Anthem making progress, but some customers still waiting

This is a picture of Deputy Insurance Commissioner Anne Melissa Dowling

Uma Ramiah / CT Mirror

Deputy Insurance Commissioner Anne Melissa Dowling: the "logjam" has broken.

After nearly a month of customer frustration and monitoring from state regulators, Anthem Blue Cross and Blue Shield has made progress in getting health care coverage set up for its January customers, according to state officials.

“I would say that in the last couple of days, I feel like there really has been a logjam broken,” Deputy Insurance Commissioner Anne Melissa Dowling said Wednesday.

Some customers who signed up for insurance that was scheduled to start Jan. 1 are still waiting for proof that they have coverage. But Dowling said the company has been making progress in getting insurance ID cards mailed to members.

Close to 20,000 Connecticut residents signed up for Anthem plans through Access Health CT, the state’s health insurance exchange, expecting to have insurance when the year began. But many customers said they hadn’t received a bill, and the company later acknowledged that it had a backlog in processing payments, which must occur for coverage to take effect. Customers have also complained of long wait times to reach a representative at the company’s call center, and some who needed surgery or other care turned to state officials for intervention.

Potentially adding to the processing challenges, on Saturday, close to 10,000 more state residents who bought insurance through the exchange are slated to get coverage, the majority with Anthem. But Access Health CEO Kevin Counihan said he expects a smoother start for people whose coverage begins Feb. 1, in part because there are fewer new members.

Counihan said there are still issues with some Anthem customer payments not being processed, but things are improving.

“I think it’s getting a little better,” he said. “I don’t think it’s resolved yet.”

Dowling said Anthem’s backlog is being reduced and the call center statistics have been improving, although she said they’re still not where the department wants them to be. Anthem has said it was adding staff to answer phone calls and would be more responsive to customer emails.

Many people have turned to the Office of the Healthcare Advocate and the Insurance Department, and Dowling said the department is still getting a high volume of calls, although it’s gone down slightly. Many callers hadn’t gotten their ID cards or hadn’t had their payments processed, she said. In addition, some people have called with urgent situations, needing coverage for scheduled treatment or to get a prescription filled — issues the department tries to address immediately.

“I’d say the numbers are lessening, but by no means have they evaporated,” Dowling said.

Waiting for her ID card

Kate Walton of New Haven is among those still waiting for proof that she has insurance. She completed her application for coverage through the exchange Oct. 26, nearly two months before the deadline for getting a plan that started Jan. 1. She picked an Anthem plan that cost $545 per month, but as part of the federal health law commonly known as Obamacare, her income qualifies her for a tax credit of more than $800 per month. As a result, she doesn’t have to pay a premium.

Walton, 62, who runs an interfaith volunteer agency that provides services to seniors, figured she’d hear from Anthem soon after signing up. When she hadn’t by December, she called and asked whether she would need to send a check for $0 to get an insurance ID card. She said she was told no, that Anthem would just send her the card.

She tried again in mid-December, and was told the company would send letters to new enrollees in the next couple days. But she got nothing. As the month went on, phone calls to Anthem took longer and longer. At one point, she called from her office, put the phone on speaker, and waited on hold for 2 hours and 47 minutes, she said. No one answered.

Then, in early January, Walton felt a persistent pain at the top of her shoulder. After a few days, she saw a doctor, who diagnosed shingles. Walton didn’t have any proof that she had insurance, but the doctor’s secretary said they would bill for the visit once Walton got her insurance card.

Nearly a month after her coverage was set to begin, Walton said she’d only heard from Anthem twice. One was a marketing letter trying to sell her a policy. The other was a voicemail meant for another customer, a man she’d never heard of, asking if his issues had been resolved.

But Walton did hear from her doctor’s office, wondering if they could submit the bill for her early January visit.

Walton said she’s thought about switching to another company, but if she did, the coverage wouldn’t take effect until March at the earliest. “I’m a hostage to them at this point,” she said.

Reach out to the insurance department

Dowling said it’s important to view Anthem’s problems in the context of the dramatic changes taking place because of the health law and the new processes that exist because of the exchange.

“For all the problems, this is a company that stepped up early to be a part of the exchange and support the [Affordable Care Act],” she said. “They kind of dove in head first and were supportive right from the beginning. That doesn’t mean that we are not putting the regulatory enforcement as strictly as we can on them.”

Dowling said customers who haven’t received proof of coverage and need care should get in touch with the department. “We just don’t want to see anybody out there not going to a doctor or not getting prescriptions refilled or not having a therapy session,” she said. “We need them to tell us if they’re struggling.”

Customers who were slated to begin coverage Jan. 1 and pay their January premium bills by Friday will receive coverage retroactive to Jan. 1.

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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