Insurance Providers

Ysleta Independent School District and the county of El Paso Texas are considering replacement of their current health care program administrator.

Last Wednesday, Ysleta trustees authorized the administration to adjust the district's current employee benefit plan so as to allow for an Open Access PPO with current administrator Foresight TPA. This would allow the plan to maintain a variety of hospital options by Jan. 1, 2009.
Separately, trustees approved that the district make changes to Foresight TPA, the third-party administrator, and reconsider prior proposals for the management of the Employee Health Benefit Plan, assuming that there are no increases in employee contributions.

The plan’s administrators have agreed to begin looking at previous proposals by other third-party administrators and determining the district's best option.

If Ysleta school district decides to continue with Foresight TPA through the end of 2009, then the district may have to pay an additional $2.35 million in order to keep all hospitals at top benefit levels.

If however, it decides to make a change and selects an option that would switch it to one of two other third-party providers, if the previous proposals have not been altered, the additional cost estimates then range from as low as $883,122 to close to $1.77 million.

Since the district is not planning to increase its contributions to the health benefits plan for its 5,700 employees, the additional money will have to be found in the district's health insurance fund balance.

County problems

After hearing on Thursday that Foresight TPA had yet to pay out more than $650,000 in claims to Tenet since March, county commissioners rescinded a bid that had been granted to the company for 2009.

Commissioner Dan Haggerty says that the county contract calls for them to pay those bills in a timely manner.

According to county human resources director Betsy Keller, under the current health insurance program, there are about 2,340 county employees who are covered. The present plan offers four tiers of coverage for hospitals, she says.

The present system allows employees to pay the least when they use Thomason Hospital and increasingly more when HCA facilities, Tenet facilities and non-network hospitals are visited.

Next week, the county's risk pool board will begin a re-evaluation of the current bids for the service will begin next week by their county’s risk pool board. Following this the board plans to meet with the Commissioners Court to firm up their decisions.

County Commissioner Haggerty said he was against the county’s rushing into dumping Foresight TPA. He points out that the company's bid is still $1.4 million lower than that of Aetna, the next-highest bidder, and that Foresight TPA has also agreed to provide an on-site health clinic for the county.

While Keller says that Foresight TPA is required to honor the current tier system through Dec. 31, it can still try to renegotiate.
According to Director Keller, Foresight TPA are saying, for their part that they can not continue to honor that contract unless Tenet becomes equal to or higher than Las Palmas.

Among the present concerns of the county is that Foresight won't meet its obligations.