Who’s accountable for WA Health Exchange snafus hien truong19/10/2011Sách Hay0 Comments After years of going without health insurance, Merrilee and Michael Altig of Vancouver, Wash., were eager to sign up for Obamacare through the Washington (State) Health Benefit Exchange when open enrollment took place earlier this year. It took four tries in person, over the phone and on line through the Healthplanfinder, the online marketplace created by the Exchange to allow people to compare and enroll in health insurance plans. “Our goal was to have health insurance.wholesale nfl jerseys from china If something went wrong, we didn’t want to have a disaster,” Merrilee Altig said. The Altigs chose Kaiser Permanente as their health provider and said, as instructed, began paying premiums directly through the Washington Healthplanfinder website. They paid their first payment in March and waited for confirmation. And waited. “I would call every couple of weeks or so,” Merrilee Altig said. The Altigs say the payment cleared their bank on March 26, but as the months went by, they received no insurance cards or other information about how to access their new health care. They called the customer support number posted on the Washington Healthplanfinder website. They called and called. “We’d ask to talk to supervisors,” Merrillee Altig said, “They would assure us that they assigned us a ticket number, and that it was being processed. So June came and we just kind of gave up, we did give up.” The Altigs said they also contacted Kaiser and were told the insurance carrier had no record they were enrolled. The Altig’s said Kaiser had not received any of the payments they’d made through the Exchange. So when the Altigs needed medical care, they went to a charity clinic through their church. “They serve people without insurance, so that’s where we went,” Michael Altig said. The Altigs aren’t alone. But it appears the Exchange was slow to recognize the magnitude of the problem until late summer when people began overwhelming the call center with complaints. Exchange CEO Richard Onizuka said that the problem has been a series of technology glitches that have proven difficult to resolve. “It’s multiple systems, multiple interfaces with multiple systems, multiple pieces of data, so it’s getting data right, and getting data right in every instance,” Onizuka said. A fix was promised by August. Then September. During the first week of October, Brad Finnegan, Associate Operations Director for Washington Healthplanfinder estimated only 1300 people were still having problems. “We have made substantial progress,” Finnegan said and predicted that the remaining billing problems would be resolved well before open enrollment for 2015 began on November 15. That’s not what insurance providers were seeing. On Oct. 30, Premera Blue Cross reported startling statistics to the Washington Health Benefit Exchange Board: 15,000 Premera subscribers had missing payments or showed no payments at all, according to Sheela Tallman, Senior Manager at Premera Blue Cross. Tallman said that meant $51 million worth of claims were in limbo. “Premera has been in daily coordination with Exchange technical staff and senior management to reach resolution on many technical issues, but these problems continue to impact our members’ ability to access medical services and fill prescriptions,” Tallman said. The Association of Washington Health Care Plans, which represents insurance providers in Washington state, estimates up to 25,000 accounts set up through the Healthplanfinder are experiencing problems between 15 to 20% of the enrollees. “It’s not acceptable for us,” said WA Health Benefit Exchange CEO Richard Onizuka. “We don’t want to be having these types of problems. We’re doing everything we can to try to make it better.” State Insurance Commissioner Mike Kreidler said that the Washington Health Benefit Exchange was slow to recognize the magnitude of the problem. Kreidler said he believes that’s because the Exchange lacks a good complaint system. Until last week, subscribers couldn’t file on line complaints, they had to call the Customer Support Center listed on the Healthplanfinder website. Kreidler said there was no system for tracking the volume and types of problems, which meant the staff wasn’t looking for the right solutions. As the state’s top insurance regulator, Kreidler finds that frustrating. Kreidler said his office has a very robust complaint system, which it offered to the WA Health Benefit Exchange at no cost. Kreidler said he was turned down. “They chose to go and buy a Microsoft product that they’re trying to modify and only doing so right now,” Kreidler said. And Kreidler can’t force the Exchange to do anything It reports to an independent board not to him not even to the governor. State Representative Reuven Carlyle of Seattle said it’s time to change that, especially now that the Exchange is asking lawmakers to approve a whopping $147 million dollars in spending for the next biennium which would nearly double its spending. “I am deeply skeptical of their budget request and until we see meaningful oversight and accountability and technology improvements, I am not going to be supportive of additional resources, until I see those improvements,” Carlyle said. Even as the Exchange scrambles to fix old problems, new ones are cropping up on the first day of open enrollment on Saturday, Nov. 15, the system had to be shut down when it was learned that tax credits were being calculated wrong. Carlyle said he was angry when he learned that the website had gone down. “We’ve given them time and money,” he said. Staffing at the call center located in Spokane has been upped to nearly 500 people and specialists in Olympia are troubleshooting the stickiest problems. But that help comes too late for the Altigs. Despite being told for months they had no insurance, they recently got a bill for $1863 for premiums retroactive to May.