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Nevada exchange offering belief-based coverage

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A Nevada insurance agent says his state’s public exchange should act quickly to make sure that consumers who are paying for private qualified health plan (QHP) coverage through the exchange have concrete proof of coverage. Today, he says, some consumers have to pay premiums for QHP coverage, even though they have no way to confirm whether they really have coverage.

Lou Cila of Best Nevada Insurance Agency described his concerns in a comment letter included in a Silver State Health Insurance Exchange board meeting packet. The Silver State has been running the state-based Nevada Health Link Patient Protection and Affordable Care Act (PPACA) public exchange.

The exchange had serious technical problems during the first individual QHP open enrollment period. The exchange board is in the process of shifting to use of the federal enrollment system for the 2015 open enrollment period, and, at press time, it was gearing up to interview Bruce Gilbert and David Haws, two candidates for its executive director post.

Cila reported in the comment letter that, because of billing calculation problems, some QHP customer files stay in “pending status” for a long time.

In some cases, “the customer [was] asked to pay for the coverage from the stated effective dates, but no cards or even a notice had been sent to the customer showing the coverage was actually effective,” Cila writes. Because the customers have no concrete proof of insurance, they are leery of going to providers for treatment based on their faith in customer service workers’ assurances that they have coverage, Cila says.

Even if the customers did seek treatment, if the providers called the carriers, the carriers would tell the providers that there is no evidence that coverage for those customers is in effect, Cila says. Everyone knows that the Nevada exchange has had system problems, but the idea of billing patients for coverage they were never able to use properly is unfair, Cila writes.

“The repairs to the system may take months, but the people are entitled to get what they have been told they were getting in a timely manner,” Cila says. “They should be able to walk into any doctor’s office that is part of the network and be treated by showing a currently dated insurance card.”

If the exchange does not to provide coverage at this point, it should tell consumers about that in writing, Cila says.

See also: PPACA: Will Exchanges Be Producers?


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