Document 552 : Docket No. 99-14 : Hearing Decision : Bureau of Insurance

STATE OF MAINE
DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE
34 STATE HOUSE STATION
AUGUSTA, MAINE 04333-0034

In Re: Application of Associated Hospital Service of Maine,	)
d/b/a Blue Cross and Blue Shield of Maine, To Convert to a	)
Stock Insurer and Voluntarily Liquidate and Dissolve	)
	)
	)	REQUEST FOR HEARING
And	)	ON CONSUMERS FOR
	)	AFFORDABLE HEALTH
	)	CARE’S MOTION TO
	)	COMPEL
	)
Application of Anthem Health Plan of Maine, Inc., To Acquire	)
the Assets of Associated Hospital Service of Maine,	)
d/b/a Blue Cross and Blue Shield of Maine, and Related	)
Transactions	)
	)
Consolidated Docket No. INS 99-14	)

Consumers For Affordable Health Care filed its Motion to Compel Anthem to Respond to Consumer Intervenors’ Second Discovery Request on March 3, 2000. Anthem filed its Motion in opposition on March 9, 2000. On March 14, 2000, Counsel for CAHC and Anthem attempted to resolve these outstanding issues.

Now comes Consumers for Affordable Health Care ("CAHC"), through its attorneys, and requests a hearing on its Motion to Compel Anthem to Respond to Consumer Intervenors’ Second Discovery Request. Specifically, the Requests referenced below:

Request 1

Please provide all documents related to financial projections developed by or for the applicants since July 13, 1999 that take into account changes in and/or anticipated changes in enrollment.

As stated in the Goldman Sachs fairness opinion, Anthem prepared internal financial forecasts. This request asks Anthem for updates prepared since the signing of the Asset Purchase Agreement. The response provided by Anthem states "Although Anthem has no duty to prepare additional analyses in response to an intervenors request, Anthem is in the process of analyzing the updated BCBSME information and will generate and file updated financial information shortly." Anthem’s response was filed March 9^th. CAHC has still not received the referenced information. Anthem’s counsel stated that "what you may be looking for you may find in the 5^th or 6^th supplemental response to the Superintendent’s second discovery request in answer to question 28 or 29 or 30." CAHC’s counsel have reviewed those responses and documents thereto. None of the responses or documents is responsive to this request.

Request 4

Please provide all documents related to the state employee health insurance contract for calendar year 2000 and beyond. Please provide all documents prepared by or for the applicants related to financial projections regarding this contract. Please describe in detail the total number of insureds that will be covered under that contract, the contract term, the total anticipated premium incurred for the first contract year and all contract provisions that allow for increases during or subsequent to the first contract year.

Anthem’s counsel stated that they are in the process of preparing information and will provide it to CAHC’s counsel once prepared.

Request 35

Please describe in detail the changes in utilization review criteria that Anthem has imposed subsequent to each BCBS plan from January 1995 to the present. Provide all documents related to changes to utilization review criteria in each state where Anthem purchased a BCBS plan from January 1995 to the present.

Anthem stated in response to question 37 of the Consumer Intervenors first discovery request that "Anthem recognizes the need for consistency in the application of these terms and is considering a strategy to achieve this objective." These terms include terms related to and involving utilization review processes. To that extent, changes nationally would or may affect utilization review criteria in Maine. It is important that any prospective changes that would override the company’s agreement to continue current BC/BS practices for a limited time or thereafter be reviewed. CAHC counsel requests this important information.

Dated: March 15, 2000

Joseph P. Ditre, Esq.

Dale Lavi, Esq.

Consumer Health Law Program

A Program of CAHC Foundation

One Weston Court, Level One

P.O. Box 2490

Augusta, ME 04338-2490

Ph: (207) 622-7083/ Fx:622-7077

Email: jditre@mainecahc.org

Patrick Ende, Esq.

Maine Equal Justice Partners

65 State Street, 2^nd floor

P.O. Box 5347

Augusta, ME

Ph: (207) 626-7058/Fx:621-8148

Email: pende@mejp.org

Counsel for CAHC

CERTIFICATE OF SERVICE

The undersigned hereby certifies that on March 15, 2000, a copy of Consumers for Affordable Health Care’s Request for Hearing on its Motion To Compel Anthem to Respond to Consumer Intervenors’ Second Discovery Request was served by United States mail, first class postage prepaid, on each of the persons listed below.

Robert S. Frank, Esq.	James B. Zimpritch, Esq.
Harvey & Frank	Catherine R. Connors, Esq.
Two City Center	Pierce Atwood
P.O. Box 126	One Monument Square
Portland, Maine 04112	Portland, Maine 04101
(Blue Cross/Blue Shield of Maine)	(Anthem Insurance Companies, Inc.)

Judith Chamberlain, Esq.	Michele M. Garvin, Esq.
State of Maine	Ropes & Gray
Department of the Attorney General	One International Place
6 State House Station	Boston, Massachusetts 02110-2624
Augusta, Maine 04333-0006	(Central Maine Healthcare Corp.)
(Office of the Attorney General)

William H. Laubenstein, Esq.	Robert I. Goldman
State of Maine Maine	Council of Senior Citizens
Department of the Attorney General	27 Bowery Beach Road
6 State House Station	Cape Elizabeth, Maine 04107
Augusta, Maine 04333-0006	(Maine Council of Senior Citizens)
(Office of the Attorney General)

	John Dieffenbacher-Krall
Gregory A. Brodek, Esq.	Executive Director
Duane, Morris & Heckscher, LLP	Maine People's Alliance
15 Columbia Street, 4^th Floor	192 State Street
Bangor, Maine 04401-6355	Portland, Maine 04101
(Maine Health Alliance)	(Maine People's Alliance)

Andrew B. MacLean, Esq.	Bonnie Post
Maine Medical Association	Executive Director or the Maine
Frank O. Stred Building	Ambulatory Care Coalition
P.O. Box 190	P.O. Box 390
Manchester, Maine 04351	Manchester, Maine 04351
(Thomas D. Hayward, M.D.,	(Sacopee Valley Health Center,
Maroulla S. Gleaton, M.D.,	Regional Medical Center at Lubec,
And the Maine Medical Association)	Eastport Health Care, Inc., and the
	Maine Ambulatory Care Coalition)

Kellie Miller	Sandra Parker
Maine Osteopathic Association	Maine Hospital Association
RR 2, Box 1920	150 Capitol Street
Manchester, Maine 04351	Augusta, ME 04330
(Maine Osteopathic Assn.)	(Maine Hospital Association)

Donald E. Quigley, Esq.
Maine Health
465 Congress Street, Ste. 600
Portland, ME 04101-3537
(MaineHealth)