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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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