Squandering valuable healthcare dollars.


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.