1 2 3 4 5 6 7 KERR COUNTY COMMISSIONERS COURT 8 Emergency Session 9 Wednesday, January 5, 2005 10 2:00 p.m. 11 Commissioners' Courtroom 12 Kerr County Courthouse 13 Kerrville, Texas 14 15 16 17 Discussion on Unresolved Insurance Issues 18 19 20 21 22 23 PRESENT: PAT TINLEY, Kerr County Judge H. A. "BUSTER" BALDWIN, Commissioner Pct. 1 24 WILLIAM "BILL" WILLIAMS, Commissioner Pct. 2 JONATHAN LETZ, Commissioner Pct. 3 25 DAVE NICHOLSON, Commissioner Pct. 4 2 1 On Wednesday, January 5, 2005, at 2:00 p.m., an emergency 2 meeting of the Kerr County Commissioners Court was held in the 3 Commissioners' Courtroom, Kerr County Courthouse, Kerrville, 4 Texas, and the following proceedings were had in open court: 5 P R O C E E D I N G S 6 JUDGE TINLEY: Let me call to order the 7 emergency meeting of the Kerr County Commissioners Court 8 scheduled for this time and date, Wednesday, January 5, 9 2005, at 2 p.m. Precinct 1 Commissioner Baldwin indicated 10 there was some problems, and asked that this matter be 11 brought before the Court. I think, in order to kind of get 12 an overview, it would be appropriate if we called upon a 13 representative of the new plan administrator to give us a 14 general summary of where we are now. With us today is 15 Mr. Jamie Ochoa with Mutual of Omaha, and are you prepared 16 to give us a plan to where we are in the entire enrollment 17 eligibility process? 18 MR. OCHOA: Yes, sir. 19 JUDGE TINLEY: All right. If you'd be kind 20 enough, we'd appreciate it, Mr. Ochoa. 21 COMMISSIONER BALDWIN: Judge, would you -- 22 excuse me. Would you allow me just a moment to talk about 23 some of the things that -- thank you. The reason I put it 24 on the agenda was, there's several items that has been 25 brought to me, and one of those things is it appears that 1-5-05 emg 3 1 our employees are not in the system, particularly for 2 medications. Several of them, including Commissioner 3 Williams, has gone to get medications and cannot get them; 4 nobody's ever heard of us. And I find that a little bit 5 strange. Very strange, actually. Here we are, the 6th day 6 of January. And there was, on the enrollment forms, no 7 designation of beneficiary, and visiting with the County 8 Treasurer, she told me that she brought that to the 9 attention of the insurance agent, and he -- his comment was, 10 "Well, that's all right. We'll just go back to the previous 11 forms and get the beneficiary's name off there and put 12 it..." Well, that's unacceptable. What if I wanted to 13 change my beneficiary? Totally different program. That's 14 unacceptable. 15 And I understand that there are numerous of 16 our employees have enrolled, and the paperwork can't be 17 found. Those things -- those are three things that, to me, 18 are major. I can't remember exactly the date that we signed 19 on, but it seemed like to me it was around December 8th or 20 so, and everybody was very clear, January 1 being the -- the 21 date that we start our new insurance program. And here we 22 are, January 6th, and we're not anywhere near up and 23 running. And I know you have some answers for us here, but 24 I wanted to make those comments. And I consider -- I 25 consider the not having our people in the system and not -- 1-5-05 emg 4 1 not able to purchase medications or other things 2 unacceptable, and I -- I consider that as a strike one. The 3 beneficiary issue, I consider it a strike two. And the 4 forms that have disappeared I consider strike three. And 5 Commissioner Letz is our baseball guru, and he'll tell you 6 that when you get three strikes, you're out. In my opinion, 7 you're out. It's over. So, I -- I think that we need to -- 8 this Commissioners Court needs to back off this thing and 9 get back as fast as we can with E.B.A. and get some 10 insurance coverage for our people. And that's all I've got 11 to say at this point. You know, that's the reason I wanted 12 to have the meeting, is those issues right there. And I 13 know you're going to explain some things to us. I don't 14 know if they're going to be satisfactory, far as I'm 15 concerned, but -- 16 COMMISSIONER LETZ: Wait, before you -- quick 17 comment. One, I know it seems like it's January 6th, but 18 it's only the 5th, Commissioner. I know we've had a lot of 19 calls the past couple days. 20 COMMISSIONER BALDWIN: These new watches, I'm 21 sorry. 22 COMMISSIONER WILLIAMS: You got a new one, 23 too? 24 COMMISSIONER LETZ: I want to echo what 25 Commissioner Baldwin says, but I also want to emphasize 1-5-05 emg 5 1 again a statement that I believe I made when we awarded the 2 contract to Mr. Wallace and Mutual of Omaha, was customer 3 service and getting the job done, the level of service that 4 we expected. And, in my mind, y'all have failed on the 5 enrollment process, and you're failing today. And I'm very 6 close to where Commissioner Baldwin is, to basically saying 7 y'all have breached your contract and we don't -- you know, 8 we can terminate it today, tomorrow, Monday, whenever, and 9 go back -- go to our second high bid. I am pretty much fed 10 up with Mr. Wallace's company and Mutual of Omaha. So, now 11 y'all can explain why we should stay with y'all. 12 MR. OCHOA: Okay. 13 COMMISSIONER WILLIAMS: I'll wait till I hear 14 your answers. 15 MR. OCHOA: Okay. First of all, I'd like to 16 say thank you for inviting us here, and I'm here speaking on 17 behalf of Mutual of Omaha. Carey Malek was not able to 18 attend; he had a conflicting appointment, but he did want me 19 to come and explain -- at least try to give you an idea of 20 what is -- what it is that's going on, and a little bit of a 21 status or where we are in getting all of your issues 22 resolved. First of all, we have had some things out of our 23 control, and it has to do with weather. And Mutual of Omaha 24 is located in Omaha, Nebraska, and on Monday, they had an 25 ice storm, which caused a lot of people not to be able to 1-5-05 emg 6 1 make it to work because of the ice. And I've been on the 2 phone making sure that all of the areas that do all of the 3 data entering to get this group up and running, making sure 4 that they are holding this account in top priority. And 5 with that information, I did get a call on my way up here, 6 as a matter of fact, that they are able to enter the 7 override for those people who need their medications on an 8 urgent level, meaning if they want to go to the pharmacy 9 this evening, they'll be able to run that prescription 10 through. 11 MS. MEEKER: Ninety days? On the 90-day 12 supply? 13 MR. OCHOA: Actually, to her question about a 14 90-day supply, the 90-day supply is run through the 15 mail-order program, and the mail-order program does take 16 about two weeks for them to process your first order. So, 17 if you had mailed your mail-order information by January 18 1st, by the time they send it to you, everything will be up 19 and running. They have also assured me that by Friday 20 morning, everyone will be in the system, including in the 21 pharmacy system, and ID cards will also be sent out late 22 Friday afternoon, the -- the permanent ID cards. So, all of 23 the departments -- we understand that it's something that 24 was out of our control, and we do appreciate the patience 25 that y'all have given us. And we -- we just want to assure 1-5-05 emg 7 1 you that everyone that's working on this is taking it in the 2 highest regard, top priority, making sure that everything's 3 getting done. And that's the reason -- I've already turned 4 in four names of four individuals who need medications 5 urgently, and by late this evening they should be able to go 6 to the pharmacy and get those. The rest of the employees 7 will be keyed in, like I said, by Friday morning, when we 8 expect everyone to be in the system, able to get 9 prescriptions. And we tried everything we could to get 10 everyone into the system by January 1st, but there was just 11 some things out of our control that we weren't able to get 12 everybody in there. 13 COMMISSIONER WILLIAMS: The ice storm 14 occurred on January 3rd. What was out of your control 15 between the time we signed the contract and January 3rd? 16 MR. OCHOA: Well, first of all, we did have 17 quite a few enrollment forms that had not been turned in, 18 and I guess the first number was around 40. We had about 40 19 people who had not enrolled. 20 COMMISSIONER WILLIAMS: So, those that 21 enrolled are penalized because of those that didn't enroll, 22 for whatever their reasons are? Is that the way it works? 23 MR. OCHOA: No, sir. As a matter of fact, 24 the information had already been sent up, and the -- the 25 loading of the plan, all the other things that have to 1-5-05 emg 8 1 happen before the enrollment is actually keyed was already 2 in the works. But -- but on Monday, when everything was 3 supposed to be keyed into the system, that was the day that 4 we did not have full attendance in all the departments. 5 COMMISSIONER WILLIAMS: Is the system that 6 you've referred to that handles claims on the medical side 7 different than the system that failed to work on the 8 prescription side? Are they two separate systems? 9 MR. OCHOA: Yes, sir. 10 COMMISSIONER WILLIAMS: What have you done to 11 correct the second system? 12 MR. OCHOA: Well, actually, what happens is 13 we use a company called Express Scripts Incorporated to do 14 all our pharmacy administration. 15 COMMISSIONER WILLIAMS: And the last time I 16 checked, they hadn't heard of Kerr County; didn't know what 17 it was. 18 MR. OCHOA: And that would be correct, 19 because what we do is, we send them a file with that 20 information and they load it into their system, which all 21 pharmacists are connected to by computer. Because we did 22 not have that file ready on Monday to give to Express 23 Scripts, that's the reason why they have not -- 24 COMMISSIONER WILLIAMS: When did we -- 25 Mr. Auditor, when did we sign the contract? Or anybody. 1-5-05 emg 9 1 MR. TOMLINSON: I don't know. 2 JUDGE TINLEY: Ms. Nemec, when did we sign 3 the contract? 4 MS. NEMEC: I don't have that paperwork with 5 me. 6 COMMISSIONER LETZ: It's not really when we 7 signed the contract, it's when the Court awarded the 8 contract. That's -- 9 COMMISSIONER WILLIAMS: Well, whenever the 10 Court awarded it. 11 COMMISSIONER BALDWIN: Around December 8th. 12 MR. OCHOA: Also, another thing that I wanted 13 to address is, Commissioner Baldwin had mentioned about that 14 they hadn't heard of us. One of the things is Mutual of 15 Omaha does not have their own network. We use a network 16 called Texas True Choice, Ethix Southwest, so we -- we 17 actually pay for the use of that network. One thing that 18 did not happen is, Texas True Choice was supposed to send 19 out a notice to all the providers in this area to let them 20 know that there's this new group sold, Kerr County; expect 21 some of their members to start showing up at the doctor's 22 offices. One of the big things that happens is if you walk 23 in the door and say, "I'm with Mutual of Omaha," the 24 doctor's going to say, "We don't take Mutual of Omaha." But 25 on the ID card, the permanent one, and also on the ID card 1-5-05 emg 10 1 documents which we made available to employees, one of the 2 -- second thing on the card is the name of the network, 3 which is Texas True Choice. Now, if you mention Texas True 4 Choice when you walk in, then they say, "Oh, yes, we take 5 that." And I -- I've also personally spoken to a couple of 6 the major providers in Kerrville who had called me to find 7 out if they were part of our network, the hospital being 8 one, and also Family Practice, one of the larger doctors' 9 offices here. They contacted me directly, and I explained 10 to them that we were part of the Texas True Choice network, 11 and as of January 1, to expect members of Kerr County to be 12 coming in. And that's part of the -- the problem. Now, on 13 Monday -- Monday afternoon, Carey did contact Texas True 14 Choice. Tuesday morning they sent out -- they sent out 15 what's called a blast e-mail to all the providers letting 16 them know there is a new group in your area. That way all 17 the providers in this area know now that they are part of 18 the Texas True Choice network. 19 COMMISSIONER WILLIAMS: When did that happen? 20 MR. OCHOA: That happened yesterday. 21 COMMISSIONER WILLIAMS: Why didn't it happen 22 before? 23 MR. OCHOA: Well, what happened is Texas True 24 Choice just failed in sending that e-mail out prior to the 25 holiday. And normally that's what they do as a courtesy to 1-5-05 emg 11 1 the providers, 'cause normally the providers -- they have a 2 contract with Texas True Choice, and anybody who walks in 3 with a card that says Texas True Choice on it, they will 4 accept. But if you walk in and say, "I have Mutual of 5 Omaha," they don't -- they don't recognize that name. Not 6 until -- 7 COMMISSIONER WILLIAMS: I have a strong 8 suspicion that we weren't made aware of these little nuances 9 when we made the decision to make a change. These are all 10 things that are being revealed to us ex post facto, if you 11 will. We didn't know that in advance. Could have been 12 explained, I can tell you that. 13 COMMISSIONER LETZ: I mean, did our employees 14 have the card that showed Texas True Choice on January 1? 15 MR. OCHOA: On Monday morning, I sent an 16 e-mail that had a -- 17 COMMISSIONER LETZ: That's not what I asked. 18 MR. OCHOA: Okay. 19 COMMISSIONER LETZ: Did they have a card -- 20 MR. OCHOA: No, sir. 21 COMMISSIONER LETZ: -- at the end of the 22 year, on January 1? 23 MR. OCHOA: No, sir. 24 COMMISSIONER LETZ: Why not? 25 MR. OCHOA: First of all, I had not sent out 1-5-05 emg 12 1 the -- the temporary ID card document until Monday morning. 2 The first -- 3 COMMISSIONER LETZ: What if someone got sick, 4 you know, on January 1st? January 2nd? What were they 5 expected to do? 6 COMMISSIONER WILLIAMS: Pay for it like I 7 paid for the pharmacy. 8 MR. OCHOA: Well, we would have -- first of 9 all, they had our -- Don's information and my information on 10 how to contact us, and we would have talked them through. 11 I've had quite a few providers -- 12 COMMISSIONER LETZ: So, someone goes to the 13 emergency room and they're supposed to go through this red 14 tape? 15 MR. OCHOA: Well, actually, unless I knew the 16 specific -- 17 COMMISSIONER LETZ: I'm just -- fortunately, 18 I don't think it happened, but I'm outraged that it could 19 have happened, and y'all weren't prepared to handle it. 20 MR. OCHOA: And -- and we're not saying that 21 we would not cover. We would definitely cover -- everybody 22 is covered as of January 1, and anyone who either saw a 23 provider or went to the hospital, all those claims will be 24 covered. 25 COMMISSIONER LETZ: Have you been to a doctor 1-5-05 emg 13 1 recently, tried to fill out the insurance forms without any 2 information? Which our employees had nothing. And you 3 expect them -- what are they going to do? 4 MR. OCHOA: I understand your concern. 5 COMMISSIONER WILLIAMS: If we seem unduly 6 harsh, it's because we like to take care of our employees, 7 and I think we have a strong sense that what we thought was 8 right is turning out to be less than right, and that would 9 explain the attitude that you're facing today. 10 MR. OCHOA: Yes, sir, I understand. And, 11 again, we apologize for any inconvenience. And there was 12 some things out of our control that we wish could have been 13 different. And just to let you know that we are on top of 14 it and making sure that everything runs smoothly. 15 MS. THOMPSON: May I ask a question with 16 regard to prescriptions? 17 MR. OCHOA: Yes. 18 MS. THOMPSON: I can't send in my mail-order 19 prescription for a 90-day supply because we're not in the 20 system. You say, well, go to the local pharmacy. Why 21 should I be penalized having to go back to my doctor to get 22 another prescription, having to go to the local pharmacy and 23 pay $42 for a one-month supply when, if I had mail-away, I 24 could pay $80 and get a three-month supply? 25 MR. OCHOA: Okay, in answer to your question, 1-5-05 emg 14 1 you can send in your mail-order, because it takes them 2 approximately two weeks to process. And -- 3 MS. MEEKER: What form? We don't have any 4 forms. 5 MR. OCHOA: The form -- okay. 6 MS. MEEKER: We have nothing. 7 MR. OCHOA: Let me explain. The form for the 8 mail-order is included in the enrollment kit that was passed 9 out at the meetings. And it is -- I brought one with me 10 just in case. 11 AUDIENCE: I've also sent an e-mail to 12 several employees. 13 MR. OCHOA: It was in this booklet that we 14 passed out. The mail-order information is on the last three 15 pages where you can either fax or mail your information. 16 MS. MITCHELL: That was pointed out at the 17 meeting, at least the meeting I was at. 18 MR. OCHOA: So, yes, you may go ahead and 19 send it, and by the time they finish processing everything, 20 it will be in the system. It won't be a problem with that. 21 COMMISSIONER WILLIAMS: What is the process 22 for recovering dollars spent for those of us who went ahead 23 and purchased our prescription at market value? What is the 24 process for recovering what we are entitled to recover? 25 MR. OCHOA: Okay, we would just need you to 1-5-05 emg 15 1 send us the receipt, and we would file that for you. You 2 can either submit it to myself or to Don's office, and we'll 3 make sure that all of those claims get processed. 4 SHERIFF HIERHOLZER: Is that for medical or 5 prescription? 6 MR. OCHOA: For either. If you had any type 7 of expense between January 1st and until the system's up and 8 running, which should be by Friday morning, everything 9 should be -- 10 SHERIFF HIERHOLZER: Okay. So I have an 11 employee -- and this did happen -- that had to pay $300 out 12 of pocket to get some medicine that they had to have, okay? 13 If they send that receipt in, are they going to get 14 everything except for the normal co-pay back? 15 MR. OCHOA: That's correct. 16 SHERIFF HIERHOLZER: How long is it going to 17 take for them to get that money back? 18 MR. OCHOA: I can't tell you for sure how 19 long it takes to process the claim, but we will put that on 20 an urgent basis. And -- 21 SHERIFF HIERHOLZER: $300 for our employees 22 that was unexpected right after Christmas is -- is putting 23 those people in a serious problem. 24 MR. OCHOA: Yeah, I understand. And we do 25 have contacts in the claims area where we can get those 1-5-05 emg 16 1 processed just as soon as possible. 2 MS. MCELHANNON: What about for the people 3 that can't afford their medicine and they're out? 4 MR. OCHOA: That are out of medication? 5 MS. MCELHANNON: I can't afford to go and get 6 mine. 7 MR. OCHOA: Well, there's a couple things you 8 can do if -- if you're completely out and you need some. 9 First of all, in the meetings we -- we told everybody, if 10 you're going to be out the first week of January, it's a 11 good idea to fill your prescription before; five days 12 before, they should be able to give you a refill. If you 13 didn't and you're out now, you can talk to the pharmacist; 14 they can give you maybe a week's supply until they can run 15 your prescription, and some pharmacists have agreed to do 16 that. Other than that, by this evening, if you give me your 17 name, I can go ahead and get you loaded into the system so 18 that you'll be able to run that prescription today. 19 MS. MCELHANNON: For three months? 20 MR. OCHOA: No, not for three months. For a 21 month's supply. Remember, at the pharmacy you only get a 22 30-day, but the three months is through the mail-order. And 23 the mail-order, if you needed some, you should have already 24 sent that off. 25 MS. MCELHANNON: I did, and they won't fill 1-5-05 emg 17 1 it. 2 MR. OCHOA: Okay. But if you give me your 3 name, by the end of the day, they will be able to process 4 it, even though their normal processing time, the first time 5 that you enroll with the mail-order program, is a two-week 6 period. After that, refills, you get those in two to three 7 days. But the first time takes the longest, 'cause they 8 have to do all the entering of your information. 9 MS. MCELHANNON: So, all I have to pay is my 10 co-pay? 11 MR. OCHOA: Yes. 12 MS. MCELHANNON: Which is $560? 13 MR. OCHOA: That's your co-pay? Okay. I'd 14 have to speak to you specifically, 'cause I don't know how 15 many prescriptions you're ordering or why it's coming out to 16 that amount. So -- but you're correct, all you would have 17 to pay is the co-pay for the mail order. 18 MS. MEEKER: Four or five times more than it 19 was last year. 20 MR. OCHOA: Was there any other concerns 21 that -- that have not been addressed? 22 COMMISSIONER WILLIAMS: Well, a follow-up 23 question here I want you talking about. If you do whatever 24 it is you were going to do as an override of somebody's 25 system to accommodate some people who have medication needs 1-5-05 emg 18 1 now with their local pharmacist, I assume you're talking 2 about any and all pharmacists in this area? 3 MR. OCHOA: That's correct. 4 COMMISSIONER WILLIAMS: And, secondly, when 5 the pharmacist is finally able to find somebody that knows 6 about Kerr County, are they also going to be able to find 7 out what the co-pay is? My pharmacist told me, not only can 8 I not get in, I can't tell you what your co-pay is. 9 MR. OCHOA: And that's correct, because the 10 company that we use, Express Scripts Incorporated, once they 11 load the information into their system -- all pharmacists 12 have a connection, so when they run it through on their 13 computer when you're in their system, Express Scripts, it 14 comes back with the information that tells them exactly what 15 you charge for that medication. 16 COMMISSIONER WILLIAMS: Instead of loading in 17 a half a dozen or a dozen names of people who have some 18 immediate needs, why can't you just load the whole damn 19 bunch in, get it done with? 20 MR. OCHOA: Well, that will happen by Friday 21 morning. Everybody will be there. Our -- the way our 22 process works, once enrollment is -- is loaded into our 23 system, the file then takes 24 hours for it to roll over 24 into Express Scripts, so it does take an additional day for 25 everybody else to show up in the pharmacy system after they 1-5-05 emg 19 1 show up in our enrollment system. And what we're doing is, 2 those people who have an urgent need for that medication, 3 what we're doing is we're jumping those ahead of the rest so 4 that they can get their medication this evening. 5 COMMISSIONER BALDWIN: Mr. Ochoa, I have to 6 admit to you that us folks up here in Kerrville are 7 small-town, and we're -- some of us are a little bit 8 backwards and some of us are a little bit slow and that kind 9 of thing; not near as smart as big-city people. And I'll 10 admit that. But what really, really ticks me off is the 11 fact that County employees are paying good, hard-earned 12 money for something they're not getting a service for. And, 13 talking about right and wrong, that's wrong. Big-time 14 wrong. 15 MR. OCHOA: Yes. And I -- I agree with you 16 that having your employees have to pay out of their own 17 pocket is not a right thing. And I can assure you that we 18 will make sure that they get reimbursed in a timely manner, 19 and that from -- moving forward, that things will run 20 smoothly. And, like I said, I have been on the phone with 21 all these different departments, pushing them, making sure 22 that gets done, letting them know how top-priority it is 23 that they get it done. And they've assured me -- all of 24 them have assured me that they are going to get this done. 25 COMMISSIONER LETZ: I guess my problem is, 1-5-05 emg 20 1 why did you sell the County a plan that you couldn't 2 implement on time? I mean, you're -- we're not talking 3 about the 3rd. Okay, you had a cold day on the 3rd; on the 4 3rd you couldn't get to the office. We're talking about the 5 8th when we got this fixed. I mean, you promised us, both 6 companies, that we would be up and running basically by the 7 31st. 8 COMMISSIONER WILLIAMS: Seamlessly. 9 COMMISSIONER LETZ: Seamlessly, no problems 10 at all. So, I mean, you all have totally failed to live up 11 to your end of the obligation. 12 MR. OCHOA: And that is exactly what we had 13 hoped for, that everything would be up and running. But, 14 because of things that -- that we could not control, we were 15 not able to complete that -- 16 COMMISSIONER LETZ: You could control them. 17 You didn't have to wait until the day of a possible ice 18 storm on January 3rd to do the information. This should 19 have been done before Christmas. 20 MR. OCHOA: I agree with you. And there was 21 other things that happened prior to that. I don't have all 22 the information and all the things that held things up, but 23 I do know that we were hoping to have everything done in 24 time. And it's just -- there's a lot of -- 25 COMMISSIONER LETZ: But my problem is, you 1-5-05 emg 21 1 didn't say, "We hope we can do it." You said you will do 2 it, and you didn't do it. 3 MR. OCHOA: Yes, sir, I understand. 4 MS. THOMPSON: Are we still able to use Lab 5 One, or is all our lab work going to go against our 6 deductible now? 7 MR. OCHOA: Her question is in reference to 8 Lab One. We mentioned that also in the enrollment meetings. 9 You don't have the Lab One program any more; however, you 10 can use the labs that are part of the Texas True Choice 11 network. And we have -- that benefit pays the same as it 12 did with Lab One. 13 COMMISSIONER LETZ: If I'm not mistaken, at 14 the last meeting, when the other Mutual of Omaha guy was 15 here, he said Lab One was going to be used. 16 MS. MCELHANNON: Sure did. 17 COMMISSIONER WILLIAMS: Lab services -- 18 COMMISSIONER LETZ: He said Lab One will be 19 the same as it was. I mean, no change. 20 COMMISSIONER WILLIAMS: There's more than one 21 lab in this town. 22 SHERIFF HIERHOLZER: And C.P.O. would not 23 cost anything either. 24 COMMISSIONER WILLIAMS: I use C P.O. What do 25 you use? 1-5-05 emg 22 1 MR. OCHOA: Is that correct? I didn't know 2 about that. 3 MR. WALLACE: Yeah, I checked on that for 4 somebody. 5 MS. THOMPSON: So, Lab One is still in 6 effect? 7 MR. WALLACE: At 100 percent, yes, ma'am. 8 JUDGE TINLEY: There's no separate deductible 9 for it? 10 MR. WALLACE: No. 11 JUDGE TINLEY: Okay. 12 MR. EMERSON: I have a procedural question. 13 MR. OCHOA: Sure. 14 MR. EMERSON: I have an employee whose spouse 15 was preapproved -- 16 COMMISSIONER WILLIAMS: Can't hear you, Rex. 17 MR. EMERSON: I have an employee whose spouse 18 was preapproved and scheduled for surgery Friday morning. 19 Is there going to be an issue with that? 20 MR. OCHOA: No. As a matter of fact, that 21 particular employee has been in contact with me already, and 22 there will be no problem. The hospital has the information 23 that they need. And I've also informed him that if the 24 doctor or the hospital need any more information on where to 25 file the claim and how it's going to be paid, that they can 1-5-05 emg 23 1 contact me directly. So, no, there will be no problem with 2 that. 3 MR. EMERSON: Thank you. 4 COMMISSIONER WILLIAMS: There better not be, 5 'cause I have a preapproved surgical procedure scheduled 6 next week as well. 7 MR. OCHOA: You shouldn't have any problems 8 at all. 9 COMMISSIONER WILLIAMS: Let us hope that's 10 the case. 11 MS. MCELHANNON: But we will get reimbursed 12 for the two weeks, right? 13 MR. OCHOA: Two weeks? 14 MS. MCELHANNON: Mm-hmm. 15 MR. OCHOA: Anything that you -- any services 16 that you might have had, are you talking about? 17 MS. MCELHANNON: No, I'm talking about the 18 medication. 19 MR. OCHOA: The medication, yes. You'll get 20 -- if you paid for a medication out of your pocket and you 21 file a claim, we'll reimburse you. 22 MS. MCELHANNON: And we'll be able to do -- 23 send all our medications in Friday, and in two weeks they're 24 going to be here? You promise that? 25 MR. OCHOA: Two weeks is the time that they 1-5-05 emg 24 1 tell us -- Express Scripts -- that it takes for the 2 processing, and that's the -- that's coming from them, that 3 in two weeks time, you will have your medication. 4 COMMISSIONER WILLIAMS: I don't understand 5 that two weeks business. Aren't you transferring electronic 6 files to these people with names? 7 MR. OCHOA: We are, but that's Express 8 Scripts. That's the information they've -- they've given 9 us, and I don't know why it takes them that long. 10 COMMISSIONER WILLIAMS: Pony Express can do 11 better than that. 12 MS. THOMPSON: I talked to somebody at 13 Wallace and Associates yesterday, and she told me that it 14 would be two to three days for them to process. 15 MR. OCHOA: And I believe -- 16 MS. MCELHANNON: Can't they overnight stuff? 17 MR. OCHOA: I believe -- actually, I think 18 you do have the option of overnighting, but that would be at 19 your cost, 'cause they use regular mail. But it is two to 20 three days once you're in the system. So, the -- 21 MS. THOMPSON: That's not what we were told. 22 MR. OCHOA: The first time that you sign up 23 for the mail-order program, the -- it takes about two weeks 24 for you to be in the system. Then, after that, after your 25 first 90-day supply has been used and you just want to get a 1-5-05 emg 25 1 refill, the refill is processed within two to three days. 2 So, there might have been some miscommunication. We 3 apologize for that. But that is -- the first time it does 4 take a little bit longer. 5 MS. MEEKER: Gentlemen? 6 JUDGE TINLEY: Ms. Meeker? 7 MS. MEEKER: I've thought from the beginning, 8 and I told all of you, this is poor planning. And I'm 9 sorry, but I have to say, for myself, a vote of no 10 confidence. And I think this is just the beginning. 11 MR. CASTILLO: I have one question. Brad 12 Alford here just mentioned something. I'm curious as to 13 where Commissioner Williams is going to get his 14 reimbursement from. If he's had -- he has the $600 plan or 15 whatever, will he get his reimbursement out of that $600, as 16 a penalty? 17 MR. OCHOA: As a matter of fact, I think 18 you're talking about the health reimbursement account. And 19 those debit cards will be -- they told us it would take two 20 weeks for the -- for them to get those processed in and to 21 you. And if you were wanting to use that $600 towards a 22 procedure that you're going to have in the next few days, or 23 that you had already, you can file a claim, just the same 24 way that you would after you use your debit card where you 25 send in your explanation, proving that it was a medical 1-5-05 emg 26 1 expense. You can also use that towards your health 2 reimbursement. 3 MR. ALFORD: That's not my question. My 4 question is, who's going to eat the cost on all these 5 overcharges right now? Prescriptions, who's going to eat 6 the cost on it? Mutual of Omaha or Kerr County? 7 MS. MCELHANNON: Employees. 8 MR. WALLACE: He's going to get all his money 9 back except the co-pay. 10 MR. OCHOA: Correct. 11 COMMISSIONER WILLIAMS: Which I understand 12 that. 13 MR. WALLACE: Except the co-pay. Is that 14 your question? 15 MR. ALFORD: Yes. It doesn't come out of the 16 $600 or anything else? 17 MR. WALLACE: Not unless he -- 18 (Court reporter interrupted and asked everyone to speak one at a time.) 19 20 MR. ALFORD: That was my question, was who is 21 going to take -- assume the cost of it, period? Does it 22 have to come out of the $600, or is this something that 23 Mutual of Omaha -- all the pharmacies and all that stuff? 24 MR. OCHOA: Okay. On a prescription, if you 25 paid out of your pocket for the prescription, they will 1-5-05 emg 27 1 reimburse you, minus your co-pay. Now, that is separate 2 from whether or not you wanted to use your health 3 reimbursement account. 4 COMMISSIONER WILLIAMS: Okay, hold it right 5 there. That's what the gentleman wants to know about. So, 6 if he wanted to use his reimbursement account from the 7 get-go to take care of his co-pay, and all this is not set 8 up, that means it's out of his pocket. How -- how does he 9 recover that? Is that your question, Brad? 10 MR. ALFORD: Yes, sir. Thank you. 11 MR. OCHOA: Okay. You would file a regular 12 form to get that reimbursed to you. So, it's just like a 13 claim, and you would get that back minus your -- and if you 14 wanted to use that -- the health reimbursement to pay for 15 the co-pay on your medication, then we'll file a form to 16 where they take that from that. 17 MR. ALFORD: No, I don't want to right now. 18 I want to save that. My question is, where we normally go 19 in and pay $40 for a refill, we're having to pay $120. Who 20 is going to cough up the other $80? 21 MR. OCHOA: We're going to reimburse you. We 22 will reimburse you. 23 MR. ALFORD: Kerr County will never see this 24 $80 again? They don't have to worry about y'all -- 25 MR. OCHOA: No, that goes directly to you. 1-5-05 emg 28 1 If you pay for your medication, we're going to reimburse 2 you, minus the $40. 3 MR. ALFORD: I understand. I'm just asking 4 who's going to eat the $80, Mutual of Omaha or -- 5 MR. OCHOA: Yes, we're the ones that 6 reimburse you, Mutual of Omaha. 7 MR. ALFORD: Thank you. 8 JUDGE TINLEY: Okay. Mr. Wallace? 9 MR. WALLACE: Well, I'd just like to say, 10 I've been doing this 18 years, and I have never had a plan 11 implemented that ran 100 percent smooth. There's nothing 12 going to run 100 percent smooth, you know, whether it's a 13 large group or a small group. There were some delays. One 14 of the problems we had in getting everything going, we 15 had -- I don't know if you know much about contracts, but 16 until we got the contract signed and got a check, the 17 contract was not legal until we got a check and got it 18 signed. So, once we got that, we got hard to work to try to 19 get everything going. I don't remember the dates on all 20 that. 21 COMMISSIONER WILLIAMS: Does that mean you 22 didn't start on the process -- 23 MR. WALLACE: No, we -- 24 COMMISSIONER WILLIAMS: -- and enroll these 25 people until you got a check in-hand? 1-5-05 emg 29 1 MR. WALLACE: No, we were working on it. We 2 were having enrollment meetings prior to that. But until 3 that was finalized right there, you know, it wasn't 4 100 percent implemented. And the -- the contract is not a 5 contract until you have a check in-hand. 6 COMMISSIONER LETZ: I go back to the what I 7 said before. Why did you tell us you could do it in this 8 time frame if you couldn't? You never mentioned about this 9 -- that we had to expedite the contract. We were told that 10 this would be up and running, and this was December 8th or 11 thereabouts. We were told if we accepted y'all's low bid, 12 it would be up and running seamlessly by the first of the 13 year. You know, you shouldn't make statements that you 14 can't back up. And, clearly, you all couldn't back up the 15 statements when you sold us. 16 MR. WALLACE: Commissioner, I understand 17 where you're coming from, but there were some unforeseen 18 problems, and -- that Mutual of Omaha encountered, and -- 19 and there was nobody that could control some of those. We 20 -- we did everything we could to get it up and running, get 21 everybody enrolled. We still have people that haven't 22 turned in applications. We had -- I think Jaime said about 23 40 that we were trying to run around and try to get. 24 COMMISSIONER LETZ: Well, that goes back 25 also -- I just brought up this thing -- Commissioner Baldwin 1-5-05 emg 30 1 brought up about some that are lost. One of the people that 2 was lost, 'cause I know they're on the list still, turned in 3 their application. And I'm quite confident that that person 4 didn't just say they did it. It's one of our department 5 heads. 6 MR. WALLACE: Sure. 7 COMMISSIONER LETZ: You know. So, I mean, 8 again, it was not the County or the County employees' fault. 9 It was somewhere in your system or Mutual of Omaha, it got 10 lost. 11 MR. WALLACE: Right. I -- 12 COMMISSIONER LETZ: So, you know, if you're 13 going to penalize -- you can't use that as an argument as to 14 why it was delayed when it was y'all's fault that it is 15 delayed. 16 MR. WALLACE: I don't know how many -- I 17 don't know. Mutual of Omaha took all the applications and 18 started processing them, and if there were some -- I don't 19 know. But -- 20 JUDGE TINLEY: Sheriff? 21 SHERIFF HIERHOLZER: I've heard Mr. Wallace 22 make the comment that none of them go smoothly, regardless 23 of what county or what size of the deal. The only thing 24 that I think I'd like to say for my employees is, I've been 25 here with this county 25 years; this is my 25th year, and 1-5-05 emg 31 1 I've seen a number of insurance companies get changed and 2 things go. I never seen one that has had this kind of 3 problem getting implemented. I've never seen one that you 4 have different representatives, whether it's from Mutual of 5 Omaha or the third-party administrator type -- Mr. Wallace 6 that had given the employees different answers to the same 7 question, and caused nothing but mass confusion and failed 8 to -- to inform the employees of everything that was going 9 on. And, personally, I'm real close to being like what 10 Billie said. I hope this isn't an idea or a sample of what 11 kind of service this County's going to get. But, as far as 12 low confidence in this group right now -- and I can't say 13 it's Mutual of Omaha's fault or Mr. Wallace's, but it's 14 somewhere in there. And I'm kind of like Buster; I don't 15 think this plan's going very well, and I hope this isn't a 16 sample of what kind of service we're going to have for the 17 next year. And that's -- I'm saying that on behalf of my 94 18 employees. 19 JUDGE TINLEY: Any member of the Court have 20 anything further with respect to this particular issue? 21 COMMISSIONER LETZ: I think the only comment 22 I have, Judge, would be that I think on Monday's agenda, 23 which I know we're past posting, I think we need to add it 24 as a late item or whatever, this same topic, and we 25 either -- for consideration, whether we're going to continue 1-5-05 emg 32 1 insurance with Mutual of Omaha or not. And I'll add the 2 County -- let the County Attorney look into it from the 3 standpoint of, you know, we've not -- well, we're as of the 4 6th, and we still don't have what we paid for, and we have 5 paid for the month of January already. What are our rights 6 as a county of opting out and changing? 7 COMMISSIONER BALDWIN: I beg your pardon, 8 Commissioner. It's the 5th. 9 COMMISSIONER WILLIAMS: It's the 5th. 10 COMMISSIONER BALDWIN: Not the 6th. 11 COMMISSIONER LETZ: It's going to be the 8th 12 before we get on the plans. 13 COMMISSIONER WILLIAMS: How about the 10th? 14 COMMISSIONER LETZ: But, anyway, I think on 15 Monday's agenda on the 10th, I think we need to have the 16 same discussion, because it's unacceptable. Okay, that's 17 all I have. 18 COMMISSIONER WILLIAMS: Anybody in this room 19 who needs to have their name added to this list for 20 expeditious handling should tell this gentleman. 21 MR. OCHOA: Yes, I'll be glad to take your 22 name after the meeting. And, again, this is when you need 23 something on an urgent basis, because remember, within two 24 days everybody will be in the system. 25 SHERIFF HIERHOLZER: Well, to get the people 1-5-05 emg 33 1 out of 94 employees -- 95 I have, we're going to have to 2 make a lot of phone calls today to find out who all besides 3 about five that I know of have not been able to get their 4 prescriptions and have to pay out of their own pocket to try 5 and get them on that list. I think that's totally 6 unnecessary work that this County's having to go through to 7 do y'all's job. 8 MR. OCHOA: And, again, we do apologize for 9 any inconvenience. And, like I said, we -- we are 10 definitely committed to making sure that it runs smoother. 11 And, like we said, there was some unforeseen things that 12 were out of our control, and we want to take care of all of 13 the issues and make sure that everybody is reimbursed any -- 14 any money they were out. 15 JUDGE TINLEY: Anything further from any 16 member of the Court? 17 COMMISSIONER BALDWIN: No, sir. 18 JUDGE TINLEY: Thank you, Mr. Ochoa. 19 COMMISSIONER NICHOLSON: I'll just say to 20 Mr. Ochoa, he's a very courageous man. You could tell that 21 there's a -- a lot of concern among our employees, and I 22 would encourage you to go the extra mile to get it fixed. 23 MR. OCHOA: Yes. And that's -- as far as my 24 commitment, I am the account executive on this account, and 25 so I -- I come on the service side. So -- and that's why I 1-5-05 emg 34 1 give out my number to anybody who needs help on anything; 2 they're welcome to call me. As a matter of fact, the number 3 I give is my cell phone, so -- 4 COMMISSIONER WILLIAMS: What is that number, 5 Mr. Ochoa? 6 MR. CASTILLO: It's area code 512, 797-1343. 7 COMMISSIONER WILLIAMS: 1343? 8 MR. OCHOA: Yes, sir. 9 COMMISSIONER BALDWIN: What about a home 10 number? No. 11 COMMISSIONER NICHOLSON: Well, as a matter of 12 fact, that is my home number. 13 COMMISSIONER BALDWIN: I see. Let's test 14 him. 15 JUDGE TINLEY: Anything else, gentlemen? 16 We'll stand adjourned. 17 (Commissioners Court adjourned at 2:39 p.m.) 18 - - - - - - - - - - 19 20 21 22 23 24 25 1-5-05 emg 35 1 STATE OF TEXAS | 2 COUNTY OF KERR | 3 The above and foregoing is a true and complete 4 transcription of my stenotype notes taken in my capacity as 5 County Clerk of the Commissioners Court of Kerr County, 6 Texas, at the time and place heretofore set forth. 7 DATED at Kerrville, Texas, this 6th day of January, 8 2005. 9 10 11 JANNETT PIEPER, Kerr County Clerk 12 BY: _________________________________ Kathy Banik, Deputy County Clerk 13 Certified Shorthand Reporter 14 15 16 17 18 19 20 21 22 23 24 25 1-5-05 emg