Blogging Bayport Alameda

May 22, 2014

Now I have taken control

Filed under: Alameda, Alameda Neighbors — Lauren Do @ 6:02 am

Has anyone been following the saga of the Alameda Alliance for Health?   So, to nutshell, Alameda Alliance for Health (based on Bay Farm island) is a local non profit managed care health plan.   In October of last year Alameda Alliance for Health was dropped from the Covered California exchange, meaning that folks had one less option for coverage on the exchange.  According to the LA Times story it was because Alameda Alliance for Health failed to secure a state license and failed to meet a minimum threshold for tangible net assets.  They needed $19.2 million but only reported having $8.4 million.   The October drop of Alameda Alliance for Health left Alameda County residents with only the three biggies which we’re all familiar with Anthem Blue Cross, Blue Shield of California and Kaiser Permanente even though neighboring counties had up to five providers to choose from.

Now, Alameda Alliance for Health is in an even worse pickle than just being dropped by the Covered California exchange, now the entire operation has been seized by the State of California:

The state has seized an Alameda County health insurance provider that covers more than 200,000 residents, most of them on Medi-Cal, saying it was at risk of going under.

But the financial problems of the Alameda Alliance are a “calamity” and a “debacle” for its mostly low-income enrollees, the state Department of Managed Care said in court papers this month after naming a conservator to oversee the nonprofit public health care provider. The health plan and its prominent East Bay backers are fighting to return it to local control, accusing a state consultant of an “irreconcilable conflict of interest” and asking for more time to sort out a backlog of unpaid medical claims.

“The crisis is not simply a matter of bookkeeping woes,” said a court memo by Carol Ventura, deputy director of the state Department of Managed Care, which regulates health plans. Ventura wrote that the Alameda-based insurer could also be committing “serious violations” of state law by not promptly paying back some 280,000 backlogged claims.

State officials also recently fired Alliance CEO Ingrid Lamirault and other top executives and escorted them out of the health plan’s office near Oakland International Airport.

An escort out of the office is pretty hardcore.

According to the article, the Alameda County Board of Supervisors loaned Alameda Alliance $5 million in late February and the Board of Supervisors appoints the Board Members to the Alameda Alliance Board.   Additionally, according to the list, it appears that quite a few of the Board Members are CEOs or heads of medical centers, hospitals, or clinic which seems odd.  Given that the relationship between the insurance company paying a claim and the hospital trying to collect the money would naturally be an antagonistic one (disputes over how much to cover whether the medical center is overcharging, etc and so forth) it feels a little like the whole fox guarding the hen house kind of thing.   But maybe that’s standard practice…   FYI, the Board of Directors for the Alameda Alliance link has been removed from their website, but it came up in a Google search.

Advertisements

2 Comments

  1. Lauren, you should come to the LWV meeting tonight and ask Wright Lassiter about Alameda Alliance in person. Seeing as how he’s now running Alameda Hospital & Highland as AHS, its certainly a valid question.

    Note both AHS Hospitals get the lowest grades in this Hospital Safety Score report: http://www.hospitalsafetyscore.org/search-result?findBy=zip&zip_code=94501&radius=50&city=&state_prov=&hospital=&agree=agree

    Comment by vigi — May 22, 2014 @ 12:06 pm

  2. Since vigi was there and asked the question about the Alliance and about the safety scores, I’d be interested to hear from vigi an analysis of the responses.

    Comment by Kate Quick — May 23, 2014 @ 6:24 am


RSS feed for comments on this post.

Sorry, the comment form is closed at this time.

Blog at WordPress.com.