<p>This! Fantastic idea. Yes, that would have solved one of my biggest problems – trying to pay that first months’ premium was an absolute nightmare. </p>
<p>We had pretty much no problem with the federal exchange (working on D’s stuff), and we didn’t even try to avoid peak hours. CoveredCA (for DH) was quite another story. There were times in late Dec/early Jan when their greeting was, “We’re too busy to talk to you. Call back later.” Click. The problem was – and what I hope they fix next year – is that they weren’t open “later.” They closed at I forget what time – but in the early to mid evening – and their lines were jammed literally every minute from opening to closing. If they’d been open 24/7 like healthcare.gov was, I could have delayed my call until midnight. Takes the pressure off the system and makes it better both for the early birds and us night owls.</p>
<p>But – employing Fang’s Razor – it’ll be much improved next year.</p>
<p>ETA – To be fair, now I’m remembering that it was Anthem which had the “Go away” phone greeting. But it was very difficult to get through to CoveredCA, much harder than healthcare.gov. And CoveredCA wasn’t open 24/7 either, unlike healthcare.gov, which was.</p>
<p>kmcmom - Reading this thread, I had assumed one had to wait for the bill. However, the one person who had no hiccups and never had to talk to anyone was given a choice to pay online as soon as he picked a plan. It was Cigna.</p>
<p>Good to know, tex. The way it worked with Anthem was that you had to wait until they had processed your application, which was taking several weeks in late December. Then you had to pay on the phone (impossible to get through) or wait for a bill (which usually arrived well after the due date). You couldn’t make the initial payment online. Stupid. </p>
<p>And over here, while they verified, I recd my cards within the stated period (5BD?) and my first bill, also as targeted- maybe that was within 21 days. I did pay that first bill (and all til March) via phone (had an online option, from the start,) and am now on autopay. </p>
<p>LF, was that Blue Shield or Blue Cross or some hybrid? Our broker was really pushing is toward Shield because she said the customer service is light years better. Next year we may do that. </p>
But one exchange that did it that way - Nevada – has run into huge trouble when people’s payments did not credited to the right insurance company. Now there’s a class action suit representing people who signed up for a plan, paid premium dollars, only to find out after they had been hospitalized or given birth to babies that the insurers they chose had no record of their enrollment.</p>
<p>So I can see why most of the exchanges chose to stay out of the business of collecting premiums. Yes it’s really difficult and confusing, and certainly required me to be proactive. But I have PROOF that Blue Shield has my money on my credit card statement. (I even know that the autopay is finally working because the credit card statement shows the premium charge on April 1). </p>
<p>I do think that a third party payment & collections system that functions as an intermediate would probably be the best solution. Maybe a business opportunity for a company like CareCredit that already is focused on health care dollars and payment solutions – they might be more adept when it comes to payment processing and their business model also offers an opportunity to work with people who fall behind on payments. </p>
<p>But I certainly would not have wanted Healthcare.gov or CoveredCalifornia to have been in charge of processing payments {i]this* year. (No way would I want to provide my credit card info to those particular web sites!). </p>
<p>They really need to have API’s in place that can take the buyer directly from the exchange (where the policy is selected) to the payment portal on the insurer’s web site… in the same way that you can click a PayPal link on a merchant web site and be taken directly to the PayPal web site to complete your payment – but unfortunately the insurers weren’t really up to speed on developing payment portals either. So nothing in place for the software developers for the exchanges to plug into, even if there had been any competent software developers for those exchange sites. </p>
<p>I hope that this is one major lesson they take from this year’s experience – that there has to be a way for people to pay at the time they enroll. This was a problem which affected a huge number of people, and it’s solvable. I bet they’ll have it fixed by November. As you say, it’s a solution that already exists in the premium-paying world. When we make our payment, we log on to the Anthem website, and it takes us to another site, Princeton something. From there, I can print the receipt, and we also get one emailed to us automatically. I’m like you, I’m not comfortable until I have a piece of paper confirming the payment.</p>
<p>I suspect they just didn’t have all the payment links set up in time because, if I recall, there was a “pay now” button on the last screen of healthcare.gov that linked to BCBS…but BCBS did not hav the portal set up…you had to get your first bill before using the online system.</p>
<p>As Calmom nets, having the exchange collect and disburse payment would likely be a bad plan ;)</p>
<p>There were a lot of technical issues to overcome. Blue Shield of California had a payment portal – but they had their online system keyed to use email addresses as unique identifier. They set up a separate portal system to handle the Covered Cal. payments, but it couldn’t handle my email address when transmitted from Covered Cal, because it was identical to one they already had in their system. So there was in fact an online payment portal that was provided at the end of the registration sequence… it just didn’t work for me. Worse, because I had opted for on-line billing at Covered Cal, BS didn’t send me paper bills either – I was in their system as an e-bill customer… but they had dropped my email address and had no way of entering it. I finally was able to set up an online portal for myself using a different email address, but the billing didn’t mesh up until sometime in late February or March. </p>
<p>I understand why they use the email address as a unique identifier --all sorts of security issues involved if the same email can be tied to different accounts, given that password retrieval systems usually are built around email confirmation. I also get why they set up two different payment systems – the exchange system has to have a mechanism to handle the extra accounting problem of the subsidies. But that is something that is fixable-- it just apparently wasn’t planned for this year. (I don’t even have confirmation that is the problem… but that is the one that fits the series of problems I ran into).</p>
<p>I think you’re completely missing the point about the Minnesota experience, Pooch. </p>
<p>The point is, 91% of us already had health insurance–far better than the national average due to a combination of more people being on employer-sponsored plans and lots of people being covered by state-subsidized programs (MinnesotaCare for people above the Medicaid eligibility level, coupled with the most generously subsidized and most successful high risk pool in the nation). Yes, the Minnesota exchange has fallen short of expectations with respect to the number of people signing up for private insurance through the exchange–but that was always expected to be a tiny number anyway, slightly over 1% of the state’s population, or a little over 10% of the (small) number of uninsured Minnesotans pre-ACA. So instead we’ll end up with a bit more than half a percent of the state’s population signing up for private insurance through the exchange in the first year of eligibility. That hardly sounds like a disaster, given the small numbers who were always expected to sign up there. But that’s counterbalanced by unexpected success in the public programs, with much larger-than-expected numbers of previously uninsured people streaming out of the woodwork to sign up for Medicaid benefits that they had always been entitled to, but didn’t know it; or for Medicaid benefits that they are newly entitled to, thanks to the ACA; or for MinnesotaCare benefits they are newly eligible for, because that program can now serve a different demographic with the expanded Medicaid picking up a lot of people previously eligible only for the state-sponsored MinnesotaCare. And as a result, our percentage of uninsured–already remarkably low by national standards–is going to end up even lower, probably in the 6% to 7% range, with prospects for going even lower still in subsequent rounds of sign-ups. To my mind, that’s an unmitigated success, because it moves us that much closer to the goal of universal coverage, at a pretty small cost to the state’s treasury. (And at a pretty small cost to the privately insured as well, because at 93%-94% insured and most of the highest-risk people on public programs, we’re darned close to having the privately insured risk pool mirror the risk profile of the population as a whole, or even to beat it by a little bit). </p>
<p>At this point you’ll object that we’re paying for all this through our federal taxes. Yes, we are, but those federal taxes haven’t gone up. Minnesota has perennially been near the bottom in return of federal tax dollars to the state. We pay and pay and pay, and our federal tax dollars go to low-income states in the South, or to states with large military installations—come to think of it, mostly in the South. Paybacks are in order. If the Southern states want to refuse the federal subsidies, that’s their choice, I guess. At any rate, the Supreme Court said so. It’s a tragedy for those millions of low-income Southerners who could be eligible for federal assistance but for the objections of their state legislators, but as a Minnesotan I say if that means more of those funds can come our way to get us even closer to universal care, I’m 100% for it. </p>
<p>bclintock, let’s say the total insured in Mn. goes from 91% to 95%. Are you saying it was worth the disruption to the millions of people who are paying more for insurance with severely restricted networks so you could go from 91% to 95%. You already admitted the main reason for the increase in the number of insured is due to the expanded medicaid program and the state-sponsored MinesotaCare, the latter having nothing to do with Obamacare. The exchanges were a non-event in Minnesota.</p>
<p>Instead of forcing Obamacare on a lot of people who didn’t want it, we could have expanded Medicaid for people without insurance. This didn’t have to be a zero sum game where many people were punished because a minority of the people in the country thought it was a good idea.</p>
<p>It’s reasonable to assume that nationwide, the number of previously uninsured people who get covered will continue to rise for the next five years or so. The number is now around nine-ish million, counting Medicaid plus private insurance, and in four years it’ll be twenty-ish million. </p>
<p>Nine million people is a lot of people. Twenty million people is a huge number of people. Whether you think it’s worthwhile to give twenty million people health coverage is a matter of opinion, but that twenty million people is a lot of people is undeniable.</p>
The given excuse was “an increase in healthy medicare beneficiaries” which is an amazingly prompt bit of analysis for those who still haven’t any idea as to the signup mix for Obamacare.</p>
<p>Backloading every unpleasant reality, and this was one, suggests that twenty-ish million number may never materialize.</p>
<p>^ Don’t know what the latest development may be, but when I previously looked at this, it was the separate Medicare Advantage and started with the fact that there hadn’t been sufficient oversight of reimbursements. That could put it in a different context. </p>
<p>There seems to be a mindset that sees all these delays of key provisions as pretty much irrelevant. That the only real hurdle was the administration claiming 7MM signups and that we’ll make up the slackers who don’t pay this year, next year. Or the year after, maybe, whenever. That the program was somehow transported to a place where it’s economic viability, no matter the liberties being taken with the original funding/enforcement scheme, is simply assured. Might be so, but I respectfully disagree.</p>
<p>As to the insurers: If they’re not whining next year, count on the taxpayers doing it for them.</p>