Riverstone Capital & Nexgen Insurance Services
UPDATE FOR MEDICAL PROVIDERS AND EMPLOYEE HEALTH PLAN PARTICIPANTS
REVISED AS OF 8/3/2020
The COVID-19 extension to June 15, 2020 that employers with existing extensions received has expired. The following employers that have received an extension to fund claims until September 30, 2020:
City of Modesto
Fox Sports Grill
JC Hospitality - Hard Rock Las Vegas
Peter C. Foy
SCE Partners - Hard Rock Sioux City
FULLY FUNDED EMPLOYERS
The following employers have fully funded their claims run obligations:
Access Labor Service
Altura Credit Union
Barstow Fire Protection District
California Expanded Metal Products Co. (CEMCO)
Circle H Holding
Contractors Wardrobe Inc.
ENKI Health & Research Systems, Inc.
Evergreen Home Health
Feizy Import & Export
Jensen Design & Survey Inc.
Kelly Paper & Spicers Paper
Lloyd Pest Control
Maric Healthcare LLC dba CS Treatment
Pine Mountain Club Property Owners
Regency Lighting/All Sale Electric
Saint Paul Enterprise, Inc.
Semillas Sociedad Civil
Teasdale Latin Foods
US Veterans Initiative
YMCA of Long Beach
The following employers owe less than $1000 and need to contact their TPAs (S&S or HMA) to resolve these outstanding amounts so they can be listed as fully funded:
Five Keys Charter School
Fox Sports Grill
Multi Skilled Home
Sierra Foothill Residential Care Inc
For those employers who have not received an extension nor have funded their unpaid claims runs, this office will be reviewing and where warranted initiating collection activities against those non-compliant employers for payment of medical benefits as provided under the health plan.
Medical providers are advised and cautioned that under the Court’s Orders, medical providers are enjoined from collection activities on these claims that are a part of the Riverstone MEWA Plan of Liquidation. Should a medical provider attempt collection in violation of the Court’s Order, this office as well the U.S. Department of Labor may seek sanctions against medical providers for violations of a federal court order. Such remedies may include reimbursement of our costs of enforcement against the medical providers for violations of the injunction.
Riverstone Plan of Liquidation: Proof of Claim Form and Process
The Riverstone Approved Plan of Liquidation calls for two stages of addressing claims. The first stage consists of sponsoring employers funding the health plan’s portion of the unpaid medical claims. This first stage is to address those medical claims of the employee/medical provider that the health plan has not paid its portion due on the health benefit. The health plan’s benefit is to be funded by the sponsoring employer. The second stage, known as the POC Process, provides a procedure to address not only medical claims, but other claims as well against the Riverstone MEWA Plan Assets. This second stage is largely to address the claims of: 1. Members/employees of sponsoring employers, who have funded and paid medical claim amounts that were required to be paid by the health plan; 2. Sponsoring employers who have fully paid their outstanding June 2019 unpaid medical claims runs; 3. Sponsoring employers who may have paid a portion of their June unpaid claims runs; 4. Medical providers who have claims that were not addressed by the sponsoring employer; 5. non-medical service providers/vendors who provided services to the health plan prior to February 7, 2019 and who have not been paid.
Below is the POC Form and the POC Definitions and Instructions
The deadline to submit the form is January 31, 2020. The form and supporting documentation must be submitted by mail to:
Riverstone MEWA Health Plan
510 Hospital Drive, Suite 490
Madison, TN 37115
Should you want proof of our receipt, you should mail your materials certified mail, return receipt requested.
If you have questions, you may email your questions to email@example.com. Please note in the subject line “Riverstone POC Process”
Plan of Liquidation
As set forth in the Revised Orderly Plan of Liquidation that was approved by the U.S. District Court on May 9, 2019, employers are to have completed their negotiations/payments of claims listed on their June 14 and June 28, 2019 unpaid claims run. Many employers are in the last stages of negotiations and questions have arisen on gaining extra time to complete these efforts. The approved Revised Plan of Orderly Liquidation provides as follows: The Independent Fiduciary will discuss in good faith the date by which the Sponsoring Employer is to have completed the payment/funding of the claims or negotiated claims and the date upon which further reports, if applicable are due, but said deadline will not be beyond October 28, 2019, absent specific allowance from the Independent Fiduciary.
To gain this allowance, the Independent Fiduciary requests that employers make a written request for an extension (e-mailed to Robert E. Moore, Jr. at firstname.lastname@example.org with “Riverstone” in the subject line) setting forth, in detail, the reasons for the requested extension, the requested extension date and a statement that, in good faith, the employer believes that the extension will result in the complete payment/funding of all remaining unpaid medical invoices.
In considering a request for an extension of the October 28, 2019 deadline, the Independent Fiduciary will consider the number and amounts of a Sponsoring Employer’s unpaid medical invoices and the efforts demonstrated by the Sponsoring Employer to address those unpaid medical invoices, as well as related matters (Approved Revised Orderly Plan of Liquidation at fn. 6). Amongst those “related matters” are (1) that the Sponsoring Employer is actively engaged, either directly or through a third party, in contacting/negotiating with the relevant medical provider(s), (2) that those efforts have yielded/are yielding specific results, (3) that the Sponsoring Employer is committed to continuing efforts to address the remaining outstanding unpaid medical invoices, and (4) that the Sponsoring Employer reasonably anticipates that the continuation of those efforts (during any extended period) will result in payment/funding of the remaining outstanding unpaid medical invoices. The Independent Fiduciary will also consider any unique issue that the Sponsoring Employer asserts has hindered its ability to have paid/funded all unpaid medical invoices by the October 28, 2019 deadline.
Many employers are reporting that providers are either not responding to efforts to negotiate or are refusing to negotiate. Providers are not required to negotiate; however the Independent Fiduciary believes the Court will not be sympathetic to providers who seek to gain more than what the Plan Document provides. To be clear, the employer is only responsible to fund the adjudicated payable amount as set forth under the Plan Document, regardless of whether the medical provider participated in negotiations. Failure of a provider to negotiate is not an excuse to not fund the unpaid claims runs from June 14 and June 28, 2019.
Instructions to Employers on Progress Reports
As a part of the court approved Revised Plan of Liquidation, Sponsoring employers of health plans in the Riverstone MEWA are to report their progress in the negotiation/payment of the claims that were listed on the June 14, 2019 and June 28, 2019 claims runs. Those progress reports are to be made to Mr. Rob Moore at Receivership Management Inc., the Independent Fiduciary. The progress reports should consist of the following:
1. A narrative report of the sponsoring employers activities and efforts to resolve the claims on their claims runs signed by an officer of the sponsoring employer.
2. A copy of each of the claims runs received noting on the claims run whether each claim is: a)pending, b)negotiated and paid, or c)paid.
These progress reports may be emailed to Mr. Moore at email@example.com referencing in the Subject line: Riverstone Progress Report. Because these claims runs contain protected health information, you may wish to send them through a secure portal to Mr. Moore. If you do not have a secure portal, please advise Mr. Moore at the email address above and a dropbox link will be forwarded to you.
Should you wish to fax the reports the fax number is 615-373-4336
Should you wish to mail the reports mail to:
Mr. Robert Moore, Jr.
Receivership Management Inc.
510 Hospital Drive, Suite 490
Madison, TN 37115
Information Regarding the Approved Plan of Liquidation
Order Granting Independent Fiduciary's Motion to Approve Revised Plan of Liquidation
The Template Letter and Release Form linked below is to be used by employers or their agents when they have reached a negotiated agreement with the medical provider to accept payment by the employer of an amount less than what is owed by the Riverstone MEWA Health Plan. THIS COMPLETED RELEASE CONTAINING THE SIGNATURE OF THE MEDICAL PROVIDER AND THE EMPLOYER SHOULD BE SUBMITTED BY THE EMPLOYER TO THE INDEPENDENT FIDUCIARY ALONG WITH THE PROOF OF CLAIM FORM WHEN THE EMPLOYER IS SEEKING REIMBURSEMENT FOR AMOUNTS IT HAS PAID ON BEHALF OF THE RIVERSTONE MEWA HEALTH PLAN. FAILURE TO SUBMIT COMPLETED RELEASE FORMS ALONG WITH A COMPLETED PROOF OF CLAIM FORM MAY RESULT IN NO CREDIT FOR THE PAYMENT OF THE
Information and Court Filings Concerning the Proposed Orderly Plan of Liquidation
Proposed Order Granting Motion to Approve the Plan of Liquidation
Important news about Plan Termination
On February 7, 2019, the U.S. District Court for the Central District of California, as a part of its Temporary Restraining Order under the provisions of the All Writs Act, 28 U.S.C. § 1651 enjoined and stayed all proceedings against participants, beneficiaries, the Riverstone MEWA Plan, employer plans participating in the Riverstone MEWA Plan, and plan assets. The Court’s Order stays all federal and state court proceedings, including collections actions, against participants and beneficiaries for unpaid medical claims.
Urgent health claims with date of service February 7,2019 forward until further orders of the Court will be paid, including prescription drug costs, under the terms of the Plan. Questions regarding the current status of the plan may be directed to 615-370-0051 or emailed to firstname.lastname@example.org. Please reference in the subject "Riverstone"