STATUS UPDATE FROM THE MEDOVA LIFESTYLE HEALTH PLANS INTERIM INDEPENDENT FIDUCIARY
On Friday, May 14, 2021, Receivership Management Inc. (RMI), the Interim Independent Fiduciary of the Medova Lifestyle Health Plans, and Medova Healthcare Financial, LLC (Medova), agreed that Medova would be replaced with a new Third Party Administrator (TPA) to provide TPA services to those Lifestyle Health Plans covered by the federal Employee Retirement Income Security Act of 1974, as amended (ERISA). The transition to a new TPA for ERISA Medova Plans will be completed no later than July 1, 2021. RMI notified the Court on May 21, 2021.
I. REPLACEMENT AGREEMENT
RMI and Medova agreed that the ERISA Lifestyle Health Plans serviced by Medova will begin the transfer process immediately, with the transfers to be completed no later than July 1, 2021. Medova will continue to service the Lifestyle Health Plans until that transfer has occurred. Medova will also continue to serve as a TPA to Lifestyle Health Plans that are sponsored by employers who are governmental entities or religious organizations.
II. NEW TPA FOR ERISA HEALTH PLANS IS
HAWAII MAINLAND ADMINISTRATORS
The new TPA will be Hawaii Mainland Administrators of Tempe, Arizona (HMA). HMA is a large TPA with experience handling numerous health plans. The new TPA has banking privileges with Arizona Bank and Trust, which is where RMI will move the ERISA Lifestyle Health Plan accounts. RMI appreciates Medova’s agreement to the transition to HMA by July 1, 2021. During the transition, there will be continuing work and contact with Medova.
RMI continues to ask for the patience and understanding of the many thousands of ERISA health plans’ brokers, members, patients and providers of the over 2,500 Medova Health Plans. RMI believes this change will improve response time but transitions are always challenging. RMI has been working diligently – nights and weekends included – to help the ERISA Lifestyle Health Plan members, patients, brokers and providers, and we will continue to do so. We understand the frustration you are experiencing and we will do our best to assist whenever possible. We are responding to calls, emails, faxes and letters as soon as we can but the volume is quite high so, please be patient with us.
III. ERISA ONLY MEDOVA PLANS
It is important to understand RMI has not been appointed to address non-ERISA health plans handled by Medova. Further, Medova will continue to serve as a TPA to Lifestyle Health Plans that are sponsored by employers who are governmental entities or religious organizations. Medova is also the continuing contact for all inquiries regarding non-ERISA Medova health plans.
IV. MEDOVA WILL CONTINUE TO PROVIDE CLAIMS ASSISTANCE UNTIL THE TRANSITION IS COMPLETE
For all Medova ERISA Health Plans until you are notified that your Lifestyle Health Plan has completed its transition, you should continue to contact Medova to:
submit new claims;
obtain required authorizations and pre-authorizations;
obtain claims status;
file an appeal and seek information regarding appeals for pending claims;
obtain copies of explanation of benefits (EOBs) and ask questions regarding EOBs; and
pay premiums as instructed.
If you are unable to obtain the necessary information, please call RMI at 615-370-0051. Non-ERISA Medova Plans will continue contacting Medova regarding all of the above matters and Medova will continue as their TPA after the transition.
V. UNPAID CLAIMS OVER 90 DAYS IN ARREARS
ERISA Medova Health Plan members, who have unpaid claims over 90 days in arrears, should provide the following information to by encrypted email with “Medova Unpaid Claims” in the subject line to email@example.com or by fax to 615-373-4336:
the Member’s full name;
the Name of the Member’s Employer;
Provide a copy of the Health Plan Card or provide your Member ID Number;
the Patient’s full name and date of birth;
the Claim Number, if known;
the Provider’s name and address;
the Date of Service(s);
the Amount Billed;
Copies of any Explanation of Benefits (EOBs) or bills you have received;
Have you been subjected to collection action regarding Medova’s portion of a bill? _______ If yes, please provide copies of the collection notices; and
Have you filed an appeal? _____ If yes, please provide copies of the appeal documents.
If you do not have all the documents, you should send what you have available. The more information you provide the easier it is to identify your claims and to seek information.
VI. PENDING REQUESTS FOR INFORMATION
RMI has issued Requests for Information (RFIs) to Medova regarding a number of unpaid ERISA Medova claims. Medova is still obligated to respond to the requests. Please be patient as we continue to try and obtain responses from Medova.
During the transition, RMI plans to only issue additional Requests for Information for persons we were already working with prior to the TPA change. We will address new issues with the new TPA after July 1. RMI will wait a few weeks to allow the new TPA some transition time. Again, please be patient with us.
VII. COLLECTION ISSUES
For ERISA Health Plan Members and Patients who are receiving collection notices and action regarding amounts owed by your ERISA Lifestyle Health Plan, U.S. District Court Judge Toby Crouse issued an Order under the All Writs Act enjoining collections and lawsuits against members and patients covered by the ERISA Lifestyle Health Plans. Click the link here to view the Order. RMI is also offering the following suggestions to Members and Patients with unpaid claims owed by the Plan to do the following:
1. Continue to gather and retain the information described above for claims unpaid by Medova for more than 90 days. Keep copies for yourself and provide to RMI as described above.
2. The Member should notify the Collection Entities in writing that you dispute the debt because it is owed by the ERISA Lifestyle Health Plan to the Provider (if such is the case). You can also notify the Collection Entities of the Motion filed by the Department of Labor and provide them with a copy. The Member should copy the letter to the Provider and RMI by encrypted email with “Medova Collections” in the subject line to firstname.lastname@example.org or by fax to (615) 373-4336.
3. Review available consumer educational materials regarding debt collection and credit reporting. For example, the Federal Trade Commission has excellent consumer information regarding how to dispute errors on credit reports and debt collection at www.consumer.ftc.gov.
4. If legal action is taken against a Member or Patient, the Member needs to respond within the legally required time frame and may need an attorney. RMI would also ask that you provide copies of any legal action taken asap to RMI by encrypted email with “Medova Lawsuit” in the subject line to email@example.com or by fax to (615) 373-4336.
VIII. ERISA HEALTH PLANS WITH INSUFFICIENT FUNDS IN THEIR ACCOUNTS TO PAY APPROVED CLAIMS
Please understand RMI cannot pay claims where the particular ERISA Lifestyle Health Plan is currently underfunded. ERISA Lifestyle Health Plans rely on contributions by the Sponsoring Employer and a combination of Stop Loss policies. Many of these Stop Loss policies will not make their payments until the end of the Policy term. Gaps that occur between the amount of funds paid by the Employer and the Attachment Point of the Stop Loss Policy are to be funded by the Employer.
Shortfalls between the medical expense amounts funded by the Employer and the Stop Loss Attachment Point are to be funded by the Employer as outlined in the Plan Document adopted by the Employer. Amounts above the Stop Loss Attachment Point MAY be required to be funded by the Employer in accordance with the Stop Loss Policy unique to the Employer’s Plan. Some or all of the amounts above the Stop Loss Attachment point paid by the Employer may be refunded when Stop Loss payments are received.
IX. COMMISSIONS CANNOT BE PAID FOR ERISA HEALTH PLANS UNABLE TO PAY CLAIMS
RMI, as Interim Independent Fiduciary, has determined that, if an ERISA Lifestyle Health Plan is unable to pay its medical claims, RMI will not approve payments for insurance brokerage commissions.
X. TERMINATION OF PLANS
Some employers and brokers have contacted RMI regarding termination of their plans. RMI cannot advise employers or their insurance brokers regarding the employers’ business decisions. RMI would advise employers and brokers to carefully review their Plan Document to determine how it would be impacted by an early termination. Employers may wish to consult an attorney regarding such an important contractual decision.
Please note: ERISA Lifestyle Health Plans cannot be renewed. At the end of the plan year, the Employer has the authority to decide whether to establish a new health plan or not to establish a new health plan.