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Public commenter urges audit of county health-plan billing; benefits staff say coding error reversed
Summary
A Walworth County resident asked the Human Resources Committee to audit the county's contract with HPS after receiving repeated bills for a colonoscopy he says should have been fully covered; benefits staff said the provider coded the procedure as diagnostic, Augsian processed a reversal on 2026-05-12, and staff will follow up if the June statement still shows a balance.
Scott McClory urged the Walworth County Human Resources Committee to complete and publish a full audit of his health-plan case and the county's contract with HPS, saying repeated bills and text-message collection notices have strained his household.
"I hereby respectfully request this committee to complete and publish the full audit of my case, forward to the full board, hold responsible those persons who were involved, and get necessary changes implemented immediately so it doesn't happen again," McClory told the committee during public comment. He said he has contacted human resources more than 10 times about a procedure he understood to be 100 percent covered.
Josh Pollock, the committee's benefits staff, told members he investigated McClory's claim after receiving a letter and traced the problem to how the provider coded the encounter. "Preventive is usually covered at 100 percent," Pollock said. "If it's coded as diagnostic, then there's going to be an employee responsibility because it's no longer preventive." He said Augsian, the county's third-party administrator, worked with the provider and that a reversal was processed on 2026-05-12; he expected the June statement to show a $0 employee responsibility.
Pollock described common idiosyncrasies in provider billing and coding and said the county's plan and its administrator have limited control once a provider submits its coding. He offered to continue working directly with McClory if the June statement still lists a balance.
Committee members pressed staff about how frequently this occurs and whether the county should pursue other vendors. Deputy Director Alicia Van Dyke (present earlier in the meeting for a grant discussion) and benefits staff said the issue is not unique to HPS and that coding disputes can arise across networks; Pollock said the county's third-party administrator historically adjudicates claims and that this case appears to have been resolved in the system.
The committee did not take formal action on the complaint at the meeting; staff said they would confirm that the reversal appears on McClory's June statement and follow up with him.
The meeting record also shows correspondence from McClory was placed on the agenda and read into the record.
