no public forum about this? No fanfare, no articles by Ohio health journalists, no consumer complaints (like mine) made public by the Ohio Department of Insurance while they let Medical Mutual insanely raise their rates throughout 2014, 2015, and 2016, just to eliminate their PPOs in 2017.

My Medical Mutual premium went up 224% in 2014 when it went on the Marketplace, and double-digits in 2015 and 2016. It wasn’t the health mandates that caused the rate hikes, that Mary Taylor tries to make a big deal of, because Medical Mutual already covered all of that. When I complained to the Ohio Department of Insurance about the crazy rate hike of 224% in the first year, they answered my complaint by giving me Medical Mutual’s answer —  that the Ohio Department of Insurance approved the rate hike so of course it must be okay. Isn’t it cozy how they’ve got each other’s backs?

I wonder how to take Mary Taylor’s statement in this article that insurance went up 91% on average in four years when mine went up 224% in just one year! If she is saying that premiums going up on average 91% in four years is bad, then how could she have ever approved of Medical Mutual’s rate hike of 224% in just one year? And why wasn’t my complaint properly addressed by her? If it had been, then maybe the individual insurance market wouldn’t be compromised today by Medical Mutual’s discrimination against us by the withdrawal of PPOs sold to self-employed Ohioans. She did all she could to usher in this crime against the individual, all in the name of some diabolical political agenda to deny healthcare to the American people.

In 2016, Ohio had the highest premiums after tax credits.  Mary Taylor has assured the failure of the ACA in Ohio in a number of ways. The CMS gave millions of dollars to States to enable “effective rate review.” Our money was used for something else because we never had effective rate review. Effective rate review would have allowed for public forums and open discussions about health insurance prices and problems. Instead, Mary Taylor rubber-stamped any and all rate hikes while keeping the facts far far away from the public. In Ohio, they like us dumb and ignorant.

Mary Taylor allows insurers to maintain provider networks that are on average 80% inaccurate, especially in Toledo where I surveyed them all. What is health insurance if not the provider network? How can insurance regulators allow such extreme dishonesty from our insurers? Why aren’t they looking out for us?

So now with the elimination of Medical Mutual’s PPO, and the total acceptance by Ohio that these new narrow provider networks, that are 80% lies, are just fine, Mary Taylor has the individual market neatly pushed aside as we get slowly snuffed out. We are artists, writers, musicians, inventors, shop owners, entrepreneurs, professionals, and hard-working breadwinners working multiple jobs. And now all of a sudden, we have to choose between having access to great healthcare, like our neighbors who work for the state and corporations, or maybe no healthcare at all, health being something we have to compromise in order to pursue our American Dream?

And what now, does Ohio dream for us? Back to the old, that’s what they want, but at really high prices that the last few years has brought us. Everyone with pre-existing conditions gets thrown under the bus. That would be 25% of us, and the majority would be the older ones my age. Gee thanks, I can’t wait to make it to Medicare age, as the joy of my perky young 60’s instantly taken away.

In Mary Taylor’s glee for dysfunction, the Ohio Department of Insurance laid the perfect backdrop for insurance and hospital hikes and mergers. On their watch, generic drug manufacturers colluded on the price of generic drugs raising prices as much as 8,000%.

And all Mary Taylor can say is, the old laws are in place to fall back on. Regression, regression, regression.

Too Much Passing the Buck

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Oliver Stone said on Late Night with Stephen Colbert that the information we are given about what is going on in the world is like a Disney cartoon.

And that is how it was last week with Lt. Governor and Director of the Ohio Department of Insurance, Mary Taylor’s testimony to the Congressional Hearing of the Homeland Security and Governmental Affairs Committee on the state of health insurance, and the propaganda that followed. It’s the same old they-don’t-say-anything, meanwhile letting every premium rate hike go through. How can we get our facts out to the world?

Hello Mary Taylor — we can’t find doctors. Stop squeezing us like geese. You are Lieutenant Governor, not Lieutenant General. We are not your toy soldiers.  We the people will not give up our rights or put down our lives to advance your personal political agenda.

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Barbara R. Sears, Assistant Director
Governor’s Office of Health Transformation:
"I am not involved with the Department of Insurance in my position in the Governor’s Office of Health Transformation (OHT) and cannot speak for the Governor, the Department of Insurance or provide a position from OHT on these issues."
But Barbara Sears, your neighbors who put you in office are hurting!

We can’t find doctors!

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Wishful thinking trying to get a message through to Committee members.

While they fight over politics we can’t find doctors.

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$10,000 per person and we can’t find doctors!

Model with cow, Denmark. Sven Türck (1897-1954)

CMS with new provider network ratings this year:

We can’t find doctors!

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Dear Insurers:

We can’t find doctors!

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Dear ProMedica, Toledo Clinic, and University of Toledo:

We can’t find doctors!

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Dear Governor Kasich:

We can’t find doctors!

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Dear Marcy Kaptur:

We can’t find doctors!

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Dear Senator Brown:

We can’t find doctors!

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Dear Health Journalists:

We can’t find doctors!

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Constituents to Congress:

HELP!

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We can’t find doctors.

Passing the Buck: Letter to Complaint Examiner (Updated Aug 25)

Spring time lapse copy
Ohio passed the buck to the Feds again, this time in regard to provider network problems.

August 6, 2016

Dear Barbara Smith Bain, Complaint Examiner Supervisor at the Ohio Department of Insurance,

There are several mistakes in your August 3 closing letter to me concerning my complaint about Medical Mutual’s inaccurate provider network directory and unwarranted high price.

First of all, the provider network issue. Because you have given Medical Mutual a pass to have grossly inaccurate provider network lists — did you even bother to check? — just last week I have identified an additional 112 provider network listings that are inaccurate. 140 out of 198 primary care physicians that I called on the Medical Mutual July 2016 SuperMed PPO network that Medical Mutual has listed online as accepting new patients, are not really accepting new patients, because I called them in July and they said they were not accepting new patients. My complaint identified 28 out of 47 that I called in November that are listed this way. What a huge percentage. Were you concerned? NO. Did you even bother to check? NO! Did Medical Mutual make any changes because I brought it to their attention? NO!

Your excuse for not dealing with this problem is not acceptable.

We have analyzed the facts as presented by both you and the company. We reviewed the documentation received and the Ohio regulations .found that this policy was purchased through the ACA Marketplace Exchange, and that the Exchange is under federal jurisdiction. At the time of the occurrence there are no Ohio Revised Code that specifies requirements for provider list information and maintenance.

Because you didn’t even bother to check in April, on what I reported on in November, that was then what I found to be a 59% inaccuracy, many more patients are NOW being hurt by the lies, deception, fraud, inaccuracies, and greed of Medical Mutual’s practice of incorrectly listing the panel status of their primary care physicians. The percentage of inaccuracies in my July survey of 198 doctors is now at 70%. Don’t take my word for it, do your own survey. Take that information behind the secrecy of your new closed door law and see what you can do about it.  I won’t be holding my breath.

Secondly, you did not address the outrageous 224% increase of my plan when it went on the Marketplace in 2014. It had all the ACA compliances in it already, in 2011. Why did it go up 224% the year it went on the Marketplace?  Please send me the actuarial memorandum and initial rate filing for the Medical Mutual 2014 Exchange plans, so I can see for myself how this increase was justified.

Thank you,

Penny Gentieu

Doctors listed as accepting new patients, but when I called them, they told me that they are not accepting new patients.

Doctors crossed out are some of the doctors listed as accepting new patients in July 2016, but when I called them, they told me that they are not accepting new patients. They were also listed as accepting new patients in November 2015, but when I called them in November 2015, they were not accepting new patients.

UPDATE ON AUGUST 23   I received this reply by email:
August 23, 2016

Re: Consumer Services Division File Number: CSD-0034217

Dear Ms. Gentieu:

Thank you for contacting the Ohio Department of Insurance (ODI) with your complaint regarding your provider network issue with Medical Mutual of Ohio (MMO). This letter is a follow up to your email received on August 6, 2016.

We understand from your email that you are not satisfied with the response you received from the Department regarding your complaint. You also provided the Department with information on network accuracy for July 2016 developed from your on line directory research.

We again reviewed the information provided by both parties and the applicable Ohio insurance regulations for the 2015 and 2016 periods. 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.

Please understand that the jurisdiction of the Ohio Department of Insurance is to provide consumer protection through education and fair but vigilant regulation of Ohio insurance laws. 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.

In regards to the 224% rate increase which you feel was not addressed. You stated in your November 30, 2015 letter to us that the rate change was for a similar plan sold on healthcare.gov for 2014 compared to the cost of the plan you had in 2013. It appears your earlier plan was a separate pre-Marketplace individual plan. Also, it appears that MMO addressed your concern in their January 21, 2016 response letter regarding the difference in the premium rates from one year to the next in light of pre and post ACA requirements.

Your public records request to the Department for Medical Mutual’s 2014 actuarial information and initial rate filings for exchange plans has been forwarded for review and fulfillment. Please understand that some records may not be available due to state retention schedules. 

Sincerely,

Barbara Smith Bain, Supervisor
Complaint Processing Unit
Consumer Services Division
Phone: (800) 686-1526 ext. 43393
Fax: (614) 719-1608
barbarasmith.bain@insurance.ohio.gov
Down the memory hole it goes….

It’s so interesting — this one-page press release the Ohio Department of Insurance issued on August 24, below. They report that the average premium only went up 91% in the individual market from 2013 to 2017. Yet my really thorough, individual market Medical Mutual insurance went up 277% from 2013 to 2016, for basically the same insurance.  Gee wiz, and now they might not even ever let me know what the actuarial reason is from the initial rate filings, because they plan on burning the information just as quickly as they possibly can.

Ohio Department of Insurance August 24, 2016 press release:

Screen shot 2016-08-28 at 4.17.08 PM

(there it is, the very last link)

Screen Shot 2016-08-25 at 8.13.43 PM

(click here to see original linked press release)

What?

I couldn’t find the NAIC Supplemental Health Care Exhibit for 2013, but  I did find it for 2014, and the weighted average annual premium per covered life for comprehensive health insurance in the Individual Market is $3,446 for 2014, which would make it a mere 30% increase from 2013, and we know that’s not true, from ODI’s own 2013 reports, so what’s up with this comparison that doesn’t sync with these facts?

Wish we could see the 2017 Rate Templates, which are not made public. What do they mean about not incorporating Trend into the calculation — Trend is part of every issuer’s actuarial memorandums that support their rate hikes, and that’s where they get the member months, so what is the Rate Data Template figure, if not the asked for, and undoubtably granted rate increase that the rate justifications are based on? And what is with this spartan one-page report? Is that ALL they have to say? Apparently the ODI issued this puny little report to comply with their idea of effective rate review!

PG168160

Provider Network Complaints Get Buried

PG168160

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!

PG168109

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

Related: Passing the Buck: My letter to complaint examiner