Politics & Government

State health exchange is giving ‘stuck’ consumers an option for direct payment to insurers

Ongoing problems with the Washington Health Benefit Exchange – including stuck payments and lack of proof of insurance – have led to a new option for health-insurance consumers. The exchange, Governor’s Office and Office of Insurance Commissioner announced Thursday that payments can be made directly to insurers for the roughly 15,000 people whose premium payments are not getting through due to technical glitches at the exchange.

The move comes shortly after the exchange gave stern guidance to its technology advisers, Deloitte Consultants, last month about problems that have defied efforts to repair them all year long.

“We apologize to all of our customers in this situation and realize that behind every application is an individual or family who is seeking care,” Richard Onizuka, chief executive for the exchange said in a news release. “It is critical that we continue to deliver on our promise of providing the best marketplace experience as expected by our state and all its residents.”

Onizuka and his staff, who have enjoyed a reputation nationally for a relatively good performing exchange, have said the number of troubled accounts is 6,000 or less at any one time and that the specific accounts affected keep changing. As some are fixed, new ones have glitches, but most accounts are performing as intended.

Among the exchange failures are invoices that don’t reach consumers, payments made by consumers that don’t get to insurers, and verifications of insurance or cancellations that don’t become available to doctors and clinics or consumers.

The direct-pay option avoids a scenario suggested by state Insurance Commissioner Mike Kreidler last month. He looked into creating a special enrollment period for consumers caught in the exchange so they could deal directly with insurance companies outside the computerized exchange, but that would not have helped consumers depending on federal tax credits that are available only through the exchange.

“People who now are stuck in the exchange, instead of making payment through the exchange, they’ll be able to make payments directly to the insurance company they are covered by. This will eliminate the middle man. This will continue through the next enrollment period, which starts Nov. 15. So this is a temporary fix,’’ spokesman Steve Valandra of the Office of Insurance Commissioner said.

Kreidler sent a letter to insurers Thursday informing them of the option. He told the insurers that direct payment gives the carrier immediate proof of payment for each enrolled consumer.

The insurance commissioner’s office said that those with problems using insurance can call a toll-free number, 800-562-6900, or file a complaint at his web site.

Consumers are first urged to call the exchange’s customer support center at Washington Healthplanfinder at 855-923-4633 to be let the exchange know of the issues. There is an option to submit payments directly to an insurer.

“We want consumers to know they have several options to pay their premiums and have the certainty they deserve that their coverage is current,” Gov. Jay Inslee said in the news release. “I encourage anyone with payment questions to contact Washington Healthplanfinder – they can help.”