Billing confusion leaves 10,000 Nevadans in insurance limbo
More than 10,000 Nevadans who may think they have health insurance through Nevada Health Link actually aren’t covered at all.
That’s how many people are on the state health insurance exchange’s “pends” list, a roster of people who have bought or attempted to buy a plan through the Nevada Health Link website but who still had no insurer weeks or months later.
One member of that list — Larry Basich — made national headlines earlier this week for a coverage mix-up that has left him with $407,000 in unpaid bills. Insurance carriers say they know of many more Nevadans stuck in the same coverage purgatory, though without the sky-high invoices Basich has racked up.
Xerox officials said Thursday that they’re working hard with consumers to move them off of the pends list.
But officials with the Nevada Health CO-OP, a nonprofit carrier established by the Affordable Care Act to sell coverage through Nevada Health Link, wrote in a March 4 letter to the exchange board that the pends list is “so inaccurate, incomplete and unworkable that it has become an enrollment graveyard.”
Added Las Vegas insurance broker Dwight Mazzone: “I think Larry Basich could be the tip of the iceberg. We don’t know how many claims are out there in limbo. There are claims that aren’t being handled because someone thinks they have insurance, and when the insurance company gets the claim, they say, ‘We don’t even know this person.’ I hear that quite a bit.”
AGGREGATION AGGRAVATION
Brokers and carriers say the number of consumers on the pends list is growing: As of Thursday, it was 10,520 consumers strong, up from about 8,000 in early March, according to one industry source. That means 27.2 percent of the 33,053 people who had chosen a plan through Nevada Health Link as of Saturday have no insurer assigned to them, though some of them have paid for their plan.
Mazzone blamed the pends list on Nevada’s payment practice: The state exchange alone uses premium aggregation, a practice in which the health insurance exchange and its contractor, in this case Xerox, collect payment and forward it to the insurer. In every other state and on the federally run exchange, consumers choose a plan, and their information is forwarded to an insurer who directly bills new members.
Gov. Brian Sandoval on Thursday told the Review-Journal that premium aggregation is a big problem.
“If we knew then what we know now, we wouldn’t have done that,” Sandoval said. “It was part of trying to have a full-service exchange and trying not to have so many steps (for consumers). Perhaps that was the big chunk that Xerox bit off that they couldn’t handle.”
An even bigger problem: The pends list is wrong in an unknown number of cases, observers said.
Take Basich. The exchange withdrew his first premium payment in November and has taken January and February payments from his savings account. The exchange even sent the CO-OP a check for his premium, said Bobbette Bond, chief project officer. Yet, the pends list showed Basich as unpaid as of late February.
Xerox has been trying to place Basich with Nevada Health CO-OP for January and February coverage, though his paperwork shows he chose a plan through UnitedHealthcare. His UnitedHealthcare coverage took effect March 1.
Other frustrated consumers came forward this week after a Review-Journal article about Basich’s problems. One Las Vegas parent who asked to remain anonymous said her two children still have no insurance though she paid premiums in late 2013.
A Pahrump woman paid more than $500 in premiums for a Nevada Health CO-OP plan in mid-February, an amount her local broker, Pat Casale, said is “lost in cyberspace.” The woman now can’t buy needed medications because her money is tied up in the exchange, Casale said.
Mazzone, who said he has as many as 12 clients on the pends list, said Xerox’s default excuse is that the consumers’ files get “corrupted.”
“It seems to be a catchall term. We hear it a lot. Then they tell us we have to re-input everything. That can take us two hours,” he said.
Mazzone said he could “tell you without equivocation” that Nevadans are going without care because of the mix-ups, delaying doctors’ appointments and leaving prescriptions unfilled.
“Frustration among my clients is extremely high. Why did they buy coverage in the first place? It’s not a matter of, ‘I’m sick, and I need coverage,’” Mazzone said. “People like to know they won’t be out of pocket $400,000 if something happens. Xerox’s reasons and excuses are getting really old, really quickly, now that they’re six months in on this project.”
THE ‘CLEAN UP’
CO-OP executives say they’re just as frustrated.
Nearly half of the pends list, or about 4,300 people, appear to have chosen coverage through the CO-OP, a locally based, nonprofit insurer created by the Affordable Care Act to sell plans on the state exchange.
Bond said she and other CO-OP officials have been pleading for six weeks with Xerox to “clean up” the pends roster so the company can contact new members and get them health care.
“It’s a confusing list. We keep asking them to break it down. Some people might have enrolled twice. We get names, but not enough information to actually reach out to them,” Bond said. “The state didn’t send us enough information. There are no phone numbers or emails.”
CO-OP officials say the pends list is diverting company resources away from guiding new patients through the system.
For Basich, at least, an answer may come soon. His case is “very close to being resolved,” said Lynn Etkins, vice chair of the exchange’s board, in the board’s Thursday meeting. Sandoval also said the case should be resolved in the next few days.
To help other new members, Xerox recently retained a third-party vendor to help with electronic-data reconciliation, “issues management” and health-care operations management, said spokeswoman Jennifer Wasmer.
“They will add capacity to the Xerox team and help us identify and implement specific improvements in our operations and technology with respect to carrier interfaces,” she said. “We also will be working with the state’s consultants from Deloitte, who have deep knowledge of the Nevada Health Link business operations system based on their prior involvement in the eligibility system connections. Their expertise will be valuable as we hone this part of the system.”
If the system isn’t refined soon, consumers face a long slog to escape the pends list.
Mazzone said he and other brokers are going case-by-case, spending four hours or more on each person, to untangle coverage issues.
He said he and other brokers also plan to make premium aggregation an issue before the exchange board later this year in the hope that carriers could start taking payments directly.
Sandoval said change could come.
“We have had that discussion. It’s under consideration to maybe do things differently,” he said. “When Nov. 15 (the next open enrollment session) rolls around, it’s got to work completely.”
Contact reporter Jennifer Robison at jrobison@reviewjournal.com. Follow @J_Robison1 on Twitter.
