Flaw in health care exchange makes it tedious to change information

The number of people having difficulty completing their enrollment in Vermont Health Connect is dropping, but the problems are taking longer to solve, state officials say.

About 2,500 people who sought to have coverage effective Jan. 1 remain stuck in the enrollment process.

The main culprit in the delay is that the “change of circumstance” function — if a user needs to update their information — is still not functional and must be done manually.

Mark Larson, commissioner of the Department of Vermont Health Access

Mark Larson, commissioner of the Department of Vermont Health Access

As people progress through the exchange toward enrollment, it becomes more time consuming to enter those changes manually, said Mark Larson, commissioner of the Department of Vermont Health Access.

That’s because there is no option for users to change their information online and make it accessible to the insurance companies or the entity that processes invoices.

If someone who has picked a plan but has yet to make a payment, or be enrolled in that plan, needs to make a change, then it only needs to be changed in the state’s system, Larson said.

However, once that person has made a payment or been enrolled in their coverage, that same change has to be made manually in the invoicing contractor’s system and the insurers’ system, which drags out the process, he said.

“Many of the people who are having a difficult time now are doing so because of a change of circumstance,” he said.

Digitizing that process and making it automatic across the entities who handle that information is his department’s top priority, Larson said.

Trinka Kerr, Vermont’s health care advocate, said her office is hearing complaints.

“It used to be when we contacted the state, and said, ‘Oh, here’s a mistake,’ it could be corrected in an hour,” she said. “Now it’s like days or weeks for things to be fixed.”

Her office has seen a 30 percent increase in calls last month over January 2013, according to figures provided by Kerr.

“We’re being overwhelmed now,” she said, “The system appears to be so clunky, that even when everybody knows what’s supposed to be happening for the individual, it’s really hard to fix it.”

VHC update

Last month, the administration allowed the two insurers in the exchange to directly sign up small businesses through March 31. Individuals who wish to be covered on April 1 should sign up through Vermont Health Connect by March 15.

The extension for small employers gave the state greater ability to focus its attention on individuals who need to sign up for exchange coverage by that time.

There are more than 24,000 Vermonters who picked a plan using the exchange website seeking individual plans effective Jan. 1, according to figures presented to lawmakers late last week by the Department of Vermont Health Access. Roughly half of those individuals qualified for Medicaid.

Of the more than 12,000 who picked a Vermont Health Connect plan and didn’t qualify for Medicaid, more than 10,000 are fully enrolled in 2014 health care coverage.

That leaves more than 2,500 people seeking coverage effective Jan. 1 on Vermont Health Connect who are still mired in the process.

By the administration’s own estimate, there are roughly 4,500 individuals mandated to have coverage through Vermont Health Connect who have yet to begin the enrollment process.

Kerr said she’s concerned about what will happen this month when a contingent of newcomers start at square one.

“I really thought the state would be farther along at this point,” she said.

Kerr listed other problems people are experiencing with the exchange, such as denials or incorrect subsidies due to eligibility mistakes, incorrect start dates for coverage and difficulty switching or dropping plans when someone is enrolled inappropriately.

Refugees continue to be denied exchange coverage due to lack of citizenship, she added.

“It’s much harder now to untangle what the problem is,” she said, adding that sometimes a person has several problems with their application or coverage, and it can be hard to identify what’s gumming up the works.

“It’s really frustrating for the consumer,” Kerr said.

Morgan True

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