Tag Archives: Provider network directories

The Price I Have to Pay

PG245180-Edit 2February 17, 2017

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Penny Gentieu found many health insurance directories to be outdated and inaccurate.
Penny Gentieu found many health insurance directories to be outdated and inaccurate.

Advice to Shoppers

pg245841We get the shaft: we’re the tiny percentage of the American population who must buy Obamacare health insurance, because we don’t get health insurance from an employer, whether it be a large corporation or the state or federal government, nor do we qualify for Medicare or Medicaid which together cover 50% of the population.

For us, the individual health insurance market, a mere 5% of the population, Obamacare is highly fragmented, with about 600 risk pools and 300 different carriers — shouldn’t we have just one?  We would not only be able to have an honest choice of providers, we’d have bargaining power as well, and we could save 50% just on administration costs because providers wouldn’t have to spend half their time on the phone with so many insurers. We could endeavor to attain the highest standard of health, as is our right as human beings, right along side the rest of the U.S. population, right along side our neighbors with the employment and the government PPOs.

However, we, the individuals who have to buy our own insurance, are forced to choose from several packs of lies in the current, discriminatory, Obamacare system. We are forced to pay more than double for less than half of what we got just three years ago before the “Marketplace.” We get only inadequate and inaccurate provider networks to choose from, because PPOs have been taken away from us, replaced by tiny newly-invented networks that are on average 80% inaccurate. None of the networks are adequate according to the standards issued by the CMS.

Our representatives and regulators know all too well about the inaccuracies but they do not care enough to demand that the insurers fix it. Consumer law apparently doesn’t count with health insurance, which is many households’ largest monthly budgeted item, as well as almost one-fifth of the entire U.S. economy. Only state insurance regulators, along with the CMS, can demand corrections. But they don’t either, because as we all know, insurance companies run the show and run the legislature. Corruption abounds. We the people all suckers to the health industry must accept our situation, because we have no voice. Buyer beware and carefully consider your options.

Make sure to have a doctor in the plan before buying a plan. Good luck.flyer-11-10

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.

Email to Governor’s Office of Health Transformations

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My email is at the bottom of the page, that I sent to Barbara Sears, the former State Representative for my neighboring town of Sylvania, (which was included in my provider network survey), who is now the Assistant Director of the Governor’s Office of Health Transformation. I thought she’d be concerned and would help.  I cc’d it to my State Representative, Rep. Teresa Fedor, who then wrote to Barbara Sears, and this is their email exchange.

The stated goal of the Office of Health Transformation is for Ohio to be the healthiest place to live, work, and raise a family. Wouldn’t any state want the best for their citizens? But there’s a double standard here. Barbara Sears is saying that if our emergency problem has to do with health insurance, the Office of Health Transformation won’t provide a position on this issue, let alone provide any help to make sure Ohioans who buy health insurance will get healthcare under the conditions I have uncovered, with 80% average inaccuracies in the provider network directories. The issues I brought up in my email didn’t faze her in the least.

Ironic, isn’t it.  Barbara Sears, in charge of the Governor’s Office of Health Transformation, simply has no opinion whatsoever about the 80% provider network inaccuracies uncovered in Toledo. Nor does Barbara Sears have any concern for the welfare of her neighbors and former constituents who voted her in as their State Representative. I bet they are sorry now.

Re: Major errors in provider network directories

Sep 13, 2016, at 9:29pm

Barbara,

It’s unfortunate the Governor’s Health Transformation would not want knowledge of this emergency for millions of Ohioans. I hope that you will be able to share this issue with him and make recommendations to move it forward to be dealt with in short order otherwise our citizens will suffer.

Rep Fedor

Sent from my iPhone

On Sep 13, 2016, at 11:17 AM, Sears, Barbara <Barbara.Sears@governor.ohio.gov> wrote:

Teresa –

Thank you for your email. 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.

Barbara

Barbara R. Sears
Assistant Director
Governor’s Office of Health Transformation
614-752-5024 (Office)
614-325-2500 (Cell)

This message and any response to it may constitute a public record and thus may be publicly available to anyone who requests it.

From: Teresa Fedor
Sent: Monday, September 12, 2016 11:23 PM
To: Sears, Barbara <Barbara.Sears@governor.ohio.gov>
Cc: Penny Gentieu <penny@babystock.com>; Jen.Stack@ohiohouse.gov
Subject: Fwd: Major errors in provider network directories

Dear Barbara,

Hello. Penny has been in contact with me for quite some time now alerting me about a very serious issue she has expertly researched and outline. I ask that Penny and others she is working with meet with you as soon as possible to address this serious issue and work on compliance measures and a plan to fix it in order to help individuals and families access critical medical needs. I am confident you can help the millions of citizens counting on the Governor’ administration to get this right. At this juncture, it rises to the level of an emergency for again millions of Ohioans. I’ll make myself available and Penny will as well.

I look forward to your quick response and a plan to address this as soon as possible.

Sincerely,

Rep. Teresa Fedor

Sent from my iPhone

Begin forwarded message:

From: “Penny Gentieu” <penny@babystock.com>
Date: September 12, 2016 at 7:59:14 PM EDT
To: Barbara.Sears@governor.ohio.gov
Subject: Major errors in provider network directories
Reply-To: penny@babystock.com

Dear Ms. Sears,

I live in Toledo, Sylvania Township. I have a website, ohiocitizenratereview.info, which I started last year to bring awareness to the severe problems we have in this city, in this state, in regard to health insurance. I’m writing to ask for your help as the Assistant Director of the Office of Health Transformation, and as a neighbor.

I’ve conducted a survey of 308 primary care provider physicians listed on six provider networks who are all listed as accepting new patients. I called the doctors, and about 80% are NOT accepting new patients. The provider networks are for individual health insurance plans sold by Anthem Blue Cross Blue Shield, Paramount, Medical Mutual, Molina, CareSource, and Buckeye Community Health. These are ALL of the plans available to individuals.

Here is a link to the survey, http://ohiocitizenratereview.info/provider-networks/ and here’s a link about the survey, http://ohiocitizenratereview.info/provider-networks/description/, and here is a link to the letters I sent to the insurers along with detailed lists, asking them to please correct their provider network directories before November 1 when Open Enrollment begins for 2017 enrollment:
http://ohiocitizenratereview.info/provider-networks/letters-to-insurers/

I created this survey because I wanted to find a primary care physician in Toledo and couldn’t find one, a problem I’ve had since I moved to Toledo seven years ago. I actually have to drive to Ann Arbor in order to see a doctor. But my good PPO health insurance is apparently being fazed out by Medical Mutual, as they transition to their extremely narrow network plans, with their 85% provider network directory inaccuracy rate of doctors listed as accepting new patients.

The ACA law forces Toledoans to buy health insurance or face a sizable federal fine. With 65% to 90% inaccuracies, Toledoans are given 5 to 1 odds that we won’t be able to find a doctor. This can’t be the intention of the state of Ohio, for their citizens to have to pay dearly, to gamble on the likelihood that they will be able to get healthcare when they need it.

Unfortunately, the Ohio Department of Insurance has not been any help, which could be why my survey shows an 80% error rate, which is much worse than the California provider network scandal of 2014-2015, which you can read about here: http://ohiocitizenratereview.info/outrageous-health-insurance-rate-increases/if-other-states-can-do-it-why-cant-we/

Times are hard for Ohioans, especially for Toledoans, whose median family income dropped 17.3% in a 10 year period, when health insurance premiums more than doubled. In fact for me, premiums went up 373% in that time period, just so I could hang on to my quality Medical Mutual PPO to see a doctor in Ann Arbor, since I could never find a doctor in Toledo, due to the extremely inaccurate provider network directories. It’s really crazy that in November, chances are we Toledoans will continue having to paying out the biggest budgeted monthly expense, for health insurance that is based on a fraudulent dishonest system, where issuers are allowed to misrepresent their products and nobody does a thing about it.

Is it possible that you could look into this, and put into motion some emergency measures so that come November, hardworking Toledoans can get actually get a fair shake, and not get duped again.

I’m happy to send you the detailed list of doctors that I sent to the insurers, if you can be of help.

Thank you for your time.

Sincerely,

Penny Gentieu

Penny Gentieu
718-788-0570

Insurers’ Flawed Directories Leave Patients Scrambling

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

Letter to U.S. Senator Sherrod Brown

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Dear Senator Sherrod Brown,

Thank you for June 10th letter, confirming that Ohio is a state that is required to publicly post rate increase justifications, to provide more transparency to the public. You said that I should share my concerns with the Ohio Department of Insurance.  I did in fact contact the Ohio Department of Insurance before I wrote to you last month. The Ohio Department of Insurance told me that they do not release the rate justifications until they are finalized.

We have a problem in Ohio with the Ohio Department of Insurance interfering in the public’s right to obtain public records.

The Ohio Department of Insurance has also withheld my April request for public records of health insurance complaints, specifically, complaints about provider networks. And I recently found out that the department shreds complaints they receive after they image them, then erase them after only two years from the date the complaint was decided on.  So already they have destroyed two months worth of complaints while they are stalling out the inevitable release of the public records, public records that I am and have been completely entitled to.

I wonder what records the Ohio Department of Insurance has destroyed in those two months during the time I had a right to see them. Why is it they are is such a big hurry to destroy public records of health insurance complaints, with a short, two-year retention schedule? Two years is hardly any time at all, to show trends, to help Ohioans understand the problems and help them solve those problems.

Continue reading Letter to U.S. Senator Sherrod Brown

Letter to Governor Kasich

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Dear Governor Kasich,

This letter is to give you feedback about the Ohio Department of Insurance and ask for your help.

I’m a constituent. 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%! Even though the benefits, including the provider networks, of the Medical Mutual insurance from 2009 through 2016 have been 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!

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?

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 destroy 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.)

Thank you for your time.

Sincerely,

Penny Gentieu

So much wool over our eyes

PG838604At last count, over 10,000 Toledoans bought health insurance this year on the Marketplace. It could be 20 or 30 million dollars of taxpayer money coming this way to help Toledoans pay for health insurance. That money is for health services, but it’s getting squandered away, because most of the Toledo medical community snub their noses at Marketplace insurance.

ProMedica and Toledo Clinic say they don’t accept the affordable Marketplace insurances. Meanwhile, CareSource, one of the two affordable insurances, has listed on its network 50 ProMedica primary care doctors who are accepting new patients, but when I called each one of them, only two of the 50 doctors were actually accepting new patients.

Yet there they are, 48 ProMedica doctors listed as accepting new patients on the CareSource network, on an insurance that the ProMedica business office told me they don’t accept. How could that be?

And why would ProMedica snub affordable health insurance and the poor people who have to buy it? The poor people in every sense.

What a squandering.

The premiums for any plan other than a very few that are issued by Ambetter and a plan by CareSource have gone up sky high. On a Marketplace that is based on affordability, to have 93 plans offered in our zip code but only a very few that are affordable goes against the purpose of the Affordable Care Act.

How is it possible that plans sold by United Healthcare, InHealth, CareSource, Medical Mutual, Aetna, HealthSpan, Molina, Anthem, and Paramount could be sold after tax credit that are 7, 10, even 15 times more expensive than what the ACA law determined to be affordable for a particular income?

How could InHealth and United Healthcare plans be sold on healthcare.gov that are even more than 1500% of what the government has specifically set by law to be affordable?

Rate reviews by insurance issuers have been redacted so that the citizen reviewer cannot make any sense out of them. Ambetter, which offered 30 plans in 2015 and 11 plans in 2016, submitted a rate review this year that has literally every detail crossed out!

CareSource’s rate review is also highly redacted, and these two companies issue the affordable plans that the Marketplace is based upon.

These are the affordable insurances that control the tax credits, and the public needs to know the details of their pricing because that is one of the purposes of the annual rate reviews. It would be great to know how many policy owners and the demographics of the policy owners, the paid to allowed claims and ratios, the incurred but not paid claims and ratios, data from their Experience Period, the credibility of Experience, the State Average Premium, the projected memberships, the medical costs increases, the age and rating area distributions, the condition of the single risk pools, etc., including all the data on all the adjustments made in determining the pricing and the changes made to the expected population. For starters.

We must try to decipher the complicated, convoluted, and confusing rationale for the pricing, because the prices are completely out of control and we just can’t take it anymore.

Below are excerpts from Ambetter’s rate review submission. I didn’t do the cross-outs, they did. Ambetter is offered through Centene Corporation, an insurance provider that has the second-highest compensated CEO, (second only to United Health), 28.1 Million in 2015.

Ambetter was the second-lowest cost silver plan in Toledo both this year and last year. And this is the kind of rate review they submit? At the top of every page is, “This document is a trade secret and needs to be kept confidential from the public realm,” and everything is crossed out. I think we have a right to know.

Pages from Centene Corporation's highly redacted rate filing for Ambetter. What an insult to the public's intelligence.
Pages from Centene Corporation’s highly redacted rate filing for Ambetter. What an insult to the public’s intelligence.
More from Centene Corporation's Ohio rate review for Ambetter, Toledo's benchmark Marketplace insurance. Centene is one of the largest Medicaid insurance providers in the country, and this is how they regard Americans -- that we are stupid and don't have the right to know.
More from Centene Corporation’s Ohio rate review for Ambetter, Toledo’s benchmark Marketplace insurance. Centene is one of the largest Medicaid insurance providers in the country, and this is how they regard Americans — that we are stupid and don’t have the right to know.

The healthcare.gov Marketplace sent emails for us to change our plan because their records showed that our plan would rise 30-50% next year. It’s as if the Marketplace wants all the other insurances to go sky high, so that everyone will have to sign up for Ambetter or CareSource.

I wanted to switch, but not after I researched them. There’s no value there. These plans have slim to nothing networks, no ProMedica which is by far the largest provider in Toledo; furthermore, they make it difficult to get care, and these insurances don’t pay as much, so I’m told. But these plans costs twice as much as our pre-Marketplace Medical Mutual PPO policy, which was far superior to Ambetter and CareSource’s extremely narrow-networked HMOs.

A notification from Healthcare.gov that our insurance is going up 30-50%! WHAT!!?? And that is ACA business as usual? What's next?
A notification from Healthcare.gov that our insurance is going up 30-50%! WHAT!!?? And that is ACA business as usual? What’s next?

When 90% of the insurance providers can sell plans after tax credit that are seven to fifteen times the cost of an affordable plan, never mind how incongruous that is — how did the prices get up so high, so fast?

This is how: a 224% hike in 2014, and double-digit hikes every single year, before and after, for several years. Our Medical Mutual plan, which is basically the same as it was in 2009, went up 373% in seven years.

That’s outrageous. And the government, the taxpayers, the enrollees, and we the people, are getting taken for a ride.

Squandering valuable healthcare dollars.

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Tax dollars are being squandered away in Toledo. Affordable healthcare plans are being sold on the Marketplace — 10,000 in Lucas County on the Marketplace alone, but the majority of the Toledo medical community is not supporting it. ProMedica, which probably has a 65%+ market share in Toledo and is presently building new facilities all over town, and is receiving favors from both the city and the state, has completely snubbed those in Toledo who have to buy insurance on healthcare.gov.

There are many ProMedica and Toledo Clinic doctors listed on the networks as accepting new patients, when in fact they are not accepting new patients. Calls to the billing offices to check on what affordable insurance they accept are met with mostly, “We don’t accept any of the healthcare.gov plans.” (Toledo Clinic billing office told me this on Nov. 12 and Promedica billing office told me this on Nov 17.) Yet you see their doctors names on the lists for CareSource as doctors in-network who are accepting new patients — 50 ProMedica doctors, with only two listings being accurate.

As for Ambetter, the least expensive insurance, you will be hard pressed to find any ProMedica doctor accepting it. Maybe one or two in an office in North Toledo.

The fact is, ProMedica, with it’s many new facilities being built all over town, with fees and charges among the highest in the state of Ohio, is fazing out their primary care doctors, replaced by nurses.

ProMedica Health System is fazing out primary care doctors, yet Lucas County spends about 15% more on medical care than the national average according to Medicare statistics. This, in our poor community where incomes are so much less than the national average.

There is no organization in Toledo to put the checks and balances on what clearly is the degradation of our local health system. There is CareNet, which was once a very useful organization, created in the ’90’s through the vision of former mayor Jack Ford and Dr. Jonathon Ross to give health care to the poor. Now we have the ACA, with the enhanced Medicaid program, and CareNet is the main organization in Toledo that trains healthcare.gov navigators. To be in such a leadership position, CareNet didn’t help when I complained to them about issues I have been raising since October 27. Nor have any of their funders responded to the open letter I posted here on Nov. 19, also posted to CareNet’s Facebook page, and emailed and mailed to seven of them. Imagine what they could do, if only they cared about Toledo’s poor.

What a squandering. These affordable plans that the Toledo healthcare community is snubbing, issued by Ambetter and CareSource (not to be confused with CareNet) cost twice as much as our quality Medical Mutual national network insurance cost in 2013, the year before the first year of healthcare.gov. It could be $30 million dollars spent annually of federal tax credit money for Toledoans. Toledo’s medical community doesn’t appreciate that? They couldn’t make sure their doctors updated their network statuses, have the billing offices accept the insurance plans? Where is that money going, when most of the Toledo medical community has snubbed it? Is it mostly going toward the compensation of Ambetter’s Centene CEO, 28 million dollars last year? How ironic that these plans cost tax payers twice as much as we paid for our 2013 plan, but the enrollees of the affordable plans get treated as if they do not deserve to get quality care.

This is the third year of healthcare.gov. The six-week open enrollment season will soon be over. Time to stick our heads back in the sand, and hope that when our kids grow up, they will leave Toledo so they can have a better life.  One day our lives will be over, sooner rather than later, because we live in Toledo where it’s no coincidence that healthcare has become the biggest industry, in our once-thriving industrial town. What we’re not doing is already catching up with us.

My email to ProMedica

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Dear Dr. Cassavar,

With Open Enrollment of the Marketplace upon us, and many Toledoans having to change insurance plans because our premiums went up so much, many of us have to find new doctors, too. But ProMedica sure isn’t making it easy to for us make an intelligent decision.

In your role as President of ProMedica Physicians, could you kindly make some changes in your doctors’ current lax custom they have of rarely updating their insurance “panel” statuses?

I know for a fact that four years ago, Dr. McAlear’s entire office of physicians was not accepting new patients, because I had a doctor in that group who left to work at the Veteran’s Hospital, and not one doctor in the group could take me. Yet, four years later, those doctors are still listed as accepting new patients!

Last week I called 50 ProMedica doctors on the CareSource network who are advertised as accepting new patients, but actually only two doctors are really accepting new patients. That does not show very good odds for the honesty and consideration of the doctors to the community that they serve.

I looked up these same 50 ProMedica doctors on the Medical Mutual SuperMed PPO network, and I found 47 on this network, and of those 47, 17 are listed as closed, but 30 are listed as accepting new patients when actually only two of those 30 are accepting new patients.

I lived in New York for 27 years, and I never had a problem finding a doctor. Doctors in New York are required to update their status within 15 days of a change. Michigan has similar rules and there is no problem there, either.

I’m sure there is some law that applies to this problem in Toledo, even if Ohio may not have a regulation like that, which I don’t know, but I assume that is the reasoning. I’m not a lawyer, just a Toledoan who has been hurt by this process, and I’m talking to other people who have been hurt too, and I’m trying to make a change for the better.

Couldn’t ProMedica doctors take the lead in our community by providing accurate information on your website and on insurance network lists for your community members? It can’t be that much effort and it sure would go a long way. In a city where ProMedica is building new buildings and has such a big name, ProMedica could show Toledoans that you are listening to their concerns and that you want to help make a better Toledo. You are Toledo’s doctors, but you are also our neighbors and our friends too.

When I hear things like, “It’s been going on for years” from doctors’ offices that will not accept new patients even when they are listed as doing so, I have to think, what does that say about our community, and what is that teaching our kids? It’s got to stop. Please, take the lead, Dr. Cassavar and ProMedica Physicians.

Thank you for your time. I appreciate your consideration.