White Coat Notes

Despite fixes, some left uncertain about Connector health insurance coverage

Cherif Kamel, wife Carol McCorkindale were signed up for insurance through the Massachusetts Health Connector. Tufts Health Plan has received no notice that he is a member.
Medway, MA - 01/04/14 - Cherif Kamel looking through documents that show he picked a health plan, has the cashed check and receipt yet he still has no information about his insurance coverage despite doing all he could to make sure that he and his wife Carol McCorkindale were signed up for insurance through the Massachusetts Health Connector. Barry Chin / The Boston Globe

Cherif Kamel had been struggling for weeks to secure health insurance coverage through the state’s online marketplace. He thought he had done it at the end of December. He chose a plan and delivered his first premium in person, only to find out days later that the Massachusetts Health Connector, which runs the marketplace, had no record of his enrollment.

Once a national model, the Connector has frustrated consumers for months. Its new website, overhauled to comply with the federal Affordable Care Act, has locked users out of their accounts and delivered confusing error messages. But, as Kamel’s story shows, the Connector’s troubles go beyond a bad website, to inconsistent enrollment data for some and poor communication, leaving some users uncertain about the status of their coverage.

The Connector’s new website has performed so poorly that the state has all but abandoned attempts to fix it. The agency’s staff is expected to report Thursday to its board about options for holding the vendor, CGI, accountable.

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Without a functioning website, the state has put most applicants into temporary insurance through the state’s Medicaid program and jury-rigged a system for processing others’ applications on paper and with simple software tools. The workaround has kept tens of thousands of people from losing coverage, despite the website woes, and provided new assistance to more then 24,000 people.

But Connector spokesman Jason Lefferts acknowledged that the workaround also has spawned misinformation, leaving some consumers confused about the status of their coverage.

“The Health Connector is working on these isolated situations as soon as they come to our attention, ensuring people have coverage,” he said.

For Kamel, the uncertainty has been stressful. His wife, Carol McCorkindale, has two sports injuries requiring specialists and physical therapy.

“We’re kind of in a bind,” he said Wednesday morning. “She’s in pain, so we need to do something. We postponed the really big [appointments], but we do the smaller ones, because we can’t wait until February to get treatment.”

Kamel said he received a call Dec. 20 from a Connector representative who said his insurance application had been accepted. Kamel, who was not applying for state assistance, specified which plan he wanted and hand-delivered a check for the first premium payment to the Connector’s Boston office the very next day.

The check cleared on New Year’s Eve, but that didn’t stop Kamel from getting a disturbing call at this Medway home. A Connector representative told him he still needed to select a plan. The information had gotten lost, but Kamel couldn’t simply choose again—that might result in duplicate enrollments, he was told.

In the week that followed, even as his wife postponed some necessary medical appointments and ran up about $1,000 in charges for others, Kamel received little clarity about the status of their coverage.

He called the Connector three days in the past week. Each time, he was told there was no record that he had selected a plan, while he was urged to be patient and promised that a supervisor would call him. No one ever did.

“They don’t live up to their promises,” he said.

On Monday, a Connector representative found his enrollment information, after some searching, but Kamel was not consoled. How could he be sure the information would get to Tufts Health Plan, the insurer he chose.

Lefferts on Wednesday evening confirmed that Kamel and his wife were enrolled and had paid their premium. Their coverage will be retroactive to Jan. 1. A Tufts spokeswoman said the insurer had not yet received Kamel’s record from the Connector. Kamel said he worries his case is not isolated, that others are confused, too.

Bailey Kaplan of Rockport was so uncertain of her coverage status last week that she cancelled her Connector plan, at a cost. She received a notice in early December that her enrollment was complete and scheduled an automatic premium payment for Dec. 26.

When she returned from vacation on Dec. 29, she found a notification in the mail that the state needed more information to finalize her application. Her payment had not been processed.

She mailed the documents the Connector had requested, expecting to hear more from the agency, but grew concerned about whether she would in fact have coverage in January. On Jan. 2, she paid $476 to have coverage through her former employer extended for one month, thinking she would pick up the Connector plan in February. The next day, with no notice to Kaplan, the Connector deducted a premium payment of $326 from her account, she said.

Kaplan has cancelled her Connector plan and is still trying to get a refund. She plans to stay on her former employer’s plan until the Connector system is working better.

Though the workaround system is “not ideal,” the state is working hard to make sure applicants receive the coverage they need, said Amy Whitcomb Slemmer, executive director of the consumer group Health Care for All.

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