Caresource customer rating

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. Contact this reporter at or jdebrosse DaytonDailyNews. 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. Skip to content. On This Page.

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