Problem state health exchange cases earn one-on-one attention

By Crystal Kang

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Nine months after the Affordable Care Act exchanges opened and five months into the new calendar year, problems continue at the state level, namely persistent “system error” messages.

As many as 5,784 customers identified as having incorrect tax credits or subsidies, according to a report by Access Health CT, the state-run online health insurance exchange.

The health exchange, which provides consumers with instant quotes, subsidies and health insurance options, estimated that 80 percent of the setbacks were due to a computer system glitch and 20 percent were attributed to a user error. The errors are now being addressed individually.

When consumers first enroll for health insurance online, their information is coded in an “834 form” by the health exchange, which the federal government and insurers use to assess and verify how much tax credit a person is entitled to receive, said Kathy Walsh, principal examiner of the Connecticut Insurance Department. Often, when customers try to correct an existing application with changes in their eligibility status that says they now qualify for subsidies, an error message indicates that incorrect information was filed.

“When the exchange enrolls someone, they send an 834 transaction (benefit enrollment and maintenance document) to the insurance companies to set up enrollment in their systems,” Walsh said. “But when someone files a change in their enrollment, the carriers can’t change people’s subsidy amounts unless it’s first authorized by the federal government through the exchange. All the transactions are generated from the exchange, so it does need to be corrected and done online.”

About 3,900 customers using Access Health CT were told they qualified for Medicaid when they did not. And an unknown number of customers got bills from their insurance companies that were more than what they expected and owed. About 903 customers were dropped by their insurers and they are in the process of being re-enrolled.

“We are working through each transaction individually with a phone call to apprise them of the change, ensure those who are eligible for insurance are given the opportunity to purchase it, and that they understand the options available to them,” said Kathleen Tallarita, government and public affairs outreach manager at Access Health CT. “The 3,900 consumers include some applicants that currently have the correct eligibility based on an income change; however, AHCT is doing our due diligence to confirm with everyone who was impacted and make sure they receive what they qualify for.”

Despite the upheaval and confusion caused by the exchange, consumers continue to enroll without penalty for Access Health CT, even after the March 31 deadline had passed.

About 247,000 consumers have signed up for insurance through Access Health CT as of July 6, Tallarita said. Of that number, 77,300 enrollees had enrolled and then dropped out due to not paying their premiums, or moving into Medicaid with an income change or starting a job that provides insurance. About 170,009 members signed up or renewed their Medicaid coverage through the exchange.

Nearly 78 percent of the people who purchased insurance through Access Health CT received some subsidies. Individuals could choose an insurance plan that offered subsidies, while others could be directly eligible for Medicaid, which is its own program.

Tallarita said Access Health CT plans to begin extensive training and education programs for brokers, assisters, application counselors and clients, so that everyone understands how best to use the system. It also plans to train its own employees and call center workers to answer technical questions for its clients.

“AHCT is continuing that effort as we find that training and education is the most critical aspect of helping people use our system to get the coverage for which they are entitled and desire,” Tallarita said. “During last year, we had close to 300 in-person assisters trained and certified. We have several hundred trained and active brokers.”

The state Insurance Department has licensed four new ACA-Obamacare insurers: HealthyCT, a new nonprofit that sells individual and small-group plans on and off the exchange; ConnectiCare Benefits Inc., a subsidiary of ConnectiCare that sells individual plans on the exchange; Harvard Pilgrim Health Care, which plans to start selling plans next year; and HPHC Insurance Co., a Harvard Pilgrim subsidiary that is marketing small group plans.

A new carrier — United HealthCare — will join in providing individual plans on the health exchange for the first time, said Donna Tommelleo, Connecticut Insurance Department spokeswoman.

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About the author

Crystal Kang
Crystal Kang, a Chicago native, is former a reporter for the Fairfield and Westchester business journals. She is a graduate of Columbia Journalism School and her work has appeared in news outlets including CNBC.com, Allstate Corporation’s investor relations website, and an NPR-based radio station in Urbana, Ill.

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