Connecticut regulators losing patience with Anthem coverage delays

David Gilbert says he sent his $825 check to Anthem Blue Cross and Blue Shield in early December. It was supposed to ensure that the Voluntown man would have health insurance by the start of this year.

But two weeks into 2014, Gilbert, 63, is still waiting for proof that he has insurance. An Anthem representative told him his check had been received, but as of Monday it hadn’t been cashed. That means Gilbert has been unable to get an insurance ID card, which he needs for a referral to an orthopedist.

He’s starting to wonder if he’ll ever get the coverage he thought he bought.

Gilbert is one of many Connecticut residents who signed up for Anthem plans through the state’s health insurance exchange but are still struggling to get their coverage set up.

And like him, state regulators are starting to lose patience.

The Connecticut Insurance Department has been in daily contact with Anthem officials, concerned about customers whose payments haven’t been processed and who don’t have a way to prove that they have coverage when they need to use it. People must pay their first month’s premium for their coverage to be activated.

“I would say that they know we’re expecting it to be worked out in a matter of days, not weeks,” Deputy Insurance Commissioner Anne Melissa Dowling said of the insurer.

Gov. Dannel P. Malloy and Lt. Gov. Nancy Wyman were scheduled to meet with Anthem officials Tuesday afternoon. Malloy said he was happy the insurer had given people until the end of the month to pay their January premiums. “Quite frankly, they need to extend it as far as they have to extend it, and prove to us that they’re getting the job done,” he said.

Part of the problem, Dowling said, is that Anthem’s parent, Wellpoint, is a national company, operating plans in 14 states. That means that many parts of its operations are not tailored for each state.

“We’re getting to the point where that’s just not satisfactory for us,” Deputy Insurance Commissioner Anne Melissa Dowling said of Anthem’s system for processing applications, which does not prioritize Connecticut customers.

“They’re not Connecticut-specific, so we’re in the queue [with people from other states],” Dowling said. “We’re getting to the point where that’s just not satisfactory for us.”

Dowling said the department has required Anthem to develop some workarounds.

The options that are now, or will be, available to Connecticut customers include:

  • A dedicated customer service email box for Connecticut residents, which is expected to be available Wednesday. Dowling said it will be staffed by 25 to 30 people who are Connecticut-based. A company spokeswoman said people can expect a response in two business days. The email form is available here.
  • Beginning Wednesday, people will be able to pay bills in person at Anthem’s office at 108 Leigus Rd. in Wallingford, from 9 a.m. to 4 p.m., Monday through Friday, through Jan. 31. People who pay that way will be able to get proof of payment there, Dowling said. Credit cards and checks will be accepted, but cash won’t.
  • Getting a “receipt” for people to take to a pharmacy or doctor’s office, confirming that they have coverage. It would be available to people who pay their January premium by telephone or in person at Anthem’s Wallingford office.

In addition, the Insurance Department’s consumer affairs division and the state Office of the Healthcare Advocate have been working to help expedite coverage for people who need immediate medical services, such as scheduled surgery or ongoing cancer treatment. Staff at Connecticut’s exchange, Access Health CT, have been taking calls too. CEO Kevin Counihan said he assisted a woman whose surgery had to be postponed because she didn’t have an ID card yet.

In a message posted on its website Monday, Anthem apologized for the inconvenience members faced. It urged people not to worry if they had not received a bill or had their credit card or bank account charged, saying “it may be due to the high volume of late December enrollments.” It also acknowledged that the company has a payment processing backlog and said it was anticipated to be cleared in the next several days.

The message also said that all applications submitted to the exchange by Dec. 23 and forwarded to Anthem would be processed for coverage effective Jan. 1 once the payment is processed.

Anthem spokeswoman Sarah Yeager said the company is taking steps to meet customers’ needs, including extending the payment deadline for January premiums to Jan. 31 for people who bought individual-market plans through the exchange or outside it. It’s also increasing staff at the call centers and extending their hours.

“Bottom line — we’re invested in making this work, and ensuring that our customers get the help and assistance they need, when they need it,” she said. “It’s important to keep in mind that this is an unprecedented time of change for everyone in health care.”

Anthem is the state’s largest insurer and has the largest share of customers who bought coverage through the state’s exchange, with about 25,000 enrollees so far.

The company’s online message Monday also said that people who don’t have a temporary ID card but have paid their premium can have their physician or pharmacist call the company’s provider service line to verify coverage and get a guarantee of payment for services the plan covers. “Members can call into our customer service line and our representatives will contact the provider and/or pharmacy on your behalf to verify benefits,” it said.

Dowling said the largest number of complaints the department has received are from customers who paid but don’t have proof. Some people have also complained because they have still not received a bill.

As for Gilbert, he’s angry and feeling ignored. “I just can’t say it often enough that most of the anguish, and confusion for consumers, could have been avoided by a simple email acknowledgement, and email updates,” he said.

Having proof in writing that he was going to be covered would have gone a long way to allay fears, he said. “But they keep you guessing…right up to the moment your check clears,” he said.

Connecticut residents who have questions about their coverage or are having problems can call or email the following:

Connecticut Insurance Department’s consumer affairs division

cid.ca@ct.gov

800-203-3447 or 860-297-3900

website

Office of the Healthcare Advocate

healthcare.advocate@ct.gov

1-866-HMO-4446

website

Anthem

1-855-738-6644

Email Anthem

Access Health CT

1-855-805-HEALTH

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