[T]he state has agreed to pay $3.5 million to Blue Cross Blue Shield of Vermont to settle billing issues from 2015 involving Vermont Health Connect.
The settlement is for health insurance premiums that Vermont Health Connect didn’t pay in 2015, and health care claims the insurer paid before customers’ coverage was retroactively terminated.
The insurer originally thought it would need $6.2 million to settle, and then invoiced the state for $4.6 million. An accounting reconciliation process brought down that number to $3.5 million.
This is the second settlement the state has paid to Blue Cross for reconciliation of accounts for Vermont Health Connect customers. In 2014, the state paid the company $1.6 million. Both parties are expecting to pay another settlement for 2016.
Don George, the chief executive officer of Blue Cross, said the insurer hopes Vermont Health Connect will be able to reconcile cases monthly in 2017 to avoid having to do an annual process that results in a settlement. He does not know if that will happen.
Cassandra (Gekas) Madison, the director of health care eligibility and enrollment at the Department of Vermont Health Access, said the state is hoping to reconcile customers accounts monthly in 2017. The first test will come in February, when the state will try to reconcile accounts from January, she said.
“Going forward, we expect to have a true-up every year,” Madison said. “But as we put more controls in place and more automated processes or more efficient processes for monthly reconciliation, it should lower the amount of money that it needs to change hands at the end of the year.”
Both parties say that open enrollment—the period between Nov. 1 and Jan. 31 when people can change their plans on Vermont Health Connect for any reason—has gone very smoothly this year. That’s in contrast to last year, when the state had to turn off a function of the website in order to prevent errors.
The state says 91.5 percent of health insurance renewals could be processed automatically on the first try, and ones that couldn’t be handled automatically were processed that same week. The previous year, about 80 percent of renewals were processed after several tries, and the rest were handled last January.
The state says payment processing errors are also way down to less than one-tenth of 1 percent, meaning that fewer people are showing up to doctors or pharmacists and being told they don’t have coverage.
