On a recent day, he hung up the phone after talking to a woman in her 50s who had lost her job and her group health insurance coverage along with it. He couldn't find an insurer willing to take her on because of a preexisting medical condition.
"She's not indigent. She owns her own house. She doesn't qualify for Medi-Cal. What can she do?" Rivas said. "This is a common call that we're having. It's tough."
Rivas doesn't blame the insurers. But he spends a lot of time explaining to clients the harsh realities of the individual market.
"Insurance is about one thing -- adverse risk," Rivas said. "If I'm a carrier and I started taking on people who are 5-foot-10 and over 265 pounds, I'm going to get all the people who are overweight. And I can't keep my doors open that way."
Another way that insurers keep medical losses down is by jettisoning customers they say did not qualify for coverage in the first place.
Several insurance companies have established departments dedicated to reviewing the applications of customers who file costly medical claims. The goal is to discover evidence that the clients failed to disclose preexisting conditions when they applied. Insurers cite such omissions as grounds to cancel policies retroactively, a process known as rescission.
Health Net Inc. of Woodland Hills, a nationwide insurer with 6.7 million members, avoided spending $35.5 million by canceling the policies of about 1,600 California customers over six years, according to company documents disclosed last year by the Los Angeles Times.
The documents showed that Health Net paid bonuses to an employee based, in part, on how many policies of sick enrollees she canceled. An arbitrator this year awarded $9 million to one Health Net customer -- a Gardena hair salon owner who was undergoing chemotherapy for breast cancer when her policy was canceled.
Public controversy, political pressure and legal challenges are forcing insurers to tread more carefully in rescinding policies. However, rescission remains a powerful tool that the industry is fighting to retain.
"Rescission . . . helps protect against fraud in the individual market," said Chris Ohman, president of the California Assn. of Health Plans.
Sally Marrari thought she was covered when she was admitted to Cedars-Sinai Medical Center complaining of sharp pain and shortness of breath. A few months earlier, she and her husband, Rick, who own an auto repair shop in Los Angeles, had taken out a family insurance policy.
She spent three days at Cedars-Sinai undergoing tests and was later diagnosed with lupus, a chronic, arthritis-like disease. When the hospital's $25,000 bill came due in late 2006, Anthem Blue Cross of California refused to pay -- and then rescinded Marrari's coverage.
"They told me they canceled me because I was lying," recalled Marrari, 51, of Playa del Rey.
After reviewing Marrari's application, Anthem said she had failed to report having taken an antidepressant years earlier. The company said she also omitted mention of a digestive disorder, an iron deficiency and back pain.
Marrari said she didn't know she had a digestive disorder or an iron deficiency when she filled out the application. As for the back pain, she understood it to be a side effect from a hysterectomy, which she says she did list on her application.
Marrari said she took the antidepressant Prozac under a doctor's care after her father died a decade ago. She stopped using the medication after a year.
"They asked if I had mental problems, and I said no, which is true," she said. "I don't have mental problems."
Marrari, one of 6,000 Anthem Blue Cross of California customers who have lost coverage in recent years, is suing the insurer in an effort to have her policy reinstated.