Critic claims Ohio doesn't verify health care provider directory
"The quote in the New York Times article was shocking," Penny Gentieu, whose odyssey to find health insurance in 2017 involved contacting 308 physicians in six insurance plans, said in an email to Patient Daily. "That the Ohio Department of Insurance (ODI) said that enforcing the directory accuracy rules is consumer-driven by the public complaints of inaccuracies, one at time."
The state does not verify a health care directory until it receives a report of a problem, David Hopcraft, an ODI spokesman, said in the Dec. 3 New York Times article.
"Things are so bad in Ohio that the legislature last year allowed the Ohio Department of Insurance to write their own rules about how they handle provider network complaints," Gentieu said. "So-called health-watch people in the know objected, but the ODI wrote in a rule that allowed themselves to make entirely confidential any investigation they had about inaccurate provider networks. Which means that not even the people who complained, let alone the public, ever get to know anything about anything they do or don't do to the insurers in regard to their inaccurate provider network directories. Not only do they not do anything, they completely delete the complaints after two years. It's so crazy!"
Gentieu, as have other consumers looking for coverage for 2017, found that doctors listed in health plan directories as "taking new patients" very often are not. In her search, which involved contacting more physicians than most consumers do, Gentieu found that about 80 percent of physicians in the Toledo area were not accepting new patients.
Gentieu posted the results of her experience to the website Ohio Citizen Rate Review. She also announced plans to complain to the ODI, which this year instituted new directory-accuracy rules for marketplace plans, according to the New York Times article. However, Gentieu said she isn't sure how much weight such complaints will have.
"The Ohio legislature is controlled by the very rich and powerful insurance and pharmaceutical lobby industry," she said. "They have meetings, lunches and seminars with the legislators that constituents are not invited to and, consequently, the public's issues are never brought to light because we are way-overshadowed by the big money of health insurance and pharmaceuticals. What the legislators know about health insurance is strictly one-sided."
If state legislators really wanted to do something about this problem, they would make laws with stiff penalties, Gentieu said.
"They would revamp the Ohio Department of Insurance so that it would be looking out for the people of Ohio and not strictly the insurance industry and some political agenda at Ohioans' expense," she said. "They would make complaints searchable on the ODI website. They would set up a truly 'effective rate review' annually, with public forums so we have a voice about this extremely terrible problem with health insurance that we face."
For now, Ohio residents who want to make informed decisions about their health care will have to do their own research, Gentieu said.
"Ohioans have to call everyone on the provider networks, spend hours and days and weeks to find doctors who are actually accepting new patients on these lists that I have shown in Toledo to be on average 80 percent inaccurate," she said. "Ohioans have to look under every rock, they have to anticipate any problem, because even though their premiums may have gone up 373 percent -- like mine went up in seven years -- they may only be getting 20 percent of the purported value of the plan."
Congress also should take action, Gentieu said.
"Congress should eliminate provider networks, make prices transparent, and take the control out of the hands of the health insurance and pharmaceutical company lobbyists," she said. "All the doctors should take all the insurance plans. Doctors are either accepting new patients or not. Doctors should not be allowed to lend their names to these plans as if just to beef up the provider network lists to give the insurance plans an illusion of adequacy, when in fact their name listed as accepting new patients when they are not accepting new patients is a total lie. It's false advertising."
A lawsuit filed this month by 20 states against six pharmaceutical companies alleging collusion and price-fixing of generic drugs -- raising prices as much as 8,000 percent -- should be a wake-up call, Gentieu said.
"We are small business owners, entrepreneurs, shop owners, artists, writers, musicians and hard-working breadwinners working multiple jobs, " she said. “All of a sudden we have to balance our personal drive and ambitions to our ability to access the best in health care that those working for the government and large corporations are entitled to. It sort of takes down the American Dream, not only for us, but for young people considering their options and people who have a dream but are trapped in their jobs because they provide health insurance."