Nevada’s Ailing Health Exchange

by Jillian Kay Melchior

Nevada’s health exchange isn’t doing so well, if three new stories are any indication.

In the past month, the Silver State Health Insurance Exchange has struggled to issue both coverage cards and timely bills. Meanwhile, some who have enrolled are finding that despite their careful research, they can’t keep their doctor or, in some instances, find an appropriate one.

The Reno Gazette-Journal reports on the woes of one 61-year-old diabetic man whose health and finances are struggling, thanks to a health-exchange glitch:

Like every morning in the last five years, last Friday started just like any other for Gary Smith.

For the 61-year-old Fernley resident, this meant sitting down for breakfast and taking his diabetes medication. With his supply of the drug Janumet gone, however, Smith feared he would be unable to take his second daily dose that evening.

“This morning was my last dose,” Smith said last week. “I’m all out.” . . .

One month since enrolling, Smith is one of several Nevadans who were unable to get insurance cards in January despite paying through the Nevada Health Link insurance exchange website. The program — which blamed a glitch for Smith’s problems — could not provide an exact number of how many Nevadans were affected, only saying that it affected “a small group of people.” . . .

More than halfway through January, Smith had yet to get his insurance card. To make matters worse, the glitch also changed his monthly insurance bill. Instead of being charged the discounted rate of $150 per month under the Affordable Care Act, Smith was being charged the full unsubsidized amount of $749.

“Not only did I not get a card, they also billed me for the entire insurance amount without the tax credits that I qualified for,” Smith said. “They already charged $150 on my credit card. This means I’m paying for insurance that I can’t even get.” . . .

Meanwhile, Smith ran into issues with pharmacies such as Costco, Scolari’s and Walmart when he tried getting a prescription for his diabetes medication filled with just his Nevada health exchange ID.

“If you come in with a valid prescription and don’t have an insurance card, they will not accept your Nevada Health Link ID,” Smith said. “They won’t even bill me, I would have to pay for any prescription on the spot. That means I would have to pay $850 instead of $200 for a month’s worth of medication, and I don’t have that kind of money just lying around.”

Not only has the health exchange failed to issue coverage cards to some enrollees; it also didn’t manage to get the bills out until after the payment date had already passed. From the Las Vegas Review-Journal:

A computer glitch delayed February premium notices from being sent out on time.

The invoices should have been mailed by Jan. 15, said CJ Bawden, spokesman for Nevada Health Link. Instead, some were mailed Friday, and the rest will be sent by Monday.

That means the bills will arrive after the due date of Jan. 25. . . .

Xerox State Healthcare is the private contractor that designed and set up Nevada’s online insurance portal.

The company was awarded a $75 million contract paid for with federal grants to build and operate Nevada’s system, part of the federal health care reform law.

Meanwhile, some who have managed to successfully buy coverage are finding their plans have changed drastically. The Review-Journal reports:

[Lenora] Kaplan, a businesswoman who runs a local marketing and media-training company, bought her policy in mid-December via the new Silver State Health Insurance Exchange. Her main requirement while plan-shopping? That the three doctors she sees for routine care were in the provider network. She thought she’d found just the coverage through Nevada Health CO-OP, a new, nonprofit insurer that listed her existing doctors in its network.

But when Kaplan asked the CO-OP last week for a new list so she could find an internist, the updated version they sent her didn’t have any of her doctors on it. Kaplan called to ask why, and said she was told that doctors can opt out of a network at any time.

“I’m paying $388 (in monthly premiums) for a plan that none of my doctors are in. Now I need to know what to do,” she said.

The CO-OP released a wide-ranging statement late Monday that blamed the state exchange’s website, Nevada Health Link, for its woes, though the insurer’s comments focused on not getting “full membership information” from the exchange, rather than explaining why it’s having network problems. The statement did say that provider networks “sometimes change as both insurers and doctors make changes to their practice.” But the CO-OP’s problems seem to affect only it.

CO-OP is an ObamaCare invention with connections to the same Culinary Union that was caught on tape bullying Las Vegas tourists earlier this year. Along with two other groups, it got big federal money:

It wasn’t supposed to be this way for the CO-OP, part of a relatively simple concept added to the Affordable Care Act to create consumer-driven, locally based health plans for state insurance exchanges. The Nevada Health CO-OP has three sponsors: the Culinary Local 226’s Health Fund; its national parent, UNITE HERE Health; and the Health Services Coalition, a local consumer-advocacy group that negotiates health care costs and tracks quality of care for more than 300,000 members employed through cities, unions and major companies.

The sponsors won the federal contract — and $65.9 million in federal startup loans — in May 2012. CO-OP officials planned to double up on the Culinary’s existing, extensive provider networks

Kaplan isn’t the only one having difficulties, either:

Also last week, an administrator for a local allergy and asthma doctor [said] neither he nor any other allergy specialists in town have signed contracts with the CO-OP. The doctor’s staffer [said] the office has nonetheless cared for a dozen CO-OP members “just for the good of the order, to take care of people.” . . .

The CO-OP’s Facebook page carries a number of consumer complaints, including one from a woman who said the only plan-based gynecologist near her has three malpractice allegations on his record. Another post was from a woman who described being “escorted” out of her primary-care doctor’s office for having “unbillable” coverage.