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Life Health > Health Insurance

Exchange plan users face calls about 'inconsistencies'

By Allison Bell

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Many of the consumers who bought “qualified health plan” (QHP) coverage through the public exchange system are scrambling to back up the information they put in their applications. The Centers for Medicare & Medicaid Services (CMS) is following up on “inconsistencies” between the information consumers put in their own Patient Protection and Affordable Care Act (PPACA) exchange applications and information coming from other sources, such as the Internal Revenue Service and the Social Security Administration.

Customers who get exchange inconsistency notices have 30 days to upload documents supporting their application answers into their HealthCare.gov accounts or to mail the documents to a HealthCare.gov office. Customers who fail to supply the requested information in time could lose their QHP coverage.

CMS officials talk about the hunt for inconsistencies in a slide deck posted on the CMS website over the weekend. 

States with state-based exchanges are in charge of their own effort to look into application problems. CMS is handling the hunt for the exchanges it runs directly for its parent, the U.S. Department of Health and Human Services (HHS).

See also: Watchdog: Exchanges have trouble counting data conflicts

HHS exchange workers are contacting customers affected by QHP application information problems through the mail, through electronic mail and through the telephone. Exchange reps who call, “state that they are from the Marketplace and will ask consumers to verify their name and date of birth, and mailing address,” officials say.

HealthCare.gov workers will accept cell phone photos of documents that can’t be scanned. HealthCare.gov uses the application information to decide whether people are eligible to buy exchange coverage, and whether people are eligible to get help from the government with paying QHP premiums or handling out-of-pocket costs.

Some of the inconsistencies may involve typos, or issues related to address changes. In other cases, customers could face questions about whether they gave accurate information about household income, or whether they really lack access to employer-sponsored “minimum essential coverage.”

See also: Witnesses: PPACA income verification is a mess

Last week, officials at the HHS Office of Inspector General said exchange program managers seemed to be having trouble counting and responding to application data problems. But the officials estimated millions of QHP customers may face questions about inconsistencies.

CMS Administrator Marilyn Tavenner said the inspector general’s review period ended months ago, in the middle of the individual QHP open enrollment period. CMS is now following up on inconsistencies, Tavenner said.

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