Rare Glitch Causes State Healthcare Enrollment Problem

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    NEWSLETTERS

    TK

    Connecticut's health care exchange has been lauded across the country as a success story, but some residents who went through the enrollment process have had difficulty getting coverage.     
               
    In late March, Mary Beth Sweeney logged onto the Access Health CT Web site and signed up for a plan with Anthem. It was supposed to start on May 1, but she became concerned as the date approached and still had not received confirmation from the company that she was enrolled.

    “I decided to resign from my job of eight years and certainly my number one priority was to have my health insurance covered,” the longtime pre-school teacher said.

    Despite five hour-long calls this month, Sweeney’s status with Anthem remained in limbo and she said she started to get nervous about having no proof of insurance.

    "I was told I had a 'phantom application' and Anthem didn't have any record of my Social Security number, or any of my information," Sweeney said on Tuesday. "As of now, it looks like I'm not covered."

    Jason Madrak, the exchange's chief marketing officer, acknowledged that there have been some problems.

    "We largely avoided large issues of other state exchanges. That said, we do have a lot of individual issues that pop up," Madrak said.

    Vicky Veltri works with residents on insurance-related disputes in her role as the state’s Healthcare Advocate and estimates about 1 percent of 208,000 people who've enrolled through Access Health Connecticut have encountered issues.

    "The stakes are high, and resolving a problem for consumers is incredibly important to them," Veltri said.

    Once the Troubleshooters and the Healthcare Advocate got involved, Access Health investigated Sweeney’s issue more closely and found a problem with the "834 form," which is sent electronically from the exchange to the carrier.

    "Every once in a while, there's a glitch where somebody's 834 does not get to the carrier, so the carrier may or may not know the person is in their plan," Veltri said.

    Sweeney’s case is now fully resolved and she said she's thrilled. 

    She's decided to begin her coverage on June 1 because she's been healthy and hasn't had any medical expenses this month.

    Officials from Access Health Connecticut said what Sweeney encountered is rare, but it's an opportunity for the exchange to continue to improve.

    "We have our team going through and making sure to analyze what happened during that session so we can resolve the issue and make sure it doesn't happen to other people," Madrak said.

    Access Health officials said Sweeney’s case should serve as an example for everyone in Connecticut.

    If you come across any problems with your coverage status or getting your insurance card, contact your carrier right away. If you still can't get answers, call the Office of the Healthcare Advocate. http://www.ct.gov/oha/site/default.asp