[U]p to 1,660 customers were dropped from the rolls of Vermont Health Connect at the end of October for nonpayment, even though many users say they paid their bills.
The Shumlin administration said in interviews it has no evidence of an internal defect that caused people’s coverage to be wrongfully terminated. But insurers say there have been cases before when Vermont Health Connect recommended the wrong people for termination.
Cassandra Gekas, the director of operations for the exchange, said the number means more people than usual were unenrolled from their insurance plans. In most months, about 1,000 users are recommended for termination, she said.
Gekas thinks many paid their bills after the Oct. 26 due date but before the end of the month. She said the exchange will nonetheless reinstate coverage for anyone who paid by Oct. 31.
“We’ve certainly received, I would say, a few hundred calls about this,” Gekas said. “I think our total population of people we’re ultimately going to reinstate … a few hundred. I certainly have my ear to the ground and have raised this as a high priority issue over the past few days.”
“We’re continuing to do root-cause analysis, and we’ll be triple-checking the termination list for this month,” she said. “If there’s a problem, we’re gonna find it, and we’re gonna fix it. From where I sit today, I don’t have any evidence of a defect.”
Most of the households who are calling Vermont Health Connect with complaints don’t receive subsidies on their plans, according to Gekas. Some users tell VTDigger they therefore decided to directly enroll with Blue Cross Blue Shield of Vermont and not use the exchange.
Annette Smith, the executive director of Vermonters for a Clean Environment in Danby, said she paid all her invoices for January through November but was disenrolled Oct. 31.
She received a notice of termination for nonpayment from Blue Cross Blue Shield on Nov. 12, and she gained coverage retroactively on Monday after several phone calls.
“They (at Blue Cross Blue Shield) told me that thousands of people had been dumped,” Smith said. “Cleary Vermont Health Connect did it.”
“I was thrilled to find out I could ditch them, which I did today,” she said on Monday. “The visceral reaction of being liberated from Vermont Health Connect surprised me. I was thrilled.”
Rob and Sue Rowell, a retired couple in Newfane, use Vermont Health Connect insurance and don’t get subsidies. They now plan to buy their insurance directly through Blue Cross Blue Shield.
“I went to get blood drawn yesterday morning at Grace Cottage Hospital right up here in Townshend, and got informed that my health insurance was cancelled,” Rob Rowell said. “I came back and told Sue, who administrates all this stuff, and she was incredulous.”
Sue Rowell said Vermont Health Connect told her to call her insurer. When she called Blue Cross Blue Shield, the customer service representative said an error at Vermont Health Connect had affected “thousands” of Vermonters, according to Sue Rowell.
Rob Rowell said: “They erroneously terminated us because of a systems issue. Now, we could not get the poor gentleman at Vermont Health Connect to use the term erroneous. He said ‘for non-payment.’”
The state cannot comment on individual customer cases without their permission, according to Sean Sheehan, the spokesperson for Vermont Health Connect. Information from state databases is also exempt from the Vermont Public Records Act.
Ongoing billing issues
The state and insurers’ ability to reconcile commercial insurance accounts on Vermont Health Connect has been a continuous source of tension between insurers and the state. In October, Blue Cross Blue Shield asked for an independent review in light of the exchange’s challenges.
Blue Cross Blue Shield, which covers the vast majority of about 33,000 individual health exchange users, said it usually gets a list from Vermont Health Connect of 200 to 300 people to terminate in a given month.
“We don’t have insights directly into the consumer files, and we are obligated to act upon the information that VHC gives us,” said Cory Gustafson, a lobbyist for Blue Cross Blue Shield.
“We are getting calls from customers, which prompts us to reach back out to VHC who confirms whether they paid or not,” Gustafson said. “If VHC confirms that they paid, then we reinstate them quickly.”
MVP Healthcare, which covers a minority of Vermonters on the exchange, issued the following statement: “There have been instances where Vermont Health Connect has incorrectly instructed MVP to terminate members for non-payment. Once these errors have been identified, MVP Health Care retroactively reinstates the member. MVP works with VHC monthly to reconcile premium payments and member status. All decisions regarding member status are determined by VHC.”
Gekas called accounting a “shared” responsibility, and the state works in a “close partnership” to determine who should be terminated. She said Vermont Health Connect is the system of record of whether a customer has paid, but insurers send out physical termination notices. (Another company, Benaissance, handles billing.)
It works like this, according to Blue Cross Blue Shield: the state sends the insurer a list of people who need to be unenrolled. The insurer then sends termination warnings, and 30 days later, Vermont Health Connect sends an updated termination list, which insurers use to discontinue coverage.
Customers on commercial plans who get no subsidies through the state or federal government have a 30-day grace period to pay their bills and must pay their balance in full once they enter the grace period, according to Sean Sheehan, the spokesperson for Vermont Health Connect. Customers who get subsidies have a 90-day grace period and must pay in full, he said.
“I think we have to change some of the timing of how they do things if this is gonna work,” said Trinka Kerr, the chief health care advocate at Vermont Legal Aid. Her office has also seen an “uptick” in calls from people whose coverage was terminated.
