Three-and-a-half months after the rollout of the Affordable Care Act, Washington’s Healthplanfinder website remains one of the better-performing health care exchanges in the country. Relative to other exchanges and taking into account how poorly the legislation considered technological realities in its design, our site still — as I wrote last fall — “doesn’t suck.”

But it’s hardly without issues. And for at least a few consumers, getting what they pay for is turning out to be more complicated than they expected.

“We started out our new year in a complete panic,” said Barry Nolte, a self-employed software engineer in Redmond.

Nolte, a husband and father of two, enrolled in a qualified health plan through the Washington exchange in October. In November he learned he was one of about 8,000 enrollees whose tax credits had been miscalculated. Working with people at the exchange, he re-enrolled and made his first payment for coverage, which he believed would start Jan. 1.

On New Year’s Eve he signed on to check the status of his plan and learned the coverage he’d paid for was not coming. He’d already received a welcome packet from Lifewise, the provider he’d selected, but a call to Lifewise showed the provider had no record of the January coverage.

Three weeks and hours of frustrating phone calls later, Nolte and his wife learned that their plan’s start date had been pushed back twice, at least once over a technical error. To re-enroll, they had to re-pay. A refund check for the original payment is in the mail.

Nolte reached out to me to ask if I’d follow up on the health of Washington Healthplanfinder. What’s behind the technical errors? Are others facing similar struggles?

Michael Marchand
Michael Marchand

I checked back in with Michael Marchand, director of communications for the Washington Health Benefits Exchange, the quasi-governmental entity that operates the site.

‘I don’t think we know what normal is’

Here’s the status: More than 71,000 Washingtonians have enrolled in qualified health plans through the state exchange, an additional 176,000 have signed up for free insurance through Medicaid and another 72,000 applications are in process.

Those are the latest figures, and compared with other states, that’s still pretty good.

But let’s look deeper.

Marchand did not know how many of the 72,000 applications in process were stuck in the system, how many enrollments had been canceled after payment or how many of the 1,200 refunds issued to consumers were issued because of an error, rather than just a change of heart.

But he did insist that Nolte’s issues are not widespread, that the site is “fairly” stable and that the exchange takes cases like Nolte’s seriously.

“It’s been a source of frustration for us as much as the consumer,” he said.

A more common headache is the call center. The exchange has added more than 200 additional customer support reps since October, with another 100 to 150 coming in February. But with call volumes being ten times what was forecast, average wait times remain high. Of 380,000 calls taken in December, 66,000 were handled, 41,000 were abandoned and a whopping 273,000 were disconnected due to high volume.

Why didn’t the exchange anticipate the volume of calls it received?

“There’s no baseline. This has never been done,” Marchand said, adding that forecasters also likely underestimated the number of calls that would come in when the site’s functionality — or lack of it — caused confusion.

Which brings us to the website, and a team of developers that is stretched thin. A recent quality assurance report called out constrained testing resources — an essential check on any online service — and though the site got aggressive updates in December, Marchand said, the exchange found itself needing to back off here and there for the sake of stability.

“We haven’t had what we’d call a normal day,” Marchand said. “I don’t think we know what normal is.”

Plenty of work left to do

The end of the year is never an easy time for health insurance. A Dec. 15 payment deadline was extended to Dec. 23 to give struggling consumers more time to get over hurdles, but it led to a bigger backlog of calls and confusion as new plans got going and some providers did not get information from Healthplanfinder in time to send out ID cards for the new year.

monipull10Eric Earling, spokesman at Premera Blue Cross, acknowledged that technical issues with Healthplanfinder, compounded with extended deadlines, likely led to higher call volumes for Premera’s own call center this month.

But Earling gives the exchange a lot of credit. Of the three exchanges Premera works with — Washington, Oregon and the federal healthcare.gov in use in Alaska — it remains, he said, the best performing, the best organized and the easiest to work with.

There’s plenty of work to do. New updates are coming, capacity is growing and the exchange has plans to form a new team to deal entirely with special cases like Nolte’s, Marchand said.

Nolte plans to attend a public meeting of the exchange board Thursday to voice his concerns. Nervous about leaving his family uninsured, Nolte rescinded his cancellation of his previous plan to reinstate his previous insurance. But it’s a backup. An early supporter of the Affordable Care Act, he’d rather see the exchange process to work for him.

“At this point, it’s more a matter of principle,” Nolte said.

Meanwhile, Nolte’s coverage starts Feb. 1 and exchange staff members are working to both provide him with retroactive coverage back to Jan. 1 and untangle whatever technical knots exist in the system to make sure it doesn’t happen again.

I heard from one other person whose payment was canceled in error. James S. Martin II of Vancouver, Wash., sent in his payment in by the deadline for Jan. 1 coverage to learn this month it had been inexplicably cancelled. The exchange confirmed the error and is working with him to start the coverage.

“We’re doing everything in our power to allow people to have the consumer experience they expect,” Marchand said.

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  • gds_anon

    The website may not suck, but Obamacare still does.

    • SemaphoreSlim

      Yeah. They should have just pushed on through with single-payer. This system, suggested by Massachusetts GOPers, crippled by the insurance lobby, and finally bashed into submission by a Dem majority in congress, is about as fubar as a redheaded-stepchild of a policy can possibly be. The only reason Obama is so adamant about it is because it’s probably the only legacy (besides killing Bin Laden) that his entire presidency has.
      This is just f*ing sad.

  • Matthew McColm

    It is so good that it is bad. The author hints at and skirts around the edges of the deep rooted problems of the horrible application of a great product. From the roll out that kept large numbers of brokers functioning. To comical phone lines. To the CEO giving himself a attaboy raise in November. To government officials that turn their backs. If the exchange ever gets back to the focus of serving the public, it is anybodies guess. Washington State can do so much better.

  • woan

    Not saying much is the key message here. Some other states don’t even take online applications as far as I can tell. ACA great, websites pretty bad. I had to go direct to provider for a combined ACA compliant health and Dental plan (which was significantly cheaper than my plan at the same provider last year with better benefits this year). These sites are only for folks that are eligible for subsidy.

    • jdurocher1973

      There’s no way you are getting better benefits for less cost this year. You need to go back and look at the whole package: your deductibles, co-pays, and coverage. You would be the only non-subsidized person in America to be getting a better deal than last year.

    • Matthew McColm

      I have had a few that have signed up for the exchange despite making over the limit for subsidies. They however are contractors and can lose their income on short notice. Several companies have stepped up in Washington State to offer Dental insurance as a supplemental to their insurance plans sold on the exchange.

  • jdurocher1973

    I was pretty shocked when the CEO got a raise. We got stymied by errors in the application process; still haven’t finished it. Even when shopping among plans it was impossible to really understand exactly what you were buying, which doctors were included and at what level, etc. There are too many undefined terms from the insurance companies with no meanings like “Preferred” and “Heritage.” On top of all this we will have far higher deductibles and out of pockets than last year. So the bottom line is the whole experience is downright depressing, yet these guys are giving themselves raises. Go figure.

  • Mark

    I believe people should have access to healthcare. This has been a disaster at both the state and federal level and I think the Govt and carriers are going to have some real surprises when the costs start coming in. As for me I signed up but it wasn’t easy. I even wrote insurance commissioner Kridler with concerns about the site and the process. The cost of my insurance went up a little over $70 a month as well. I have my 1st doctor appointment next week and hope everything works. I even went the extra step to call the carrier to make sure my doctor was on the approved list. I guess I’ll find out next week.

    • Igor

      Hello!! Everybody has access to healthcare. Just walk in to an Emergency room (which are overtaxed by malingerers, people too dumb to take care of themselves, and illegals) – there’s your access.
      This disaster is brought to you by people that think healthcare is a Gubmint-given Right, when it is most assuredly NOT.
      Again and again and again: ANYthing run by the Gubminty costs more and delivers less (if anything). Open your eyes, please.

  • Igor

    The front end “sorta” works, the “backend” is broken, and the product is a non-starter.
    ANYthing run by the Gubmint is going to cost more, take more time and resources, and in the end give you a lump of coal. If you’re lucky.

  • lll

    Denied coverage by WA HealthPlanfinder now for 2 months! They have no solution to the technical problems. Who knew that under the old way we would be denied based on our health, and under ACA we are denied due to “computer problems”. WA Healthplanfinder reps grow silent on the other end of the phone when we say – we SIGNED UP, we PAID on time, WHY are we being denied coverage? The carriers are flabbergasted…the fix is simple…you pay you get coverage. At least that’s what the law is supposed to be. Now, what will happen if we TRY and TRY and they still refuse to sign us up due to “computer problems”?

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