Unfinished

PG242997-Edit-Edit

Today is the day that the Ohio Department of Insurance said that they would have an answer on my appeal of their complete denial of any wrong-doing by Medical Mutual brought up in my complaint dated October 27, 2015, consumer complaint no. CSD-0034217.

I asked them to specifically look again at the issues of pricing and inaccurate provider network directory. Why did our plan jump 224% when it went on the Marketplace? And their otherwise double-digit rate hikes for years besides that.

I know what to expect, because I know who they work for. So I just want to get this on the page now, before I am completely depressed.

On Monday, I received a phone message from Kaylee (no last name, no phone number) at Medical Mutual, who said that we are paying $134.63 less a month than the actual amount we are paying. She said if I have any questions, to call healthcare.gov.

That was weird. $134.63 less. Hmmm…..

Then I received this letter from Medical Mutual, that had no contact information at all, no email address or phone number, just that I should call the Marketplace about a case number*:

IMG_20160531_0001sm

So I called healthcare.gov to ask them about that case number. I spoke to Felicia on a long phone call, who found nothing, and she had her supervisor research it, who found nothing, as well. The case number does not exist.*

I called Medical Mutual, but I was not permitted to talk to Douglas J. Bennett. From my call, I’m not even sure he exists.*

It wasn’t the first time Medical Mutual pawned things off on healthcare.gov. See, this, about their $0 premium mirror plans.

Here is a chart showing how much my Medical Mutual health insurance premiums have gone up:

2009 2010 2011 2012 2013 2014 2015 2016 2017
$413 $454 $425* $476 $560 $1,255 $1,355 $1,542 $?,???

How is that good? I’ve written more about rate increases and affordability on the page, Medical Mutual 7-year rate increases.

Enclosed in the Ohio Department of Insurance’s February 24 closing package (meaning, they were finished with my complaint) was Medical Mutual’s reply letter to my complaint, specifically this justification:

“All of our rates are filed, reviewed and approved by the Ohio Department of Insurance (ODI), so we are confident that this process assures us and our members the rates they are being charged are valid.”

That was all that was needed for the Ohio Department of Insurance to dismiss my pricing complaint.

Does the Ohio Department of Insurance exist for the citizens of Ohio or does it exist only for the wealth of the health insurance industry?

to be continued…

UPDATE AUGUST 23:
  • *The Ohio Department of Insurance’s explanation: “The company goes on to state that HICS E1604930964 was not a fraudulent case number and Mr. Bennett does not work in their Customer Care Center; therefore, he does not take calls.”

And there you have it!  That is simply all it takes — They are the billion dollar boss! Their billion dollar words carry so much weight, they don’t even have to say much of anything at all. A couple of words will suffice! And I will never know why they said on the phone message that my premiums are $134.63 less than what they actually are — they skipped over that little issue — or why my premiums jumped 224% in 2014 because their answer to that is rock-solid:

  • All of our rates are filed, reviewed and approved by the Ohio Department of Insurance (ODI), so we are confident that this process assures us and our members the rates they are being charged are valid.

As for the ghastly provider network inaccuracies, the ODI explains:

  • At the time of the occurrence there are no Ohio Revised Code that specifies requirements for provider list information and maintenance.

Are you sure? But what about now, I asked….

  • 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.
  • 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.

139 doctors on their list marked as accepting new patients, but when you call them, they aren’t….okay, great, thanks….and I have to pay good money for this?

  • 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.

Cool. Hope to get to figure out the actuarial reason why my premiums jumped 224% in 2014 before you burn the evidence.

More about my thwarted complaint.