Billing service

At outset of Obamacare, all eyes were on the troubled healthcare.gov launch that gripped the administration on October 1, 2013. While the Affordable Care Act was being lauded as the coveted reformer of the health insurance, it had its own demons to fight.

As time passed, exchange problems were weeded out and the system became better, with the administration launching offline enrollment measures to keep enrollments up. When the results started coming in, the administration had exceeded its expectations to finally deliver 8 million newly insured individuals on the federal exchange. The number of young adults, coveted for risk balancing in health insurance industry, signed up in decent numbers, with nearly 35 percent people signing up from this demographic. The administration thought most of the exchange problems were solved.

However, a new set of challenges is confounding some states and confusing to the people who are insured through their state exchanges. Billing problems are the latest issue to arise in Obamacare.

Take the Vermont Health Connect, for instance. Vermont Health Connect was one of the successful state exchanges that aligned with the law by creating a separate exchange and expanding Medicaid. It processed a fair number of enrollments, but in the last quarter, it has been receiving calls about billing issues. The problems range from incorrect billing and no invoice generation to delayed vendor payments and canceled reimbursements. Lt. Gov. Phil Scott has also mentioned that the exchange is receiving billing complaints on a regular basis, with usually three billing complaints daily. Lawrence Miller, the chief spokesperson for Vermont Health Connect, has also confirmed these problems.

The two popular categories are people who are not receiving bills and invoices, resulting in delayed payments, and people who are receiving bills late due to delays in invoice processing and settlement. And then there is the category of people who are receiving inflated invoices.

The case of inflated invoices is not uncommon. A resident of South Burlington, VT., has been receiving incorrect bills since she enrolled in a Blue Cross plan last winter. The resident was being charged double for her insurance, and she repeatedly called and informed the authorities at VHC of the lapse. Even though she continued to pay her bills on time, she received a huge, inflated bill of nearly $5,000. The bill showed that she hadn’t paid any premiums till date, and she was liable to pay the whole cost, including penalties. This was after she made all the necessary calls and paid everything that was due within the deadline. She now runs the risk of losing her health coverage, all because of a billing snag that is inflating her bills and sending her incorrect invoices.

That’s not all. Several people who have paid for their insurance are yet to see the payments reflected in the system. Some have given their premiums, but are still waiting for their insurance coverage to begin as the health plans still have no notification of payments. In all these problems, billing is taking the center, with delayed vendor payments and ineffective collection channels for binder payments marring the flow. Thankfully, the authorities are admitting that billing is a problem, and has started working to resolve this issue before the second enrollment period opens up.

The health exchange has started sending paper invoices to everyone to ensure that people don’t forget to pay in case of non-receipt of invoice. Similarly, the overdue payment notification and deadline of payments have been moved to different dates to avoid sending overdue payment notifications to people who have already paid. These changes are already in place at Vermont, and they are making a difference. On the other hand, the administration might make use of a dedicated billing system that could eliminate all these billing issues for them. These new market billing systems are designed to automate the new requirements of ACA, including binder payment collection, vendor payment disbursement, and payment reminders.

Like Vermont, several other states and health plans are facing these billing issues while navigating the evolving landscape of Obamacare. Through dedicated billing system and nifty strategies, other states can learn from Vermont and avoid these problems altogether.

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