December 12, 2017 - 12:13 pm
Updated December 12, 2017 - 5:43 pm
When former Clark County School District school psychologist Diana Goodsell was injured by an alleged drunken driver in 2015, she required a cervical spinal fusion surgery.
But just before the operation, Goodsell remembers, she was told it would cost her $6,800 out of pocket.
“I couldn’t believe it,” Goodsell said. “I actually had to have a hospital administrator come down and try to explain it to me, and they couldn’t really. … It really just came out that that was part of the agreement with the Teachers Health Trust.”
She delayed the surgery, living in pain for months.
Now Goodsell and other current and former district employees have filied a class action lawsuit against the Teachers Health Trust, which provides health insurance for thousands of Clark County School District employees and their dependents. The lawsuit, filed Tuesday in District Court in Las Vegas, alleges breach of contract, consumer fraud and other actions that the plaintiffs say have forced them to pay more for health care and receive less.
It’s the second legal challenge that the embattled trust, which is overseen by a trustee board of licensed district employees appointed by the local teachers union president, has faced in a span of roughly five months.
The lawsuit names the trust, seven of its trustees and WellHealth Quality Care, which manages the trust’s network of doctors, as defendants. It claims that WellHealth violated its contract by refusing to pay claims, charging double the $10 co-pay for doctor visits and leaving teachers with higher yearly out-of-pocket expenses than the specified cap of approximately $6,800.
“They were paying insurance premiums for something they didn’t ultimately get,” said Mitchell Bisson, one of two attorneys representing the employees. “They were supposed to get product A. They got product Z — if any product at all.”
In some cases, employees were sued over unpaid medical bills or were refused medical treatment, the lawsuit states.
But the lawsuit also lays blame on the trust and its Board of Trustees, claiming that they turned a “blind eye” to the “gross mismanagement and ineptitude” of WellHealth.
“The problems with WellHealth were well known to the Teachers Health Trust, and to its individual trustees, yet nothing was done,” the lawsuit states. “It is estimated that there may be as many as 30,000 union members who, like plaintiffs, paid health insurance premiums to WellHealth but did not receive the promised health care.”
The trust insurance is available to all licensed district employees paid on the salary scale for teachers who are also eligible to be represented by the Clark County Education Association. Teachers in charter schools sponsored by the district, as well as union and trust employees, also are eligible.
The trust’s chief operating officer, Kim Phillips, said in an email that the trust had no comment.
WellHealth also declined to comment.
The lawsuit is the latest blow to the trust, which also faces a whistle-blowing legal challenge from members of its former executive board.
The former trust employees — CEO Gary Earl, Chief Operating Officer Felipe Danglapin, Director of Operations Philip DiGiacomo and executive assistant Michael Ielpi — claim that the trust breached its fiduciary duty by entering no-bid contracts that hiked its administrative costs from WellHealth and other providers.
The former employees say they witnessed a series of questionable financial decisions by trust managers and alleged that Earl was rebuked when he questioned a proposal to build four clinics that would cost more than $1 million each.
The former employees had plans to sue the trust and John Vellardita, executive director of the Clark County Education Association. But the trust struck first, filing a lawsuit against the plaintiffs that accused them of releasing confidential information to the district and making unauthorized purchases on trust credit cards.
The trust also is locked in battle with the Clark County School District, which filed an unfair labor practice complaint over lack of access to financial information required for contract negotiations, where health care is likely a contentious point.
Teachers have lobbied the district for higher insurance contributions, but the Clark County School Board has lost faith in the trust’s financial capabilities. However, its proposal to switch to UnitedHealthcare insurance has also been met with strong resistance by educators.
Goodsell said she ultimately left the district for better healthcare options.
She and her attorneys estimate she ended up paying roughly $18,000 in out-of-pocket expenses in 2016 alone. She said she’s also being sued over medical bills the trust did not pay.
She said she is not the only one with these issues.
“I know that a lot of people who have the Teachers Health Trust are putting a lot of things off that they need, and I was doing the same thing,” she said. “I just couldn’t do it anymore, so I did leave for better health insurance.”
The School Board said it has received numerous complaints about the trust’s health care coverage.
Emails previously requested by the Las Vegas Review-Journal show concerns from other employees regarding unpaid bills, shrinking network coverage and rising costs. Some cast blame on the district, while others voiced concern over the trust.
“I have multiple problems with the trust,” one teacher wrote to the School Board in June. “One is the economic instability of the self-funded model with its current financial state. This has caused me, personally, repeated problems as bills are turned over to collection due to slow pay.”
The district said in a statement that it is concerned about the complaints.
“That’s why the Board of School Trustees offered to include teachers in our district health care plan, which is currently pending in arbitration with the teachers’ union,” the statement reads.
“Medical providers are now so familiar with problems with non-payment by the Teachers Health Trust that they are simply refusing service to patients. That’s an urgent crisis.” — Matthew Callister, attorney in class-action lawsuit against Teachers Health Trust and WellHealth