Users frustrated with administration of Washington health exchange

Joleene Ries knew for five months she wasn’t paying enough for medical insurance but couldn’t get the state agency that collects her money to raise her premiums.

“I’m more than frustrated about it,” the Spokane retiree said after months of trying to update her income on a computerized state system. “I want to pay what I’m supposed to pay.”

Jerry Descoteaux signed up for medical insurance for his family in April after losing his job and paid premiums for five months, but couldn’t get proof of insurance from the company he selected because the state agency that runs the Washington health exchange kept demanding more documents, then needed time to review them.

“It just seemed like a comedy of errors,” the Spokane tax accountant said.

In the last week, Descoteaux and Ries were both notified by the state Health Benefit Exchange, which runs Washington Healthplanfinder, that their problems appear to have been solved – after months of phone calls and inquiries from The Spokesman-Review.

Ries was told she can expect to be billed for a higher premium sometime in the coming months. Descouteaux and his family got proof of insurance for the Blue Cross plan he’s been paying for since April.

The agency, which said last month it has problems with about 6,000 accounts, recently announced fixes to correct some billing problems people have reported. But neither Ries’ nor Descoteaux’s problem are among those solved by the latest fixes.

The agency urges consumers who have problems to contact the toll-free customer support center. But Ries and Descoteaux said they did that and it didn’t help.

Not paying enough

Ries liked her old insurance plan, but she wasn’t able to keep it because it ceased to exist on Dec. 31. She and her husband are retired and live off investments. He’s on Medicare, but at 56, she’s too young to qualify. Last fall she went on the state health exchange and selected an Asuris Blue Shield plan that was similar in many aspects to her old plan but had some things she doesn’t need, like maternity coverage.

The $363 premium was about $130 higher than her old plan. But when she entered the income reported on the couple’s 2012 tax return, she qualified for a federal subsidy; her premium was $45. She signed up.

This April, when the couple’s 2013 taxes were completed, their investments had done much better and Ries knew her premium should go up. She went online to enter new income figures, but she couldn’t get the system to update her premiums. She worried about a big bill from the Internal Revenue Service at the end of the year, and possibly even penalties for not adjusting her income figures.

Ries called the customer service line as soon as she had the new income tax figures, and she was told the income figure would be corrected in 24 hours. It wasn’t. In May she didn’t get an invoice, called and was told there was a problem with a change in her email address, so she paid $45. Later that month she got notice that some information was incomplete on her application. She called in early June and was told she should submit a request for a manager to contact her; she did, but no one called.

She kept calling back as calls weren’t returned as promised and more misinformation was provided, she said.

Ries said she’s not a complete novice about health insurance. She once was a manager for Medical Services Corp. of Eastern Washington, which was one of Spokane’s biggest medical insurers before it merged with Premera Blue Cross, and she understands some of the complexities of forms.

But she described herself as “more than frustrated” by the inability to make what seemed like a simple change.

“I don’t deserve that deal,” she said of the $45 premium. “I believe everybody needs to be covered, but everybody needs to be paying into the system, too.”

Paying premiums, nothing to show for it

When Descoteaux was laid off this spring after Sound Enterprises downsized, he selected a plan from the health exchange to cover himself, his wife and two children. He began paying the monthly premiums but never received cards from Premera that said the family was covered.

In June, he called the agency’s customer service and was told they were approved – conditionally. There was something missing from his file, proof that he didn’t already have insurance. He submitted the necessary documents, but when he still didn’t get insurance cards, he was told his file had to be reviewed.

“I was told, ‘You kind of have insurance – any medical bills you’ve paid, we’ll reimburse,’” Descoteaux said. But only after final approval, which could take as long as six months.

“I’m stuck in the middle of no man’s land,” Descoteaux said, adding medical offices seemed familiar with the problem and have been patient.

He said each time he called to check on the review, he talked to a different customer service representative in a different city.

In July he found out that his son, who starts college this fall, must provide proof of insurance by Aug. 15 or buy a plan through the university for $1,400. He called to find out when the review might be done and was told the agency’s reviewers were way behind.

“I was told, ‘It could be tomorrow, it could be another three months,’ ” he recalled. “I said, ‘How do I lodge a complaint?’ They said, ‘You talk to us.’ ”

Individual fixes

Bethany Frey, a spokeswoman for the Health Benefits Exchange, said Ries’ problem updating her income information was not one the agency had experienced before.

Sometimes when customers make multiple changes in a short time period, it can create payment or billing problems, Frey said. “Our recommendation to customers would be to make only changes that are absolutely necessary – understanding that some can’t be avoided,” she said.

But the agency may see more problems soon. Just this week, the IRS issued a statement reminding people who get their insurance through the Healthplanfinder to report changes to their income.

Ries said an agency representative called her late last week to say the agency made the correction manually.

“She said she’s never seen it before,” Ries said. But the retiree will probably still be billed for $45 in September because the change may take several months, so she’s setting aside money for a big bill she knows is coming.

Descoteaux’s situation was different than the more common billing problems that the latest fix was designed to address because he signed up outside the open enrollment period, Frey said. But it is a problem the agency has seen and is working to correct.

Descoteaux has a few suggestions for customers dealing with the agency: Keep a record of when you call, whom you talk to and what they say. Let the representative know about any medical condition or deadline you face. If the person who answers the phone can’t seem to help, ask to speak to a supervisor or manager, and say you’ll stay on the phone until one is available.

“And most of all,” he added, “stay calm.”