Caresource provider complaints

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The Dayton area is largely served by Dayton-based CareSource, which enrolls more than half of the 1. CareSource not only dwarfs its competitors in size, it also logs more complaints, with the vast majority coming from health care providers. Of provider complaints last year, were lodged against CareSource and 46 against Molina, according to the Ohio Department of Job and Family Services.

In nine of the months between January and January , CareSource was at or above the state average for provider complaints. But Dr. Treatment denials are a common physician complaint. Grace said that before the state took over the Medicaid prescription drug program in February, CareSource refused to pay for more expensive medications for treating high blood pressure until patients first tried ACE inhibitors — a class of drugs that she says has proven ineffective in African-Americans.

And if you get cut off, you have to start all over again. CareSource covers about 40 percent of his patients, he said. Cutler says CareSource uses a variety of technical reasons for delaying and denying claims. The statement also said CareSource pays 97 percent of its claims within 30 days — well above the state requirement of 90 percent — and that the majority are paid in 17 days. Morris pointed out that all HMOs must pre-authorize treatments that are not standard practice in order to remain financially viable and provide quality care to patients.

With the number of jobless people in Ohio at their highest levels in decades, Medicaid rolls have grown at a time when the state also is cash-strapped.

The average monthly number of Medicaid clients grew from 1. In just alone, the rolls have climbed 11 percent over last year, according to state data. But as their ranks swell, Medicaid patients say their choice of doctors is limited, especially for specialists. Most doctors want to serve the poor in their communities, said Mark Jarvis, senior director of practice economics for the Ohio State Medical Association. CareSource, for instance, pays the same amount of money for an office visit whether the physician is in primary care, a specialty like orthopedics or cardiology or even a sub-specialty, such as brain surgery.

Plans are offered in three states and may differ from state to state. CareSource offers health insurance coverage through the state marketplace at several levels. Options range from comprehensive coverage to more affordable plans.

There is one main plan at the Gold level, with the option to add dental and vision coverage. There are four levels at the Silver tier, three of which are only available to those who qualify based on income level. Each plan has the option to add a dental and vision plan. The base-level Silver Plan is available without income restrictions. There are three more Silver levels at Silver 1, Silver 2, and Silver 3. All of these levels offer the same three underlying options, but with adjustments made for cost-sharing reductions based on income level.

Silver 3 has the lowest deductibles and out of pocket costs for those with low incomes. There are three options at the Bronze level. One includes an HSA and no dental and vision coverage is offered. Dental and vision can be added to the other two. The HSA Bronze plan is the only plan that offers the use of a health savings account. As usual, both deductible and out of pocket maximums are doubled for a family.

All of these rates are for an applicant who does not qualify for any low-income subsidies, and they are generally on par with what we have seen elsewhere for an HMO. Comparing rates for health coverage is difficult due to the many differences in deductibles and copays, but overall CareSource rates seem reasonable for the coverage offered.

Like most health insurers the company does not have much in the way of information regarding claims on their website. In general, claims are processed directly between providers and the insurance company, and most members rarely get involved.

As an HMO, we would expect customer service to be relatively speedy about processing claims due to the limited provider network. Although the BBB file does not name the government action in question, this is likely the reason for the lowered rating.

The company also has a total of complaints on file with the BBB in the past three years, 28 of which were closed in the past twelve months.

Compared to similar companies, this is a bit on the high side, rising from the number of complaints we saw in a previous review of this company.

We were unable to find a report from the National Committee for Quality Assurance for the company, which is surprising but may be due to lack of data. Review site Birdeye has 63 reviews, resulting in an overall 1.

The majority of the reviews are negative and cite issues including difficulty finding providers and denial of claims. The increasing number of negative reviews, however, is worth a note of caution. With similar rates available elsewhere, consumers may want to shop around for a stronger reputation for quality health care.

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CareSource is available through the health insurance marketplace by searching plans here or you can get several free health insurance quotes here. Each state has its own marketplace. Anthem is available through the health insurance marketplace or you can get several free quotes here. Each state has their own marketplace. CareSource accepts claims in various formats, including paper and electronic claims. Reimbursement is based on the prevailing state Medicaid or Medicare fee schedule.

With Marketplace Plans, you can make claims inquiries at Indiana , Kentucky , Ohio , , Georgia and West Virginia. Visit your app or www. Make sure you use the claim form from your benefit plan because each type is different. File the paperwork within the time limit. Cancellation inquiries can be made at Indiana , Kentucky , Ohio , , Georgia and West Virginia. All services that require prior authorization from CareSource need to be authorized before the service is rendered.

It is commonly used to manage pregnancy, asthma, diabetes and more. For Ohio members can Find a Pharmacy here. The complaint ratio on individual health plans are lower than complaint ratios on group health plans. Both fall below the average number of complaints compared with other carriers. Anthem is a trusted medical insurance provider which serves millions of Americans. Complaint ratios, however, tend to be a bit higher than average on group insurance plans.

Like most health care plans, Anthem has an annual flat-dollar deductible you must meet before your plan begins to pay your medical expenses.

Fran Majidi manages content on SmartFinancial's website. She's had nearly a decade's worth of experience writing about insurance-related topics.

Prior, she was an arts and entertainment editor in New York City. She has a B. She writes books under her given name, Afarin Majidi. CareSource vs. Anthem Insurance Which health insurance company is the best option for you and your family? Fran Majidi October 26, Affordable marketplace plans with different tiers of coverage. Grace said that before the state took over the Medicaid prescription drug program in February, CareSource refused to pay for more expensive medications for treating high blood pressure until patients first tried ACE inhibitors — a class of drugs that she says has proven ineffective in African-Americans.

And if you get cut off, you have to start all over again. CareSource covers about 40 percent of his patients, he said. Cutler says CareSource uses a variety of technical reasons for delaying and denying claims. The statement also said CareSource pays 97 percent of its claims within 30 days — well above the state requirement of 90 percent — and that the majority are paid in 17 days. Morris pointed out that all HMOs must pre-authorize treatments that are not standard practice in order to remain financially viable and provide quality care to patients.

With the number of jobless people in Ohio at their highest levels in decades, Medicaid rolls have grown at a time when the state also is cash-strapped. The average monthly number of Medicaid clients grew from 1. In just alone, the rolls have climbed 11 percent over last year, according to state data. But as their ranks swell, Medicaid patients say their choice of doctors is limited, especially for specialists.

Most doctors want to serve the poor in their communities, said Mark Jarvis, senior director of practice economics for the Ohio State Medical Association.

CareSource, for instance, pays the same amount of money for an office visit whether the physician is in primary care, a specialty like orthopedics or cardiology or even a sub-specialty, such as brain surgery. For hospitals, that means Medicaid patients showing up in emergency rooms with more serious problems may have to be hospitalized while they wait to be seen by an available specialist, such as an orthopedic surgeon for a broken bone.

Bucklew said hospitals are working with their community partners, including CareSource, to come up with a solution. Larry Litscher, a Dayton urologist with offices downtown and in Centerville, said sees Medicaid patients from as far away as Springfield because other urologists refuse to accept CareSource. Finding specialists in all parts of the region and the state who will take Medicaid patients has been a challenge for all HMOs, Morris said.

In the Zanesville area, she said, CareSource worked with a physician-hospital collaborative that now does its own pre-authorizations for hospital care. The collaborative includes specialists, many of whom may not have participated in Medicaid on an individual basis.