The Hummel Report

Investigative Reports That Get Results

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Enrolled... But Not Covered

HealthSource RI - Rhode Island’s version of Obamacare - is heading into its second year with thousands of new subscribers and 80 percent returning from last year. But signup problems continue to plague the agency. This week: one woman’s fight against the clock to make sure she has health coverage - and a maddening maze of red tape to get it done.  Jim Hummel has her story, and sits down with the new director - who says the  enrollment problems are unacceptable.

 

Click here to see our original story on Healthsource RI.

 

SCRIPT:

``Year One of HealthSourceRI was a success, and now it’s time to look forward to Year Two…’’

The enrollment numbers are up and 80 percent of those had subscribed to HealthSourceRI in 2014 signed up again.

But you might have a hard time convincing some Rhode Islanders that the state’s version of Obamacare is a success - not yet anyway.

Fitzpatrick: ``It’s been very frustrating. Many nights where I just wanted to pull my hair out.’’

Beth Fitzpatrick moved to Rhode Island last year from Massachusetts, where she had been enrolled in that state’s  groundbreaking health exchange system. Fitzpatrick submitted her first application to  HealthSourceRI in early December.

Fitzpatrick: ``We did all the stuff, submitted the application online, heard absolutely nothing, got no updates on the account they make you set up. Money was taken out of my bank account Dec. 15th, thought everything was fine.  I was told I would get my cards from the insurance company like 7 to 10 business days.’’

Hummel: ``The person on the phone told you that?’’

Fitzpatrick: ``Yes, multiple times.’’

It is a familiar story, and one we first reported nearly a year ago when HealthSourceRI was initially ramping up. Mike Kelley of Barrington paid two months’ premiums but wasn’t showing up in his health care provider’s system, forcing his wife to cancel several appointments. He was repeatedly enrolled, then disenrolled and it went on for weeks.

Fitzpatrick - who has a health condition that requires expensive medication - found out firsthand that those same problems persist.

Fitzpatrick: ``I started calling and hounding starting on December 29th.’’

Hummel: ``How were they when you talked to them, did they seem to know what they were talking about?’’

Fitzpatrick: ``It was frustrating. I’ve spoken to many people there, many people. And probably the most frustrating part was either getting one answer one day another answer another day, another answer another day. It was not consistent whatsoever.’’

Hummel: ``You had to reinvent the wheel every time.’’

Fitzpatrick: ``Every time I had to explain my situation. Every time they had to put me on hold ,look at my record. Every time they had to tell me one thing or tell me another thing; I was told multiple times `Oh, by the end o this week you’ll be all set, no worries.;”

Wallack: ``It’s a problem that wasn’t created on my watch but it has to be solved on my watch.’’

Anya Wallack is Governor Raimondo’s choice to lead HealthsourceRI, replacing Christine Ferguson, who helped launch the exchange. Wallack, who arrived last month, says she’s heard the same problems we have.

Wallack: ``From the first day I walked through the door here, clearly that was a problem for us and it’s not acceptable for us to have the kind of customer service problems that we’ve had for some customers.’’

Fitzpatrick: ``I was told multiple times that it was put on the supervisor’s desk and I would be getting a call back, which I never got a call back once.’’

Hummel: ``Nobody ever called you.’’

Fitzpatrick: ``No one ever me called back. I called other every day…’’

Hummel: ``Why would they make that assurance>’’

Fitzpatrick: ``I don’t know. I probably have about three or four people that specifically said: `I’m making this an emergency priority.’”

Wallack: ``We have to get the kinks out of our information system , which is the source of most of those problems and make sure this is really a well-oiled machine for our customers.’’

Hummel: ``Is it training, is it manpower, is it technology, or is it all of those? ‘’

Wallack: ``You know, I’m assessing that. I think a lot of it is just the technology. That the technology itself is causing us to work around with people who are…to add resources, which we have done ,in order to improve the situation we’ve added a lot of resources.’’

Fitzpatrick, who took extensive notes, says she spent 550 minutes - more than nine hours - on the phone trying to get thing straightened out. And she is not alone.

Fitzpatrick: `I explained my situation, she said that I was the 5th person that she was submitting the same exact situation to, to her supervisor since she started her shift that day.’’

Ferguson told us last year that 10 percent of those trying to enroll were having the same type of problem Mike Kelly was having. Wallack said they are still trying to pinpoint current figures.

Hummel: ``Did they seem confident in what they were telling you, or was there a little bit of hesitation?’’

Fitzpatrick: ``There was a lot of hesitation, a lot of people said they were just very flustered.`I understand, you’re not the first person that, you know, has come to us with this situation. I just answer the phones I’m not quite sure what to do,’ then they pass it on to the supervisor.’’

Hummel: ``So when you talk to United (Healthcare), what did they say?’’

Fitzpatrick: ``We don’t have any information about you. So I was in no one’s hands.’’

Hummel: ``When United says `We don’t have any information from HealthSource  and Healthsource says we’ve sent it over…’’

Wallack: ``It drives people crazy.’’

Hummel: ``Is that technology?’’

Wallack: ``It could be technology, it could be training at either end, that people are, you know, giving out bad information. It could be people trying to finger point. It’s really hard for me to say having been here for a couple of weeks, but we will investigate all of those potential problems.’’

Hummel: ``And they had no problem taking your money.’’

Fitzpatrick: ``That was taken out of my bank account instantly, Dec. 15th, instantly taken out of my account.’’

HealthSourceRI’s multimillion advertising campaign and some of the positive media coverage the exchange has received rings hollow for Fitzpatrick.

Hummel: ``Have you seen the media reports about….’’

Fitzpatrick: ``How well they’re doing.’’

Hummel: ``The rave reviews about HealthSource. When you hear those, what do you think?’’

Fitzpatrick: ``Well, technically like if you’re talking about the ones where they’re talking about enrollment numbers soaring and stuff like that, technically I’m enrolled with HealthSourcRi, I just wasn’t covered.’’

h JH You don’t see that stat, right? Enrolled but not covered. BF You don’t see that stat anywhere. JH I mean does ti drive you a little bonkers to hear. BF it does - JH It’s a great success and it’s a model for the country. :BF Yes.

Late last week, Fitzpatrick finally got her insurance cards. Now she is trying to get reimbursement for out-of-pocket expenses in January.

Wallack acknowledges the challenge ahead: working out the kinks and proving that Rhode Island should keep its own health exchange, something House Speaker Nicholas Matiello has questioned. And despite the glitches, Wallack is upbeat about HealthSourceRi’s future.

11:20 Like a lot of states we’re dealing with all of the warts and bumps of thee early years, we’re dealing with the fact that states did try to implement this on what was problem, by industry standards, a faster track than what you would normally do, //11L34 But if we can even out the operations provide excellent customer service, I think we have a great case to make for sustainabilty:42

51:40 JH What’s the message to the higher ups here? BF It shouldn’t be this hard. There’s got to be an easier way to figure this out: 48

:57 I shouldn’t be putting my health and my life on hold for something that is supposed to be an easy process:02

In Providence, Jim Hummel for The Hummel Report.