Health care exchange backlog reduced, but many cases still unresolved

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MONTPELIER -- Vermont Health Connect is still straining to resolve requested changes to people's information or health coverage, some dating back almost a year, just weeks before it must begin processing new customers and renewals.

The exchange's Web portal remains offline, and the state and its contractors are processing changes manually, even as hundreds of new requests come in each day.

State officials say they are on track to have the site back up before the next open enrollment period begins on Nov. 15, though they don't have an exact timeline.

But clearing the backlog of change requests, which customers are supposed to be able to do online but never were, is proving a Sisyphean task.

Some cases don't actually require updates. Some had previously been resolved, while others are from people who never bought insurance. But the state and its contractors are undertaking a massive due-diligence effort to make sure that needed changes are being made.

The exchange had a backlog of untouched change requests that Optum, since being hired in June, has worked to eliminate. Optum also helped create a process to elevate cases where a change could impact the customer's access to care.

The backlog reached a high of more than 15,000 in August. Since then, the state and call center contractors have closed out more than 19,000 cases, but the backlog still sits at 3,300.

Hundreds more requests pour in each day, said Lawrence Miller, Chief of Health Care Reform, but the exchange is getting better at resolving them quickly, keeping the backlog from ballooning as it did over the summer.

However, if you combine the 3,300 backlogged change requests with those that the state is still working through, the figure is closer to 13,800.

Roughly 2,000 are for people who started an application online but never purchased insurance. Those people are being contacted to make sure they aren't still trying to obtain coverage.

Miller said he's confident the exchange can work through enough of the 13,800 change requests, plus any more that come in over the next three weeks, so that resources can be focused on renewals and new customers during open enrollment.

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Priority is being given to customers with commercial insurance and households with a mix of commercial and Medicaid customers, because Medicaid recipients don't have to re-enroll on Nov. 15. There are 5,800 backlogged or active Medicaid changes, reducing the number that need to be resolved before open enrollment by 42 percent.

In addition to the 13,800 cases being processed, there are an additional 1,900 awaiting a response from the customer as to whether a requested change still needs to be made. Those customers have failed to return multiple calls.

"It's important that people who get calls return that call to let us know that change has been completed, or that they still need our help," Miller said.

Cases where the customer hasn't responded are never wiped out of the system, according to Miller, but workers aren't actively trying to close them either.

Every time someone calls the call center it generates a service request, but those requests aren't always closed when the issue is resolved, unless call center workers can confirm the customer no longer has an issue.

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Unhappy encounters with the system

Joanne Duhl, 62, of Waitsfield, was surprised to receive a call at 6:40 p.m. on a recent Friday. The caller said he was with Vermont Health Connect and asked for her to confirm personal information.

"The person didn't sound authoritative, or like they were clear on what they were doing," she said.

The call was so bizarre that she thought it might have been a scam to obtain her personal information. She called the state police, who suggested she contact the Attorney General's consumer protection hotline.

The next day she received a mailed notice from Vermont Health Connect asking if she still needed to add people to her policy. The made a little more sense, and Duhl was able to relax.

But she doesn't understand why there was no internal communication between Vermont Health Connect, her insurance company and the call center contractors that rang her on a Friday night.

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"They should know the change has been made because I'm paying the premium and I have for months," Duhl said.

There are internal communications between the entities that make and confirm changes, Miller said.

"But that doesn't mean it's very good in all cases," he added.

The workers processing changes receive a case history for the customer, but those are complicated and often involve multiple service requests for the same change.

Canceling an exchange policy is also not a simple matter, as Ed Adrian, 44, of Burlington found out recently. He is transitioning to employer sponsored health care, and called Vermont Health Connect to cancel his policy.

The call center worker he spoke with was polite and helpful, but he was surprised when she told him canceling a policy takes several months.

He was told that he would receive a call back in a few weeks from the "change center." Out of curiosity, Adrian said he asked where the change center is located, and was surprised to hear it is in North Carolina.

State officials confirmed that there are four call centers in four states, in addition to the Burlington center operated by Maximus. Maximus has an additional support center in Illinois, while Optum has call center's in North Carolina, Texas and Florida.

Adrian, a former Burlington city councilor, appeared chagrined by his experience with Vermont Health.

"As someone that wants see government programs work, the process and the system, not the insurance, have been a failure and that's disappointing," he said.

But for many health care advocates, the insurance has been a disappointment as well; some who were enticed in by low premiums have been hit with unexpectedly high out-of-pocket costs.


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