Post by Moses on May 29, 2005 8:17:20 GMT -5
www.thekansascitychannel.com/news/4539521/detail.html
Man Dying Of Cancer Frustrated Insurance Won't Cover Care
2,000 Doctors File Lawsuit Against Metro's Major Insurance Companies
POSTED: 8:37 am CDT May 27, 2005
UPDATED: 11:18 am CDT May 27, 2005
KANSAS CITY, Mo. -- Tracy Pierce is dying of cancer. He has insurance, but it won't pay for any of his care.
His wife, Julie, works at Saint Joseph Health Center. KMBC's Jim Flink reported her insurance plan is supposed to cover all his medical needs, but repeatedly, both the hospital and the insurance provider have rejected Pierce's claims, despite the fact his doctors pleaded with both to provide that life-saving care.
Pierce has kidney cancer.
"I don't know what else to do, but just wait," Pierce said.
He has already been waiting months for his wife's insurance provider to approve life-saving care. But each time First Health Coventry has said no, saying Pierce's care either is not a medical necessity or is experimental. This week, he was rejected again despite a 27-page appeal by his doctor.
"My husband is sick and needs a cure. But he's denied because of money," Julie Pierce said.
Julie Pierce said she has a drawer full of appeals and rejections. She's even petitioned her employer, Saint Joseph Health Center, pleading for help.
"And they look at you and tell you, 'Well, I'm sympathetic to your situation.' And I said, 'Well, your sympathy is not going to do me any good when I'm burying him next year," Julie Pierce said.
Saint Joseph Health Center is owned by Carondelet Health. On its Web site it says, "Our commitment to human dignity compels us to provide compassionate, quality health care for body, mind and spirit with a special concern for the poor. We are responsible stewards serving the needs of all people from conception to death."
Julie Pierce said she used to believe that.
"They're basically killing him. They're allowing this to happen and they have the power to change it," Julie Pierce said.
Each month that Tracy Pierce waits, he gets worse, Flink reported. This week, he got his latest test results.
"He's got masses in both lungs," Julie Pierce said.
"Just get me some help. That's what I need. I need help," Tracy Pierce said.
Flink asked Saint Joseph's trustees why it has rejected Pierce's claims. They issued a statement saying, "Health plans cannot cover every medical procedure and remain affordable for plan participants. The Carondelet Health medical plan is a comprehensive plan that provides coverage for many illnesses, procedures and medications. Experimental, investigational treatments are excluded with the plan."
Tracy Pierce said he will continue to appeal.
Flink reported earlier this month that 2,000 local doctors are suing the metro's major insurance companies, alleging insurance companies are deciding patient care and not doctors. That lawsuit goes to court July 15.
www.forbes.com/businesswire/feeds/businesswire/2005/05/03/businesswire20050503005546r1.html
BusinessWire
Coventry Health Care Reports Record First Quarter Earnings of $1.09 per Diluted Share; Increases 2005 EPS Guidance $0.05 To $4.48 to $4.58
05.03.05, 7:27 AM ET
Coventry Health Care, Inc. (NYSE:CVH) today reported operating results for the quarter ended March 31, 2005. Operating revenues totaled $1.57 billion for the quarter, a 21.5% increase over the first quarter of 2004. Net earnings were $112.7 million, or $1.09 per diluted share, a 51.6% increase over net earnings for the first quarter of 2004 and a 32.9% increase on a per diluted share basis. The quarter includes results from Coventry's First Health acquisition for the period from when the transaction closed on January 28, 2005 through March 31, 2005.
"I am delighted with the progress our Company made in the first quarter of 2005," said Dale B. Wolf, chief executive officer of Coventry. "Our health plan earnings came in slightly ahead of plan, First Health revenue is settling in as expected, and operations and expense reduction progress is either at or ahead of schedule in almost all areas. Overall, our opportunities and prospects have never been better." -0- *T Consolidated First Quarter Highlights -- Revenues up 21.5% over the prior year quarter -- EPS up 32.9% over the prior year quarter -- First Health $0.04 or 3.8% accretive in Q1 2005 -- Cash flow from operations of $217.3 million or 193% of net income Health Plan Business First Quarter Highlights: -- Health Plan Membership up 0.7% over the prior year quarter -- Revenues up 10.5% over the prior year quarter -- Medical Loss Ratio (MLR) of 79.8% improves 150 basis points over prior year quarter -- SGA ratio of 11.2% is an improvement of 40 basis points over the prior year quarter -- Operating Margin of 10.4%, up 180 basis points over the prior year quarter -- Membership. As of March 31, 2005, Coventry had total health plan membership of 2.45 million members, an increase of 18,000 members, or 0.7%, over the prior year quarter and a decrease of 60,000 members over the prior quarter due to previously announced large group losses primarily in the St. Louis marketplace. -- Health Plan Insured Commercial Rate Increases. Commercial insured yields rose to $242.10 PMPM (per member per month) in the quarter, an increase of 9.0% over the prior year quarter. The Company expects the 2005 commercial risk yield increase, net of benefit buydowns, to be in the range of 9.5% to 10.5%. Rate increases are expected to rise during the year as there is a higher mix of small group renewals than in the first quarter. -- Medical Loss Ratio (MLR). Health Plan MLR was 79.8%, a 150 basis point improvement over the prior year quarter, primarily driven by Medicare results. Commercial MLR of 78.8% improved 60 basis points, Medicare MLR of 82.2% improved 670 basis points, and Medicaid MLR of 83.4% improved 350 basis points. -- Selling, General & Administrative (SG&A) Expenses. SG&A expenses were 11.2% of operating revenues for the quarter, an improvement of 40 basis points over the prior year quarter. SG&A PMPM of $21.68 is an increase of 5.6% over the prior year quarter. -- Balance Sheet. Net Premium Accounts Receivable of $86.5 million represent 5.5 days of sales outstanding (DSO) with the Health Plan commercial only DSO running at 4.4 days. Days in Claims Payable (DCP) were 54.0 compared to the prior quarter of 55.8. Reduction in DCP was primarily due to timing of claim payments and reduction of inventory levels from the prior quarter. First Health Businesses First Quarter Highlights The First Health acquisition closed on January 28, 2005 and therefore only results from January 28, 2005 through March 31, 2005 are included in Coventry's first quarter financial statements. -- Revenues. Overall revenues of $141.9 million were consistent with Coventry's seasonally-adjusted expectations. Revenues by business line are contained in the First Health operating statistics schedule included with this press release. -- Selling, General & Administrative (SG&A) Expenses. SG&A expenses were 65.3% of operating revenues for the quarter. Since the transaction closed on January 28, 2005, 213 positions have been eliminated, and an additional 255 positions have been notified of termination to become effective before the end of the year. Coventry is on track to achieve the $25 million of synergies for 2005 outlined in previous guidance. -- Revenue Guidance. Overall revenue for 2005 for the First Health businesses is expected to be between $885 million and $905 million on a full year basis. Due to the timing of the closing on January 28, 2005, Coventry expects to realize approximately 11/12 of the full year estimate in calendar year 2005 results. This timing adjustment also applies to the First Health business specific guidance provided below. -- Federal Employees Health Benefits (FEHB). Final January open enrollment results were slightly better than expected with 262,000 actual subscribers enrolled versus an expected enrollment of 260,000 subscribers. The 262,000 subscribers results in total Mail Handlers' membership of 483,000. Total revenue in 2005 is expected to be between $220 million and $230 million on a full year basis. -- Corporate/ National Accounts. Total revenue in 2005 for Corporate/National Accounts is expected to be between $155 million and $165 million on a full year basis. As of March 31, 2005, the National Accounts business is comprised of approximately 806,000 members in 130 customer accounts. -- Network Rental. Total revenue in 2005 for the Network Rental business is expected to be between $95 million and $105 million on a full year basis. -- Workers' Compensation. Total revenue in 2005 for the Workers' Compensation business is expected to be between $215 million and $225 million on a full year basis. -- Medicaid/Public Sector. Total revenue in 2005 for the Medicaid/Public Sector business is expected to be between $185 million and $195 million on a full year basis. Consolidated 2005 Guidance Details Q2 2005 Guidance -- Total Revenues of $1.64 billion to $1.68 billion -- Earnings per share (EPS) on a diluted basis of $1.12 to $1.14 2005 Full Year Guidance -- Risk revenues in the range of $5.78 billion to $5.88 billion -- Management services revenues of $875.0 million to $925.0 million -- Medical loss ratio (MLR) of 80.0% to 81.0% of risk revenues -- Selling, general, and administrative expenses (SG&A) of $1.15 billion to $1.17 billion -- Depreciation and amortization expense of $85.0 million to $95.0 million -- Investment income of $45.0 million to $48.0 million -- Interest expense of $56.0 million to $60.0 million -- Tax rate of 37.0 % to 37.5% -- Diluted share count of 107.5 million to 108.5 million shares -- Earnings per share (EPS) on a diluted basis of $4.48 to $4.58 *T
Mr. Wolf will host a conference call at 8:30 a.m. EST on Tuesday, May 3, 2005. To listen to the call, dial toll-free at (800) 810-0924 or, for international callers, (913) 981-4900. Callers will be asked to identify themselves and their affiliations. The conference call will also be broadcast over the Internet at www.cvty.com. Coventry asks participants on both the call and webcast to review and be familiar with its filings with the Securities and Exchange Commission (SEC). A replay of the call will be available for one week at (888) 203-1112, or for international callers, (719) 457-0820. The access code is 4360719.
This press release may contain forward-looking statements, made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, relating to future events or future financial performance. Actual performance may be significantly impacted by certain risks and uncertainties, including those described in Coventry's Annual Report on Form 10-K for the year ended December 31, 2004.
Coventry Health Care is a national managed health care company based in Bethesda, Maryland operating health plans, insurance companies, network rental / managed care services companies, and workers' compensation services companies. Coventry provides a full range of risk and fee-based managed care products and services, including HMO, PPO, POS, Medicare Advantage, Medicaid, Workers' Compensation and Network Rental to a broad cross section of employer and government-funded groups, government agencies, and other insurance carriers and administrators in all 50 states as well as the District of Columbia and Puerto Rico. More information is available on the Internet at www.cvty.com and www.firsthealth.com.
Man Dying Of Cancer Frustrated Insurance Won't Cover Care
2,000 Doctors File Lawsuit Against Metro's Major Insurance Companies
POSTED: 8:37 am CDT May 27, 2005
UPDATED: 11:18 am CDT May 27, 2005
KANSAS CITY, Mo. -- Tracy Pierce is dying of cancer. He has insurance, but it won't pay for any of his care.
His wife, Julie, works at Saint Joseph Health Center. KMBC's Jim Flink reported her insurance plan is supposed to cover all his medical needs, but repeatedly, both the hospital and the insurance provider have rejected Pierce's claims, despite the fact his doctors pleaded with both to provide that life-saving care.
Pierce has kidney cancer.
"I don't know what else to do, but just wait," Pierce said.
He has already been waiting months for his wife's insurance provider to approve life-saving care. But each time First Health Coventry has said no, saying Pierce's care either is not a medical necessity or is experimental. This week, he was rejected again despite a 27-page appeal by his doctor.
"My husband is sick and needs a cure. But he's denied because of money," Julie Pierce said.
Julie Pierce said she has a drawer full of appeals and rejections. She's even petitioned her employer, Saint Joseph Health Center, pleading for help.
"And they look at you and tell you, 'Well, I'm sympathetic to your situation.' And I said, 'Well, your sympathy is not going to do me any good when I'm burying him next year," Julie Pierce said.
Saint Joseph Health Center is owned by Carondelet Health. On its Web site it says, "Our commitment to human dignity compels us to provide compassionate, quality health care for body, mind and spirit with a special concern for the poor. We are responsible stewards serving the needs of all people from conception to death."
Julie Pierce said she used to believe that.
"They're basically killing him. They're allowing this to happen and they have the power to change it," Julie Pierce said.
Each month that Tracy Pierce waits, he gets worse, Flink reported. This week, he got his latest test results.
"He's got masses in both lungs," Julie Pierce said.
"Just get me some help. That's what I need. I need help," Tracy Pierce said.
Flink asked Saint Joseph's trustees why it has rejected Pierce's claims. They issued a statement saying, "Health plans cannot cover every medical procedure and remain affordable for plan participants. The Carondelet Health medical plan is a comprehensive plan that provides coverage for many illnesses, procedures and medications. Experimental, investigational treatments are excluded with the plan."
Tracy Pierce said he will continue to appeal.
Flink reported earlier this month that 2,000 local doctors are suing the metro's major insurance companies, alleging insurance companies are deciding patient care and not doctors. That lawsuit goes to court July 15.
www.forbes.com/businesswire/feeds/businesswire/2005/05/03/businesswire20050503005546r1.html
BusinessWire
Coventry Health Care Reports Record First Quarter Earnings of $1.09 per Diluted Share; Increases 2005 EPS Guidance $0.05 To $4.48 to $4.58
05.03.05, 7:27 AM ET
Coventry Health Care, Inc. (NYSE:CVH) today reported operating results for the quarter ended March 31, 2005. Operating revenues totaled $1.57 billion for the quarter, a 21.5% increase over the first quarter of 2004. Net earnings were $112.7 million, or $1.09 per diluted share, a 51.6% increase over net earnings for the first quarter of 2004 and a 32.9% increase on a per diluted share basis. The quarter includes results from Coventry's First Health acquisition for the period from when the transaction closed on January 28, 2005 through March 31, 2005.
"I am delighted with the progress our Company made in the first quarter of 2005," said Dale B. Wolf, chief executive officer of Coventry. "Our health plan earnings came in slightly ahead of plan, First Health revenue is settling in as expected, and operations and expense reduction progress is either at or ahead of schedule in almost all areas. Overall, our opportunities and prospects have never been better." -0- *T Consolidated First Quarter Highlights -- Revenues up 21.5% over the prior year quarter -- EPS up 32.9% over the prior year quarter -- First Health $0.04 or 3.8% accretive in Q1 2005 -- Cash flow from operations of $217.3 million or 193% of net income Health Plan Business First Quarter Highlights: -- Health Plan Membership up 0.7% over the prior year quarter -- Revenues up 10.5% over the prior year quarter -- Medical Loss Ratio (MLR) of 79.8% improves 150 basis points over prior year quarter -- SGA ratio of 11.2% is an improvement of 40 basis points over the prior year quarter -- Operating Margin of 10.4%, up 180 basis points over the prior year quarter -- Membership. As of March 31, 2005, Coventry had total health plan membership of 2.45 million members, an increase of 18,000 members, or 0.7%, over the prior year quarter and a decrease of 60,000 members over the prior quarter due to previously announced large group losses primarily in the St. Louis marketplace. -- Health Plan Insured Commercial Rate Increases. Commercial insured yields rose to $242.10 PMPM (per member per month) in the quarter, an increase of 9.0% over the prior year quarter. The Company expects the 2005 commercial risk yield increase, net of benefit buydowns, to be in the range of 9.5% to 10.5%. Rate increases are expected to rise during the year as there is a higher mix of small group renewals than in the first quarter. -- Medical Loss Ratio (MLR). Health Plan MLR was 79.8%, a 150 basis point improvement over the prior year quarter, primarily driven by Medicare results. Commercial MLR of 78.8% improved 60 basis points, Medicare MLR of 82.2% improved 670 basis points, and Medicaid MLR of 83.4% improved 350 basis points. -- Selling, General & Administrative (SG&A) Expenses. SG&A expenses were 11.2% of operating revenues for the quarter, an improvement of 40 basis points over the prior year quarter. SG&A PMPM of $21.68 is an increase of 5.6% over the prior year quarter. -- Balance Sheet. Net Premium Accounts Receivable of $86.5 million represent 5.5 days of sales outstanding (DSO) with the Health Plan commercial only DSO running at 4.4 days. Days in Claims Payable (DCP) were 54.0 compared to the prior quarter of 55.8. Reduction in DCP was primarily due to timing of claim payments and reduction of inventory levels from the prior quarter. First Health Businesses First Quarter Highlights The First Health acquisition closed on January 28, 2005 and therefore only results from January 28, 2005 through March 31, 2005 are included in Coventry's first quarter financial statements. -- Revenues. Overall revenues of $141.9 million were consistent with Coventry's seasonally-adjusted expectations. Revenues by business line are contained in the First Health operating statistics schedule included with this press release. -- Selling, General & Administrative (SG&A) Expenses. SG&A expenses were 65.3% of operating revenues for the quarter. Since the transaction closed on January 28, 2005, 213 positions have been eliminated, and an additional 255 positions have been notified of termination to become effective before the end of the year. Coventry is on track to achieve the $25 million of synergies for 2005 outlined in previous guidance. -- Revenue Guidance. Overall revenue for 2005 for the First Health businesses is expected to be between $885 million and $905 million on a full year basis. Due to the timing of the closing on January 28, 2005, Coventry expects to realize approximately 11/12 of the full year estimate in calendar year 2005 results. This timing adjustment also applies to the First Health business specific guidance provided below. -- Federal Employees Health Benefits (FEHB). Final January open enrollment results were slightly better than expected with 262,000 actual subscribers enrolled versus an expected enrollment of 260,000 subscribers. The 262,000 subscribers results in total Mail Handlers' membership of 483,000. Total revenue in 2005 is expected to be between $220 million and $230 million on a full year basis. -- Corporate/ National Accounts. Total revenue in 2005 for Corporate/National Accounts is expected to be between $155 million and $165 million on a full year basis. As of March 31, 2005, the National Accounts business is comprised of approximately 806,000 members in 130 customer accounts. -- Network Rental. Total revenue in 2005 for the Network Rental business is expected to be between $95 million and $105 million on a full year basis. -- Workers' Compensation. Total revenue in 2005 for the Workers' Compensation business is expected to be between $215 million and $225 million on a full year basis. -- Medicaid/Public Sector. Total revenue in 2005 for the Medicaid/Public Sector business is expected to be between $185 million and $195 million on a full year basis. Consolidated 2005 Guidance Details Q2 2005 Guidance -- Total Revenues of $1.64 billion to $1.68 billion -- Earnings per share (EPS) on a diluted basis of $1.12 to $1.14 2005 Full Year Guidance -- Risk revenues in the range of $5.78 billion to $5.88 billion -- Management services revenues of $875.0 million to $925.0 million -- Medical loss ratio (MLR) of 80.0% to 81.0% of risk revenues -- Selling, general, and administrative expenses (SG&A) of $1.15 billion to $1.17 billion -- Depreciation and amortization expense of $85.0 million to $95.0 million -- Investment income of $45.0 million to $48.0 million -- Interest expense of $56.0 million to $60.0 million -- Tax rate of 37.0 % to 37.5% -- Diluted share count of 107.5 million to 108.5 million shares -- Earnings per share (EPS) on a diluted basis of $4.48 to $4.58 *T
Mr. Wolf will host a conference call at 8:30 a.m. EST on Tuesday, May 3, 2005. To listen to the call, dial toll-free at (800) 810-0924 or, for international callers, (913) 981-4900. Callers will be asked to identify themselves and their affiliations. The conference call will also be broadcast over the Internet at www.cvty.com. Coventry asks participants on both the call and webcast to review and be familiar with its filings with the Securities and Exchange Commission (SEC). A replay of the call will be available for one week at (888) 203-1112, or for international callers, (719) 457-0820. The access code is 4360719.
This press release may contain forward-looking statements, made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, relating to future events or future financial performance. Actual performance may be significantly impacted by certain risks and uncertainties, including those described in Coventry's Annual Report on Form 10-K for the year ended December 31, 2004.
Coventry Health Care is a national managed health care company based in Bethesda, Maryland operating health plans, insurance companies, network rental / managed care services companies, and workers' compensation services companies. Coventry provides a full range of risk and fee-based managed care products and services, including HMO, PPO, POS, Medicare Advantage, Medicaid, Workers' Compensation and Network Rental to a broad cross section of employer and government-funded groups, government agencies, and other insurance carriers and administrators in all 50 states as well as the District of Columbia and Puerto Rico. More information is available on the Internet at www.cvty.com and www.firsthealth.com.
