Tag Archives: Teresa Fedor

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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VOX

3.

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

4.

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

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

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

Click the photo to visit Oscar’s News page

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

5.

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

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

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

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

Click on the photo to visit the DC Health Link

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

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

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

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

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/

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.

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