Another logjam: MNsure slow to process insurance coverage changes

  • Article by: JACKIE CROSBY , Star Tribune
  • Updated: June 18, 2014 - 5:35 AM

The insurance exchange is in talks with Optum to resolve long waits for people whose coverage needs have changed.

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Scott Leitz

Photo: Glen Stubbe, Star Tribune

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Thousands of Minnesotans whose insurance needs have changed because of a lost job or other life event are waiting weeks and sometimes more than a month to get coverage through the MNsure exchange.

Since open enrollment ended in March, about 6,000 Minnesotans have contacted MNsure because of events such as a new baby or change in marital status. But systems are still not in place to quickly handle their insurance needs.

Officials at MNsure, the state’s online insurance exchange, said the issue is one of several “high priorities,” and that the agency is in discussions this week with Eden Prairie-based Optum to help it work through the backlog.

“We do understand the importance of this issue, and it’s critical for us to make the processes as simple as we can for people,” MNsure CEO Scott Leitz said. “In an ideal world, all of this would be automated. It’s not.”

Leitz said MNsure’s focus to date has been on fixing systemic problems to get people through open enrollment.

Last week, the state reported that the number of uninsured has dipped to a record low 5 percent, despite MNsure’s well-documented technical problems with lead vendor IBM and hourlong waits at the call center.

Much of the sign-up effort relied on paperwork and manual workarounds, which remains a problem in addressing the current “qualifying life events” under the Affordable Care Act.

To that end, Deloitte Consulting is expected to present a report at Wednesday’s MNsure board of directors meeting that will be the fullest assessment to date of what needs to be done to get the state’s online health exchange system functional by November, when the next open enrollment period begins.

Optum, a UnitedHealth Group subsidiary, has helped other state exchanges figure out how to address the complications related to life changes, and is familiar with MNsure’s issues. Earlier this year, Optum produced a bruising report on MNsure’s overall operations.

Hiring Optum in a new role could be handled out of the existing MNsure budget, Leitz said, though no contract has been drawn up. The earlier report was done at no cost to taxpayers.

MNsure has hired Deloitte on a nine-month, nearly $5 million contract to chart a path to solve immediate problems and make the site work over the long haul.

Mike Moran is among those still locked in anxious limbo. He lost his workplace insurance in April and had an option to pick up a COBRA plan. But Moran said he was delighted to find a better and less costly PreferredOne plan through the MNsure website.

It took six weeks of back-and-forth with few answers before Moran got a call from MNsure last Friday offering assurance that he would have retroactive coverage to May 1. But the insurance company has yet to get the paperwork, and his COBRA option runs out June 30.

“I’m starting to get bills. Do I need this kind of stress? No,” said Moran, 59, who said he and his wife got hit with three medical events in May. “Should this MNsure process go beyond June, I’m out of alternatives.”

Handling life event changes have proved to be a complicated process in some cases, particularly when a family’s size changes, because it can affect federal poverty guidelines and access to public health insurance programs or tax credits.

MNsure said it is prioritizing cases when a person needs to be added to coverage, such as with the birth or adoption of a child or loss of job. Out of more than 700 of those elevated cases, about half have been resolved, MNsure said.

It takes MNsure staff an average of five to six hours to process one of the “add a person” cases, according to the agency, though officials couldn’t say how many days or weeks it takes to get a case resolved. Consumers have complained that they have been told to wait from four to eight weeks.

Part of the process requires call center operators to fill out a 19-page questionnaire, verify income and in some cases recalculate public subsidies.

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