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DECEMBER NEWS FROM GOLDEN & COHEN

Stephanie Cohen named to 2010 SmartCEO100 list

Hello, and welcome to our December news blast. We're very pleased to announce that this month our own Stephanie Cohen, CEO of Golden & Cohen, was named one of SmartCEO Magazine's 2010 Smart100 CEOs.

“After another competitive year of nominations, the selection committee has chosen Stephanie Cohen to join an elite group of 100 of Greater Washington's leading CEOs and their organizations,” announced SmartCEO magazine's Makenna Coyne. “Combined, this group employs more than 150,000 people, boasts revenues in excess of $9 billion, and has won almost 1,500 business awards. In addition, the group shares a philanthropic spirit by donating time, energy and money to local Washington area charities.”

Each winning company reported revenue in excess of $5 million annually and was selected based on the CEO's leadership, strategic vision and character, said Coyne noting that Cohen was an obvious choice to be part of the 2010 list due to her initiative to organize and host last year's DC Health Summit (www.dchealthsummit.com), her charitable work with the ALS Association's DC/MD/VA Chapter (which helps empower people with Lou Gehrig's disease), and other nonprofit organizations, and her sheer determination to fight for her client's rights.

“I am incredibly excited to be acknowledged for the work that I do on behalf of my clients,” says Cohen, who with her husband and business partner Scott Golden has run her firm since 1992. “I have a passion for this work, and truly want to make a difference. I know I can't change the world, but I can do my part in improving things by helping one person at a time.”

TUNE IN DEC. 19 to hear Stephanie Cohen on Executive Leadership Radio

Stephanie Cohen has been invited to talk about her leadership style and how she and her husband / business partner Scott Golden have built their company into one of the largest insurance brokerage firms in the DC Metro region. Tune in on Saturday, Dec. 19 to WHFS 1580 AM. The show will air from 10-11 a.m. Or, log onto www.bigtalker1580.com.

IN THIS ISSUE

Read on below to hear our thoughts on healthcare reform and what it'll mean to our clients. You'll also find useful advice from DC attorney Brian Leventhal about the importance of writing good contracts. And new this month we'll be featuring entries from Stephanie's new book, “You Gotta Laugh: My life in the trenches of the health insurance business.”

From everyone at Golden & Cohen, we wish you and yours a very happy and healthy holiday season!

Stephanie Cohen, CEO, stephanie@golden-cohen.com
Scott Golden, CFO, scott@golden-cohen.com
Jack Cohen, COO, jack@golden-cohen.com

THOUGHTS AND REFLECTIONS ON THE LATEST DEVELOPMENTS IN HEALTHCARE REFORM

By Scott Golden, CFO
Golden & Cohen
scott@golden-cohen.com

Each month, our goal is to keep you up-to-date on the latest in the healthcare reform debate. This week the discussion took a new turn when “the public health insurance option died on Thursday, December 10, 2009, after a months-long battle with Senate parliamentary procedure,” as the Huffington Post put it. “The time of death was recorded as 11:12 a.m. Eastern Standard Time.”

The public option would have created several national insurance policies administered by private companies but negotiated by the Office of Personnel Management. If, however, private firms were unable to deliver acceptable national policies, a government plan would be created.

Indeed, it was the biggest roadblock preventing the bill from moving to a final vote.

Then on Monday, Senate Democratic leaders said that they were prepared to drop a proposed expansion of Medicare and make other changes in sweeping health legislation as they tried to rally their caucus in hopes of passing the bill before Christmas. Under the proposal, uninsured people ages 55 to 64 could purchase Medicare coverage. 

Still, the debate rages on and we want to bring you up-to-date on what the new bill means for you, our clients.

The Uninsured

Both bills expand coverage for the uninsured, which obviously does not affect our current clients directly because, obviously, all of our clients have insurance. However, there will be a cost to provide insurance for every American and that will impact us all.

How we pay for this will likely take many forms, and all will probably lead to higher taxes for some or all of us. Certain types of group plans may be taxed, as well.

The Senate bill has also advanced the idea of opening up Medicare to people age 55 or older who meet certain criteria. There are no details released on this proposal. However, already there has been opposition to this concept as it adds to an already massive entitlement program. Additionally, many people believe that this might be the pre-cursor to the development of a “back-door” public option.

The Insured

One reason the public option is so controversial is that it puts the government on a level playing field with private carriers. The Congressional Budget Office estimates that the cost for the public plan will be higher than the private carriers. In order to build this governmental system, there will be a cost paid for by some revenue source.

In my opinion, that's what makes it so controversial, but this option does not appear to put either groups or individuals who are currently insured in a better financial position. However, there will probably be a prohibition against pre-existing condition limitations and on low lifetime maximums, and that could help some people. This concept is still at issue and remains a sticking point between the House and Senate.

Group Plans, in general

My biggest beef with both bills is that they don’t address the base cost of healthcare as well as the growth of premiums over inflation. Both bills encourage (through financial penalties) groups to offer coverage to employees. This could make business more difficult as some groups do not offer coverage or pay less than the government might mandate.

My forecast

As mid-term elections get closer, the politicians will feel even more pressure. The next several months should make for a great political soap opera. We'll keep you posted.


GUEST COLUMNIST: ATTORNEY BRIAN LEVENTHAL

Brian H. Leventhal, Esq

When it comes to contracts, nothing is standard

By Brian H. Leventhal, Esq.

“It looked pretty standard to me.” In my years as in-house counsel, I cannot tell you how many times people from all different departments at all different levels said those exact words to me when I questioned them about signing a contract without legal department approval. Of course, the reason the contract at hand had been brought to my attention was that some matter of dispute had arisen.

It is this common mistake that brings me to my words of caution for today…in the world of contracts, nothing is “standard”. Certainly, there are legal provisions that those of us in the field would agree are commonly found in contracts of the same type. But, the notion that a contract is a mere formality or that it contains only “standard” language can cause a company serious trouble down the road.

Trust me, I have been on the cleanup end too many times. Just because it is in smallish print, dual column format, and the other party called it their “standard form”, does not mean it is safe to sign or that it is not negotiable.

Manage Your Risk

Contracts are a mechanism to set out the basic business arrangement between two parties and to allocate risk between them.

However, many business people focus only on the former, figuring that the contract is just a matter of course and they can safely ignore the “legal mumbo jumbo.” Some do not consult with an attorney because they fear slowing down the process, while others simply don't want to spend the money.

Instead, these business owners opt to rely on trust in the other party, because of a long standing relationship or reputation, or on common law to protect them if something goes wrong. Many simply ignore the possibility that anything could go wrong at all.

Well, I am here to tell you that trust is fine, but a good contract is finer. A properly drafted and negotiated contract is likely to limit the impact of a future dispute to a fraction of the impact the same dispute might have if either no contract was used or if a party simply signed the other party's “standard form” without having it reviewed by an attorney.

Be Safe, Not Sorry

As Benjamin Franklin once said, “An Ounce of Prevention is Worth a Pound of Cure.” My work is living proof of that wisdom. Remember, litigation takes months and years while contract negotiation usually takes hours or days.

The bottom line is that making sure you have good contracts in place is a fundamental best practice that all businesses should follow. Of course, one contract policy does not fit all companies, but the general value proposition and awareness of the risks/benefits should be universal. Do not make the mistake of measuring success by how quickly things get done. Measure it by how well they get done.

ABOUT BRIAN LEVENTHAL

Brian has more than 12 years of experience assisting corporate clients with a variety of legal and business issues. He began his private practice in 2004 after helping to sell Teligent, Inc., a once public telecommunications company where Brian had worked for six years as Senior Counsel. In 2006, he dedicated his practice to a single client and became General Counsel to WashingtonVC, LLC (www.washingtonvc.com), a private equity firm that incubates early stage technology companies.

There, he was responsible for managing the company's legal affairs, including negotiating and structuring investments. He also played a key role in business development and operational management for the firm and its portfolio companies. Brian resumed taking on additional clients in 2009. Currently, his law practice focuses on complex commercial transactions, private equity, corporate governance and outsourced general counsel services.

Brian received his JD with honors from Washington College of Law at the American University, and his BA from the University of Pennsylvania. He is a member of the Maryland Bar and the District of Columbia Bar.

For questions about this article or help with specific contracts or other business law matters, email Brian at brian@leventhallegal.com. For more information about his practice, visit www.leventhallegal.com.

This article is intended for general information purposes only and should not be construed as legal advice with respect to any particular set of facts or circumstances. It is not intended to create, nor does any reading of this article create, an attorney-client relationship.


CUSTOMER UPDATE:
RX 'N GO

Jack Cohen

Golden & Cohen introduces a Revolutionary Product to Meet Rx Challenges of Employers and Employees

By Jack Cohen, COO
Golden & Cohen
jack@golden-cohen.com

In October, we told you about a new partner of ours, Rx ‘n Go, a solution to the rising costs of health care and prescription coverage. This will come as great news to employers who have been forced to cut back on employee benefits, because with this new program they may not have to.

Rx ‘n Go offers discounted drug pricing to the employee, and typically provides the employer with substantial overall savings.

Through its focus on 90-day prescriptions, mail order delivery, and the use of high-quality generic drugs, Rx ‘n Go is able to pass along low costs for maintenance medications. And because it's not insurance, there's no monthly premium, no back-end claim for the employer to pay, and no extra fees.

Please click here to learn more about Rx ‘n Go.

Employers: If you're an employer who doesn't provide insurance or prescription coverage for your employees, Rx ‘n Go can help. With our high-quality, low-cost generic savings program, you can now offer an affordable prescription option to your employees.

Brokers: If your clients are depending on you to help them optimize their benefits program, why not include Rx ‘n Go as a value added option? With more than 1,100 drugs across nearly every therapeutic category, Rx ‘n Go could be a valuable supplement to any benefits program. Both the employee and the employer typically enjoy drug savings.

Group funding options available: Various funding options are available. The employer can pay for all, some, or none of the cost of the Rx ‘n Go prescription program. Let us conduct an Rx Cost & Utilization Review to show you how to build a savings program that’s right for you.

Co-branding opportunities: Benefit providers can display their brand identity on the Rx ‘n Go Website for all click-through referrals from their Website.

Check it out today and start saving on your prescriptions: www.golden-cohen.com/rxngo.

Have questions? Send me an email: jack@golden-cohen.com


 

YOU GOTTA LAUGH:
My Life in the Trenches of the Health Insurance Business

A new book by
Stephanie Cohen, CEO
Golden & Cohen, stephanie@golden-cohen.com

Coming in 2010

Stephanie Cohen, Scott Golden, Jack Cohen

Welcome to the first entry of the book we'll be publishing in 2010 entitled: You gotta laugh: Life in the trenches of the health insurance business. Because we think our customers will find it useful, each month in our newsletter we'll be posting an example of the health insurance problem that is so maddening and frustrating that we just gotta laugh at its absurdity.

Our goal, however, is to find a way to improve the U.S. healthcare system for everyone. We truly believe that by talking about this issue, and starting a conversation about what changes need to be made and how we can make them, we will be able to move mountains.

This month's issue: What do you do when you have it in writing from your insurance company that you have maternity coverage — but when you go to use the benefit, the customer service department tells you otherwise?

The situation: When our client Randy, a nurse, found out a few years ago that she was having her first baby she was thrilled. Immediately, she called the insurance company to confirm her pregnancy benefits — the fundamental first step prior to having any major test, ongoing therapies or any surgery.

To Randy, making the call was merely a formality, because when she originally purchased the policy years before she was single and didn't opt for the maternity rider. However, after she got married, she added maternity coverage because she knew she'd someday want to start a family.

Indeed, when she made the call to the insurance company, they confirmed that she had the insurance she needed. However, after her first check-up at the OB/GYN, she received a letter saying she was, in fact, not covered.

Panic ensued, followed by a slightly hysterical call to our office. We quickly phoned the carrier, and unfortunately it took two weeks of repeated calls to them to get the information we needed. At last, we received an email from a reliable supervisor confirming that the rider had been added and she was covered.

Fast forward to three years later. Randy once again is pregnant, and following proper health insurance protocol, she called the insurance company to notify them of her condition. Here’s the shocker: The agent on the line tells her she has no coverage. Surely this was a mistake, Randy thinks, so she hung up, composed herself, and called back.

This time another agent told her that she herself had dropped her maternity coverage the day her first child was born. Who would drop coverage on the day they are in delivery, she asked? Most people in the throes of 27 hours of labor are not calling their insurance company.

Frustrated and confused, Randy called us and we remembered she received an email from the insurance company months earlier stating that she had maternity coverage. We both had saved the letter, and we promptly took it to the head of the claims department.

Still, despite the fact that the letter clearly stated that she had maternity coverage, it took three people making nine calls for four weeks to get a definitive answer that Randy did, in fact, have coverage and that the policy would pay for her delivery. What we never did discover was why the coverage was dropped in the first place. Who authorized the change? And why did it take so long to resolve the matter?

You gotta laugh.

Here's how you can take control

1. When you are thinking about getting pregnant, call your broker or insurance carrier to confirm that you are covered.
2. Make sure to get the name and telephone number of the person you spoke with, the department and supervisor's name and telephone number, and the reference number for the call.
3. Always write down the date and time that you placed the call.
4. When buying a policy, if you are of childbearing age, be certain that you are covered for maternity.
5. Get a copy of your contract and review it carefully to be sure you are covered for all the potential situations that you may need the insurance for in the future.

If I were the health insurance ambassador

If I were in charge of health insurance policy, I would require every carrier to clearly outline and explain what is covered in the policy. When amendments are made, the policy needs to be updated and the customer needs to be notified. I would also post these changes on the insurance company's website using easy-to-understand language.

Too often, this information is buried in the policy and is difficult — if not impossible — for consumers to understand. I'd also make sure that carriers were required to respond to issues like Randy's within 48 hours, so as not to leave paying customers hanging. This is their health we're talking about, and they are spending large sums of money and trusting that the insurance firms will fulfill their end of the bargain.

I often ask myself, why is this such a big problem. Is it corporate greed? Or are health insurance companies so big and bloated that no one knows what is going on? Either way, there obviously needs to be a change in the system.

The painful truth

The reality is that for now consumers are stuck having to fight for their rights and too often their calls are not returned in a timely manner. This serves to frustrate them more, and makes the insurance industry seem like an even greater villain. For now, there's little that can be done to change the system. The best solution for the consumer is to know what you are buying, ask a lot of questions, and have a great broker that you can trust.

We encourage you to share your insurance nightmares with us, too. (Send an email to our newsletter editor, hope@inkandescentpr.com).

Newsletter by Inkandescent Public Relations
Writing by Hope Katz Gibbs, president & founder; Copyediting by Patricia Gray

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