[V]ermont’s largest health insurance provider says its members still call with complaints over Vermont Health Connect and the company’s auditors are waiting for regular customer billing reconciliations.
Blue Cross and Blue Shield of Vermont is now recommending that the Legislature start an assessment of the exchange’s “long-term sustainability” and says they should hire an independent consultant to analyze the exchange’s technology, long-term costs and other compliance issues with the Affordable Care Act.
“While we are encouraged by (Vermont Health Connect) progress, it is not fully automated,” the insurer wrote in a presentation. “(The) state-based exchange will require continuous and expensive (information technology) infrastructure maintenance.”
The insurance company brought its concerns to a special meeting of the House Health Care Committee at the Statehouse on Wednesday.
Lawrence Miller, the chief of health care reform for the Shumlin administration, who was also at the meeting, said Vermont Health Connect has made substantial progress.
The backlog of life changes that needed to be adjusted for customers in the system was over 10,000 this spring, and is now down to around 40, Miller said. All of those remaining customers have been contacted directly because the changes are so complicated.
About 33,000 people had private insurance through the exchange in August, according to Miller. Another 38,000 people are covered by small businesses that buy insurance directly through Blue Cross Blue Shield or MVP Health Care. The state is in the process of moving about 143,000 Medicaid patients from an old computer system over to the Vermont Health Connect system and has about 60,000 remaining.
For the first time since it launched in 2013, users will be able to change basic information on their insurance plans — such as their address or phone number — using the so-called “change of circumstance” feature on the Vermont Health Connect website.
Two weeks ago, the progress on that change of circumstance function led Gov. Peter Shumlin to declare the historically dysfunctional health exchange ready for Vermonters to use when open enrollment for 2016 starts Nov. 1. That marked the first time in two years that open enrollment on Vermont Health Connect could be automated that way.
But Blue Cross Blue Shield and MVP both say there are still issues with the change of circumstance feature. Miller contests that the issues remaining are “the next objective” for the administration to tackle.
Customers on the exchange can only sometimes change their subsidy levels, or, the tax deductions that allow middle-income people to afford private insurance, according to Blue Cross Blue Shield. They can’t change their benefit details or terminate their coverage. They still cannot remove a dependent from their plan or add a newborn child to their plan by themselves under Vermont Health Connect’s technology.
Don George, the president and chief executive officer of Blue Cross Blue Shield of Vermont, said the insurance company also wants to be able to reconcile the plans monthly to make sure all the customer details are right. That’s required by the Affordable Care Act, he said, but the Shumlin administration has not allowed the company to do so because of the backlog.
“I think ultimately the goal is to have these automated,” George said. He called manual reconciliations “a chore to say the least.”
In 2014 and 2015, Blue Cross performed one reconciliation of accounts manually each year. In 2016, they are hoping to get permission for monthly reconciliations.
“We’re anxiously awaiting a monthly reconciliation,” said Dawn Schneiderman, who handles auditing and anti-fraud measures for Blue Cross Blue Shield. “The real purpose of that is to make sure that customers’ information is still synced and lined up and corrected timely.”
“Vermont Health Connect is the one that has a relationship with the billing vendor,” Schneiderman said. “We’re still receiving calls from customers who are having challenges with their billing.”
In August, two women told VTDigger about their billing issues using the exchange. One was paying for insurance she wasn’t getting, and another continued to be covered by insurance without paying for anything. Their stories are not uncommon.
“Ultimately, we still see a lot of people on the exchange going through a lot of distress with regard to billing discrepancies,” George, from Blue Cross Blue Shield, said.
In order to address ongoing issues, the insurance company is planning to directly enroll customers who don’t need subsidies so they can avoid the exchange, and they will “proactively collaborate” with the state to solve their customers’ problems.
Blue Cross Blue Shield offers 10 health insurance plans on the exchange. About 65,000 people have the company’s insurance through the exchange, comprising 35,000 enrolled through small businesses and 30,000 individuals.
Trinka Kerr, the chief health care advocate, said customers are often confused about when bills are due and how long the grace periods are if they pay a bill late. Right now, someone buying insurance through the exchange using a subsidy has a 3-month grace period to pay her bill; if the person isn’t receiving a subsidy, she has 30 days to pay.
“We’re hoping to improve the notices that (are sent to customers),” Kerr said. “If they don’t catch up, you’re not going to be able to get insurance until next year.”
Customers are also appealing the decisions Vermont Health Connect makes about their coverage, according to Kerr. They go to the state’s Human Services Board, which she considers understaffed, and the issues get backed up.
“Many of these cases that are going to hearing should not be going to hearing,” Kerr said. “I am concerned that the Human Services Board is very understaffed and the Vermont Health Connect appeals are adding to that problem.”
Miller, the reform chief, told the House committee that there’s no need to have a dispute in front of a board over whether a judgment made was wrong. It’s just a matter of making the change, he said.
He also said in an interview that the administration is “moving toward being able to accommodate” Blue Cross Blue Shield’s request to do monthly reconciliations.
CORRECTION: Remarks that were originally attributed to Susan Gretkowski were made Trinka Kerr. This story was updated Friday to include the number of Medicaid recipients remaining to be moved to Vermont Health Connect.
