Changes are coming to the Clark County teachers’ health insurance plan in an effort to keep the trust solvent.
THT Health announced last week a new administrator and two new insurance plans for the Clark County School District’s 18,000 teachers and their families, who continue to report cases of being turned away or asked to pay up at their doctors’ offices.
The measures are part of a deal between the teachers union and the school district to shore up the nonprofit health trust, which had been running at a deficit of around $1.5 million per month before the changes, according to a union official. As part of the agreement, the district received a $35 million advance in exchange for more transparency from the trust.
The updated plans will be open for enrollment on Sept. 1, but anyone needing services in the interim can seek them under the new network, according to an email from the trust.
Educators who are pregnant, in the middle of a treatment, or have planned health care services can continue to receive care from their current providers.
The changes are meant to put the trust on a steady path for the future, said John Vellardita, executive director of the Clark County Education Association, which oversees the health plan formerly known as the Teachers Health Trust.
The new third-party administrator, UMR, a subsidiary of United Healthcare, will take on both new claims and act to resolve the backlog of unpaid claims, according to Vellardita, who said he “could not speak authoritatively” on the size of the backlog nor the priority process for settling claims.
The district did not return a request for comment on THT. A Review-Journal public records request for documents related to THT has been pending since June 14.
But the provisions of the trust’s agreement with the school district have been met, Vellardita said. The district has paid out the $35 million advance to the trust, which has in turn provided an accounting of its finances and chosen the new administrator.
“I’m confident from what’s being represented that (THT is) going to be in a pretty good position moving forward,” Vellardita said.
In addition to settling claims that have left some providers unpaid for months or more, the new administrator will also provide case management to monitor how the insurance is used going forward, Vellardita said.
Beginning Sept. 1, educators will have two Preferred Provider Organization plans to choose from through THT, Vellardita said. One is specifically aimed at the 10 percent of the user base that accounts for 61 percent of the trust’s costs, he added.
Costs and deficit
The goal is to keep the transition period as seamless as possible, Vellardita said. But there may be difference in providers for some educators, similar to what occurred during a transition the health trust went through in 2016, during its last round of financial woes.
“This is not a light-switch moment, where all the issues folks have been experiencing disappear,” Vellardita said. “There is going to be a transition period.”
In a CCEA podcast, Vellardita also said the insurance has been impacted by growing costs from an aging and chronically ill population.
“We have to make these changes now, or the trust is insolvent,” he said.
Dependent coverage and prescription costs in particular contributed to these losses, according to Vellardita. But he also laid some of the insurance’s issues at the feet of a former management team who “didn’t do well and left abruptly.”
The trust’s new leadership team is charged with streamlining its own administrative costs, he said, including taking pay cuts.
Vellardita said the union has directed THT to be more aggressive about addressing providers who send teachers to collections over claims unpaid by the trust.
Though the deal to save THT Health was signed in late May, teachers continue to report being asked to pay upfront for care — or being turned away altogether — by providers who have outstanding unpaid balances from the insurer.
Many also were shocked by an email from the insurance sent late Thursday informing them that the individual deductible for the new insurance plan would soar to $7,500. A follow-up email correcting the mistake was sent shortly after, with a revised estimate of $500.
Brian Scott, a teacher at Cortney Junior High School, is among those caught in the middle of the trust’s financial troubles.
He said he underwent the preparation for a colonoscopy appointment only to be told when he arrived at his doctor’s office that he’d have to pay for the procedure upfront due to the provider’s issues with THT.
The $1,400 sum proved to be too much, and Scott left without the screening.
“Guys my age need screenings, it’s necessary,” he said. “When you wake up and they say everything’s fine, the relief is wonderful. Instead of that, I got, ‘You don’t have enough money to be healthy.’ ”
Scott said he shared his experience on social media after struggling to get a response from THT Health about the delay. Since then, he said, other teachers have reached out to him about similar issues causing disruptions to their care.
‘It’s like not having insurance’
His appointment still hasn’t been rescheduled, Scott said, and he received a bill from the office for two other visits unpaid by the insurance.
By not paying for the preventative care, the insurance is risking a higher payout if he ultimately does get sick, Scott said. And delaying the appointment will ultimately force him to take time from the classroom, he added.
He also said that when he first joined the district in 1998, doctors told him THT was the best insurance plan in town. Now, with insurance issues during a global pandemic, Scott said he feels teachers are expected to “suck it up and deal with it.”
“If they’re not taking claims and doctors are saying you can’t come here, it’s like not having insurance,” he said.
Contact Aleksandra Appleton at 702-383-0218 or email@example.com. Follow @aleksappleton on Twitter.