Gail Demartin of North Haven paid her monthly premiums for her insurance she purchased through Connecticut’s health insurance exchange, but she received notice that her plan was canceled on March 8.
She was told it was because funds were not available for her premium. However, along with the cancellation notice she received the check she sent to make her premium payment. Demartin, like 70 percent of those purchasing insurance through the exchange, receive a subsidy from the federal government for a portion of their monthly premium.
If she paid her portion of the bill is it possible Uncle Sam just failed to pay the difference?
Frustrated with the lack of answers she was getting from Access Health CT, Demartin reached out to her elected representatives, including Sen. Leonard Fasano.
Fasano and House Minority Leader Lawrence Cafero wrote Access Health CT’s CEO Kevin Counihan earlier this week asking for an explanation, because Demartin wasn’t the only constituent to inform them a plan had been canceled.
Unable to explain what had happened, Fasano and Cafero asked Counihan for an explanation.
“What is the source of the problem; how many people have been so affected; how will the issue be addressed so that coverage can be restore?” wrote Fasano and Cafero.
In a June 17 response, Counihan says his office has “received no such complaints of this sort.” Counihan was referring to the cancellation of policies due to the nonpayment of federal subsidies.
In a phone call last Friday, Counihan said they were looking into Demartin’s case file, but he said he didn’t have a good answer as to why her plan would have been canceled if she was paying her premium.
Demartin said that’s odd because she calls the Access Health CT offices on an almost daily basis seeking answers. She said she has never received a phone call back from the center, which she said seems to dutifully take your information and give you a reference number that you provide to them the next time you call.
Demartin said she has four unpaid doctor bills and a CAT scan, which was pre-authorized by her insurance carrier, Anthem. However, Anthem said she’s no longer insured so they won’t pay it. She has re-applied for insurance and was supposed to hear back.
A spokeswoman for Anthem said none of their clients who are subsidized by the federal government have been canceled.
But what about Demartin?
It’s possible the form Access Health CT sent over to Anthem detailing the amount of the subsidy the company would receive from the federal government was wrong.
The income data a client gives to Access Health CT is verified with the Internal Revenue Service before the information is sent over to the insurance carrier. There have been some problems with the way in which the information is transmitted to the insurance carriers, but the two other insurance carriers participating in the exchange say they aren’t experiencing the same problems.
“Anthem has not and would not cancel a member entitled to a federal subsidy on the basis of not receiving the applicable subsidy payment from the federal government,” Sarah Yeager, an Anthem spokeswoman, said in an emailed statement last week.
Yeager continued: “Members may be cancelled on the basis of a member’s failure to pay their portion of any premium due after the expiration of the applicable grace period. On the occasion that we have subsequently received updated information indicating that the member was entitled to a federal subsidy, we have worked quickly and diligently to reinstate the member and cover them retroactively.”
It’s possible Anthem had no idea Demartin was supposed to be receiving a subsidy based on the information it received from Access Health CT.
Connecticut Republican leaders, who have been critical of Obamacare, want to know how many more residents are in the same situation as Demartin.
State Healthcare Advocate Victoria Veltri said Monday that she didn’t think the situation was widespread. However, there have been cases where the wrong subsidy amount was reported to the insurance carrier or no subsidy was reported to the carrier and the client was billed for the wrong amount.
Counihan admitted that it could happen where a wrong amount was reported, because every time a change is made to an application it generates a new 834 form. But he maintained that he hasn’t heard of anyone losing coverage because the federal government failed to pay the subsidy to the carrier.
Counihan said he would look into Demartin’s case and talk with the carrier to try and figure out what’s happening.
“If you’re Gail you don’t care about how widespread the problem is you just want it solved,” Counihan said.