The Tape They Don’t Want You To Hear

February 3, 2020

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You pay Texas Children’s Health Plan nearly a billion dollars to provide health insurance for children. So why are they now spending money instead threatening Dolcefino Consulting? You are about to hear why.

You’ve got to love a children’s health insurance commercial. They care, they really care. Bet you’ll never see mental health therapist Rob Ortega in one of their commercials.

“You think these kids get cheated?” said Wayne Dolcefino, President of Dolcefino Consulting.

“Yes, of course. They, they’re not getting the help that they need,” said mental health counselor Rob Ortega.

Wonder if Texas Children’s Health Plan knows what teachers and principals are telling Martha Lopez.

“There are lot of students, particularly in HISD, that have Texas Children’s and they’re not receiving the services that they need,” said mental health counselor Martha Lopez.

And we all know what can happen when a student with mental health problems doesn’t get the help they need. They can become a danger, and not just to themselves.

“No student should be afraid to go to school. Texas must act now to make our schools safer,” said Governor Greg Abbott at the start of last year’s legislative session.

TCHP gets $980 million a year, nearly a billion dollars, from taxpayers to provide health care to needy kids, including mental health services. 385,000 kids just here in Harris County.

But TCHP told both Martha Lopez and Rob Ortega they didn’t need any more mental health providers in their insurance network because they already had plenty.

“You think that’s bull,” Dolcefino said.

“I believe that’s bull,” Lopez said. “I think that it’s about the money. I mean, what other excuse do they have?”

“Good question. When we first called TCHP to talk about the controversial subject of mental health for school children who need it, they sicced the big, bad lawyers on us. What happened to all that caring stuff?” Dolcefino said.

The folks at TCHP later cried foul over the Dolcefino Consulting investigative video that aired in December. We called it Blowing The Whistle To Protect Houston Kids, and with a title like that I was clearly up to no good.

“It’s a scam. If you really want to know the truth, it’s a scam,” said Troy Marsaw, owner of On Site Counseling.

Troy Marsaw of On-Site Counseling Services has become TCHP’s public enemy number 1.

“The bottom line is that the health plan is profitable from not seeing, not allowing these kids to be seen,” Marsaw said.

But he’s clearly not the first person who’s ever suspected an insurance company was being greedy. But he’s repeatedly filed formal complaints with the State of Texas. This investigation proved TCHP should have paid for dozens of kids they refused to pay for.

“62 of these were in Texas Children’s Health Plan’s (TCHP) prior to the contract termination for onsite counseling. HHSC was able to verify that services were received prior to the contract termination,” read the report from the Texas Health and Human Services Commission.

Since 2015 TCHP has been fined $1.9 million for either not paying claims or for not having a provider to provide the service.

“You think it’s because, simply put, they don’t want to spend the money for mental health for children,” Dolcefino said.

“That’s my, that’s my opinion,” Marsaw said.

“It makes it very difficult from a legal strategy for us to respond, for us to defend, for us to protect TCHP because he continues to make these little wins along the way,” said a TCHP employee in a secretly recorded meeting.

But it’s this secretly recorded audio tape that has the high-priced TCHP lawyers all in a flutter. It may evidence of retaliation against those folks who are sounding the alarm.

“Now currently as we stand is they’re, they’re an out of network provider, so in my mind they’re automatically, it’s null and void,” a TCHP employee said.

Just days after our broadcast of this revealing audio, TCHP went to court to get a restraining order against Troy Marsaw.

“Cease, desist and refrain from publishing and/or disclosing any recording or materials pertaining to TCHP’s meeting and communications that may contain internal discussions among TCHP personnel and its attorneys,” the court document stated.

In other words, you don’t have the right to know if an insurance company getting your tax money is playing games. Late in January we got our second threatening letter from Carlos Rainer, a partner with the high-priced law firm of Norton Rose Fulbright.

“We again request here your return of the audio recording… we further request you remove the video from the internet,” the letter read.

“If TCHP’s big, high-priced lawyers didn’t like that first piece of audio tape we played in December, well I’ve got a hunch they’re going to like part two even less. But you know what? I don’t like bullies. This is about kids and about your money,” Dolcefino said.

You rarely get to hear insurance company folks behind the scenes joking about how they deny coverage, especially when a mental health counselor has just asked to see a kid in trouble to try and diagnose what’s wrong.

“They are getting smarter, right? Because we were previously denying therapy… Because you have no diagnosis. So now they’re asking for this… Right. I would challenge the smartness,” TCHP employees said.

“Hey, anyone got a copy of my license? Look, I’m no medical professional, but let me ask you this question. If you’re a mental health professional, how do you diagnose a child who may need help if you don’t actually ever get to see the child? Or maybe that’s the point,” Dolcefino said.

Here’s a call between On Site Counseling and Dr. Scott Gordon from Prest & Associates, a Wisconsin company TCHP uses to review claims after they have been initially denied.

“Have you ever seen G——i?” Marsaw said.

“No why, this is a peer to peer. I wouldn’t have seen G——I,” said Dr. Scott Gordon.

“OK then. We’ve never seen G——i either and so,” Marsaw said.

“OK,” Gordon said.

“OK so we’re doing a peer to peer on somebody we’ve never seen, so how do we start?” Marsaw said.

“Uh good question. I don’t know,” Gordon said.

“I think that TCHP, Texas Children’s, is willing to roll the dice for profits,” Marsaw said.

“I do believe somebody needs to take a closer look at what TCHP is doing,” Ortega said.