Tribe changing health benefits administrator

By Danielle Harrison

Smoke Signals editor

The Confederated Tribes of Grand Ronde is transitioning away from Redmond-based Shasta Administrative Services as the third-party administrator for its employee and Tribal member health plans.

Tribal Human Resources Director Sarah Harvey sent out an all-employee email on Wednesday, Feb. 21, regarding the change.

“Over the last year or so there have been issues with Shasta’s ability to timely process claims resulting in customer complaints and loss of revenue,” Harvey said. “In 2023, we heard from several members and employees that their medical claims were not being processed. This was the result of a problematic software conversion Shasta made which caused them to fall behind. As a result, some of our employees and members report they have lost their doctors or (were) sent to collections. In the end, we feel this decision is one that is in everyone’s best interest.”

The Tribe will instead utilize the services of Wisconsin-based Forest County Potawatomi Insurance Department as its third-party administrator. Harvey said that transition is expected to be complete by mid-summer.

According to its website, Forest County Potawatomi specializes in benefits administration services for Tribal nations, focusing on utilizing federal resources available to Tribes and thus minimizing Tribal dollars spent. The benefits administration includes claim processing for medical, dental, vision, optical and prescription plans.

When asked if employees and Tribal members could expect timely claims processing with the new administrator, Executive Director of Health Services Kelly Rowe said yes.

‘They have very high rates of claims processing and are good at what they do,” she said. “We’re hoping the transition will be as seamless as possible.”

Finance Officer Chris Leno, who serves as a trustee of the employee health plan, said the Tribe has been considering a different third-party administrator since late 2022.

“We want good customer service on the employee side and the Tribal member side, and efficient, timely claims processing,” he said.  

Harvey added that with 7,000 people covered on both the employee and Tribal member plans, the Tribe will remain involved with Shasta during the transition.

“The Tribe is interested in the successful administration of claims under our plans and will be involved until we have transitioned to a new TPA,” she said. “They (Shasta) have caught up on claims for the most part and most of their software issues have been resolved.  However, the company has lost clients and is in financial hardship.  They have largely relied on loans from (Tribally-owned business) Upqwena to fund operational expenses it cannot cover.”

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On the business side, the Tribe still owns 51% of Shasta, purchased in November 2012 with Hawaii-Western Management Group, which owns 49%. The purchased price was not disclosed.

Then-Tribal Economic Development Director Titu Asghar said the purchase made sense in the Tribe’s pursuit of diversifying its non-gaming businesses because the company was already processing claims for the Tribe’s self-funded health plans.

“Since that time, Shasta has achieved steady growth and maintained our reputation of integrity, quality, value and service at a competitive price,” the company states on its website.

The Tribe has made several loans to Shasta through Upqwena since 2022 to help the company with ongoing operational expenses and alleviating backlogged claims. To date, it has provided nearly $1.6 million. Shasta is required to pay back the loans in full.

In Oct. 2023, then-Tribal Economic Development Manager Bruce Thomas said that the Tribe was seeking to sell Shasta.

 “We’re exploring that,” he said. “It’s an industry where efficiency and economies of scale are critical. And what’s happening is that industry is consolidating with bigger and bigger operators. It’s hard for us with the number of clients that we have with that organization to really generate the profit we were hoping for.”

Tribal Communications Director Sara Thompson said Shasta has not yet been sold. 

“There was a prospective buyer last fall but it withdrew after completing its due diligence,” she said. “Others have expressed interest in acquiring Shasta but no formal offer has been received from them.”

Employees are asked to contact Benefit & Risk Manager Tammy Gould at 503-879-2031 for more information.

Tribal members with questions about Skookum coverage should call Health Benefits Specialist Barbara Steere at 503-879-2487 or Business Office Manager Melody Baker at 503-879-2011. 

Additionally, a Shasta update meeting was held in executive session for Tribal members only on Tuesday, Feb. 20.

All questions about claims can be directed to Shasta at 1-800-880-5877. Updated insurance cards will be sent out when the Tribe completes its transition to the new third-party administrator.