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Maine.gov > PFR Home > Insurance Regulation> Administrative & Enforcement Actions > Document 570 : INS 99-14 : Hearing Decision
Consumers for Affordable Health Care (CAHC) filed a Motion to Compel Anthem to respond to certain of the requests contained in CAHCs second discovery request. Anthem responded to the motion on March 9, 2000. After attempting to resolve the outstanding areas of dispute, CAHC filed a request for hearing on its motion with the Superintendent. Oral argument was taken on March 17, 2000.
Patrick Ende, Esq. appeared on behalf of CAHC while Jeffrey White, Esq. appeared on behalf of Anthem. Mr. Ende stated that of the three requests that CAHC believed were in dispute, only one of the three remained for consideration by the Superintendent. Specifically, CAHC asks that Anthem be compelled to respond to request 35 of CAHCs second discovery request. Request 35 seeks a description of changes made in utilization review criteria following Anthems acquisition of each BCBS plan from January 1995 to the present. Documents related to such changes also were requested.
CAHC argues that it is important to have a good understanding of how Anthem has conducted itself following its acquisition of various Blue Cross plans around the country. To that end, changes to utilization review are a logical area of inquiry from the perspective of the consumer. Several other intervenors concurred with the position taken by CAHC.
Anthem, however, argued that to provide five (5) years of information from at least four (4), if not five (5), states is unduly burdensome. Counsel for Anthem represented that he had been informed it would take at least a week to compile such information. Further, Anthem does not believe the requested information is relevant to the pending proceeding. Anthem argues that decisions such as utilization review start at the local level. Thus, what may have occurred in Connecticut is not predictive of what will happen in the future in Maine.
After consideration of the materials on file and the arguments made, the Superintendent hereby GRANTS the motion of CAHC to compel Anthem to provide a response to Request 35 of CAHCs second discovery request. The response shall cover January 1995 to the present and shall include a description of the changes made to utilization review criteria as well as any documents related to those changes. Anthem shall file and serve its response no later than
3:00 p.m. on Friday, March 24, 2000.
PER ORDER OF THE SUPERINTENDENT OF INSURANCE
DATED: March 21, 2000
ERIC A. CIOPPA Deputy Superintendent of Insurance
Last Updated: January 21, 2014
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