[W]itnesses from two insurers and Vermont Legal Aid all started their remarks to legislators Wednesday by saying positive things about Vermont’s embattled health insurance exchange and the people who run it. But the issues they’re having dominated the meeting.
The House Health Care Committee was holding its second hearing to determine whether the state should abandon Vermont Health Connect and move to the federal exchange.
Susan Gretkowski, the lobbyist for the insurer MVP Health Care, noted that her company covers only 10 percent of the roughly 30,000 people buying commercial insurance on Vermont Health Connect and does most of its business in New York, which also operates its own exchange. But she said its workers are disproportionately affected by the Vermont exchange.
“Our eligibility, enrollment, billing and customer care folks all say that they spent more time generally on Vermont issues than they do on New York issues,” Gretkowski said. “I think that’s clearly because of the IT problems that Vermont has.”
She said fixing the exchange’s information technology would solve a lot of the problems. She also echoed previous testimony from Blue Cross Blue Shield of Vermont — which insures the other 90 percent of commercial customers on the Vermont exchange — asking the state to improve the way it handles billing customers, collecting payments and dropping people from coverage.
Currently, Vermont Health Connect is the system of record for whether someone paid his or her health insurance bill. A Nebraska-based company called Benaissance handles billing and collection. Benaissance forwards that money to insurance companies but holds onto any underpayments or overpayments.
“We’ve advocated that either Vermont Health Connect do everything, or we do everything,” Gretkowski said. “In New York, we’re doing our own billing and premium collection.”
Administration officials reported progress Wednesday on one problem that has plagued the exchange: a backlog of updates to customer accounts. The number of pending life changes to accounts, called changes of circumstances, hit 5,700 on Jan. 25, increased to 5,848 on Jan. 27, and then fell to 5,577 by Monday, according to Lawrence Miller, the chief of health care reform for Gov. Peter Shumlin.
The state is now using the automated change of circumstances function again and aiming to reduce the backlog by 100 a day or 3,000 every two weeks.
Cassandra Gekas, the director of operations for Vermont Health Connect, said she has a team of six people analyzing the root causes of a common set of error messages that come through the exchange.
When the state turned off the change of circumstances function, the main reason was to avoid receiving that type of error messages. Gekas said she expects to give a report on that analysis to lawmakers in the next few weeks.
Vermont Legal Aid says it’s helpful to have the automated function working again for people who sought to make changes at the beginning of 2016, but the changes for 2015 still need to be worked out.
“The state still can’t process 2015 change of circumstances, so we’re still getting calls and working on cases that haven’t been resolved for 2015 changes,” said Trinka Kerr, the chief health care advocate for Vermont Legal Aid.
“And one of the consequences of that is that people are starting to get their tax forms now, the 1095-As, and they will be wrong if their change of circumstance wasn’t properly recorded,” she said.
The form lists how much money in subsidies a person receives.
“We already talk to the Vermont Health Connect staff once a week … and now we’ve scheduled an additional meeting trying to address tax-related issues,” Kerr said.
Gekas said she has a second team of people who, for the next four months, will do nothing but work with customers who need to understand or request changes to their 1095 tax form.
A third team is working on financial reconciliations, she said.
“I think we need to revisit the issue of alternatives” to the state exchange, said Rep. Bill Lippert, D-Hinesburg, who chairs the committee. “I want to hear in more detail the analysis that was done in terms of the federal exchange, state-federal exchange.”
He told Gekas that hearings would continue in his committee Wednesday mornings for the foreseeable future, adding, “I think we both need to understand what your analysis is and then see if there’s any other analysis that we need to ask for.”
Vermont Legal Aid
Kerr testified for the second time in two weeks about customer experiences. She said a woman called her office in tears Tuesday because she was erroneously dropped from her commercial insurance on Vermont Health Connect.
“I think she tried to get some medication and was told that she didn’t have coverage,” Kerr told the committee. “She was saying that she was going onto anxiety medication because it was so stressful.”
The room fell silent when lawmakers heard Kerr tell the story. Lippert closed his eyes and paused for a moment before asking her further questions.
“We’re still seeing a lot of problems,” said Kerr. “We’re still getting slammed with calls. I’ve looked around for some good things to tell you, and there are a few good things.”
She said that even though the number of customer calls to her office increased at the end of 2015, fewer people called last month than in January 2014. But she said her staff is still frustrated “by what they describe as returning cases.”
“The bad things are we’re still getting a lot of calls, and they’re really complicated,” Kerr said. “That’s really frustrating to people, too — the fact that their changes from last year haven’t been resolved.”
Shumlin administration weighs in
Miller, the chief of health care reform, said the change of circumstances function was turned back on Jan. 27 after an underlying software problem was solved. The number of pending cases changes often because new requests come in each day, he said, and out of the 5,700 specific cases that were in the queue Jan. 25, only about 4,600 remain.
Gekas said Vermont Health Connect staff are prepared to have an extensive conversation with the House Health Care Committee about its billing processes next week. Representatives from Benaissance, the third-party biller, will also attend.
“To me the hallmark of good customer service is someone calling and not having to call back five times to have their issue resolved,” Gekas said. “What we need to do is prevent new discrepancies from occurring so that we’re not just treading water.”
She said that would involve ongoing reconciliations of customer accounts and managing data across all the different parties that are part of the billing process.
