Latest / NYPD Through The Looking Glass / NYPD Retiree United Healthcare PPO Lawsuit
Transcript
- 0:00SPEAKER_02: Retired NYPD sergeant and moderator of the NYPD retiree emblem, GHI Doctor Dental Information Facebook page.
- 0:07SPEAKER_02: Bill has also set up the Health Care for Heroes Fund to raise money to defend retired NYPD members living out of state's health care rights.
- 0:19SPEAKER_02: And of course, my co-host for today is retired NYPD detective turned vigilante Marik Bartoles.
- 0:25SPEAKER_02: Marique is host of the Mons of the Mike podcast.
- 0:27SPEAKER_02: Bill, Lou, Marik, welcome to the show.
- 0:30SPEAKER_01: Thank you.
- 0:31SPEAKER_02: Thank you very much.
- 0:31SPEAKER_01: Thank you very much, Mike.
- 0:33SPEAKER_02: Bill and the current state affairs with the emblem/slash United Healthcare Lawsuit.
- 0:40SPEAKER_00: Well, I think actually Lou just told me last week that well he went and had another court date and uh he won.
- 0:47SPEAKER_00: And uh I think it would be better if Lou spoke about the court date because he's the one actually uh doing the court legwork on the case.
- 0:53SPEAKER_00: I might like to add so everybody knows.
- 0:56SPEAKER_00: Absolutely.
- 0:56SPEAKER_00: Lou, could you take it for this?
- 0:58SPEAKER_01: Yeah, I mean this case was started back last November um by a group called Hands Off New York Care.
- 1:06SPEAKER_01: Um the group itself, we don't know how big it is, um, but they have eight people that's uh case was started back are represented by Hands Off New York that we know of.
- 1:19SPEAKER_01: And the law firm and the group itself friends of theirs uh um in this lawsuit they're not um petitioners, but um petitioners.
- 1:29SPEAKER_01: That means information about the case that others may not.
- 1:33SPEAKER_01: And information about the case that others may not.
- 1:35SPEAKER_01: Anthem Health Anthem Health.
- 1:37SPEAKER_01: Was the group that had our insurance before this new plan.
- 1:42SPEAKER_01: Now they had lost the um they had lost the plan, so they um started a lawsuit, as I said, back in November, and trying to say that the new plan was illegal.
- 1:53SPEAKER_01: Basically, their position was that New York City cannot have a self-funded plan because that's what the new plan is.
- 2:00SPEAKER_01: It's a self-funded plan, and it uses both Emblem Health and United Healthcare as as their um networks.
- 2:09SPEAKER_01: So Emblem Health will work in New York City and the surrounding counties, you know, Long Island, Westchester, and that area.
- 2:16SPEAKER_01: And United Health Care will take care of the of the rest of the country.
- 2:21SPEAKER_01: Now they hands off New York Care, as I said, are saying that this is illegal because it's self-funded.
- 2:28SPEAKER_01: The city pays directly.
- 2:30SPEAKER_01: So the Emblem Health and United Healthcare just administer the networks, setting up people to get to doctors and everything, and that's how they make the money.
- 2:38SPEAKER_01: So they're not in a traditional way paying the claims.
- 2:42SPEAKER_01: The city is what the city did basically was cut out the middleman on the claims.
- 2:47SPEAKER_01: Um so they filed an attempt to say that it was illegal, and they said one, it didn't comply with the City Administrative Code because the City Administrative Code does not allow self-plan self-funded plans.
- 3:02SPEAKER_01: And secondly, it stated that the entity that is to approve these plans is City Council, not the mayor.
- 3:09SPEAKER_01: And since City Council did not approve this plan, it is it it is illegal in that in that sense, too.
- 3:17SPEAKER_01: Um and so that was their basic uh positions.
- 3:20SPEAKER_01: The lower court, whether it was when they were seeking preliminary relief, basically keeping the plan from going into effect um till it went into effect and then to were going to the appellate court to argue they wanted to re-argue other things, they've lost all three times with the lower court.
- 3:39SPEAKER_01: And basically, the lower court is basically saying is that the city's position of using a self-funded insurance is not irrational.
- 3:50SPEAKER_01: Uh, you know, when you're looking at how a city acts and looks at an administrative code or statute that they use, if there's a rational basis for what they're doing, the courts will not upset it.
- 4:01SPEAKER_01: So the courts will not put their judgment in place of the city's judgment.
- 4:06SPEAKER_01: And that's what the court has said.
- 4:07SPEAKER_01: The city, you know, he says that the administrative code does not bar self-funded plans.
- 4:12SPEAKER_01: The city is acting rationally in creating this plan.
- 4:16SPEAKER_01: Um, then the court went on also to say that, you know, these self-funded plans not only are not, you know, barred, but the city council, you know, isn't really the ultimate um entity to make these decisions.
- 4:32SPEAKER_01: I mean, I work for the city.
- 4:35SPEAKER_01: I started a couple years before I joined the police department in 89.
- 4:38SPEAKER_01: So I worked from the with the city from 87 to 2009.
- 4:42SPEAKER_01: And I was pretty active with the unions and everything.
- 4:46SPEAKER_01: And in that 20-some odd year period, I don't think city council ever once got involved in any health care decision.
- 4:53SPEAKER_01: Now we have Anthem, which is uh a is on the side of Hands Off New York, complaining about this process.
- 5:01SPEAKER_01: But the irony is it's the same process that they got their first, they got their um contract awarded under.
- 5:07SPEAKER_01: So they're complaining about something that benefited them in the past, and now it doesn't benefit them.
- 5:12SPEAKER_01: They want to get, you know, get out from under it.
- 5:15SPEAKER_01: So we're pretty much done with the uh Supreme Court, which everybody should know in New York is the trial court.
- 5:22SPEAKER_01: And we are going up now to the uh appellate court.
- 5:26SPEAKER_01: It will be the first department, which is located in Manhattan.
- 5:30SPEAKER_01: Um, everybody's briefs and arguments will be due in October.
- 5:35SPEAKER_01: Then there'll be oral arguments.
- 5:37SPEAKER_01: I would say sometime in early next year, we should have a decision from that court.
- 5:43SPEAKER_01: And then we'll see what they say and then go from there.
- 5:46SPEAKER_03: First, I want to thank Lewis for all of the work that you're doing on behalf of every employee because um me being in Florida, I'm directly affected by having, you know, from Emblem, I had one doctor, I think, in the, you know, 500 mile radius, and now I have multiple that I can pick from.
- 6:02SPEAKER_03: So, you know, obviously you can choose your best one.
- 6:04SPEAKER_03: Competition is best.
- 6:05SPEAKER_03: Um, so I understand that the self-funded is better because basically the city is paying for our insurance.
- 6:11SPEAKER_03: So you you go to the doctor, a claim gets sent into um the insurance company, and then the insurance company basically bills the city and the city pays for it, type of a thing, is the self-funded versus where you have a middleman that pays for it and it gets all messy that way.
- 6:25SPEAKER_03: So the city's saving, I guess, a billion dollars from it.
- 6:28SPEAKER_03: So when I was when I was looking into this, um, because you had mentioned Anthem, right?
- 6:33SPEAKER_03: So, and and just so that everybody who's watching this can get a kind of grasp on the timeline.
- 6:37SPEAKER_03: And if, you know, I d I'm I'm pretty sure if I'm off here, just let me know.
- 6:40SPEAKER_03: But so in October of 2022, so this isn't like a recent thing, it's been going on for a few years, New York City starts to look for a replacement health benefits arrangement, right?
- 6:48SPEAKER_03: So Anthem is basically the incumbent company.
- 6:51SPEAKER_03: Um, Anthem, Aetna, and Emblem Health are selected to compete for the title of the person who provides uh health insurance to police officers.
- 7:00SPEAKER_03: So August 2nd of 2023, Anthem is eliminated from future negotiations.
- 7:05SPEAKER_03: Anthem is pissed off.
- 7:07SPEAKER_03: So they bring Article 78 proceeding challenging the exclusion of their company.
- 7:12SPEAKER_03: So in September of 2024, uh the court dismissed that first Anthem challenge that you spoke about, Anthem Appeals.
- 7:18SPEAKER_03: Now, a year later, August 26th of 2025, Hands Off New York Care is incorporated.
- 7:24SPEAKER_03: And you had mentioned them.
- 7:25SPEAKER_03: And I find this country, this company really interesting because its own petition says that it formed in August specifically in response to New York City's announcement of this new self-funded New York City PPO, which Anthem is not happy about.
- 7:38SPEAKER_03: So Anthem now brings another challenge in the fall of 2025 concerning the final procurement and the new self-funded arrangement.
- 7:45SPEAKER_03: So Anthem argues New York City admin code 12126 and Hands Off New York Care in October 29th, just a month later, files their lawsuit under the same um administrative code.
- 7:59SPEAKER_03: So what was interesting is I did a dive in Hands Off New York Care.
- 8:03SPEAKER_03: And what I found was within weeks of Hands Off New York Care incorporating, they had a brand new organization which automatically had lawyers.
- 8:12SPEAKER_03: They had professional communications, they had digital advertising, uh, they had mailers, they had an LED billboard campaign, it hired um a major law firm for litigation, and then it hired Global Strategy Group for basically PR and communications.
- 8:26SPEAKER_03: So now Global Strategy Group, now I hone in on that, right?
- 8:30SPEAKER_03: So Anthem and Hands Off New York Hair.
- 8:32SPEAKER_03: Anthem isn't getting their way in court.
- 8:34SPEAKER_03: So all of a sudden now Hands Off New York Hair is basically fighting the same battle for Anthem separately, but they're fighting the same thing.
- 8:40SPEAKER_03: So the Center for Media and Democracy reports that GSG, the global um strategy group, which is hands-off communications firm, has a long-standing history of lobbying and communication work for Anthem and other health insurance interests, right?
- 8:57SPEAKER_03: So the this chick Wanda Williams, who's um in charge of the hands-off New York City, said that it was funded by multiple nonprofit healthcare organizations.
- 9:07SPEAKER_03: She didn't name who these organizations was.
- 9:09SPEAKER_03: Um it's hard to find out who works for New York City hands off and and what the deal is with that organization.
- 9:15SPEAKER_03: But there was an article in Politico in April of 2026 that had received at least$1.4 million in contributions.
- 9:22SPEAKER_03: So we don't know where these contributions came from, but it's interesting that a new company is starting, you get that massive amount of money.
- 9:28SPEAKER_03: So now I have this company, America's Health Insurance Plans, or AHIP, right?
- 9:32SPEAKER_03: This is a nonprofit trade association that's funded by health insurers.
- 9:36SPEAKER_03: So basically, all the health insurance companies like Anthem give money to this company, AHIP, and they go out and help those companies with their interests or particular interests, right?
- 9:48SPEAKER_03: So now AHIP, this company, America's Health Insurance Plans, has used and paid GSG millions of dollars for advocacy work.
- 9:57SPEAKER_03: So we have AHIP, which uses GSG for major healthcare public pressure campaigns.
- 10:02SPEAKER_03: They use digital television, print, social media.
- 10:04SPEAKER_03: And now we have hands-off NYCare that is also using this firm, GSG, to promote their side, which is basically to stop better health care for being provided for city workers and the city saving a billion dollars.
- 10:19SPEAKER_03: Um, so this this is just the whole thing was really interesting to me, especially because AHIP had been used in the past, they had paid GSG to lobby the federal government with Medicare um advertising to get to get the um federal government to um basically they operated, AHIP operates a coalition for Medicare choices, right?
- 10:45SPEAKER_03: Which advocates for Medicare Advantage.
- 10:47SPEAKER_03: So when federal changes were proposed threatening Medicaid Medicare Advantage payments, GSG's campaign operation ran a massive public campaign designed to mobilize Medicare Advantage beneficiaries to get them to support it so that the government would not cut the funding.
- 11:03SPEAKER_03: So it did a huge campaign, 75 million impressions across 34 states GSG did.
- 11:09SPEAKER_03: And ultimately Congress um submitted to this basically mob mentality and protected the Medicare Advantage funding that that this company wants.
- 11:18SPEAKER_03: So this is like a lobbying firm.
- 11:19SPEAKER_03: And I find the ties between the GSG public relations firm that is representing New York healthcare, with who also represents Anthem, I find the ties there really interesting.
- 11:31SPEAKER_03: You know, obviously you're not going to find money because I'd have to subpoena bank records and stuff to find out where the money's going.
- 11:37SPEAKER_03: But I'm wondering if this tie to Anthem, who pays millions of dues to AHIP, who uses GSG for public relations, and now all of a sudden Hands off New York Care is using the same public relations firm, and they all of a sudden get an infusion of$1.4 million that they're not saying where they got it from.
- 11:54SPEAKER_03: If there are ties here and if it's possible that Anthem was using back channels, possibly, allegedly, to fund another group to help gain steam and traction because they were losing the court.
- 12:07SPEAKER_03: So they hire somebody else and his group of people to battle the same battle for them and fund it separately so that they can get momentum going for their movement.
- 12:14SPEAKER_01: Yeah, I mean, hands-off New York Care is basically, in my opinion, is the alter ego of Anthem.
- 12:20SPEAKER_01: It was basically created to get a second bite at the Apple because Anthem lost.
- 12:25SPEAKER_01: When you look at their membership, um, you can go to their Facebook page, there's nothing.
- 12:32SPEAKER_01: Uh they've never turned over a membership list to the court.
- 12:36SPEAKER_01: About the only people we know involved in it are eight.
- 12:39SPEAKER_01: That would be the board board of members and a couple of uh stragglers.
- 12:45SPEAKER_01: Of all those eight, probably only one person is affected by this health plan.
- 12:51SPEAKER_01: Most of them are over 65 or never worked for the city.
- 12:55SPEAKER_01: Or they're still working for the city, so the union members.
- 12:58SPEAKER_01: So a union member cannot sue the city for its health plan or other benefits because that's a right owned by its union.
- 13:07SPEAKER_01: The union has to do it.
- 13:08SPEAKER_01: So if this plan was as bad as they're saying, you would see unions, you know, NYP sergeants, captains, PBA, EMS, fire department, you would see those unions joining this on behalf of their members.
- 13:23SPEAKER_01: But they're not.
- 13:24SPEAKER_01: They're part of what?
- 13:25SPEAKER_01: They're part of protecting the plan.
- 13:28SPEAKER_01: So it's I th it's it's just a gaslight, and it's, you know, the money they got was in two big tranches.
- 13:36SPEAKER_01: It wasn't, you know, you look at a uh holistic group, you could look at our group, and we've just done some fundraising.
- 13:42SPEAKER_01: You'll see somebody get$20 there,$100 here, this or that.
- 13:46SPEAKER_01: Here you get like boom, boom, two big dumps of money from somewhere.
- 13:51SPEAKER_01: So it's just they're just trying another angle because they lost Anthem lost, so they created this to see if they could get a better decision.
- 14:01SPEAKER_03: So this is a lot of money for Anthem.
- 14:02SPEAKER_03: This is a huge client to lose, basically, financially for them.
- 14:06SPEAKER_01: Oh, it's huge money.
- 14:07SPEAKER_01: I mean, it's you know millions of dollars, multi-millions, probably billion dollars or so over over the life.
- 14:15SPEAKER_01: Um my only comment on that is they should have, you know, they should have realized that while they had the contract and done better.
- 14:25SPEAKER_01: I mean, they shouldn't have you know, as you know, they shouldn't have had a contract where anybody who lives outside of spitting distance of New York City can't find health care.
- 14:34SPEAKER_01: Um the only reason we joined this is that their health care was non-existent under their plan that they were a part of and they were profiting.
- 14:43SPEAKER_01: They profited greatly on it.
- 14:45SPEAKER_01: I mean, how much money do you think they kept where they created a health network outside of the city but never paid anything or never had any doctors in it?
- 14:54unknown: Yeah.
- 14:54SPEAKER_03: Right.
- 14:56SPEAKER_03: So is so would any of this apply, because now that we're gonna go to the appellate division, right?
- 15:01SPEAKER_03: Is there is first is there any precedent where the appellate division might uphold the plaintiff's argument and say, yeah, you know, and send it back down?
- 15:11SPEAKER_03: Like what like what uh do you have any idea of how this is gonna play out?
- 15:15SPEAKER_01: That's a definite risk.
- 15:16SPEAKER_01: Um we don't know how the department will rule.
- 15:20SPEAKER_01: Um I think we have strong grounds because we have the city, we have the unions, we have the healthcare people involved, and we have retirees involved.
- 15:31SPEAKER_01: We have all the groups that are affected by this hand by this plan, you know, sticking up for it.
- 15:37SPEAKER_01: And I think that will that means a lot to the court.
- 15:39SPEAKER_01: It meant a lot to the to the trial court that, you know, we submitted, I think, about a hundred affidavits from retired police officers, et cetera.
- 15:50SPEAKER_01: And he was struck by where, you know, somebody living in Carolina has to go up to New York for their, you know, cancer treatment.
- 15:58SPEAKER_01: Or they got to go to Florida just to see um a primary care, and they live in like the Carolinas.
- 16:04SPEAKER_01: You know, just driving four, eight, twelve hours at it, you know, just to get to find the doctor is it was it was not a health plan.
- 16:12SPEAKER_01: It was it was an illusion.
- 16:14SPEAKER_03: Right.
- 16:14SPEAKER_03: And that also, I think, kind of violates our contract with the city where they said that they were going to part of the contract was to provide health care.
- 16:22SPEAKER_03: Is that also a stipulation?
- 16:23SPEAKER_01: Well, it it it the city has to provide health care.
- 16:27SPEAKER_01: That would be a good question if they were violating it or not.
- 16:30SPEAKER_01: I mean, you know, in form they could say they had it, but in substance, they they really didn't.
- 16:36SPEAKER_01: Um but that would that would be a trickier question to answer.
- 16:40SPEAKER_01: Um, and it would it would be a lot more fact-specific.
- 16:43SPEAKER_01: What we're doing right now is a lot more just on the statutes.
- 16:46SPEAKER_01: They're saying, you know, the city council has to be the arbiter, uh which you know as I said has never happened before.
- 16:54SPEAKER_01: And even if it's true, the city council can delegate its power.
- 16:59SPEAKER_01: There's nothing that says that the city council can't say, hey, you, Mr.
- 17:03SPEAKER_01: Controller, take care of this.
- 17:05SPEAKER_01: And the controller does it, and they do that pursuant to state law, because the state law requires a uh procedure set a procurement procedure set up for contracts, and that includes health contracts.
- 17:19SPEAKER_01: So, as I said, since the 80s, what do we got?
- 17:23SPEAKER_01: We got the, you know, um going through the same process and into into today.
- 17:29SPEAKER_01: I mean, you know, we do a procurement process, and that's the important thing.
- 17:33SPEAKER_01: And they followed it.
- 17:34SPEAKER_01: And that procurement process is what Anthem won its contract under.
- 17:39SPEAKER_01: So it's it's been a consistent process for a good 40-some odd years, probably longer.
- 17:44SPEAKER_01: I'm not, you know, I'm not my 80s or yet, so I can't talk about the 60s and 70s and everything.
- 17:50SPEAKER_01: But I mean, you know, I I they're just I think they're just they're obviously upset and they just want to burn the whole thing down and say if we can't get the money, then nobody should get it.
- 18:00SPEAKER_01: And I think that's their position.
- 18:02SPEAKER_01: Um and they got a handful of people that will do their bidding for them.
- 18:08SPEAKER_01: And you know, I mean Wanda Williams she got paid you know, uh it was twenty-five thousand or something.
- 18:19SPEAKER_01: Yeah.
- 18:20SPEAKER_01: So, you know, she's just a hired hand, you know.
- 18:23SPEAKER_01: You know, with twenty-five out of I don't know what what was that, one point five million that they infused them with is you know, chump change.
- 18:32SPEAKER_01: But that's what we did.
- 18:34SPEAKER_03: So so she has standing then because she was a DC 37 member?
- 18:39SPEAKER_03: No.
- 18:39SPEAKER_01: She not in my opinion, the court didn't reach it because the court said that they weren't going to grant the petition anyway.
- 18:46SPEAKER_01: They didn't reach that issue, but she was never a city employee.
- 18:51SPEAKER_01: Um there was a question if she was already 65 or not, looking at when she went to college and everything.
- 18:58SPEAKER_01: Um so she only got health care through the city as a a side agreement between the city and the AFL, you know, the union her union, which was not a a city union.
- 19:11SPEAKER_01: They just said, you know, we'll give give them uh health care.
- 19:14SPEAKER_01: And that's what she used to say that she had standing.
- 19:17SPEAKER_01: Um and she didn't.
- 19:20SPEAKER_01: Uh you know, she's never been a city employee.
- 19:23SPEAKER_01: And she's not even married to a city employee, so I don't know where she thinks she had standing.
- 19:28SPEAKER_01: So you look at the whole board of uh hands-off New York care, none of them have sta are affected by this health care plan.
- 19:38SPEAKER_01: Not one of them.
- 19:39SPEAKER_01: So if they're not involved, why is the organization involved?
- 19:43SPEAKER_03: Right.
- 19:44SPEAKER_03: Can you use that in in the appellate division if it looks like maybe things are going south with where the money came from, the connections with AHIP and Anthem using AHIP and and you know the GSG and the PR campaign and stuff?
- 19:56SPEAKER_03: I mean, is there because I I feel like it shows that Anthem is trying to tip the scales a little bit in their favor by getting, you know, it's it's basically public outreach to get public support for their side, right?
- 20:05SPEAKER_03: That's that's the idea, which is how these things usually work.
- 20:08SPEAKER_03: So is is there anything in in the court that you could present that would argue and say Anthem is basically not really not only just not operating in do in good faith as a business and you know you lost the bid and that is what it is, but trying to use another company paying through potentially paying through back channels to pay this company to fight the fight for them as well.
- 20:30SPEAKER_03: Is there anything else?
- 20:31SPEAKER_01: Well, on an appeal, generally you can only well almost always you can only use the record from the lower court.
- 20:38SPEAKER_01: Now there are some inferences in there about Anthem and Hands Off New York and dark money.
- 20:46SPEAKER_01: Um it was it would be something I would bring up just in a general sense to put that in the back of the minds of the uh appellate judges saying this isn't kosher.
- 20:55SPEAKER_01: But if it goes back down, if they overturn the lower court and then we have to then litigate this again, uh it would be something that we would definitely look into um and and push more.
- 21:05SPEAKER_01: Um the reason we didn't really get to it is because the court just denied their petition, said, you know, your petition isn't isn't doesn't meet the standard and we're not gonna go any further.
- 21:16SPEAKER_02: I had a question, I've been in Florida now for about 18 years, about four or five years ago, I started noticing with Emblem, they just weren't updating the doctors.
- 21:26SPEAKER_02: And the doctors were getting pissed off because they weren't getting reimbursed what they thought they should be getting reimbursed, or sometimes the payments were slow.
- 21:35SPEAKER_02: And then what wound up happening is you'd go on the web uh the Emblem website, I'd find a doctor, I'd call them up and they says, Oh, we got rid of them last year or six months ago.
- 21:45SPEAKER_02: So that there was there was some kind of miscommunication where Emblem just basically, in my opinion, just kind of walked away from retired members living out of state.
- 21:55SPEAKER_02: Oh, they absolutely did.
- 21:56SPEAKER_01: I mean as as I said, I live about three and a half hours from the city.
- 22:00SPEAKER_01: And I have to drive two and a half hours to find a doctor on the old plan.
- 22:04SPEAKER_01: Um but you know, it's one of those things, you know, strange bedfellows, they're on our side in this.
- 22:11SPEAKER_01: Um and I, you know, when I lived in the city, the the care was great from Emblem Health.
- 22:18SPEAKER_01: And I think they can take care of the city very well.
- 22:21SPEAKER_01: And that's I think they're doing that.
- 22:24SPEAKER_01: So I think retirees and active members are probably happy with them, and then that's great.
- 22:32SPEAKER_01: However, outside of the city and you know the surrounding counties, it's non-existent.
- 22:39SPEAKER_01: And this plan that takes the best of both worlds.
- 22:43SPEAKER_01: It gives Emblem Health what it knows to do and where it works, and then it gives us a national network that actually exists.
- 22:51SPEAKER_01: I mean, United Healthcare has a great network.
- 22:54SPEAKER_01: Now they they may have other issues and stuff uh between them and healthcare providers, but for us right now, it's a it's just uh it's unbelievable.
- 23:01SPEAKER_01: I went from zero doctors under any any special that you can think of to probably close to a hundred.
- 23:11SPEAKER_00: Can I just add to that?
- 23:12SPEAKER_00: That's all right.
- 23:13SPEAKER_00: Um going back to the Emblem statement that you made originally, um, what was happening was that they weren't recertifying doctors that left the organization or you know, or retired.
- 23:22SPEAKER_00: Uh, Emblem specifically did that because they wanted to keep collecting the money, the check every month they're getting to pay for our care.
- 23:30SPEAKER_00: And convert what they were doing was they would keep the money that uh that money and then convert it into profits for their upper management.
- 23:36SPEAKER_00: Like Kathy Ignani, who was the CEO at the time, she was getting a five million dollar bonus a year because it was leftover funds that should have gone to our care.
- 23:45SPEAKER_00: So by not updating the out of state members, they were generating uh a what do you call a bonus check for themselves at the end.
- 23:51SPEAKER_00: That's what they were doing.
- 23:52SPEAKER_00: And by not updating the list, it was showing that they had more doctors in network than they did.
- 23:57SPEAKER_00: So when they're presenting their contract offer to the city, it looked like they had a bigger network, like they were saying, we have this many doctors for this, that many doctors for this, and they actually didn't have that many doctors in that network.
- 24:08SPEAKER_00: So it was all it was all smoke and mirrors as far as Emblem went with that.
- 24:12SPEAKER_00: And it took me, like when my my wife's gynecologist retired, right?
- 24:16SPEAKER_00: It took me a year and a half because they had to invest these doctors and stuff, and which is all done intentionally.
- 24:22SPEAKER_00: It took them a year and a half to invest to investigate a gynecologist.
- 24:25SPEAKER_00: When he first got he took our coverage for about a month, after he first got payments from Emblem, he was getting like four dollars for a Papsy.
- 24:33SPEAKER_00: So he couldn't afford to even see us anymore.
- 24:35SPEAKER_00: So these are it was the whole Emblem plan is um basically smoke and mirrors, like I said before.
- 24:41SPEAKER_00: Now, um going back to the new plan, the city's front is actually paying the bills on everything.
- 24:46SPEAKER_00: It's a self-AMR, which is a self-funded plan.
- 24:49SPEAKER_00: So the city pays the bills, and all they're doing is paying um uh they're playing emblem in this for the people that live in the city in the 17 counties around New York City, and for the people that live out of state, they're um they're allowing us to use the uh united uh doctor uh doctor pool, and which is great because it allows us access access to doctors, but we're not we don't really have an M uh a united plan.
- 25:09SPEAKER_00: The city's still paying the bill.
- 25:11SPEAKER_00: So basically they're getting paid an administrative fee.
- 25:13SPEAKER_00: And because they're cutting out the middleman, the city's actually saving money, which benefits us too, because now with the medic it goes back to the Medicare situation, they they're not really forcing the Medicare advantage down our plan because they made a savings with this plan.
- 25:27SPEAKER_00: And you know, it all comes back to who's it all comes back to backdoor deals as far as Emblem being the carrier for as long as it was.
- 25:34SPEAKER_00: You know, that they put down familiarity with the city.
- 25:37SPEAKER_00: When they did the contract, if you look at the the bids, uh Aetna's was actually better than the city's.
- 25:42SPEAKER_00: But the city, when they were doing the contract, they actually added a category which says um familiarity with the city.
- 25:49SPEAKER_00: And that's how Emblem was uh chosen with this new plan.
- 25:52SPEAKER_00: But Emblem's not making the bonuses they were before from us because they're only getting administrative fate, just like United is at this point.
- 25:59SPEAKER_00: So I hope that clarifies it for some people.
- 26:02SPEAKER_00: It it does, but is that a crime?
- 26:04SPEAKER_00: As far as a crime, I I don't know.
- 26:06SPEAKER_00: I I mean it goes to white collar crimes, and I if it if it is one, and I'm not really sure about that if it is, but I mean, as far as what's going on now with Anthem and the this dark money they're funding it, you know, two checks in the same location from the same post office box or or building wherever it came from, there's some companies that have nobody working there, no one answers the phones, and they get two checks for almost uh what was it low?
- 26:32SPEAKER_00: Almost a million, 1.5 million dollars to try to get a full one uh to try to get a four billion dollar contract act is what basically what they lost.
- 26:40SPEAKER_00: So if that that part is for easy now, if we could link the anthem to this, to this new group, I wonder if it would disqualify them from even bidding on future contracts because of the deceptive tactics that they actually used.
- 26:54SPEAKER_01: Well, I think them fighting the city tooth and nails will um pretty much disqualify them for the uh for the near future.
- 27:01SPEAKER_01: I don't see the city, you know, get getting into a contract with them after they caused the city all this trouble in in in acting this plan.
- 27:11SPEAKER_01: So that's why I said earlier I think they're just burned the whole thing down.
- 27:14SPEAKER_01: That's their attitude.
- 27:16SPEAKER_03: Maybe that's why they changed their name to uh what what do they change it to?
- 27:20SPEAKER_03: Variant or elevants?
- 27:22SPEAKER_03: Elevate elevants, I think.
- 27:23SPEAKER_03: Anthem changed their name to?
- 27:25SPEAKER_03: Elephants.
- 27:25SPEAKER_03: Yeah.
- 27:26SPEAKER_03: They're trying to revamp their public relations uh abilities here.
- 27:31SPEAKER_00: Yeah.
- 27:31SPEAKER_00: It's well, you know, it was Anthem blew up Blue Cross Blue Shield, and then they and this this company uh I guess the grandfather of all those companies in together to merge them all together would be actually but yeah, it's just like you know, when companies go out of business, they change the name and they go and they open up again, you know, it's the same thing.
- 27:51SPEAKER_00: But they lose their reputation for blue cross and blue shield and anthem that repositor for all years all those years, and that's basically flush it down the toilet.
- 27:58SPEAKER_00: But this is what they're doing now.
- 28:00SPEAKER_00: And causing us all this unnecessary stress and everything else.
- 28:04SPEAKER_00: We've had the plan uh what almost 10 months now.
- 28:07SPEAKER_00: It's been great for everybody.
- 28:08SPEAKER_00: Yeah, yeah.
- 28:09SPEAKER_00: And you know, and then going into bringing a lawsuit together, and then putting people on that lawsuit on that board that are on Medicare that have no uh no no reason to even be on the lawsuit because it doesn't affect them.
- 28:20SPEAKER_00: And putting out these little videos and stuff, and it was all like I said, smoke and mirrors again, all fake.
- 28:25SPEAKER_03: Yeah, the I think the Global Strategy Group, I think that was uh it may have been a slight Hail Mary on Anthem's behalf because they they but they have been effective prior to that.
- 28:34SPEAKER_03: They they do run public ad campaigns that push public sentiment to make people make certain decisions.
- 28:39SPEAKER_03: So I think that's probably why Anthem uses Global Strategy Group and and hands off New York City use them as well as a PR campaign, because it's worked in the past.
- 28:47SPEAKER_03: So we're just grateful that this time it it didn't really work and it didn't really seem to gain any traction because you got two big parties here.
- 28:55SPEAKER_03: You got city workers and you have New York City that have come together, and it's it's hard to break that that bond down because it's just it's too powerful.
- 29:03SPEAKER_00: And the funny part is all the money comes if you when you s we sat back and we did research on this, and I told I have a actually I don't want to mention his name, but he used to be um a forensic accountant in his apartment.
- 29:16SPEAKER_00: He worked in white collar crap and he's been helping me go track all this money down, and it's all coming from Ohio company, a real estate corporate is so much that it goes back to.
- 29:26SPEAKER_00: We have pages and pages of how this money actually made its way to to uh uh to handle oh my gosh, it's I can't believe it.
- 29:38SPEAKER_00: And it all goes back to the dark money.
- 29:40SPEAKER_00: I guess if they I guess that if they actually have to push us, I think that's when uh we have to go to court and expose it, right Lou?
- 29:46SPEAKER_01: Well, yeah, we'll see how the appeal goes, because if if the appeal goes well, that should end the case.
- 29:51SPEAKER_01: Um but there's always a chance it could go to the Court of Appeals.
- 29:54SPEAKER_01: It involves the city.
- 29:56SPEAKER_01: So there's a there's a strong likelihood it would go up to Albany after this round.
- 30:02SPEAKER_01: But you're also looking at that time, you're probably you know, getting into around two, two and a half years into this contract.
- 30:11SPEAKER_01: Um so the longer the contract is in play, I think the less and less chance the courts would step in and and get rid of it, because it would just cause too much chaos.
- 30:21SPEAKER_00: Um, what I'm saying is that when I talk to my doctors and stuff, the doctors that used to take the the emblem CBP plan are no longer accepting it.
- 30:31SPEAKER_00: So now we have no doctor uh base outside of New York.
- 30:34SPEAKER_00: There's no pool for doctors anymore.
- 30:36SPEAKER_00: So now for the doctors uh if we had to go back to the original Emblem CBP plan out of state, we would have no doctors and we'd have to wait for them to get recertified.
- 30:44SPEAKER_00: And at the slow rate that Emblem does it, we'd be looking without coverage for like a year and a half at some point, because that's how long it took me to get one doctor the last time.
- 30:52SPEAKER_00: And if we have to replace all these doctors, it's gonna we won't have coverage.
- 30:55SPEAKER_00: We'll have no doctors in network out at all outside of state at this point.
- 30:59SPEAKER_01: Well, I mean I think most of the locations out of state didn't have any doctors anyway.
- 31:05SPEAKER_01: Right.
- 31:05SPEAKER_01: I mean, there is you know, I know certain areas in Florida would have a lot of some doctors, and I was talking earlier the Poconos has some doctors, but generally speaking, nobody had doctors.
- 31:17SPEAKER_01: So I don't know.
- 31:20SPEAKER_00: But I'm just saying whatever we had before, the the small amount, we would have none now.
- 31:24SPEAKER_00: Zero.
- 31:24SPEAKER_00: So we don't have the option of driving two hours anymore.
- 31:27SPEAKER_00: We'd have to go back to New York.
- 31:29SPEAKER_01: I would think the courts would have to fashion some type of order to um protect everything as it was getting sorted out in court if it got overturned down the road.
- 31:39SPEAKER_00: Like you said, the longer it stays in place, the better chance we have of keeping it because it's a five-bia contract and we're almost a year into it already.
- 31:46SPEAKER_03: Which explains why hands-off New York City was really critical to being started at that early onset of this whole court battle, because they needed to get as much public support for their side and as much cases in court, so it looked like the city was doing something wrong when it really was it wasn't.
- 32:02SPEAKER_03: It was it's a win-win for everybody.
- 32:04SPEAKER_03: So but I think I I think it's really interesting that America's health insurance plans gets money from Anthem, and then they pay Global Security Group Global Strategy Group for their PR, and Global Strategy Group just happens to be the PR campaign, the the PR campaign for hands-off New York care.
- 32:22SPEAKER_03: That that's too much of a coincidence for me to just ignore.
- 32:26SPEAKER_02: It's true.
- 32:27SPEAKER_02: Question for for Lou and Bill.
- 32:29SPEAKER_02: So Marique and I recently spoke to DEA president Scott Monroe about the DEA's diminished dental plan.
- 32:35SPEAKER_02: And the feeling I walked away with, maybe you did too, Marik, is there wasn't enough money to get an all-inclusive dental plan like we had.
- 32:44SPEAKER_02: How is how is the city doing financially funding our health care?
- 32:49SPEAKER_01: Um, again, that that's all through uh union contracts, or you know, when the unions negotiate their contracts, that's where their money comes from.
- 32:58SPEAKER_01: So the city's um finances shouldn't impact what the unions are offering at all.
- 33:04SPEAKER_01: It's you know, um I'm the CEA and I'll knock on wood.
- 33:11SPEAKER_01: You know, our plans haven't really changed for the worst.
- 33:15SPEAKER_01: If anything, they got a little better.
- 33:16SPEAKER_01: Um I know the DEA has been having some problems and others.
- 33:20SPEAKER_01: Um the only thing I, you know, I talked with Bill with this is, you know, if you have enough people, you could start your own entity to provide, you know, the dental eye prescription to your members.
- 33:35SPEAKER_01: And what that would do is it would take the money away from the unions.
- 33:40SPEAKER_01: You're no longer contributing to you to the unions as a retiree, and that's money they count on.
- 33:45SPEAKER_01: Um, so you know, if that's a possibility, that's you know what you would have to do.
- 33:50SPEAKER_01: Um it would probably, you know, probably get done because they don't think it, but everybody's re eventually retired.
- 33:59SPEAKER_01: Um and so I don't under a lot of times I don't understand the union's logic when they um shortchange to retirees because they're gonna be one.
- 34:09SPEAKER_01: You know, I understand and you know, the old saying when union contracts came up, screwing the unborn, you know, back in the 90s and everything, you know, if you weren't a cop yet, you you don't you're not knowing what you're missing.
- 34:22SPEAKER_01: And then so we, you know, they would always, you know, cut the money up front on people coming in.
- 34:27SPEAKER_01: But we're all gonna retire one day.
- 34:29SPEAKER_01: So I don't understand the union's position of, you know, shortchanging their members because they're gonna be retired one day, voluntarily or forced.
- 34:39SPEAKER_00: I I think it all comes down to the fact that retirees have no vote.
- 34:43SPEAKER_00: And because we have no say in them, they don't have to cater to us.
- 34:46SPEAKER_00: They're gonna cater to the people that keep them in office for years and years and years.
- 34:50SPEAKER_00: And with that last lawsuit that the unions decided to do, they didn't do any lawsuits to help retirees.
- 34:54SPEAKER_00: No, they only did a lawsuit to keep themselves in office until they turned 65.
- 34:58SPEAKER_00: So now the retirement age is 65, they get out and they go right into Medicare.
- 35:02SPEAKER_00: And by that time, I mean, they their pensions are good enough, they can buy their own plans if they need to, or they'll work their own, get second jobs or whatever they'll they'll do.
- 35:10SPEAKER_00: But as far as um the money, the retirees and the active uh and the active members get the same amount of money per person.
- 35:17SPEAKER_00: So with the amount of money, uh it's a three to one ratio, actually, because I think it's like 15,000 to 5,000 actives, but 15,000 are being retired.
- 35:25SPEAKER_00: And I think um with that type of money you're talking about, you can probably get a much better plan.
- 35:30SPEAKER_00: And if you do all the unions together, you could probably do one.
- 35:34SPEAKER_00: It only gets a little hairy when you start dealing with prescriptions because prescriptions are out of control, and it's you know, it's a little bit harder to get those prescription plans, but you know, something that can be worked out.
- 35:45SPEAKER_00: But my wife and I had did look into other plans, and there are other other player plans out there for lower uh costs.
- 35:50SPEAKER_00: It's just a matter of knowing what you're doing.
- 35:52SPEAKER_00: And then the fact that um I believe Scott said that Eric Palladino was being paid to be their um their this funds administrator, but yet he's not doing his job.
- 36:02SPEAKER_00: He's getting paid, God knows, I don't even know how much money.
- 36:04SPEAKER_00: Uh generating salary, and he and yet he's they're hiring an outdoor uh another company to come out and do his job for him, which makes absolutely no sense to me.
- 36:14SPEAKER_00: A funds administration uh administrator is supposed to be negotiating his contracts on behalf of the union himself.
- 36:20SPEAKER_00: And not and Paladino is doing nothing to earn his paycheck, as far as I see.
- 36:24SPEAKER_03: Yeah, and to your point, Vic, I think it it's interesting where where the money is being saved to to because the you know the unions do their thing, but the city, uh you know, the when I because I was looking into the self-funded because I didn't really know anything about it, but basically the self-funded plan that that the city is using now is the city play pays claims directly instead of paying a premium to an insurance company.
- 36:45SPEAKER_03: So when you have like the city of New York, so if you have a small company, right, um, and if they were self-insured, if one person, if one of us gets really badly sick, the company can go bankrupt because they have to pay for all the health benefits, right?
- 36:59SPEAKER_03: So that's why something as big as the city of New York is actually going to end up saving money because fully insured health plans are heavily regulated by New York State and are subject to like state um insurance premium taxes, self-funded plans, which is what they change to, um, are governed by like a federal law and they're exempt from state premium taxes, which saves New York City a fortune.
- 37:20SPEAKER_03: So by by switching to a self-funded plan where basically the city pays the bill for your health care when you go to the doctor, if most people are healthy or if you have a good year when people aren't really going to the doctor, you bank that money and then you use it for the rainy day when, you know, maybe you have a lot of people making claims.
- 37:37SPEAKER_03: But I think that's how uh this was was financially beneficial to the city.
- 37:41SPEAKER_03: Um, and and it was a win for us because we got better coverage throughout the country.
- 37:45SPEAKER_03: But also it saved, like I think it was actually a billion dollars that the city ends up seeing just by doing a self-funded plan as opposed to paying a an insurance company to do the work for them.
- 37:54SPEAKER_00: Correct.
- 37:54SPEAKER_00: Remember when you got an alight community?
- 37:56SPEAKER_00: The city pays for it.
- 37:57SPEAKER_00: That you don't use your healthcare when you go to the hospital.
- 37:59SPEAKER_00: So they've been doing those plans for years.
- 38:01SPEAKER_00: So nothing to do with that.
- 38:03SPEAKER_00: And they do know how to um save money with those plans by cutting out the middleman.
- 38:08SPEAKER_00: Does anyone else have any questions or want to add anything?
- 38:11SPEAKER_00: Yeah, I just want to add, like Louis said, we're in the middle of trying to figure out a board for this uh new company we're doing or new organization we're doing.
- 38:18SPEAKER_00: Um we're in the process of doing that right now.
- 38:20SPEAKER_00: We have some people that have applied to be uh positions on the board.
- 38:24SPEAKER_00: Um I'm with some other people to make decisions before we go through with it.
- 38:28SPEAKER_00: And like I said, we're gonna do it by the book.
- 38:31SPEAKER_00: There are gonna be time limits for everybody on the board.
- 38:33SPEAKER_00: It's gonna be alternating years just like the Senate does with elections.
- 38:36SPEAKER_00: So you don't have a whole new board every three or four years, whatever the time limits gonna wind up being.
- 38:42SPEAKER_00: Um we think we need uh we need somebody to be watched doggy watching up for our benefits, or you're negotiating our benefits at this point.
- 38:48SPEAKER_00: We just I have to talk to Lou in depth to see what we can do, what we can't do.
- 38:53SPEAKER_00: And um, I'm gonna be guided by Lou's wisdom on this because Lou is the man who knows what he's doing, and I rely heavily on his info.
- 38:59SPEAKER_01: I I'd just like to add that, you know, um the appeal will be heard uh probably before the end of the year.
- 39:09SPEAKER_01: Uh I'll send out a um notice to the group the Facebook group.
- 39:15SPEAKER_01: It um the Appellatevisions, they live stream their oral arguments so people can tune in and listen to it.
- 39:22SPEAKER_01: And generally you'll get a decision four to six weeks after the oral arguments.
- 39:27SPEAKER_01: So I I would assume January or February, just roughly.
- 39:33SPEAKER_01: But I'll know more, you know, be able to say more once I have a date for the oral arguments.
- 39:38SPEAKER_01: Our brief is due in two weeks, so I'm working on that now.
- 39:42SPEAKER_03: Is that is there any way that the members can can help you out, Lou, with the work that you're doing?
- 39:47SPEAKER_03: Because this is you're doing this like kind of on your own.
- 39:49SPEAKER_03: And what what can we do to help you and Bill out with with pushing this forward and and fighting the uh the appeal?
- 39:57SPEAKER_01: At this point, leave me alone.
- 40:00SPEAKER_01: Um, I got uh I got through uh the group, I got a uh law a person who just recently graduated from law school.
- 40:07SPEAKER_01: He's a police officer in Westchester County, I believe.
- 40:10SPEAKER_01: Um, and he's helping me out with it.
- 40:13SPEAKER_01: Um The record on appeal is big.
- 40:17SPEAKER_01: It's four volumes, probably close to 2,000 pages.
- 40:21SPEAKER_01: So there's a lot of stuff to go through.
- 40:23SPEAKER_01: Um been meeting with the other respondents, the city, the municipal uh labor committee, emblem health, et cetera, and kind of understand where I'm gonna emphasize, what they're gonna emphasize, and then we'll go from there.
- 40:38SPEAKER_01: Um I'm not gonna get too much into the weeds about the negotiations, this and that, because I wasn't really a part of it.
- 40:45SPEAKER_01: I think the most important thing we can add is the effect of the um new plan and why the new plan complies with the law.
- 40:53SPEAKER_02: What is this lawsuit called?
- 40:54SPEAKER_01: It's George Anderson versus City of New York.
- 40:58SPEAKER_01: Um it's also hands-off New York Care.
- 41:01SPEAKER_01: So George Anderson is the lead plaintiff, not uh the retired chief.
- 41:08SPEAKER_01: I don't know if is he still alive, George, the old and yeah, it's not so don't don't be you know sending them.
- 41:18SPEAKER_02: He's a member of our group.
- 41:20SPEAKER_01: Yeah.
- 41:20SPEAKER_02: So you know what the angry mob with torches in pits for people for this guy's inbox.
- 41:27SPEAKER_01: And you also can go on uh ny s cf, nice if that is the um New York State Court's um website.
- 41:36SPEAKER_01: And you can look up the case there, just put in George Anderson or hands off New York Care under uh plaintiff petitioner, and it'll come up.
- 41:45SPEAKER_01: And you can read everything um that's happened so far.
- 41:49SPEAKER_02: And Bill has set up a uh GoFundMe page to finance this law to go against this lawsuit.
- 41:54SPEAKER_02: It's health healthcare for heroes on GoFundMe, if you could check it out.
- 41:59SPEAKER_02: Maybe drop a couple of bucks in the bucket with these filing costs and everything.
- 42:03SPEAKER_02: Um Bill, uh I mean, um Lou, do you is do you want me to promote your law firm or yeah, LewisLombardiLaw.com.
- 42:11SPEAKER_01: Yes, the lum the football coach and then law.
- 42:14SPEAKER_01: If you forget to put in law, you're gonna get a lawyer up by Scranton.
- 42:18SPEAKER_01: There's two of us in Pennsylvania, so make sure you put law at the end.
- 42:21SPEAKER_01: Otherwise, we get each other's emails and stuff.
- 42:24SPEAKER_01: I push to him and he pushes to me.
- 42:27SPEAKER_01: So um we go both go by Lewis, but both our first names are Luigi.
- 42:32SPEAKER_01: The only difference is he was born in Italy and I was not.
- 42:37SPEAKER_02: Bill Mack, Lou Lombardi, thank you so much.
- 42:41SPEAKER_02: I really appreciate your time and doing this for us because we had no voice until you guys came along and helped us out quite a bit.
- 42:48SPEAKER_02: I really appreciate it.
- 42:49SPEAKER_02: Marik, thank you so much for being on the show.
- 42:51SPEAKER_02: Where can all listeners check out your your podcast?
- 42:55SPEAKER_03: That yeah, thanks, Vic, again, for having me.
- 42:57SPEAKER_03: And thank you, Louis and Bill, for fighting the holding the line for all of us.
- 43:00SPEAKER_03: And uh, you can check my podcast out.
- 43:02SPEAKER_03: Mons on the mic on YouTube, Spotify, and Apple Podcasts, and my book 20 and out is available on Amazon.
- 43:08SPEAKER_02: Guys, thank you so much.
- 43:10SPEAKER_02: Thank you.
- 43:10SPEAKER_02: Take care.
- 43:11SPEAKER_02: And on Thursday, I will have out an episode, if all goes well, retired MYPD detective and author Mike Moy, author of the book Bad the Blue, the true story of a Chinatown gangster who became an NYPD detective.
- 43:24SPEAKER_02: As always, I want to thank everyone for tuning in.
- 43:26SPEAKER_02: And if you work in law enforcement or had an interesting criminal background, drop me a note on Twitter, Instagram at VicFerrari50.
- 43:33SPEAKER_02: Thanks again, everyone, and I'll see you in a couple of days.
- 43:35SPEAKER_02: All right.
- 43:36SPEAKER_02: Thank you.