#selectcare

      In yet another glaring example as to why Guam NEEDS a new Public Auditor, Calvo-owned KUAM is reporting that all but one of the four different insurance companies that responded to the Government of Guam's Fiscal Year 2013 health insurance RFP have now filed a protest. Highly respected, associate plan administrator for Staywell, Frank Santos, told KUAM that the current negotiation process is, "not what the GovGuam employee wants. I mean, they're looking for better rate and better coverage, and that's what we're Staywell are here to do."

KUAM - The Government of Guam negotiating team has yet another protest in front of them as less than two days after Calvo's Selectcare filed its protest, Staywell has followed suit contending prejudicial treatment and violation of procurement law. Three out of the four health insurance companies that responded to the Government of Guam's Fiscal Year 2013 health insurance RFP have now filed a protest.

"After reviewing first the TakeCare protest and then the subsequent protest by SelectCare, we felt that it was in the best interest of IHIC and Staywell to go ahead and proceed with the protest based on our findings," said Staywell associate administrator Francis Santos. Island Home Insurance Company, the underwriter for Staywell Guam, filed its protest late Thursday because just as Calvo's Selectcare did earlier this week, contends that Takecare Insurance andofferer number three were allowed to modify their proposals after the process was closed. Selectcare says they only knew this occurred after takecare published its protest online.

Staywell meanwhile alleges that Takecare was the only offeror privy to what was supposed to be a confidential evaluation. "So I think to protect the protest rights of our company, it was the proper way to do it within the rules and procedures of the protest in GovGuam procurement rules," Santos added.

Govguam's health insurance negotiations were stayed as a result of   the first protest filed by Takecare Insurance earlier this month. Takecare alleged that the Department of Administration and the health insurance negotiating team acted in such a way to discriminate against the company. According to the protest the company was invited to negotiations but then later uninvited.

Santos adds there are obviously issues with the whole health insurance negotiating process, stating, "And I think in the end it's not what the GovGuam employee wants. I mean, they're looking for better rates and better coverage, and that's what we're Staywell are here to do."

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The government contract with SelectCare expires at the end of next month. Many in the community are beginning to worry about a disruption of healthcare insurance for government employees and retirees.

In the meantime, the OPA Public Auditor Doris Flores Brooks remains complacent and as invisible as Insurance Commissioner Art "The Invisible Man" Ilagan...fueling public sentiment that perhaps the Public Auditor has also abandoned her responsibilities to the people of Guam in favor of profits for her friends in the insurance industry.

          AMID the ongoing kittylitter battle between former senator Eddie Calvo (through his mouthpiece Toy "Get It Wong" Torres) and Vice Speaker BJ Cruz over Medical Loss Ratio rebates, penalties and (mis)appropriations, Guam Blog receives confidential documents that seem to indicate Calvo's Selectcare will rebate to Guam policyholders as much as $11,900,000 in August. This figure would represent more than 2/3 the total amount of all MLR rebates the US Dept of Health & Human Services has estimated would be owed to local consumers by the island's local carriers.

According to HHS figures, the 18,000 families on Guam covered by a health insurance policy, can expect to receive well more than $15 million dollars in rebates, with the average check amount at just over $850. By law, checks are due to be received, along with a Notice of Rebate to enrolless explaining the reason for the rebate to consumers, sometime in early August.

Meanwhile, by contrast, TakeCare (which apparently doesn't actually exist any longer) will payout to its shareholders over $15, 275,000.00, while their enrollees and policyholders will receive $0 in rebates, purportedly.

Unlike local lawmakers, including then-senator Eddie Calvo, who did little to nothing to prepare the island and government for the massive healthcare reform impacts, Joe Husslein began his plot to cheat local policyholders back in 2009.

Because of crafty plotting and immaculate bad faith tactics such as the kind used at Guam Memorial Hospital to reduce or refuse payments that Guam Blog reported on earlier this year, Tan Holdings, June Mair (wife of David Mair) and George Chiu will divvy up with Husslein a bonanza windfall profit the kind most of us will never see in a lifetime - let alone a single year!

       Democrat senator Dennis Rodriguez Jr. rushed to the defense of TakeCare when the insurer was finally called on its egregious denial of claims and abysmal payment policy that has earned the carrier record-breaking profits at the expense of the health of island residents who unwittingly bought policies from TakeCare. Rodriguez Jr., a former businessman with his own background of questionable business practices and legal issues, insisted GMH management reconsider a cancellation of the Direct Payer Agreement with TakeCare. Subsequently, but quietly the new Chief Financial Officer who had tried to fix the longstanding problem with TakeCare was forced out and TakeCare is back in at GMH.

TakeCare's 2011 Financial Audit shows that despite cash being down, unpaid claims, general expenses and total liabilities all up, dividends to this small coterie of profiteers nearly doubled over the prior year's haul.

With so much excess profit one must question why the GMH board of trustees is not demanding that TakeCare pay up and make current all its outstanding debts and continue thereafter with timely and fair payments.

Sneaky identity Quietly shifting the primary focus and function of TakeCare so it is no longer really identifiable as a primary insurance carrier was a strategy developed by Husslein to do a run-around the intended goal of the national healthcare reform law.

As Guamblog reported before, on December 9 last year, all employees of TakeCare were given a Notice of Termination and Transfer of Employment. All positions at TakeCare were transferred to a new entity, Veiovis. The Veiovis website claims the company is a Medical Travel operation. Not an insurance company.

Employees at TakeCare who signed the release, a heavily conditioned employment transfer by December 30, 2011, their jobs with TakeCare ended the next day; their employment with Veiovis becoming official January, 1 this year.

Employees who did not sign had their employment terminated on New Year’s Eve.

An example of the type of criminal profiteering practiced by TakeCare is a case handled by intrepid local attorney Curtis Van de Veld.

Ina Gill's husband Peter was denied critical coverage by TakeCare and the widow denied reimbursements and payments she and her husband had counted on to help through their health crisis. Peter had to be medically evacuated in an emergency trip to the Philippines - for which TakeCare refused service payment. He eventually got off island, but never made it back home to Guam.

Later, TakeCare refused to take care of the elderly widow following the death of her husband. She was left with the burden of overwhelming financial debt and the loss of her husband.

Company executives claimed they shouldn't have to pay out the insurance policy she thought she and her husband had paid for because the TakeCare plan is a merely a supplemental health insurance policy.

Van de Veld petitioned the courts for relief for the anguished widow charging TakeCare never informed the Gills that they were purchasing a supplemental policy. The attorney further told the court that TakeCare was clearly not approved as a supplemental insurer and that Husslein's company refused to comply with even the bare minimum requirements of the Employee Retirement Income Security Act - or ERISA. This is of vital importance to island residents because thousands of local Federal employees are subscribed to TakeCare and such practice is blatant violation of fiduciary trust - and a crime!

                   Joe Husslein, left, celebrated record-breaking profits at TakeCare this year, with chief operating officer Jeff Larsen, right, and his partners at the shady insurer Tan Holdings, June Mair and George Chiu. The insurance bandits made off with more than $15, 275,000 in dividends even as GMH still struggles to get timely and fair payments from the company.

Jackals and wolves With TakeCare free to wage war against its own customers on Guam, and SelectCare using the governor's communication office to manufacture a relentless flurry of falsehood and deceptions daily to hide its own gross profiteering from hapless government workers and retirees, the public seems to be left all alone to fend for ourselves among the jackals and wolves.

SelectCare owes almost $1 million to GovGuam for the unlawfully withholding utilization reports to hide that company's own enormous insurance profits; this fact remains as undisputedly baldfaced as Joe Husslein's head.

In documents from SelectCare Plan Administrator Frank Campillo, Sen, BJ Cruz and acting director at DOA Benita Manglona, available online at the PNC website, SelectCare through oversight or intent, unmistakably filed reports late and incurred a penalty that the Calvo family-owned business refuses to pay - money that this administration likewise refuses to collect as required by law. 

The more we learn about insurance on Guam, the more we can be sure of one thing readers, there is no one on your side in the healthcare reform and health insurance debate, despite what some would have you believe.

Yes, Senator BJ Cruz is engaged in a spat with Torres that reminds more of a gay high school musical gone bad than a thoughtful dialog seeking resolution to a serious problem. Unfortunately, the Cruz/Torres skirmishes have failed to even consider those island residents that do not work for GovGuam, vulnerable people being cheated through the continuing bad faith criminal practices of carriers, like TakeCare.

Let's see how much SelectCare actually gets back into the pockets of enrollees covered under their policies. If it is in fact even close to the $11.9 million figure Guamblog looked at today, then maybe no one will even notice who TakeCare screwed over as it continues to peddle to the public something other than what they think they're buying.