Tag Archives: Public records request

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

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.

Public Records request for rate filings

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I submitted this request to the Ohio Department of Insurance for 2017 rate review filing public records on May 16:

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Their response on May 23:

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My reply on May 23:

Dear Ms. Washburn,

What do you mean by HIC? When will you approve the rate filings? Doesn’t Ohio have an “Effective Rate Review” where the public can contribute to the rate review process? If so, then I would like to see the filings. According to the CMS, Ohio has an “Effective Rate Review” process. I would appreciate your prompt relpy. If you could please note what law you are relying on to deny me access to these records at this time, I would appreciate knowing that, too. Additionally, Medical Mutual does sell on the Exchange.

No answer to that.

My first request on April 21 below:


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Would you think they would lie about something as important and serious as the public’s right to see the actuarial memorandums and rate justifications before the rates are approved?


The link they gave me to access approved filings was on a 2013 press release webpage:

http://insurance.ohio.gov/Newsroom/Pages/06062013ACAProposedRates.aspx

Then you have to follow the links through the press release:

But you won’t get in like that. You have to go back to their 2013 press release about how much more health insurance was going to be in 2014 on the Marketplace. For some funny reason, they put the link there. That’s the secret way in!

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Error message you get when you don’t know the secret passageway.

Here, you will find the corresponding highly redacted documents, that should not be highly redacted, because all the information is crossed out that is meant to mathematically substantiate why the rates are going up so much, but we need to see those numbers and double-check the math. I don’t know for sure, but I will take an educated guess that Ohio could, but they don’t, require these issuers to disclose all those important numbers on the redacted-for-trade-secrets version of their rate filings. The numbers, naturally, are very basic public information — the reasons why, are not trade secret!!  Obviously, CMS requirements exist for this disclosure, since it’s the fundamental principle of effective rate review.