STATE OF MAINE

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION

BUREAU OF INSURANCE

34 STATE HOUSE STATION

AUGUSTA, MAINE 04333-0034

Now comes Consumers for Affordable Health Care (CAHC), by and through its attorneys, with its first request for information and production of documents on behalf of consumer intervenors pursuant to the the Superintendent of Insurance’s Order for Coordination of Discovery. Pursuant to Rule Chapter 350 of the Maine Bureau of Insurance, the consumer intervenors request that the applicants respond to the following requests for documents and information within 14 days. The request and response to it shall be governed by the following definitions and instructions:

1. "Anthem" means Anthem Insurance Companies, Inc., including each predecessor-in-interest, and its present or former officers, directors, consultants, employees, agents, representatives, counsel, and all persons and entities acting or purporting to act on its behalf or under its control, and each and every subsidiary, affiliate or parent of Anthem Insurance Companies, Inc. wherever located including but not limited to those located in Colorado/Nevada, Connecticut, Kentucky, New Hampshire, and Ohio, unless otherwise noted in the specific request. This definition of "Anthem" shall include Anthem East, Inc. and Anthem Health Plans of Maine.
2. "Applicants" means Anthem and/or BCBSME as defined herein. Unless otherwise stated, a separate response is expected from "Anthem" and from "BCBSME".
3. "BCBSME " means Associated Hospital Service of Maine including each predecessor-in-interest, and its present or former officers, directors, consultants, employees, agents, representatives, counsel, and all persons and entities acting or purporting to act on its behalf or under its control, and each and every subsidiary, affiliate or parent of Associated Hospital Service of Maine unless otherwise noted in the specific request.
4. "Bureau of Insurance" means the Maine Bureau of Insurance.
5. "Document" or "documents" means the original and any copy, regardless of origin or location, or any writing or records of any type or description, including but not limited to the original and any copy of any book, correspondence, pamphlet, periodical, letter, media advisory or release, memorandum, telegram, report, records, study, inter-office or intra-office communication, handwritten or other note, working paper, diary, calendar, application, permit, chart, paper, graph, survey, index, tape, minutes of meeting, notes, agreement, contract, memorandum, diagram, illustration, photograph, telegram, written analysis, report, recording, transcription or memorandum made of any telephone conversation, written communication, office bulletins, notices, instructions, questionnaires, surveys, charts, graphs, papers, books, tape recordings, or other sound or visual reproduction materials, magnetic tapes, or other storage media used in connection with computer and data processing equipment, electronic mail and attachments thereto, world wide web pages and sites, and any other written matter or tangible or physical objects, however produced or reproduced, upon which words, phrases or other alphabetical or numerical characters or information are written, imprinted, or otherwise affixed, or from which words, phrases, or other alphabetical or numerical characters or information, by appropriate transcription methods may be read, produced, printed out, written or otherwise made accessible, any of which are in the possession, custody, or control of the Applicants or their agents, attorneys or employees. It includes the original, any copy with notations, markings or writings thereon, and any drafts thereof.
6. "Governmental agency" or "governmental agencies" means any local, state or federal entity that regulates or has jurisdiction over the operations of the applicants or other carriers, insurers and HMOs.
7. "Insureds" means all certificate holders, contract holders, enrollees, members, policyholders, and subscribers including the dependents of such.
8. "Purchase" or "purchases" or "purchasing" means acquisition, affiliation, consolidation, merger or take-over.
9. "Related to" or "relating to" means constituting, evidencing and/or directly or indirectly mentioning, describing, referring to, pertaining to, being connected with or reflecting upon the stated subject matter.
10. Each and every request for a document or documents to be produced requires production of the document, in its entirety, without abbreviation or expurgation, and without redacting any portions thereof unless accompanied by a claim of privilege or immunity the information for which is provided in accord with definition N.
11. More than one request may ask for the same document. The presence of such duplication is not to be interpreted to narrow or limit the normal interpretation placed upon each individual request. Where a document is requested in more than one request, only one copy of it need be produced.
12. If a request is made for production or identification of documents which are no longer in the possession or subject to the control of the Applicants, state when such documents were most recently in the possession of or subject to the control of the Applicants and what disposition was made of them, including an identification of the person presently in possession or control of such documents. If the documents have been destroyed, identify the person who destroyed the documents, the person who directed that the documents be destroyed, state the reason(s) the documents were destroyed, and the date and manner of their destruction.
13. When a request seeks documents or things from a corporate entity, such corporate entity includes its present and former directors, officers, employees, representatives, agents, consultants, contractors, legal counsel and all persons or entities acting or purporting to act on its behalf or under its control.
14. Whenever the Applicants in a response to any request asserts a privilege, immunity or qualified immunity, please state: (1) the privilege asserted and the basis for asserting the privilege, (2) the name of the person/group originating the document, (3) the date of the document, (4) the name and employment at the time of viewing of each person who has seen the document, and (5) a brief description of the nature of the document.
15. The requests are continuing in nature, and require supplementation by Applicants as documents are located, discovered, generated or prepared.
16. To the extent that any of the documents or information requested herein have been provided in a previous response to questions asked or requests made by any other party, please identify the response or document by the appropriate title, number and subsection, binder and tab, and page number.
17. With each response provided, state the name(s) of all person(s) and/or their employer(s) preparing and/or assisting in the development of the response with the exception of secretarial or administrative staff.

Information and document requests

1. Please provide all documents prepared by or for the Blue Cross and Blue Shield Association and its predecessors relating to its rules, practices, policies, procedures, Articles of Incorporation, and bylaws of the said Association.
2. Please provide all documents prepared by or for the Blue Cross and Blue Shield Association and its predecessors related to a licensee and/or member: a) operating on a for-profit basis; b) operating as a mutual insurer; and/or c) acquiring, merging or affiliating with other licensees and/or members.
3. Please provide all documents prepared by or for the Blue Cross and Blue Shield Association and its predecessors related to the decision by the Association to allow its members to operate on a for-profit basis and/or to purchase another member.
4. Please provide all documents prepared by or for the Blue Cross and Blue Shield Association and its predecessors related to competition among or between members and/or licensees in or for the same service area or market.
5. Please provide all documents prepared by or for Anthem related to competition between Anthem and members and/or licensees of the Blue Cross and Blue Shield Association in or for the same service area or market.
6. Please provide all documents prepared by or for the applicants related to purchasing any interest in Harvard Pilgrim Community Health Plans. Please describe in detail any and all discussions and/or communications by Anthem with Harvard Pilgrim Community Health Plans or its representatives and/or with any governmental agency having jurisdiction over Harvard Pilgrim Community Health Plans.
7. Please provide all documents prepared by or for the Blue Cross and Blue Shield Association that support the contention by BCBSME that BCBSME could not have opened the bidding process to a company outside of the Blue Cross and Blue Shield Association.
8. Please provide all documents prepared by or for the Blue Cross and Blue Shield Association and its predecessors relating to BCBSME’s maintaining its good standing in, membership in, and/or licenses and trademarks of the Association from 1995 to date.
9. Please provide all documents between the applicants relating to the status of or requirements on BCBSME to maintain its good standing, membership, trademarks and licenses in and with the Blue Cross and Blue Shield Association from January 1998 to date.
10. Please provide all documents prepared by or for Anthem and/or BCBSME related to cost savings, efficiencies, synergies, and/or economies of scale that could or would be gained under the proposed sale. Please describe in detail how these savings will affect premiums. Please provide all assumptions used in calculating the cost savings, efficiencies, synergies, and/or economies of scale.
11. Is there any correlation between the sale price and premiums to be charged by Anthem? Please state all assumptions underlying the correlation. Please quantify in dollars the effect that increasing the sale price may have on premiums for each million dollars that the price is increased over and above the total consideration stated in the Asset Purchase Agreement dated July 13, 1999.
12. Please provide all documents prepared by or for Anthem related to the preparation of the attached Anthem policyholder notice in Kentucky (see Attachment "A").
13. Please provide a chart that describes in detail all Anthem purchases of BCBS plans anywhere in the United States from 1993 to date and provide a schedule of premiums for each and every product offered by the seller during the 24 month period prior to the sale and by Anthem in the 24 month period subsequent to the sale. In states where Anthem has less than one year of premium experience, such as New Hampshire and Colorado/Nevada, please state the premiums currently in place and the premiums that Anthem has sought or will seek in the next six months for each and every product offered.
14. For each purchase identified in response to question number 13, please provide a chart that describes in detail each and every: a) product added and/or dropped; b) increase or decrease in coinsurance rates and/or copayment amounts by item or service and by product; c) increase or decrease in lifetime and/or annual benefit amounts or payments by product; and d) increase or decrease in benefits and/or coverage levels by item or service and by product, for the first 24 months after the purchase. In states where Anthem has less than one year of experience, such as New Hampshire and Colorado/Nevada, please provide the above information as it is currently in effect and any proposed modifications Anthem has sought or will seek in the next six months for each and every product offered.
15. Please provide all documents related to Anthem’s plans to gain marketshare in New England from January 1997 to the present. Please provide all documents prepared by or for Anthem related to the desirability to be in the New England market.
16. Please provide all documents prepared by or for Anthem and/or BCBSME from January 1998 to the present related to the financial condition of competitors of Blue Cross and Blue Shield plans in Connecticut, Maine, New Hampshire, Rhode Island and Massachusetts.
17. Please provide the minutes of BCBSME and/or Anthem board meetings related to the proposed purchase.
18. Please provide all documents prepared by or for Anthem related to demutualization from 1995 to date.
19. Please provide all documents prepared by or for Anthem Insurance Companies, Inc. of Indiana related to the positive or negative effects a demutualization of Anthem Insurance Companies, Inc. of Indiana would have on insureds in Maine and any other state in which Anthem operates. Please describe in detail what persons would receive stock, dividends, assets, or anything of value and in what proportions if Anthem Insurance Companies, Inc. of Indiana were to demutualize under current Indiana law. Please provide all documents prepared by or for Anthem Insurance Companies, Inc. of Indiana related to lobbying efforts by Anthem Insurance Companies, Inc. of Indiana in connection with the passage of Senate Bill 33, affecting Indiana Code sections 27-9-1, et seq.
20. Please provide all documents related to Anthem’s description of itself as a "for profit mutual" or its operations as "for profit" from 1990 to date.
21. Please describe the applicants’ efforts or plans to gain marketshare in each state or jurisdiction with regard to products such as life, health, disability or administrative services from January 1997 to the present.
22. Describe all activities considered as "administrative" for purposes of medical loss ratio reporting by the applicants to or for governmental agencies, A.M. Best, and internal accounting purposes. Please state with specificity all activities considered as "administrative expenses" of the applicants by Milliman and Robertson, Inc. for the purposes of preparing its November 2, 1999 Comparative Premium Rate Analysis.
23. Provide the applicants’ medical loss ratios by product for each of the calendar years 1998 and 1999.
24. Please provide a chart that describes in detail the medical underwriting practices and/or criteria used by the applicants by product and by item or service. Please include in the chart all waiting periods, exclusions of services and items, exclusionary periods, rate and rating variations which are dependent on age, sex, health status and medical condition, used or in effect for each of the calendar years 1997, 1998, 1999 and 2000.
25. Please provide the number and rate of prior authorization requests made from January 1998 to the present to the applicants. Please also include in the response, the number and rate of prior authorization requests reversed on appeal for the same period. Please also estimate the dollar value of those services authorized as a result of appeals during that same time period.
26. Please provide a schedule of the five procedures and/or services most frequently denied by the applicants from January 1998 to date. Please provide an estimated dollar value per procedure or service.
27. Please provide all documents related to the rapid disenrollment rates (i.e., disenrollment within six months of enrollment) for Anthem’s Medicare HMO products.
28. Will Anthem offer a Medicare HMO product in Maine? Will Anthem offer a Medicaid HMO product in Maine?
29. In which states did Anthem offer Medicare HMO and/or Medicaid HMO products from January 1997 to date? Has Anthem terminated or proposed to terminate any such product offering in any state during that period? Please state which product(s) and in which state(s) such termination or proposed termination has occurred or may occur. If Anthem intends to offer a Medicare HMO product and/or a Medicaid HMO product in any state, please identify which state, which product(s), and when the product(s) will be offered.
30. Please provide all documents related to prescription drug formulary or formularies used by the applicants for each product offered. Please describe in detail the formulary development, evaluation and/or review process(es) used by the applicants?
31. How many lives did Anthem insure in the non-group market for each of the calendar years 1998 and 1999? Please provide an aggregate number of insured lives for all states in which Anthem does business and an aggregate number of insured lives per state.
32. During calendar years 1998 and 1999, please state how many of the applicants’ insureds were insured or covered on a secondary basis by another health insurance plan – private or public?
33. Has Anthem terminated or proposed to terminate non-group product offerings in any state during calendar year 1998, 1999 or 2000? If yes, please specify in which state and when such termination was or will be effective. For each non-group product termination, state how much time in days insureds were given as notice of termination. Please provide a sample of the notice for each non-group product termination.
34. In which state(s) does Anthem impose or anticipate imposing waiting or exclusionary periods for prescription drugs, durable medical equipment or supplies, and mental health services? Please provide all documents related to the waiting or exclusionary period(s) for each of these items and services.
35. Please provide a list with the names, addresses and phone numbers of the pharmaceutical benefits manager(s), the durable medical equipment or supply manager(s), and the mental health benefits manager(s) which administer the applicants’ prescription drug, durable medical equipment and supplies, and/or mental health benefit programs. Please state the termination dates for contracts with all such managers. Please state which manager(s) Anthem intends to employ in Maine during calendar years 2000, 2001 and 2002.
36. Please provide a list with the names, addresses and phone numbers of the independent review organizations (IROs) with which Anthem and BCBSME have contracted and/or intend to contract during the calendar years 1998, 1999, and 2000. Please provide the total number of appeals made to each of these IROs during the calendar years 1998 and 1999. How many appeals were denied in each of those years? Provide a redacted copy of a decision by each of the identified IROs for each of the calendar years 1998 and 1999.
37. Provide all documents prepared by or for Anthem and BCBSME which define or provide definitions of the terms "medical necessity", "medically necessary", "short term therapy", "case management", "experimental treatment", "clinical trial" and "emergency" in effect during the calendar year 1999 for each state in which Anthem operates.
38. How many of the applicants’ insureds have requested case management services for each of the calendar years 1998 and 1999? How many of the applicants’ insureds have received case management services for 30 or fewer days, 31 – 60 days, 61 - 90 days, and more than 90 days during each of those two years?
39. Please provide all documents prepared by or for the applicants related to criteria used or in effect for the purpose of determining whether someone qualifies and/or continues to qualify for case management services for each of the calendar years 1998 and 1999. Please provide the aggregate number of case management services requested and the aggregate number of case management services denied by the applicants during those two years. How many of those denials were appealed to the applicants? How many were reversed on appeal by the applicants? Please provide one redacted copy of an Anthem decision and one redacted copy of a BCBSME decision denying case management services for each of the calendars years 1998 and 1999.
40. Please provide all documents used by the applicants for the purpose(s) of identifying and/or subrogating costs to other insurers or coverage sources – public or private.
41. Please state in detail the applicants’ practices and/or policies as primary and/or secondary payer where the insured is also covered by Medicare and/or Medicaid.
42. Please provide the applicants’ complaint ratios for the calendar years 1998 and 1999 and the methodologies for calculating such ratios. Please provide a detailed explanation where the ratio for complaints exceeds marketshare during that time period.
43. Please provide all documents used by the applicants which state the criteria for covering experimental treatment or transplants services?
44. Please provide a chart that describes in detail the total amount of consideration paid by Anthem for Blue Cross and Blue Shield plans in New Hampshire, Connecticut, Ohio, Kentucky, and Colorado/Nevada. Please include in your response the date of closing for each sale and the total number of insureds for each plan on the closing date. For each of these purchases, please describe in detail any and all increases in the total amount of consideration paid over and above the total amount of consideration stated in the Asset Purchase Agreement or Purchase and Sale Agreement for that particular purchase. Please describe in detail each and every reduction and/or downward adjustment ordered or agreed to by Anthem to the total amount of consideration stated in the Asset Purchase Agreement or Purchase and Sale Agreement for that particular purchase.
45. Please provide a list of all lawsuits or litigation initiated against Anthem by name, court, jurisdiction and state where filed from January 1997 to the present where the total amount of damages and/or benefits sought and attorneys fees exceeds or may exceed $1,000,000. Please provide a detailed description of the nature of the litigation and the amount entered in judgment against and/or agreed to in settlement of such litigation.

Respectfully submitted,

__________________________

Joseph Ditre, 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: (207) 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 04332-5347

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

Email: pende@mejp.org