Blue Cross DOUBLE C...
 

Blue Cross DOUBLE CROSS Call your Senators and ask the Government  

 

CarlHartmann
(@CarlHartmann)
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September 1, 2016 8:17 pm  

All:

Today Blue Cross/Blue Shield of the Virgin Islands (after previously informing policyholders, and I believe, the government, that it would service all existing policies with end dates after 2016, until February 2017) emailed a link to a letter stating that on October 1st, it will be unilaterally "transferring" those policies to something called Elan Solutions, Inc. (d/b/a United West Indies Insurance).

If you are a policy holder you might wonder such things as, will Elan be able to pay your claims if you incur $1 million in medicals.....is Elan a VI approved insurer......how solvent are they......has this "transfer" been approved by the VI.....will BC/BS in the States honor my multi-state BC/BS plan.....does BC/BS remain ultimately liable if Elan is unable to pay -- and (finally) can an insurer transfer a CONTRACT for insurance it has with me without my approval.

Carl Hartmann

ps. And if someone in the Government did approve this, who and when -- and did they get the answers to these questions ?

BCBS-USVI Plan Member Transfer Notification

September 1, 2016

Dear Plan Member:

We would like to notify you that BlueCross BlueShield US Virgin Islands (BCBS-USVI) and Elan Solutions, Inc. (d/b/a United West Indies Insurance) (“Elan”) have reached an agreement pursuant to which BCBS-USVI will transfer all of its current commercial health insurance policies to Elan (the “Transfer”). The Transfer, which was approved by the Commissioner of Insurance of the United States Virgin Islands, will be effective on October 1, 2016 (“Effective Date”).

BCBS-USVI will honor and process claims for covered health services rendered prior to the Transfer Effective Date. For all inquiries about services rendered before the Transfer Effective Date, you may contact BCBS-USVI customer service.

Upon the Transfer date, Elan will be responsible for all covered health benefits under your health insurance policy.

Shortly after this notification, you will be receiving a communication from Elan informing you about the Transfer and their contact information for all questions you may have.

We want to thank you for having entrusted us with your health insurance needs.

Cordially,

Elena M. Díaz Molina, Vice President Sales and Account Management Division


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OldTart
(@the-oldtart)
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September 1, 2016 8:38 pm  

BCBS-VI has always been handled through Elan.
https://www.bcbsusvi.com/


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CarlHartmann
(@CarlHartmann)
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Posts: 158
September 1, 2016 9:12 pm  

Yes, but this is not being "handled through" -- this is BC/BS actually trying to transfer the policies to Elan. Big difference.

QUOTE

BCBS-USVI will honor and process claims for covered health services rendered prior to the Transfer Effective Date. For all inquiries about services rendered before the Transfer Effective Date, you may contact BCBS-USVI customer service.

Upon the Transfer date, Elan will be responsible for all covered health benefits under your health insurance policy.


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CruzanIron
(@cruzaniron)
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Joined: 6 years ago
Posts: 2447
September 1, 2016 9:24 pm  

Cell phone contracts are an example of a contract transfer when one buys another. Yes, they can sell or transfer your contract.


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Carlstx
(@Carlstx)
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Posts: 53
September 1, 2016 11:27 pm  

Insurance carriers enter new markets and leave existing markets all of the time. As a health insurance agent with over 30 years of experience, I have seen this process unfold dozens of times. However, it is more noticeable here because we both have a very small marketplace and have always had very few health insurance carriers.
Blue Cross Blue Shield of the VI, owned and operated by Triple S Insurance of Puerto Rico, made the decision to withdraw from the U.S Virgin Islands marketplace. Elan Solutions, the managing general agent for BCBS of the VI, has taken the bold step to provide a new insurance product. Both parties are lead by experienced insurance professionals and we in the local industry expect a smooth transition.
This new policy has been reviewed and approved by the Division of Banking & Insurance of the V.I. Lt. Governor’s office and all of their products are re-insured by MunichRe, an A+ rated carrier.
Elan Solutions has assembled some of the best and most experienced Third Party Administrators,(TPA’s), Claims Administrators, Medical, Dental, Vision and Air Evacuation carriers, to fill the void left by Triple S. Given the experience, financial soundness and the experienced team of professionals and suppliers this should be viewed as an upgrade
The entire transition will take place over the time frame originally published in accordance with their renewal date. Each individual group can opt to expedite the transition to Elan Solutions and a variety of plan options exist. New group health insurance clients will be accepted after October 1, 2016.
Currently the only other insurance carrier offering group health insurance in the U.S. Virgin Islands is United Health Care.
If you have any questions or need further information, contact the local agent that handles your BCBS policy or me. Carl@InsuranceVI.com


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CarlHartmann
(@CarlHartmann)
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Posts: 158
September 2, 2016 1:34 pm  

Carl:

Can I present my Blue Cross-Blue Shield card at my specialist in DC on October 2nd.

Since I anticipate the answer is no....can I present my new "Elan Card" there and automatically get service and payment?

Carl


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OldTart
(@the-oldtart)
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September 2, 2016 1:35 pm  

Carl:

Can I present my Blue Cross-Blue Shield card at my specialist in DC on October 2nd.

Since I anticipate the answer is no....can I present my new "Elan Card" there and automatically get service and payment?

Carl

"If you have any questions or need further information, contact the local agent that handles your BCBS policy or me. Carl@InsuranceVI.com"


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CarlHartmann
(@CarlHartmann)
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September 2, 2016 5:43 pm  

I'm afraid you don't understand why it is important that this issue be discussed. The last time Blue Cross / Blue Shield withdrew from the VI it resulted in a major scandal. As I was the attorney who litigated the case here and in the Eastern District of Virginia -- I have a little bit of knowledge about BC/BS and VI insurance.

If they are "leaving" and "transferring" policies -- it maybe an issue for the Territory and may impact the broader insurance system -- especially if it being 'approved' by someone in the government without pre-approval disclosure and discussion with policyholders. Trust me, I could care less about my individual policy....I can easily get another. But there are many who may no9t be able to do so.

Carl Hartmann

See the article at this Link: "Blue Cross Controversy Reaches the VI" --Daily News, Jan. 3, 1991

also

"Judge James C. Cacheris of the Federal District Court of the Eastern District of Virginia, gave Carl Hartmann and attorneys for Blue Cross and Blue Shield until Friday to submit 10 page briefs on the unsealing of court documents. Cacheris said he will consider the briefs before deciding whether the documents should be unsealed. "

and

"According to the court findings, GHMSI carried out a clandestine plan to use the Blue Cross and Blue Shield trademark illegally in several foreign countries. . . GHMSI masterminded an international scam involving numerous insurance companies and hospitals around the world, according to Court findings."


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Alana33
(@Alana33)
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September 2, 2016 6:08 pm  

(tu)


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OldTart
(@the-oldtart)
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September 2, 2016 6:24 pm  

I don't underestimate its importance but I'm not sure that harking back to a legal issue from 15 years ago on a forum tops contacting either the poster or the Insurance Commissioner for clarification.


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CarlHartmann
(@CarlHartmann)
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Joined: 12 years ago
Posts: 158
September 2, 2016 8:17 pm  

The issue is simple....previously the BC/BS provider in the USVI tried to withdraw from the VI by giving policyholders a card for another entity. It turned out to be a massive fraud -- and the government did not know what was going on and left the policyholders out in the cold. Private parties and their counsel had to look into it and investigate it.

I did send and email to the person who posted. This is what I got back -- do you understand what it says....what it means? Would you like to give the policyholders some sort of guarantee as to what it means????

From: Omar Haedo [mailto:omar.haedo@elan.agency]
Sent: Friday, September 02, 2016 4:54 PM
To: carl
Cc: Carl Gotts
Subject: Your questions

I don't have your policy or plan number so it's tough to answer you specific question.
Carl Hartmann

If you have a Peak Plus - or open access policy - you will have access to over 1mm providers in the USA through 1st health. Www.First health.coventryhealthcare.com

As BCBS/SSS notified, your BCBS plan won't be active after 10/1.


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watruw8ing4
(@watruw8ing4)
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Posts: 850
September 2, 2016 9:15 pm  

Ah, memories! Or should I say nightmares.

I was an employee (and am a paid retiree) of GHMSI. I worked there from '81 thru '93, and remember much of this fiasco. While the company (under BCBS/NCA) was kosher in the DC region, it overstepped its bounds in the USVI, and over 20 countries. It was so bad our CEO, Joe Gamble, had to take the 5th in a Congressional hearing to stay out of jail. Gamble illegally used the BCBS trademark to give credibility to his subsidiaries, which misled people into thinking they had more extensive benefits than they actually did, and which allowed him to negotiate higher income because of the BCBS reputation. These subsidiaries "insured" more than health care costs when all was said and done (lost luggage - now that's a serious health care expense), and they weren't sound - they lost the company nearly 200 million.

To add insult to injury, Gamble enjoyed a multi-year, luxurious globe-hopping spree conducting "business" while bleeding the company dry. He nearly ran a thriving, 50 year old, non-profit company into the ground, which pretty much forced the merger with BCBS of MD to stay in business. (And all of this caused a rewrite, with substantial downgrade, of retiree benefits - so, yeah, I'm still bitter).

People don't realize what they give up when they leave a BCBS licensed company (which I don't believe Elan currently is, but feel free to correct me). Reciprocity, networks, co-payment limits . . . you name it. I, too, see a little bit of deja vu all over again and see this history as relevant. While the letter stated this transfer was approved by the VI, I don't think it's off-base to question the government's due diligence in the approval. They failed to see the pitfalls before and it bit them in the backside. What's changed?

Those who are covered should count themselves lucky that they have some sort of coverage, and they may not notice a difference in service and payments. But I encourage those whose coverage is being transferred to read the fine print once the transfer takes place, to avoid unnecessary surprises.

Also (and I'm not a lawyer) my understanding is that the contract is between the group and the insurer. At least that's what I had to tell subscribers when they wanted to see their actual "contract". While it's the little guy who may or may not be impacted by this the most, isn't it the groups who bear the responsibility of verifying their new arrangements?


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CarlHartmann
(@CarlHartmann)
Advanced Member
Joined: 12 years ago
Posts: 158
September 4, 2016 3:11 pm  

As you say...good times.

And by the way...I want to make it clear that my issue is with my BC/BS provider. I too have worked with Elan without any problems in the past -- and don't want it to sound like Mr. Haedo is at fault or involved with BC/BS's "issues". it is possible that he and Elan are just as much negatively affected by the decisions in San Juan as I -- and Elan was simply the only entity professional enough to respond.

Carl Hartmann


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