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Maine.gov > PFR Home > Insurance Regulation> Administrative & Enforcement Actions > Document 136 : INS 99-14 : Hearing Decision
STATE OF MAINE
DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE
The Superintendent of Insurance is in receipt of Motions to Intervene on behalf of Maine Medical Center (MMC), the Maine Hospital Association, Inc. (MHA), the Maine Osteopathic Association (MOA), Boyd R. Buser, D.O., the American Lung Association of Maine (ALAM), and Lee Ann Baggot, M.D. Intervention is requested for Dr. Buser and Dr. Baggot as President of MOA and ALAM, respectively. The Superintendent finds it unnecessary to have the head of an organization made a party as well as the organization, itself. Any organization granted party status must designate an appropriate person to act on its behalf but need not have a representative intervene as a party. The Superintendent considers the motions of Dr. Buser and Dr. Baggot as having been withdrawn and, therefore, will act only upon the motions of MOA and ALAM along with the other requests.
Anthem Insurance Companies has filed the only response to the pending motions to intervene. It is Anthems position that, while it does not object to the requests for intervention, any order granting party status should be conditioned upon the coordination of discovery efforts with existing intervenors. Specifically, Anthem asks that MMC be required to coordinate with Central Maine Partners Health Plan and Central Maine Healthcare Corporation, and that MHA and MOA be required to coordinate with the provider group of Intervenors. It is worthy of note that MHA recognized the need for coordination and requested to be included within the provider group of intervenors for that purpose.
The Superintendent has previously granted intervention as of right to physician and hospital provider professional associations and organizations based upon the significant contractual relationships between the providers represented by these groups and Blue Cross Blue Shield of Maine. See Order Granting Applications to Intervene of the Maine Health Alliance, Maine Medical Association, Maine Council of Senior Citizens, Consumers for Affordable Health Care, Maine Peoples Alliance, Maine Ambulatory Care Coalition, and Central Maine Healthcare Corporation (Bureau of Insurance Document Number 58.) The provider associations and organizations granted party status to date do not directly represent the interests of MOA and MHA. Thus, intervention as of right is granted MOA and MHA. The two associations will coordinate discovery efforts with the provider group of intervenors as set forth in the Superintendents Order on Coordination of Discovery of Intervenors (Bureau of Insurance Document Number 82.)
Intervention as of right has been granted Central Maine Healthcare Corporation as a result of its partnership relationship with Blue Cross Blue Shield of Maine in Central Maine Partners Health Plan, Inc. Maine Medical Center also has a partnership relationship as the 50% owner of the outstanding stock in Maine Partners Health Plan, Inc. That relationship, coupled with the potential for change in the governance and value of Maine Partners Health Plan, Inc. justifies the grant of intervention as of right to Maine Medical Center. MMC will coordinate its discovery efforts, to the extent it engages in discovery, with Central Maine Partners Health Plan, Inc. and Central Maine Healthcare Corporation. Additionally, MMC must file a letter with the Superintendent with a copy to the service list explaining the extent to which it expects to engage in discovery.
The application of ALAM appears to be a hybrid of the applications received to date. While on the one hand ALAM professes to represent interests of physician providers and others with contractual relationships with Blue Cross Blue Shield of Maine, it also asserts an interest as the holder of a group health plan with Blue Cross. Additionally, ALAM believes intervention is warranted as the result of its work with Blue Cross over a number of years on community projects and public policy issues.
To the extent ALAM asserts it may have an interest as the result of the participation of physician providers in its organization, the interests of those providers appear to be adequately covered by the provider groups which have intervened to date. It is questionable what ALAM could add to issues surrounding provider contracting that will not already be addressed by the Maine Medical Association, the Maine Osteopathic Association, and the other provider organizations.
ALAM has failed to identify in a clear manner the substantial and direct affects the pending transactions may have on its membership. It is true that general concerns can be implied from ALAMs relationship as purchaser of health insurance as well as its cooperative efforts with Blue Cross to improve public health. Nonetheless, no specific impact has been identified which distinguishes ALAM from any number of organizations or members of the public who carry with them similar concerns. It is noted that no objections to ALAMs motion have been filed and the Superintendent is interested in obtaining as much input into his decision-making process as possible. Consequently, ALAM is granted permissive intervention pursuant to 5 M.R.S.A. § 9054(2). ALAM is required to coordinate its discovery efforts with the consumer group of intervenors since its interests lay more in the area of public policy than specific provider issues.
As parties to the proceeding, each Intervenor shall be bound by all procedural requirements set forth in Title 24-A, Bureau of Insurance Rule Ch. 350, and all procedural orders issued by the Superintendent during the course of this proceeding. The Intervenors are advised that a procedural order was issued on November 4, 1999, and a protective order limiting access to confidential materials was issued on October 19, 1999. Both orders should be reviewed carefully as they contain a number of requirements relative to the filing and service of documents as well as access to documents.
PER ORDER OF THE SUPERINTENDENT
DATED: December 22, 1999
Last Updated: January 21, 2014
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