Health & Education
Tribal Council issues statement regarding Shasta billing issues
By Dean Rhodes
Smoke Signals editor
Tribal Council issued a statement on Thursday, Sept. 29, regarding billing issues at Redmond-based Shasta Administrative Services, a third-party administrator for health care services that the Tribe co-owns.
The topic of billing issues at Shasta was brought up by Tribal member Peter Grout during the Other Business portion of the Wednesday, Sept. 28, Tribal Council meeting.
Grout said that some casino employees were reporting that their medical claims were not being paid in a timely manner and some employees had seen their bills referred to collection agencies because of the delays.
“The Tribe has learned that some Tribal member and employee Shasta insurance claims have taken longer than normal to process,” the Tribal Council statement says. “We have demanded that Shasta remedy this situation. We are committed to seamless care for our Tribal members and our employees.”
The Tribal Council statement says that any Tribal members or employees with questions or concerns about their medical claims should contact Shasta directly at 800-880-5877. Tribal members wishing to speak to a Tribal representative should contact Melody Baker, Kayla Leno or Erica Mercier at the Health Clinic’s Business Office at 503-879-2008.
The Tribe purchased Shasta Administrative Services in November 2012 in partnership with Hawaii-Western Management Group Inc. of Honolulu, Hawaii. The Grand Ronde Tribe owns 51 percent of the company while HWMG owns the other 49 percent.
Shasta was formed in January 2001 to serve the needs of Jeld-Wen Inc. and other self-funded employers in the Pacific Northwest. The Grand Ronde Tribe became a Shasta client in January 2009 and purchased the company because it was already processing its health care claims.
At the time, the purchase was touted as being “synergistic” with the Tribe’s efforts to diversify its economic interests beyond gaming and timber.
It also was stated at the time that the Tribe would not actively manage the company, leaving the management team, which includes President Paul Kaiser and Vice President of Operations Addie Fagan, in place.
“We recognize claims have taken longer than normal to process and apologize for any concerns, frustration or issues this may be causing people,” Fagan said in an Oct. 12 e-mail to Smoke Signals. “We are diligently working to resolve these delays as soon as possible. Please know claims will be processed and turnaround times for both claims and customer service calls are our top priority.”
Fagan said the delays are being caused by the implementation of a major system upgrade and staffing shortage issues similar to those being experienced by other employers throughout the country.
“We are dedicated to resolving these issues and providing the level of service you deserve,” she added. “Members can choose to reach out to customer service by either calling, sending an e-mail or logging into our web portal.”
The web portal at www.shastapa.com allows some self-service options, such as viewing claims received and tracking their status, viewing explanation of benefit statements, ordering identification cards and accessing benefit plan documents.
Fagan said people can call the customer service line at 800-441-4518 or send an e-mail to firstname.lastname@example.org if they are having problems and she is willing to talk to clients as well.
Tribal Council held executive sessions on Wednesday, Oct. 5, and Wednesday, Oct 12, to receive updates on the Shasta situation and then during its Wednesday, Oct. 12, Tribal Council meeting approved a $350,000 capital contribution to the company using the Tribe’s line of credit that will eventually be paid back.
Tribal Council Secretary Michael Langley said the loan will help Shasta address a backlog of claims and provide the financial resources the company needs. He added that the recent software upgrade did not go as smoothly as hoped and caused the claim backlog.
“Our priority has always been, and remains, ensuring seamless care for our members and our employees,” Langley said. “This loan will help provide Shasta with the resources that they need.”
Tribal Council Chief of Staff Stacia Hernandez added that the funds also will give Shasta the flexibility to pay overtime for employees to catch up on the backlog.
Tribal Attorney Rob Greene added that despite the company’s financial problems, the priority for the Tribe’s executive team was to ensure claims are processed and paid.
Shasta employs approximately 60 people and makes about $17 million in annual revenues, according to the website Datanyze.