By Ray Stern
By Ray Stern
By New Times
By Amy Silverman
By Stephen Lemons
By Stephen Lemons
By Monica Alonzo
By Chris Parker
But Pete Rubi suffered a massive heart attack, and for more than a year now, he's been in a coma, dependent on others to look out for him, especially his wife, Ana Rubi. She is more than up to the challenge. Since April, she's been fighting Intergroup Prepaid Health Services to keep Pete alive, she says.
Intergroup wanted to terminate Pete's coverage at a skilled-care facility in Tucson on May 5. But Ana says Intergroup offered 30 additional days of coverage if she would sign a living will which would cut off her husband's food and fluids if it was determined he was in an "irreversible" coma.
"I said, 'What if I don't sign it?' They said, 'Well, then you don't get it.' I said, 'Well, then I guess I don't get it.' That's signing my husband's death sentence," Ana says.
Ana thinks Intergroup wanted her to sign the living will "because now more money is going out of Intergroup than going in," she says. "Before, he put all that money in there [into Intergroup]; now that he needs it, it's easier to get rid of him. Why bother with him?"
Ana believes Pete is coming out of the coma, and she's not about to give up on him. She has a referral from Pete's doctor for another six months in a skilled-care facility, and she plans on fighting Intergroup for her husband's due.
"He paid for that. And he's going to get it, or you know what? They haven't heard the last of me," Ana says. "Everybody says, 'You can't fight Intergroup.' I say, 'Why not?' They're just people like you and I. . . . They're not God. They think they are, but they're not."
Intergroup won't comment on Ana Rubi's complaint. But such clashes between managed-care companies and patients are one reason a group of state employees is protesting the award of a contract for indemnity health insurance to Intergroup. The employees say indemnity insurance, favored by people who need the most medical services, shouldn't be trusted to a company which makes people fight for treatment. They point out that when Intergroup first tried to manage state workers' indemnity coverage four years ago, the state departments of Insurance and Administration tagged it with the largest fines in state history for an HMO.
Intergroup says it's more than qualified to deliver quality indemnity care now, and the state Department of Administration, which awarded Intergroup the contract, says there's nothing wrong with Intergroup's bid. However, problems exist:
* Mary Ann Knight, manager of the state's employee-benefits program and the person who made the request for bids, admits she's married to an Intergroup account manager--but insists there's no conflict of interest.
* New Times has learned that doctors are quitting Intergroup, which may affect its ability to meet the terms of the contract. In 1995, Intergroup lost 142 primary-care physicians. In the past nine months, at least 75 more physicians have left or given notice to leave the physicians' association which contracts with Intergroup to provide doctors--a turnover rate of 22.9 percent since 1995. More are expected to give notice.
* The Department of Administration, faced with criticism over the selection of Intergroup, attempted to make Blue Cross a co-offerer of indemnity insurance three months after choosing Intergroup. Blue Cross is challenging the legality of that move.
* Members of the legislative oversight committee--established in response to the furor created the last time Intergroup held the state indemnity contract--say DOA never notified them of the awards, as required by law. DOA says the lawmakers were notified. At the request of Senator Ann Day, a Tucson Republican, the attorney general is looking into the matter.
* Intergroup lost more than $3 million last year, according to records on file with the state Department of Insurance. And a former assistant medical director of Intergroup says the company will also lose money with its indemnity bid.
* DOA and Intergroup officials reportedly told state employees that the company had no new complaints since Intergroup was bought by Foundation Health Corporation, Inc. In fact, hundreds of new complaints have been lodged with the Department of Insurance.
DOA says there's no cause for state employees to worry, and some say Intergroup deserves the contract.
But there's a vocal group of state employees that says it's heard that before--and it's not buying it this time.
On May 21, the state Department of Administration held a meeting at Arizona State University to inform staffers of the selection of a new indemnity carrier and new HMOs for an annually renewable, five-year contract for employee benefits.
Mary Ann Knight, employee-benefits manager for the state of Arizona, and Jerry Kertesz, vice president of sales and marketing for Intergroup, announced that Intergroup again had been chosen as the state's indemnity carrier.
Harvey Smith, a math professor at ASU, was surprised, to say the least.
"I don't have anything against Intergroup," he says, "except that they screw up all the time."