Errors leave some without insurance
State's complex system blamed
Tens of thousands of people insured under the state's universal healthcare system have had their coverage terminated since the start of the year, state enrollment figures show. In some cases, patients were terminated because of mistakes they made themselves and in other cases because of errors by the state.
The state figures, however, do not show how many of the people later re-enrolled, nor do they track how many were wrongfully terminated. But lawyers and community advocates said they have seen a "steady stream" of enrollees whose insurance was unilaterally canceled by the state through no fault of their own. State regulators acknowledge that some have been mistakenly cut from the system but put the number at fewer than 100.
The terminations reflect growing pains in the state's first-in-the-nation law requiring virtually every resident to have coverage. Earlier this week, the state reported that since the law's launch in 2006, nearly three-quarters of previously uninsured Bay Staters had gained medical coverage; roughly half are covered under private health plans.
But about 173,000 of the newly insured are enrolled in Commonwealth Care, which is insurance for people who don't qualify for employer-sponsored health coverage and earn too much to qualify for Medicaid. Those enrollees must renew their insurance annually and must also report to the state every time they change jobs.
The state's eligibility documents are complex, advocates said, leading some patients to have their insurance terminated - even though they are eligible for coverage - because they made mistakes filling out the forms. Mail sent by the state to the wrong address is also cited as another reason coverage is dropped.
In other instances, the state misinterprets information on the forms and mistakenly bounces people out of the program, advocates said.
Patients terminated by the state can unknowingly rack up thousands of dollars in medical bills only to discover that those expenses will not be reimbursed. The only way they can get the money back is to sue the state.
"We get a steady stream of people who were erroneously dropped," said Barbara Anthony, executive director of Health Law Advocates, a nonprofit that has sued the state on behalf of some Commonwealth Care members who were mistakenly terminated. Health Law Advocates did not have exact figures.
"This is an issue of fairness," she said. "I think there would be a huge outcry by state government if a private insurance plan behaved that way."
Melissa Boudreault, director of Commonwealth Care, estimated there have been fewer than 100 wrongful terminations brought to the attention of the Commonwealth Health Insurance Connector board, the state agency that regulates Commonwealth Care.
"If we are made aware of an instance where medical debt was incurred, or someone needs to see a doctor, we work on a case-by-case basis to resolve those issues," Boudreault said. "We are really trying to get this right."
Boudreault said that state regulators are aiming by January to overhaul the massive computer system that runs Commonwealth Care and the state's Medicaid program, known as MassHealth. That upgrade, Boudreault said, should ease the wrongful termination issue and allow the state to reimburse those whose coverage was erroneously canceled.
Consumers caught in the middle said the experience can be maddening and expensive.
"It's confusing and frustrating, and who's got the time to deal with this?" said Elizabeth, a 55-year-old part-time midwife in Springfield who signed up for Commonwealth Care in January. Elizabeth asked that her full name not be used because she does not want her family to know she is receiving subsidized healthcare.
Elizabeth is not eligible for insurance at the hospital where she works because she is part-time, but the hospital agreed to deduct monthly premiums from her paycheck and send it to Commonwealth Care. Unbeknownst to Elizabeth, though, her employer was getting the premium bill on the day it was due, so even though the bill was being paid, Elizabeth was marked as delinquent.
So Elizabeth said she was bumped from coverage for four months. Although she continued to pay her $400 monthly premiums, Elizabeth said, her insurance card was rejected when she went to the drug store to pick up allergy medication. The pharmacy billed her the full $125 each month.
Maritza Smidy, the office manager at the hospital where Elizabeth works, helped sort through the mess.
"I would consider myself a fairly educated person," Smidy said, "and I got confused."
A prime source of confusion, Smidy and others say, is that consumers are directed to the Connector Authority to sign up for Commonwealth Care and for questions about the insurance. But they must work with a separate state agency, MassHealth, to prove they are eligible and for yearly renewals.
Leaders of two of the health insurance companies that cover most of the Commonwealth Care customers, BMC HealthNet and Network Health, say members frequently seem to be terminated by the state and then re-enrolled several months later.
"The paperwork is complicated material from the state," said John Cragin, a top BMC HealthNet executive.
Jennifer Kritz, a spokeswoman for MassHealth, said the state is refining its mailing system. But she said that because a significant number of Commonwealth Care members fail to notify the state when they move, her agency is trying to work with advocates to come up with a reminder system. Kritz said the state also is developing a more easily understood document to simplify the annual renewal process.
"MassHealth is keenly aware of this issue and has a shared interest with members, providers and advocates to prevent disenrollments whenever possible," Kritz wrote in an e-mail.
Correction: Because of a reporting error, a Page One story Saturday about some people losing state-subsidized health insurance coverage wrongly said a 55-year-old part-time midwife in Springfield was temporarily dropped by Commonwealth Care, the state-subsidized plan. She was covered by another plan. 