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Athens resident urges council oversight after delays and denials by city health‑plan administrator
Summary
A city resident and covered dependent described extended delays, reversed approvals and out‑of‑pocket costs tied to biologic medications under the EBSC‑administered city plan, urging council to scrutinize vendor approvals and ensure benefit continuity for employees and dependents.
At the March 2 meeting Grayson Schultz, a city‑employee spouse and covered dependent, addressed council for about three minutes to describe prolonged problems obtaining biologic medications under the city's health plan administered by EBSC (employee benefit service center) and its pharmacy‑benefit manager TrueScripts.
Schultz recounted months‑long delays, reversed approvals and difficulty coordinating between EBSC, TrueScripts, the specialty pharmacy and the treating provider, which Schultz said produced serious health and financial harm. "My rheumatologist put in her officially documented notes on July 11th, 'This is a documentation of the fact that this company is obstructionist and unethical,'" Schultz said, attributing the quoted line to the rheumatologist's notes that were included in Schultz's written submission. Schultz said approvals were issued and then reversed and that in 2025 they did not receive a first dose until May 9, after more than 80 hours spent coordinating calls.
Schultz said the delays resulted in new spinal damage, worsened mobility requiring purchase of a wheelchair, and $38,550 in financial impact in 2025 alone. Schultz asked council to require more scrutiny of vendor performance and to attach accountability when the city approves EBSC as the plan administrator so "no employee or dependent is cut off from essential life‑preserving care."
Council members received the comment; no formal action was taken during the meeting. Several members suggested the council and administration should ensure vendor performance is monitored and recommended staff follow up with HR and potentially bring options for increased oversight or alternative vendor arrangements if problems are systemic.
