Access to VHC difficult for navigators and patients alike

About 70 navigators and brokers have had trouble accessing their Vermont Health Connect accounts since the start of open enrollment earlier this month, making it difficult for them to help people sign up.

Security upgrades made during the two months the state’s health exchange was offline caused some navigators to lose access to their accounts, said Sean Sheehan, a spokesman for VHC.

The changes added an additional step to the login process, and some accounts were frozen due to inactivity while the site was offline.

Last week, navigators raised concerns that it was taking too long to regain access, Sheehan said. VHC workers and contractors changed their process, he said, and issues can now be resolved within a day of being reported.

The exchange is functioning better this time around, but the application process — not to mention choosing an insurance product — can still be difficult and time consuming, according to stakeholders.

Many people rely on navigators to complete the enrollment process or make changes to their coverage.

It’s especially important for navigators working in free clinics and community health centers to have access to the system, because they’re often assisting people who need medical services but don’t have health coverage.

Volunteer navigators at the Bennington Free Clinic were among those who lost access to their accounts. It wasn’t until this week that those issues started to be resolved, according to interviews and emails obtained by VTDigger.

In an email to state officials Monday, Sue Andrews, the clinic’s director, tells a state official that she is “beyond frustrated” with VHC. Nine days into open enrollment, her volunteers still couldn’t login to the system, she wrote.

Her email describes the stress that lack of access for the clinic’s volunteer navigators has created in patient’s lives.

The clinic had four appointments Monday morning with people needing health coverage and they were largely unable to help enroll those people through VHC.

One man, a father of five with “frighteningly” high blood pressure, needed access to urgent care and arrived accompanied by his sick two-year-old son. The man had been up vomiting all night, and workers at the clinic gave him an antihypertensive medication and scheduled a follow-up visit with medical staff, according to the emails.

He had just lost his job of many years and needed to enroll in coverage through the exchange. His family had an existing VHC application, but that information could not be used to enroll him in Medicaid, the clinic’s navigators were told.

Andrews had to send him home, sick child in tow, to retrieve the Social Security numbers of each member of his family, so that information could be re-entered in a new application.

“I set up an appointment for tomorrow [a.m.] not knowing if we will be able to enter his information. I will keep my fingers crossed,” she writes.

Andrews told VTDigger on Tuesday that VHC had responded to her concerns and is working with the clinic to make sure the problem is resolved. She declined to provide greater detail on her staff’s access to their VHC accounts.

There are no open service requests from the clinic’s navigators, Sheehan said, and the last communication from navigators to VHC technical staff Monday night reported several navigators were now logged into the system.

The clinic’s medical director, Dr. Richard Dundas, wrote in an email to state officials that he understands VHC is working to fix a difficult situation, and its staff is overwhelmed, but added that, telling patients they’ll have to delay blood work or an X-ray is painful for all involved.

Lawrence Miller, chief of health care reform, was alerted to the clinic’s situation by Bennington County lawmakers looking to help resolve it last week.

Secretary of Commerce & Community Development Lawrence Miller. File photo by Hilary Niles/VTDigger

Secretary of Commerce & Community Development Lawrence Miller. File photo by Hilary Niles/VTDigger

He said Tuesday that he understands the critical role point-of-access navigators provide to people who need medical care but don’t have coverage.

“The free clinics, health centers and other places where Vermonters get care, those are the most important places to make sure they can also get coverage,” he said. “I find what they had to experience very unfortunate and regrettable.”

One lesson from this situation is that communication with navigators must be improved beyond what was done this year, Miller said.

Andrews noted in her email that navigators received “minimal” communication from VHC in the run-up to open enrollment.

That’s partly because the state’s only staffer dedicated to coordinating with navigators left VHC just weeks before open enrollment began, Miller said.

Better training and communication is a “consistent theme” that VHC can improve upon going forward, he said.

There are still many ways that this year’s open enrollment period is a success, according to Donna Sutton Fay, a navigator and director of the Vermont Campaign for Health Care Security Education Fund.

She, too, had trouble accessing her account in the first days of open enrollment, but was able to resolve the issue quickly by calling the assistor help line.

The website is streamlined, its links easier to follow and ultimately take people where they’re meant to, she said. Her team of navigators has been able to enroll new people online, and have had a better experience with the call center.

Fay’s office isn’t housed within a medical facility, so her appointments to help people obtain coverage are more easily rescheduled, she said.

It can still take close to an hour to complete a renewal or new application, and it can take even longer for people with complex applications that need to be done over the phone.

That’s just the time it takes to enter people’s information, and does not include the time it takes to help people understand what their coverage options are, Fay said.

The application questions are far easier to answer correctly this year, especially with a navigator’s help, though some are still not intuitive, she said.

Andrews, at the free clinic in Bennington, was less sanguine about the call center’s ability to resolve people’s enrollment or coverage issues.

Her staff spends hours on the phone with workers at the call center and eligibility unit, many of whom appear “newly trained,” and are unable to give proper guidance, according to her email.

One volunteer was told by a call center worker that an application with urgent medical need couldn’t be fast-tracked, and they had other unresolved cases involving urgent medical need on their desk dating back to August.

The call center worker later got back to the clinic and said workers would be able to enroll the patient within the next few days, according to the email.

Other patients at the clinic are being billed hundreds of dollars more than they owe. They are worried that if they pay less than what they’re being billed, their coverage will be canceled, Andrews wrote.

The navigators’ different experiences could be fueled, in part, by the fact that a free clinic is more likely to see people with pressing medical needs and more complex personal and family situations.

Many households served by VHC have a mix of members who are covered by Medicaid and commercial insurance.

Enrolling or making changes to existing coverage for these families is complicated by the numerous systems in which those changes need to be recorded in order for people to receive the correct bill.

Open enrollment continues through Feb. 15, and VHC had processed 3,588 new applications and 4,415 renewals as of Tuesday.

There are 32,000 existing customers with commercial insurance, most of whom will re-enroll in the coming months, though many will be automatically routed into their same coverage.

VHC and the eligibility unit serve 105,000 Vermonters who are new to Medicaid under that program’s expansion.

Another 36,000 small business employees were enrolled in exchange products directly by insurers last year, and some new companies are likely to purchase insurance for their workers in the coming months.

Morgan True

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  • The problems with the Vermont Health Exchange are why i believe that all Vermont public institutions should have a mandate to first consider Open Source Software.

    I believe an open source solution would have been far less expensive and if properly configured more secure.

    The current choice of expensive commercial software is failing VT.

  • Craig Powers

    Here is what $100 million buys you these days when incompetent bureaucrats are in charge! How can they keep smiling at the public and spinning that the VHC is as good as fixed?

    • Ralph Colin

      Because, Craig, they are politicians. What can you expect of them?

  • Lyle M. Miller, Sr.

    No fix yet? not surprised. Shumlin and company have failed to serve Vermont and need to go.

  • rosemarie jackowski

    The Navigators in Bennington also have another problem. When I talked with them months ago, they were failing to inform people about the ‘clawback’ provision of expanded Medicaid. Their training probably did not include any information about that. Some Vermonters will lose the family home/farm because of this failure.

    The ‘clawback’ provision should be made absolutely clear before anyone signs up. Everyone has the right to an informed choice.

  • Ellen Oxfeld

    This article actually shows that the sooner we get away from the complexities of the private insurance health exchange and move toward guaranteed publicly funded health care, the better off we all will be.

    When people walk into a clinic with dangerously high blood pressure and sick children, and they cannot get the care they need until they enroll in private insurance, then we have a problem.

    Single payer is the opposite of such a system, because it is a publicly funded system in which coverage is guaranteed by virtue of Vermont residency. Act 48 is clear on that, all Vermonters will be covered by Green Mountain Care even if they have other coverage as well (such as Medicare). So, coverage is automatic.

    In a single payer system, payment, in the form of taxes, is detached from individual coverage, which is automatic by virtue of being a Vermont resident.

    Such horrible situations as not being able to be cared for because you had not first enrolled and paid for your enrollment would not happen in a publicly funded system.

    Again, detaching payment from coverage is key — and that is what happens in all public systems. The woes of Vermont Health Connect are a good reason for us to move on to single payer.

    • paul lutz


      Why is a parent walking into a health clinic without coverage in the first place?

      Detaching payment from coverage?? Really?? Think about that.

      • walter carpenter

        “Why is a parent walking into a health clinic without coverage in the first place?”

        This is a really good question. Why are there so many millions of Americans uninsured in the first place? In single-payer nations no one is uninsured.

    • Marie Parker

      “When people walk into a clinic with dangerously high blood pressure and sick children, and they cannot get the care they need until they enroll in private insurance, then we have a problem. ”

      Today people can get healthcare without insurance. Laws are in place to ensure all individuals can receive the care they need regardless.

      • Sandy Vollerisen

        I think you need to clarify that statement a little, Ms. Parker…

        “Today people can get emergency treatment without insurance. Laws are in place to ensure all individuals can receive the EMERGENT care they need regardless.”

        In this case, yes, we have EMTALA to ensure anyone that is seen in the ER is discharged in stable condition. NO ONE can go into a doctors’ office and “get healthcare without insurance” unless they are willing to pay–sometimes up front, sometimes in the form of bills–which can lead to collection agencies or garnishments or worse if they are not paid.

        If someone walks into a clinic with dangerously high blood pressure, they are stabilized. It is the law.

        If your kid has a cold, or needs some other outpatient service—then yes, you’ve got a problem, because there is no emergent need that brought you to the ER.

      • walter carpenter

        “Today people can get healthcare without insurance. Laws are in place to ensure all individuals can receive the care they need regardless.”

        This is true to a degree. The question is how much care, what kind of care, and who pays for the care. When an uninsured person seeks care, it is the insured who end up paying for that through the cost shift.

        • rosemarie jackowski

          Often the medical care is sub-standard – sometimes there is no care at all. Recently someone went to the local ER with a back ache. She was found sometime later ‘by non-medical personnel. She was dead’. The ER ‘lost’ her?

          Here is another case:

    • Thomas Powell

      The true believer mythology of single payer advocates never ceases to amaze me in its naivete. The idea that all will be well in a government-run and tax-financed health care system flies in the face of a number of inconvenient truths, such as doctors leaving Vermont, restricted access to specialty care, hospital bankruptcy, and a new bureaucratic apparatus that will make VHC look like a model of efficiency. And just wait until it becomes the job of the legislature to establish a budget for health care expenditures and taxation to support it. Vermont will find itself a northern Mississippi when the capital flight begins. And it surely will. Your gauzy faith in this model of care needs a reality grounding rod. Single payer is a simple answer to a complex problem, which happens to be wrong.

  • Stan Hopson

    “The changes added an additional step to the login process, and some accounts were frozen due to inactivity while the site was offline.”

    Please remember this years-long trail of incompetence when the Governor, Peter Sterling and your local Democrat tell you Single Payer is the answer.

  • walter carpenter

    “Please remember this years-long trail of incompetence when the Governor, Peter Sterling and your local Democrat tell you Single Payer is the answer.”

    And when a republican tells you that private insurance is the answer, with its high deductibles and huge CEO salaries, or that we would be better off if we could buy insurance from out of state, and so on please remember that these exchanges are private insurance with a few bones thrown in for reform. Also remember that medicare is a true single-payer program which our senior citizens do not especially want to lose.

  • Dave Bellini

    “Single payer is the opposite…”

    In your head perhaps. No one knows how complex or simple a yet to be designed system will be. But keep living the dream. There will be co-pays and deductibles and employees who have to calculate, take payment and make sure it is all correct. There will be waits for care. There will be unintended consequences. There will likely be program cuts when the budget gets tight. A new system could be better and user friendly. But, will it be? With these same people in charge?

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