HealthChoice Claim Challenges Declining

After six months of working to resolve problems, the HealthChoice claims backlog is beginning to decline. Issues with the new claims processor, EDS, caused the agency to fall months behind in paying claims.

“It is important to remember that the problem was not caused by the state employees who work at OSEEGIB, but a contractor of the agency that administers HealthChoice claims,” said OPEA Policy and Research Director Trish Frazier. “This part of the agency was privatized several years ago and the new corporate vendor was not up to the task.”

State employees reported long wait times or being cut off while waiting to talk to a claims representative. According to HealthChoice, who has been monitoring the contractor’s performance, customer service wait times have been reduced significantly. Since beginning claims payment at the end of January, EDS has processed a total of 1.76 million claims with payments totaling $270 million.

Over the past six months OSEEGIB employees have been working to help the contractor resolve issues, spending additional hours on site.

OPEA Member Problems Resolved Quickly

One of the benefits of OPEA members is help with state health insurance programs. This has proved invaluable to OPEA members during the problems with the EDS claims processing issues.

OPEA helped resolve OPEA member Mike Zaleski’s claim problems. After a sudden illness while traveling in Texas, Zaleski was faced with over $150,000 in medical bills. Providers were threatening to send his bills to a collection agency. Within a week after he called OPEA, the total had been reduced to $3,700 and threatening bills no longer appeared in his mailbox.

“My OPEA membership is well worth $15 a month,” Zaleski told co-workers during a recent OPEA recruitment visit to his office. “OPEA’s help was invaluable. It’s a great relief to have this resolved.”

“OPEA has been working with members at the agency to resolve our member problems with the processor,” said Frazier. “Since January, I have talked to hundreds of members about this issue and sent some of their problems on to our members at HealthChoice for resolution.”

OPEA members who still have unresolved problems with HealthChoice claims processing should call and talk to Trish at the OPEA office, or e-mail her at

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