In­sur­ers fret over po­ten­tial IT prob­lems for en­roll­ment

Modern Healthcare - - NEWS - By Dar­ius Tahir

Health plan of­fi­cials are press­ing the CMS to af­fir­ma­tively no­tify them when their mem­bers choose a dif­fer­ent plan through Health­Care.gov for 2015 rather than re-en­rolling in the same plan. But the CMS merely says it is ex­plor­ing whether it will ac­com­mo­date that re­quest.

The CMS has an­nounced that con­sumers who bought a 2014 ex­change plan will, if they take no ac­tion, be au­to­mat­i­cally re-en­rolled in the same plan for 2015. But in­surance in­dus­try of­fi­cials worry that con­sumers who se­lect a dif­fer­ent plan dur­ing the com­ing open en­roll­ment might not be au­to­mat­i­cally dis-en­rolled from their old plan. That cre­ates the po­ten­tial of a con­sumer be­ing dou­ble-charged on pre­mi­ums, which one plan of­fi­cial called “a cus­tomer ser­vice night­mare.”

A CMS spokesman said the agency has de­signed the re-en­roll­ment process so that Health­Care.gov will send an en­roll­ment trans­ac­tion to in­sur­ers for ev­ery­one who should be re-en­rolled, the spokesman said. “Is­suers who do not re­ceive a trans­ac­tion for a mem­ber can safely let their pol­icy end.”

But an in­surance company rep­re­sen­ta­tive who did not want to be named said in­sur­ers would pre­fer to get an af­fir­ma­tive no­ti­fi­ca­tion of mem­bers’ ter­mi­na­tion to avoid any mix-ups.

The agency al­ready sends out such ter­mi­na­tion no­tices when a con­sumer switches plans midyear be­cause of a change in life cir­cum­stances. That leaves open the ques­tion as to why the agency can­not send such ter­mi­na­tion trans­ac­tions to ad­dress in­surer con­cerns.

When asked, the CMS spokesman said the agency is “ex­plor­ing the ex­tent” to which it can send such trans­ac­tions.

There’s also anx­i­ety about the new en­rollee lo­gin sys­tem. Ex­change of­fi­cials scrapped the old lo­gin sys­tem, called EIDM, and re­placed it with a new one. Ob­servers hope it will pro­vide a smoother, more in­tu­itive ex­pe­ri­ence for con­sumers.

But the re­place­ment lo­gin sys­tem is in test­ing and won’t be broadly avail­able for in­spec­tion by the in­surance com­mu­nity un­til Oc­to­ber. Open en­roll­ment starts Nov. 15.

“If there are glitches, there’s not a cush­ion,” said Fer­ris Tay­lor, chief strat­egy of­fi­cer at Arches Health Plan, a con­sumer-gov­erned co-op in­surance in Utah.

Dan Schuyler, the se­nior di­rec­tor of ex­change tech­nol­ogy for Leav­itt Part­ners, pre­dicted Health­Care.gov’s cus­tomer ex­pe­ri­ence will be bet­ter for 2015 than it was for 2014, ar­gu­ing that the cloud tech­nol­ogy pro­vided by Ama­zon Web Ser­vices will make a dif­fer­ence.

But, he cau­tioned, the cus­tomer traf­fic may be so heavy that site per­for­mance will still slow down.

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