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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

December 18, 2014 at 2:31 PM

Exchange board votes to turn invoicing over to insurers

In a move that took some by surprise, the board of the Washington Health Benefit Exchange voted to take the exchange out of the business of managing customer payments and invoices.

The action came on a motion made by Phil Dyer, a member of the board, which operates the Washington Healthplanfinder exchange. After heated comments at a board meeting this morning, members voted 4-3 to stop this key part of the exchange’s operations in the fall of 2015. The payment system has been the subject of numerous consumer complaints.

“Our core competency at the exchange is in eligibility and enrollment determination and no one else can do that,” Dyer said in making his motion. “However, our core competency is not invoicing and invoice reconciliation.”

Many board members have expressed frustration with the ongoing problems the exchange has had in managing invoices and payments. In numerous case, consumers have made payments according to procedures but have been told by their insurers that they do not have coverage. The insurers say the payments and other account information had not reached them.

Dyer’s motion came despite a report by consultants hired by the exchange to look into the consequences of abandoning the exchange’s managment of payments. That report, delivered to the board this morning, urged caution in making changes.

According to Karli Stander, a senior consultant at Cambria Solutions, the study found risks and costs whether the exchange keeps or abandons its management of payments, which is referred to as “premium aggregation.” Premium aggregation refers to the collection of individual payments from consumers and then forwarding aggregated payments to carriers.

“We do see [making changes in the system] as a higher risk because right now we know what the issues are and we have processes in place to try and resolve those,” Stander told the board. “That’s where we saw the risk being higher in removing premium aggregation because you’re making changes to your system that are more significant than if you just try to resolve the current issues.”

Before the vote, several board members voiced strong objections.

“I think that this motion is premature,” said board member Teresa Mosqueda. “We just heard that it is possible that costs would be passed on to consumers, that there would be potential increases in administrative fees.”

Mosqueda pointed out that the exchange staff said it wanted to do an analysis of whether getting rid of premium aggregation would solve the problems the system had been having. “I think we need some time to hear back from staff on multiple issues,” she said.

Mosqueda and other board members were also taken aback that the vote was not scheduled and the public had no opportunity to comment on the move.

“I’m not sure we have all the facts yet and we certainly haven’t given an opportunity to the public to offer their comments,” said non-voting board member Mike Kreidler, the state’s insurance commissioner. “I’m very concerned about making decisions on issues as complex as this one when there are other facts and inputs that we probably should listen to.”

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