Archive for February 23rd, 2010

Half Guilty, Half Pregnant Insurance Agent Seeks Separate Sentencing

Tuesday, February 23rd, 2010

Half Guilty, Half Pregnant insurance agent, Arnulfo C. Olivarez, filed an Unopposed Motion for Separate Sentencing on February 1, 2010. His current sentencing date is March 4, 2010. The petition reads “Defendent Arnulfo Cuahtemoc Olivarez respectfully requests that he be sentenced alone and separate from all other defendents in this case. This request is made not for the purpose of delay but so that justice may be done.”

Under seal, the court has received a “Confidential Sentencing Recommendation” dated February 5, 2010.

Editor’s Note: For more information on this felon, type in “Olivarez” in the search box on this blog.

Protected: Hospital Contract Exposed – Major Carrier Hides Behind Magical Curtain

Tuesday, February 23rd, 2010

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Medicaid Feels Pinch of Economy

Tuesday, February 23rd, 2010

More than half the states are reducing Medicaid services and payments to health care provider this year as the recession propelled enrollments to record levels and sapped money from treasuries.  Many states are threatening bigger cuts starting in July unless Congress extends a higher federal contribution incuded in last year’s $862 billion economic stimulus law. Some of those custs would make it harder to low-income people to qualify.

California plans to close adult day health care centers next month. Nevada is cutting coverage for eye glasses, dentures and hearing aids.

Medicaid enrollment rose by 3.3 million people or 7.5% in the 12 month period ending June 2009 for example. Enrollments rose in every state for the first time since the early 1990’s. Medicaid, on average, 21% of state budgets, equal to education, and is expected to increase even more as the recession continues.

XYZ Insurance Company Hospital Contract – Guaranteed Cash Flow Mechanism

Tuesday, February 23rd, 2010


Below is actual language found in an insurance company’s  Hospital Contract which in effect gives the participating hospital an annuity contract of sorts. The participating hospital is guaranteed a weekly cash payment whether they see a member patient that week or not.

XYZ Insurance Company will adjust the weekly Uniform Payment Plan (UPP) for all applicable allowances for Covered Services rendered to XYZ Insurance members. The UPP means the weekly payment that shall be made from XYZ Insurance Company to Hospital representing the average weekly claims volume incurred in the previous running quarter.  The adjustment to the UPP check will be the estimated difference between the Net Covered Charges and the applicable XYZ Insurance Company liability based upon the agreed upon rates attached hereto for each Hospital as a separate Exhibit and incorporated by reference herein. Net Covered Charges means Covered Charges for Covered Services rendered to XYZ Insurance Company members less deductibles and co-payments, less coordination of benefits amounts.

The estimated XYZ Insurance Company liability for Covered Services rendered to XYZ Insurance Company members will be determined based on the amounts reflected in the Rate Exhibits attached hereto.

Adjustments will be reviewed and recomputed by XYZ Insurance Company only as necessary to reflect actual XYZ Insurance Company claims and/or contractual allowances for XYZ Insurance Company Covered Services rendered to XYZ Insurance Company members by the Hospital during the particular year as evidenced by XYZ Insurance Company processed claim data and/or Rate Exhibits. In the event of termination of this Agreement any indebtedness of Hospital to XYZ Insurance Company may be offset and/or recouped via reductions to or elimination of UPP payments during the month prior to the effective date of termination. In addition, XYZ Insurance Company has the right to offset 100% of any claims liability due the Hospital beginning on the effective date of the termination until XYZ Insurance Company has been paid in full, regardless of whether Covered Services were rendered prior to or subsequent to the date of termination.

XYZ Insurance Company will periodically reconcile for each year during the term of this Agreement the payments made by XYZ Insurance Company to Hospital, and the weekly adjustments to UPP.

Editor’s Note:  Many hospitals are dependent upon the cash flow advantages of this and similar hospital contracts. With up-front health care financing, reconciliation strategies employed may very well reward the insurance company with higher fees than are normally  paid to competing payers. However, consumers will never be able to learn the truth because, as is the case with all the various hospital contracts we have  been able to review, invaribly there is the famous paragraph that reads something like this: The hospital certifies that unless otherwise required by law, the specific compensation rates and discounts under this Agreement have not been, and will not be, disclosed by Hospital, its employees, agents or independent contractor, to any third parties including Hospitals or competitors of XYZ Insurance Company.

Swing Votes on Healthcare

Tuesday, February 23rd, 2010





We don’t believe that there is any chance of stopping Obama’s renewed push for his horrible healthcare changes in the Senate. Harry Reid is going to use the reconciliation procedure to jam it through with 51 votes — and he will get them. All the hype about how difficult it will be is to distract us from the real battle which will come in the House.

There, where every member faces re-election, it will be a lot harder for Pelosi to round up the vote she needs.

Last time she passed healthcare by 220-215. This time, it won’t be so easy.

The League of American voters has produced ads targeting these swing Congressmen and we urge you STRONGLY to CLICK HERE to send them money to help fund these ads.

But please do more. If you live in any of the states from which these swing Congressmen come, please call them. Let them know your opposition to healthcare changes. The phone for Congress is 202-224-3121. Here’s the list:

Vulnerable Democratic Congressmen Who Voted FOR Obamacare The First Time Around

These are the folks we need to pressure to switch their votes!


Harry Mitchell (Phoenix suburbs)
Gabrielle Giffords (Tucson)
Ann Kirkpatrick (most of rural Arizona, NE part of state)


Jerry McNerney (Stockton and Pleasanton)


John Salazar (Pueblo)


Jim Hines (Fairfield County)


Alan Grayson (Orlando)


Bill Foster (Dixon, Batavia, and Geneseo)


Baron Hill (from Kentucky border up to Bloomington)


Mark Schauer (Branch, Calhoun, Eaton, Hillsdale, Jackson, Lenawee & Washtenaw counties)
Gary Peters (Oakland County)


Dina Titus (Las Vegas)

New Hampshire:

Carol Shea-Porter (Portsmouth, Manchester, Lakes Region)

New York:

Tim Bishop (Suffolk County)
John Hall (Northern Westchester)
Bill Owens (Plattsburgh up along Vermont border to Canada)
Mike Arcuri (Utica and south central NY)
Dan Maffei (Syracuse)

North Dakota:

Earl Pomneroy (at large)


Steven Driehaus (Cincinnati west to Indiana border)
Mary Jo Kilroy (Columbus and west to Indiana border)
Zach Space (Dover, Zanesville, Chillicothe)


Kathy Dahlkemper (Erie)
Patrick Murphy (Bucks County)
Christopher Carney (NE Penn)
Paul Kanjorski (Scranton, Wilkes-Barre)

South Carolina:

John Spratt (rural SC between Columbia and Charlotte)


Tom Perriello (Charlottesville, Bedford, Timberlake, Martinsville & Danville)

West Virginia:

Alan Mollohan (Wheeling, Morgantown)
Nick Rahall (Huntington)


Steve Kagen (Green Bay)

Let’s get busy to save healthcare in America!

Please support the League of American Voters in their efforts to stop Obama — Go Here Now.

SPBA Email Alert – Message from Fred Hunt

Tuesday, February 23rd, 2010

Personal observations from SPBA President Fred Hunt      

The descriptions in my recent e-mails about the intents of the various players in health reform right now and heading into the Summit on Thursday all still apply, so take what I say and what you see and hear in the media in that context.  

The $200 billion Congressional Democratic “ping-pong” plan to ram through a Reconciliation version that would make the corrections the House wants to the Senate bill, and then the House pass the Senate bill (meaning that they would pass a superceding corrections bill before passing the underlying bill), thus meaning that both chambers would have passed the Senate version, and it could go directly to the President for signing into law) is still trying, but it assumes a lot of wishful thinking that 51% of the two chambers of  Congress will go along.

Major newspapers are giving pretty good charts & descriptions of the Obama “starting point” proposal for the Thursday Summit.  Don’t drive yourself nuts trying to micro-analyze each provision.  It is essentially like a dealer reshuffling the cards of the existing House & Senate bills and dealing you a new distribution of cards.  Besides, it is just a brainstorming vehicle. 

So, instead of an item-by-item analysis, let me just share some insights about things to which you should be alert during & after the Summit, and the net outcome.

1.  Democrats are approaching the new Obama proposal very cautiously.  It was written in secret within the White House without  Congressional input.  This is a double insult for Congressional Democrats.  First, because Obama is asking them to stake their political futures on something unknown and untested, and features they desire, Obama might abandon.  Second, Congressional Democrats are still resentful that for the past 9 months, Obama kept arm’s-length deniability from the specifics of the Congressional bills,  so they have been battered by angry constituents without any progress to show for it, because Obama never laid out precisely what was and was not his priority items.

2.  The most fierce and divisive issues among Democrats have not been resolved in the Obama proposal, and would tend to generate some “no” votes from needed Democrats in the House & Senate.  For example, the Obama abortion restrictions mirror the Senate bill (which are not acceptable to many House Democrats)  Also, there is no Public Option, instead steering more people into private insurance company policies (via the mandate to have coverage). for regulated MEWA-like self-funded plans for small employers to be allowed.  No such solutions are provided. .   This is one of the Catch-22 provisions in the proposal.  Small employers are forced to have health coverage ….but without any new or streamlined ways for employers to do so.  For example, Republicans for 20 years have been pushing for regulated MEWA-like self-funded plans for small employers.  No such options are made available.

3.  There are more subsidies for low & medium income people, but the trade-of is to subject investment income to Medicare 2.9% taxation for individuals with incomes above $200,000 and couples over $250,000.

4.  The Cadillac tax has become sort of a vestige joke.  To keep unions happy, the family-premium trigger rises to $27,500, but (here’s the kicker) it would not take effect until 2018.  Eight years is a lifetime in politics , so this is mainly window-dressing apt to never happen or in riddled with exceptions. 

5.  The employer mandate is tougher than the Senate version.  Employers with more than 50 employees would be mandated to offer employee health coverage or pay a $2,000 annual fine per employee if even one employee sought federal subsidies. The mandate penalty phases in higher for employers in the 50-80 worker size.

6.  The special deals to Nebraska & Louisiana to subsidize the state’s Medicaid load has been “eliminated” and transformed into more subsidy for all states for Uncle Sam’s share of Medicaid. 

7.  After all the hand-wringing about the necessity to have CBO scoring on every bill & provision, CBO has said that this version is so vague they can’t really issue a precise figure.   You’ll hear the number $950 billion over 10 years and that it does  not add one penny to the deficit, but all of this is like playing with Monopoly money.

A BIG PICTURE LONG-RANGE THOUGHT:  For months, I have had the nagging feeling that  a long-range strategy or outcome of this process will be to drive the insurance companies out of the health market.  If they force mandates of who must be covered and in what conditions, and they impose politically-sensitive veto power over what insurers can charge for that coverage, and they funnel more and more people onto the insurers (such as the mandates) ….does it make business sense and/or can insurers survive for long?  Will insurers voluntarily drop out of the health market state by state or altogether?  That will leave a giant vacuum, and most of self-funding is restricted to employment-related health plans, because ERISA is employment-related law.  Amid much uproar in the country, Uncle Sam would be called upon to come to the rescue with a public option.  This may seem like wild imagination, but I know that single-payer reformers in the past have envisioned this kind of scenario as a strategy if they could not get an instant governmental plan.  I mention this just to have on your radar.


Health Care Service Corporation Issues 2009 ERISA Disclosure Report

Tuesday, February 23rd, 2010


The Department of Labor, Department of the Treasury, and the Pension Benefit Guarantee Corporation have issued new regulations effective with the 2009 Plan Year for new disclosure requirements needed to complete ERISA Form 5500.

Attached (Blue Cross Erisa5500-2009_supp_disclos) is the 2009 ERISA Disclosure Information Form issued by Health Care Service Corporation (HCSC). HCSC operates through its Blue Cross & Blue Shield plans in Illinois, Texas, New Mexico, Oklahoma and several subsidiaries.

Page 4 of the report is interesting. A careful read may bring to mind more quesitons than answers. The report states “Additional information about those types of fees, the amount of those fees and the sources of these fees is available upon request.”

Editor’s Note: Are 100% of PPO discounts passed on to the consumer? 

Molly Mulbrier, famed sci-fi novelest and fictional writer of Hollywood fame writes, “For example, suppose the hospital bills an insurance company $100,000 for John Doe’s recent hospital admission. If, for example,  the insurance company has an agreement with the hospital to charge a fee of up to 15% of billed charges, then the insurance company would earn up to $15,000 in fees on this claim. But, the billed charge of $100,000 has to be re-priced through the PPO network and that is reduced to $65,000 in this example (35% discount off billed charges). In this fictional and probably completely untrue scenario, the insurance company would then pay the hospital $50,000 but draft $65,000 from the employer’s self-funded claim account. ” Mulebriar continues “But this is so obscene and irrational, it could not be true and would never ever happen in the real world.”