Customers of Washington’s online health-insurance marketplace
who say they have paid their premiums but are being told by insurers they have no coverage aren’t imagining things.
They’re victims of “system defects and data issues,” the CEO of the Washington Health Benefit Exchange said late last week.
“Over the past three months, the Washington Health Benefit Exchange has identified several system defects and data issues that have impacted the creation and accurateness of Washington Healthplanfinder customer invoices,” Richard Onizuka wrote in a statement late Friday.
The defects “may result in invoices not being generated or incorrect payment adjustments, resulting in inaccurate statements.”
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Because of these problems, customers may be incorrectly billed by Washington Healthplanfinder, Onizuka said. And in some cases, insurance companies are left “unaware of completed payments.”
The problems, he said, affect fewer than 5 percent of the 164,000 customers who bought private plans through Healthplanfinder, the online marketplace created by the Affordable Care Act.
The Seattle Times contacted the exchange earlier in the week after having learned that a number of people who say they’ve paid for health plans through Healthplanfinder don’t actually appear to be insured.
Some were told by the exchange that they were caught in a glitch, and their accounts would be fixed. Others received incorrect bills.
Gordon Hempton of Indianola, Kitsap County, said he paid premiums for months but never received coverage for himself or his daughter.
Hempton, 61, an acoustic ecologist and sound engineer, said he enrolled in January, pleased to find affordable coverage for a hearing problem that had affected his work.
The next month, he enrolled his daughter, Abby, 23. But soon, a series of problems began. He couldn’t get into his account, and neither he nor his daughter appeared to have coverage. More than 35 hours of phone calls, hours on hold, transfers from person to person, resulted only in more frustration. The exchange created “trouble tickets” that never appeared to be acted upon, he said.
Meanwhile, the months ticked by, he kept paying for coverage — a silver plan through Premera Blue Cross — but nothing changed.
Finally, with no resolution in sight, he received a huge bill in the mail — many times what he should have owed for premiums, and with no explanation.
In frustration, Hempton canceled the insurance he apparently never had.
“Attitude is a really important ingredient of health, and this was ruining my health,” Hempton said. “I feel so much better already, even though I’m uninsured.”
Onizuka defended the exchange, saying it has processed more than $60 million in customer payments and has made “significant improvements” to billing processes and customer correspondence.
“However, Exchange staff recognized the frustration this has caused our customers and take these issues very seriously,” Onizuka said. The exchange has been working with its IT vendor, Deloitte, to resolve these payment and invoice issues as quickly as possible, he added, and expects that many of the problems will be ironed out this weekend in a system update.
He said no customers have had their coverage canceled due to known payment or invoice problems. However, a number of people said they had not been able to get health care because they remained uninsured despite having paid premiums.
Bethany Frey, spokeswoman for the exchange, said staff had received about 100 complaints from people who said they had paid their premiums but had claims rejected by their insurer or were told by a medical provider that they did not have insurance.
The exchange processes all premium payments for plans purchased there, and premiums are due on the 23rd of the month by 5 p.m. Checks mailed must be received with a payment coupon by the 21st of the month to be processed. Premiums are sent to insurers in a few monthly batches, Frey said.
In the April exchange board meeting, exchange officials said they had produced nearly 130 different data and manual fixes to correct the data sent to insurers.
So far, about 400 customers’ insurance has been canceled because they had not paid their premiums, Frey said. April was the first month that coverage was canceled for customers who stopped paying premiums.
Carol M. Ostrom: 206-464-2249 or email@example.com. On Twitter @costrom