Directories
Quick Searches
Find a Job
Quick Search
For Employers
Yahoo! HotJobs Local Search
Teachers lament their health insurance
By: JENNIFER KABBANY - Staff Writer | ∞
TEMECULA ---- Although tensions have calmed between educators and administrators after teachers narrowly voted to ratify their employment contract recently, teachers are still talking about one unresolved, hot-button issue ---- health insurance.
Some Temecula Valley Unified School District teachers contend their insurance plan is not up to par. While teachers voted for a 3.15 percent midyear salary increase for the 2004-05 fiscal year, that particular offer did not change the amount the district contributes for their health benefits.
The increased cost of health insurance was one of the biggest teacher complaints leading up to the vote. In addition to soaring costs, some teachers say, there are problems such as the insurance company not paying patients' bills, unorganized billing and no paid coverage for local emergency room visits except in life-threatening cases.
In response to teacher concerns, as well as an annual review process, the district late last year hired a broker to identify new insurance options, Assistant Superintendent Jeff Okun said. Proposals for those plans should be presented to the district's insurance advisory committee this month, he said, adding that employees will hear all the details in April or May.
The insurance committee consists of teachers, administrators, support staff and union leaders who review the district's insurance and make recommendations about possible changes. District employees would vote on any changes to their plan.
High costs and more
Some teachers say their complaints with the district's insurance go beyond rising health care costs, although that is a large part of it.
Cara Conroy, a teacher at Temecula Elementary School, said she thinks the insurance policy is horrible.
"I don't feel safe or secure," she said. "I feel like a bum on the side of the street who doesn't have insurance, not like a seven-year teacher."
The district offers three medical plans for all of its estimated 1,800 full-time employees to choose from:
Temecula Valley Educators Association's President Jim Thomas said that about 1,000 members of the estimated 1,300-member association are enrolled in the $40 plan.
He said most teachers do not choose Kaiser because its Wildomar clinic is already overburdened with patients, the closest Kaiser hospitals to Temecula are in Riverside and San Diego, and teachers like to stick with their family doctors, with whom they have a history.
Across town
Conroy, like many of her colleagues, has the plan where she contributes $40 a month.
In contrast to Conroy's situation, for example, the plan the majority of teachers in the Murrieta Valley Unified School District are enrolled in does not have a deductible or payroll contribution, and an office visit is $5, according to the district's human resources department.
Okun said, however, that Temecula teachers have the option to participate in a plan with no deductibles, although their monthly contribution would rise. He also said teachers were given the option of increasing the district's health benefits contribution during the 2004-05 negotiations, but opted instead to put all of the money offered into salaries.
Just as the amount teachers contribute and the benefits they receive varies among districts, so does the amount the districts contribute toward the educators' benefits.
Temecula's health benefits contribution per person remains lower than many nearby districts. It stands at $6,888 annually, while Murrieta's is at $8,275 and Lake Elsinore Unified School District's is at $8,786.
District spokeswoman Danielle Clark said 87 percent of the district's budget is directed toward salaries and benefits, "so the cost of benefits is a large expense for us."
Nevertheless, Conroy said, "we just feel so not taken care of by our district. We have good jobs. We work for the community. It just doesn't seem to be fair."
Case in point
Recently, Conroy said she experienced a severe migraine headache and felt she needed to go to the emergency room, but two local hospitals ---- Rancho Springs Medical Center in Murrieta and Inland Valley Medical Center in Wildomar ---- are not part of the district's network of providers. The Temecula resident said her closest emergency room options were in Fallbrook and Menifee.
The contract with the other two hospitals "expired or terminated" in the summer of 2004, said the hospitals' spokeswoman, Teresa Fleege, who declined to elaborate.
Okun said that the district has no control over which hospitals accept its insurance plan, that hospitals and insurance agencies are in charge and people are just "pawns."
Moreover, he said, not all Temecula teachers live in Southwest County, and teachers tend to simply go to the closest hospital when needed.
"Teachers have options," he said. "In all these issues, (one) tends to focus on the now ---- on today. These issues are not today issues. They are overall issues. Employees would be paying much more out of their pocket today if we stayed (with our prior plan)."
Changes over time
The district moved three years ago to a self-funded plan administered through the South Counties Employees/Employer Trust. Clark said the move was made because the district's premiums were consistently rising. SCEET is a nonprofit trust that helps school districts such as Temecula Valley administer health plans.
"The move was a collaborative decision spearheaded by the insurance advisory committee, which is a representative committee," she said.
Thomas said part of the reason teachers agreed to continue with SCEET and Community Care Network for 2004-05 was because of a $4.6 million debt that had accumulated in large part because of dozens of catastrophic claims.
"Staying in the existing plan gave the greatest opportunity to arrest or eliminate the debt," Thomas said.
Okun said that, last year, district officials considered assessing all employees $189 to cover the debt, but ended up using money budgeted this year to pay for 2003-04's claims. Okun said this year there are higher deductibles and, hopefully, fewer claims, which could erase that debt.
Meanwhile, the insurance committee agreed in February that the district should withdraw from SCEET. Okun said that would save some overhead costs and put the district in a better position for moving to a different plan in July, assuming that's what is decided.
The insurance advisory committee's goal is to have the insurance process for next year, including open enrollment, completed by the end of May, Okun said.
Meanwhile, teachers wait
Vail Ranch Middle School teacher Lisa Linn said she would like to see changes made in the district's health plan. She said one of her biggest complaints is a confusing stream of information from her health-care providers.
For one, she said, she does not know how much of her $1,000 deductible she has satisfied.
"There is so much going back and forth between billing, I have no idea where I am," she said. "Nobody has sent me a statement."
Linn also said she believes a $1,000 deductible per person can be difficult for some.
"What if you are a teacher and you are raising four children?" asked Linn, who is battling what she describes as a severe and expensive allergy problem. "If my husband didn't make the income he does, we would be in deep, deep trouble."
She said that when the district switched to a self-funded plan it was sold as a way to save money, and the first year things went smoothly. After the second year of catastrophic claims that created the debt and higher premiums, it looks as though the decision was a mistake.
"It clearly hasn't saved us money," she said. "Things need to be changed. ... Teachers are giving people, and none of us want this kind of fight, but some of us are so tired of it. I, for one, will not sit for it anymore."
Gardner Middle School teacher Kim Evans said her problem is that she is paying off a $1,000 bill that was sent to a collections agency almost two years after her husband went to a doctor about a breathing problem.
She paid the portion she was required to under her plan, but the insurance administrator didn't pay its part. So the health care provider sent the bill to collections, she said, and she's now on the hook for the amount owed.
"I never received a bill, and when I finally did, (Community Care Network) said if they are not billed within a certain time period, then they are no longer responsible," she said. "It's been very frustrating. Now, I am stuck with the bill ---- with interest."
Ysabel Barnett Elementary School teacher Stephanie Jones has a similar story. She said she recently received a $556 bill for blood work she had done in June 2004. She said the notice she received said the bill would be sent to collections if she did not take care of it.
Jones said she lives hand-to-mouth and doesn't even have enough money to get tested for a skin ailment that has been festering for a year.
"I'm panicked," she said. "We have catastrophic coverage."
Okun said there is so much paperwork and red tape when dealing with insurance companies that oftentimes problems that arise have less to do with the plan and more to do with human error.
"Sometimes the doctor is billing under the wrong code, and people are quick to (blame) the district," Okun said. "But we work to resolve these problems, and 90 percent of the time we do."
Not alone, reaching out
Temecula Valley isn't the only school district facing insurance problems.
"The issue of health insurance is universal," said Laura Jeffries, legislative advocate for the Association of California School Administrators, a Sacramento-based nonprofit organization representing 16,500 school administrators. "Districts up and down the state are grappling with how to deal with the increasing cost of health insurance, workers comp, and unemployment insurance."
Employees are increasingly picking up a larger share of the costs, she said.
To start talking through educators' frustrations about these issues and others, Superintendent Dave Allmen is creating a Superintendent/Teacher Council. Two teachers from every school will join with Allmen and other administrators monthly beginning in April.
Allmen, at a recent board meeting, also said he would do something similar for the district's support staff.
Additionally, trustees agreed at that meeting to also start visiting campuses in pairs, to talk to teachers directly, listen to their issues, and have an active dialogue about ways to address concerns.
Contact staff writer Jennifer Kabbany at (951) 676-4315, Ext. 2625, or jkabbany@californian.com.
More Stories
Advertisement
Two Contracts were canceled with Inland and Sharp's Hospitals wrote on Jan 27, 2008 3:11 AM:And the quietly kept reasons of TVUSD Governing School Board Members is that they did not pay the billing timely if at all.
Why not?
Funny, look on the California Ed Dataquest for TVUSD health benefits. It does not show that they had "ever" negative debts for their insurance.
Once the Districts submits their data, the Data can never be changed/updated.
So, I think this means false data was submitted.
OOps.
- ESCONDIDO: Man shot dead at Fourth of July party (18)
- TEMECULA: Parade, fireworks draw thousands on nation's birthday (11)
- FALLBROOK: Peruvian chocolatier living sweet American dream (10)
- CARLSBAD: Golf benefit raises $20,000 for Conner's Cause (9)
- SAN PASQUAL VALLEY: Animal park offering extended hours, extra shows and activities (7)
Advertisement