A North Haven woman who was dropped from her Affordable Care Act plan even though she was paying her monthly premiums, is not alone.
According to Access Health CT CEO Kevin Counihan, there are 5,700 consumers who were inadvertently dropped from their plans for a variety of reasons.
Counihan told CTNewsJunkie Wednesday that they have been working on the issue on a case-by-case basis with consumers and insurance carriers, and will have a programming fix ready that will take care of a majority of the problems on July 18.
Continually touted as one of the more successful state exchanges with plans to sell its system to other states, Counihan admitted that the rollout hasn’t been without its glitches.
“I don’t think the issue is that there was a glitch,” Counihan said. “It’s about how quickly we are able to fix it.”
But one Republican lawmaker said admitting there’s a problem is the first step toward fixing it.
Sen. Len Fasano, R-North Haven, who wrote a letter to Counihan in June asking about these types of problems on behalf of his constituents, was told that there wasn’t a problem.
“I appreciate your raising this issue to us as we have as yet to receive no such complaints of this sort,” Counihan wrote in the June 18 letter to Fasano and House Minority Leader Lawrence Cafero.
That didn’t sit well with Fasano.
“He was trying to be too cute by half,” Fasano said Wednesday. “That to me is a lie.”
Counihan said he was referring to the cancellation of policies due to the nonpayment of federal subsidies. He said the federal government has not been avoiding its payment responsibilities to insurance carriers.
The problem was that there were changes made to the application that generated a new 834 form. Every time a person changes information such as their income or street address a new form is generated. The 834 form is then sent to the insurance carrier by Access Health CT and is used to convey the federal subsidy amount. The various changes to the application may have generated an inaccurate 834 form, and could have caused problems for about 5,700 consumers. There are an estimated 80,000 consumers enrolled in plans with one of the three private insurance carriers.
In the case of one of Fasano’s constituents, she was paying her portion of the premium and was still canceled. The insurance carrier even sent her back the check when they canceled her policy. It left her wondering if the federal government just hadn’t paid its half. That wasn’t the case, but it prompted Fasano to write a letter to Counihan asking about the situation.
In his letter, Fasano tried to convey the situation his constituents were explaining to him, but may not have used terms that meant the same thing Counihan believed they meant.
“He’s trying to play cute with words to avoid being embarrassed by the fact he knew there was a problem,” Fasano said.
Counihan said Fasano’s original letter was not clear. He said it’s a complex issue and it’s seductive to “draw broad conclusions.”
Counihan said they were aware of the problem and a majority of it is related to a “programming error” which is scheduled to be fixed on July 18.
In a follow-up phone call, Fasano said all he wants to know is that the problem is being corrected.
“I do believe he’s trying to fix the problem,” Fasano said Wednesday after talking to Counihan.
The Insurance Department doesn’t regulate Access Health CT, but it does regulate the private insurance carriers that offer plans through the exchange.
In his letter to Fasano, Leonardi said the specific issue regarding the cancellation of coverage and the 834 forms was disclosed to the Insurance Department on May 9.
“At a regularly scheduled meeting on June 20th the Department was notified that the subsidy issues, and the resulting consumer impacts such as policy cancellations, were the result of enrollee’s self-reported changes in income or in some cases manual processing errors by AHCT’s vendor,” Leonardi wrote. “Furthermore, in some cases, a misrepresentation of enrollee’s citizenship occurred and policies were dropped in compliance with the requirements of the ACA. In other cases, a misrepresentation by enrollees of income had been discovered leading to the reduction or elimination in the federal subsidy.”
Leonardi went onto say that he believes Access Health CT is addressing the issue and his department will keep pressure on them to “ensure that any policyholder that was wrongfully dropped is made whole.”