Frustration mounts with ‘heartbreaking’ state insurance exchange

There’s no other way to put it.

The website errors, hours-long customer-service waits, confusion about doctor networks, dismal enrollment numbers and missing insurance cards boil down to one simple fact: The Silver State Health Insurance Exchange is broken.

That’s not to say the problems are irreparable, or that the state-run exchange created by the Affordable Care Act fails all who use its Nevada Health Link website. But right now the system hurts more than helps many users. Widespread dissatisfaction could mean trouble if the exchange doesn’t improve.

Just two groups of people will talk openly about the problems: Patients, who can’t sort out whether they’re covered, and insurance brokers, who hear nonstop from panicky customers unable to get answers from either insurance carriers or the exchange. Insurers and doctors are mostly mum, possibly feeling “a little fear of retribution” from some of the exchange’s powerful players, said one industry source.

But those willing to talk say the system contractor, Xerox, has had trouble meeting deadlines, and exchange officials failed to force the company to prove it could produce on schedule.

Here’s how that affects users, and what the state says it’s doing about it.


Rebecca Gray said Monday that she’s been trying to buy coverage for a month, but it “has been incredibly difficult to sign up.”

“The website has been down and it is impossible to sign up over the phone,” she wrote the newspaper. “I have yet to actually get through to anyone to talk to them.”

Irene McHone’s journey has taken longer.

McHone and a friend, Ray Ellis, have been trying to sign up McHone since November, when her income went up and she no longer qualified for Medicaid. Ellis estimates he spent 40 hours over two months trying to complete McHone’s application online or by phone. Earlier this month a broker helped Ellis find a plan, but the website’s payment function hasn’t worked. McHone still has no plan.

Since November, McHone, who has chronic obstructive pulmonary disease, has paid $100 a month to keep her oxygen tank flowing. She’s about to run out of medications that cost $300 to $400 a month each without insurance. And she has no idea how she’ll pay to see her cardiologist next month.

“It takes a toll on you. You just wonder what the problem is going to be today,” McHone said. “I just need health care. I don’t want to sit here and die little-by-little every single day.”

The exchange’s problems show most dramatically in enrollments. More than 1 million consumers had visited the website by Jan. 11, but only 13,159 paid sign-ups were recorded by Jan. 22. That’s a conversion rate of 1.3 percent.

McHone’s broker, Patrick Casale of Patrick Casale &Associates, said the share of people who buy coverage should be at least 10 percent. That means roughly 100,000 of Nevada’s estimated 600,000 uninsured would be enrolled, and the exchange would be approaching its goal of 118,000 sign-ups by March 31.

Consumers either can’t escape the site’s electronic limbo, Casale said, or they can’t find coverage they like or can afford.

The exchange has two more months to meet its goal, but enrollments are trending against it. Plan selections peaked at 4,933 from Dec. 23 to Jan. 4, but fell to 1,535 between Jan. 11 and Jan. 18. Paid enrollments dropped from 4,328 between Dec. 23 and Jan. 4 to 1,750 between Jan. 11 and Jan. 18.

Consumers are having a hard time partly because insurers are, too.


“Nevada’s insurers are not receiving full membership information from the state exchange and in some cases, the information we are receiving is incorrect,” Nevada Health CO-OP CEO Tom Zumtobel said in a Jan. 20 statement to the Review-Journal.

That’s creating hardship for insurers. Zumtobel described how the new carrier is covering care for members even if it can’t prove they enrolled in CO-OP plans. That included spending most of Jan. 17 arranging for a heart transplant.

“We have covered office visits, prescriptions, procedures, and hospitalizations,” Zumtobel said. “We ensured one member was able to get to the hospital after a midnight call — again, without confirmation from the exchange that this person is actually a CO-OP member.”

Other insurers seem to be having trouble getting enrollment details.

The Xerox system was supposed to upload consumer applications directly from Nevada Health Link to insurance carriers, but that’s not always reliable.

A Las Vegas insurance broker said the exchange delivered “a box of printed paper applications” to Health Plan of Nevada, the state’s biggest insurer, so that staffers write policies by hand. That’s caused a “tremendous delay” issuing cards and contracts, the broker said.

A spokeswoman for Health Plan of Nevada parent UnitedHealthcare said she would try to find someone to talk about the issue, but no statement was forthcoming.

Anthem, Nevada’s second-biggest carrier, may have the same issues.

Surya Iacono told the Review-Journal that exchange officials informed her they had to manually send her information and payment history to Anthem in mid-January. Anthem wouldn’t comment for this story.

CO-OP officials said having to double-check or verify new members has bled resources from patient and doctor education. That’s created its own problems, including pulling CO-OP officials away from discussing networks and contracts with doctors, who are themselves feeling the heat.


For Comprehensive Cancer Centers of Nevada, it’s been a rough month.

The practice and its doctors are listed in provider networks, but there’s a big problem: The oncology center isn’t actually contracted to provide care through any exchange plans. That’s caused consternation for patients who come in for care, or who hear the center is refusing those who can’t verify coverage, said Executive Director James Kilber.

“I can’t imagine being diagnosed with cancer, and having to go through that,” Kilber said. “To also have to go through the confusion of the exchange — it’s heartbreaking. We’re in medicine to cure and help people. When we hear that people are getting the wrong information, or (fear) that we would dump them onto the street without care — which we would never do — it’s very frustrating,” Kilber said.

Comprehensive Cancer Centers isn’t alone. Many primary-care providers, allergists and other doctors report being incorrectly listed in provider networks, though few would comment for publication.

Kilber said the practice aims to ink network deals by Friday with Blue Cross Blue Shield and the Nevada Health CO-OP, almost four months to the day after the exchange started telling people the cancer center was in its provider networks.

The center will continue to see patients already in treatment, regardless of changes in insurer or network, but won’t see new patients with exchange-based plans until network contracts are signed.

That leaves desperate patients turning to insurance brokers for help.


More than 1,500 brokers signed up to sell coverage by the time Nevada Health Link launched, but they still lack a working brokers’ enrollment web portal.

Casale, Irene McHone’s broker, said he doesn’t expect the portal to be up and running until after March 31. That’s making it tough to help people get covered. An off-exchange enrollment that takes five minutes can take hours when signing up through the marketplace, Casale said.

“I’ve had clients for 20 to 25 years that I’m trying to take care of, and I can’t get them into the system. It’s absolutely deplorable,” Casale said. “It’s so redundant and slow, it’s unbelievable. You can’t go back if you make a mistake. We’re told they have a dedicated phone line for brokers. My colleague calls in, gets through right away, and is put on hold for two hours.”

Reno-based broker Nick Goman said the website’s tax-credit calculator initially didn’t work. While he’s been assured it’s been fixed, one client’s application remains stalled because of the glitch. Another client who paid for coverage on Dec. 15 was still waiting for a policy as of last week.

“They advised that it is hung up in the accounting department after they told me all was fine and good and the carrier was just slow in putting out ID cards,” he said.

For Las Vegas broker Dwight Mazzone, working through the exchange “takes away from” other parts of his business. To even determine whether someone should sign up for a private plan or go through Medicaid, Mazzone has to “gather every bit of information” about the consumer. He might have to fill in the same data two or three times. Worse still, there’s no way to back up and make changes before you buy.

“The website that was built by Xerox is absolutely the worst thing we’ve ever had to deal with,” Mazzone said. “It’s in a constant state of change. We have more people uninsured now than we did before this thing started. Nobody really has a grasp from the federal level down on how we can make it work better, easier or more efficiently.”


Xerox is universally blamed for the mess, but industry observers also fault exchange officials for not forcing Xerox to perform.

Exchange officials say that’s not true; Xerox promises they’re working on it.

Xerox won a $72 million contract in September 2012 to build Nevada Health Link and to launch its Henderson call center. The company at that time touted more than 40 years of experience working with government health agencies “to enhance the efficiency of health programs,” and pledged to use “proven solutions from the commercial marketplace” to “create a more consumer-friendly experience.” Spokeswoman Jennifer Wasmer said the state exchange would land in the middle range in scope and size of all of the projects it’s handled.

But as the Oct. 1 launch date loomed, Xerox began to miss deadlines, said one insurance-industry representative. The company didn’t run test files through the system before it went live. Exchange officials, meanwhile, accepted Xerox’s word that it was working on the system rather than taking the company to task and enforcing a strict timeline, the representative said.

Casale agreed a lack of urgency caused many of the exchange’s problems.

“This cluster started with Xerox,” he said. “They’re not delivering. There are performance guarantees, but I haven’t heard a clue about what they’re doing to pay back the state based upon the lack of performance.”

Exchange spokesman CJ Bawden said Xerox has not been paid in full, though he said he didn’t know how much of the $72 million the company has collected. He disputed reports that exchange officials are lax with Xerox.

“There is a timeline the exchange watches on a daily basis,” Bawden said. “We communicate with Xerox on a daily basis. Things that are not addressed are escalated to the highest levels of the CEO of Xerox. Xerox has committed full resources to making sure Nevada Health Link is operational.”

With errors ranging from application glitches to plan selection, “there are many different things that need to be corrected,” he said.

Bawden also said some consumers were signing up and paying as early as Oct. 1, so it’s unfair to say the entire system is broken.

“Multiple things may affect each individual account. Some of them involve back-end (programming) issues, but others can be on the user’s side. Most of them would seem to be incompatibility issues between the portal and the system the person is using,” he said.

For its part, Xerox in a written statement said it “continues to be committed to Nevada Health Link and to helping Nevadans get access to affordable health care through the state’s health insurance exchange. We are fully committed to getting all aspects of Nevada Health Link right, and we’re re-directing resources and focusing additional support to achieve this goal. We are also taking measures to ensure carriers have faith in the integrity of the exchange and can provide their members with care in a timely manner. This is a milestone moment in the state’s health care history, and we regret any difficulties Nevadans may be experiencing, but we are dedicating ourselves to ensure they receive the health care support they deserve.”

Wasmer said the company has formed “dedicated teams to address questions from brokers and other issues that require special handling.”

Mary-Sarah Kinner, spokeswoman for Gov. Brian Sandoval, said the governor gets regular updates from Xerox, and holds weekly conference calls with CEO Ursula Burns.

“While the conversations have been respectful, they have also been candid and direct by both individuals,” Kinner said. “Ms. Burns has promised Xerox’s full attention to Nevada Health Link and has directed additional resources to the exchange to address web and call-center issues.”

As a result of those talks, Kinner said, Xerox now has 106 local customer-service representatives. That will grow to 175 mid-February.

“There is a plan in place and the governor intends to keep his focus on this issue until it is resolved,” she said.

Contact reporter Jennifer Robison at Follow @J_Robison1 on Twitter.

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