EDITORIAL: Nevada exchange fails paying customers

Remember when the viability of the Affordable Care Act was said to be dependent in large part on states creating their own health insurance exchanges? The Nevada Legislature and Gov. Brian Sandoval did just that back in 2011. Good times.

Today? Not so much, particularly for the nearly 4,000 Nevada Health Link customers — representing 10 percent of the exchange’s total enrollment — who have unresolved issues and who in some cases have paid thousands of dollars in premiums, only to later learn their coverage was in flux. And sometimes, these customers are belted with thousands of dollars of medical bills for procedures they thought were covered.

As reported by the Review-Journal’s Jennifer Robison last week, Bobby Tran and wife Ha Le paid out $573 a month for platinum coverage beginning Jan. 1 — nearly $4,600 in premiums so far. But Xerox, the Nevada Health Link website contractor and the party responsible for forwarding payments to insurance carriers, was apparently not sending Mr. Tran and Ms. Le’s payments to Health Plan of Nevada. Consumers lose their coverage after 90 days without payment, so Tran and Le had their policy terminated in April, though they didn’t get a cancellation notice until July.

That was two months after they’d arranged for medical procedures, lab tests and medications they thought were covered. The couple ended up with $3,000 in medical bills. Mr. Tran and Ms. Le both said they were persistent in contacting Nevada Health Link about the problem, but couldn’t resolve it. Instead, in what’s becoming a familiar pattern, Nevada Health Link and Health Plan of Nevada resolved the issue last week in just three hours — after a call from the Review-Journal about Mr. Tran’s case.

So we now know how to solve this massive problem for the untold number of customers who have paid and aren’t getting coverage: Call the Review-Journal, which will then call Nevada Health Link, and you’ll have coverage by the end of the day.

Call right now! Our operators are standing by!

But this is no way for an insurance exchange to operate. Nevadans who hope to get subsidized coverage have to go to Nevada Health Link — there are no other options, unless you’re willing to pay full price with no subsidy. It’s beyond ridiculous that the state-created exchange can’t assure customers that they are covered and can’t properly remit payments to Health Plan of Nevada.

Much of the blame falls on Xerox’s design of the exchange, but make no mistake, it’s also tied into the extremely poor decision to have the exchange handle payments and forward them to the carrier, instead of having customers send direct payments to insurance companies. And as Ms. Robison reported, customers may get some help in November, when the state exchange — which fired Xerox — will start utilizing the federal healthcare.gov exchange, on which insurers work directly with customers.

That said, here’s the bottom line: If exchange officials can fix the problem within hours after a call from a journalist, then they can resolve any issue right now. They just don’t have the people willing to do it. They need to be less concerned about bad PR and more concerned about their paying customers.

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