Insurer may be dropped
November 14, 2008
Officials of Ysleta Independent School District and the county, which both hired Foresight TPA as their third-party health administrator this year, have initiated steps to replace the company.
Written by Zahira Torres and Erica Molina Johnson , The El Paso Times
Sierra Providence East Medical Center
EL PASO -- The county and one school district are considering replacing their health insurance administrator after learning it won't fulfill its obligations and may cost district taxpayers millions of dollars.
Officials of Ysleta Independent School District and the county, which both hired Foresight TPA as their third-party health administrator this year, have initiated steps to replace the company.
Ysleta trustees voted to remain with Foresight TPA but will seek other options for a third-party administrator. If the district remains with Foresight through 2009, it would cost taxpayers an additional $2.35 million.
The County Commissioners Court decided Thursday to reconsider bids for a health insurance administrator for 2009.
The possible departure from Foresight TPA stems from the resolution of a contractual dispute with Tenet Hospital Corp., which runs El Paso's Providence Hospital, Sierra Medical Center and Sierra Providence East Side Hospital.
According to documents, the resolution states that if Tenet is not listed as a primary hospital option, employees of the county and school district who use the company's services would have to pay all billed charges not covered by benefits.
Under the current plan, employees pay only a percentage of a negotiated rate.
Ysleta and the county were two of the largest remaining local governmental entities to contract with Foresight TPA, formerly Access HealthSource.
Ysleta sought new bids for a third-party administrator last year after Access HealthSource and its former president and CEO, Frank Apodaca, were listed as targets in the FBI's public corruption case. No charges have been filed against Access or Apodaca.
"Access couldn't meet their contractual promises in 2005, which cost our district millions of dollars, which ultimately, at the time, caused programs to be cut and affected our students," Ysleta Trustee Liza Montelongo said.
"In 2008, we are at the same juncture," she said. "Foresight TPA/Access couldn't deliver what they promised and, in my personal opinion, they lied in order to get the contract. I strongly believe we need to show them the door and move on and ensure that the employees needs will be protected and it will not be at the cost of our students."
Foresight TPA officials, who according to county commissioners said the company was being sold, could not be reached for comment Thursday.
Ysleta's plans
Ysleta trustees on Wednesday authorized the administration to adjust the district's employee benefit plan to an Open Access PPO with Foresight TPA, which would maintain a variety of hospital options by Jan. 1, 2009.
Trustees separately authorized the district to make changes to the third-party administrator, Foresight TPA, and to reconsider previous proposals for management of the Employee Health Benefit Plan without increasing employee contributions.
Administrators said they would begin looking at past proposals by other third-party administrators and determine the district's best option.
If Ysleta continues with Foresight TPA through the end of 2009, the district may have to pay an additional $2.35 million to maintain all hospitals at the top level of benefits.
If it selects an option to switch to one of two other third-party providers, and if previous proposals have not changed, additional cost estimates range from $883,122 to nearly $1.77 million.
Since the district will not increase contributions to the health benefits plan for its 5,700 employees, money will come out of the district's health insurance fund balance.
County woes
After hearing that Foresight TPA had not paid more than $650,000 in claims to Tenet since March, county commissioners on Thursday rescinded a bid granted to the company for 2009.
"Our contract calls for them to pay those bills in a timely manner," Commissioner Dan Haggerty said.
About 2,340 county employees are covered under the current health insurance program, which offers four tiers of coverage for hospitals, said county human resources director Betsy Keller.
Under the system, employees pay the least when they use Thomason Hospital and increasingly more for HCA facilities, Tenet facilities and non-network hospitals.
Next week, the county's risk pool board will begin re-evaluating bids for the service. The board will then meet with the Commissioners Court to finalize decisions.
Haggerty said he didn't want the county to rush into dumping Foresight TPA. He said the company's bid was $1.4 million lower than the next-highest bidder, Aetna, and it also agreed to provide an on-site health clinic at the county.
Keller said Foresight TPA must honor the current tier system through Dec. 31, but it could try to renegotiate.
"They (Foresight TPA) are saying we can't continue to honor that contract unless Tenet becomes equal to or higher than Las Palmas," Keller said.
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