A recently-published article in Health News Colorado exposed a billing snafu at the Colorado Healthcare Exchange. Apparently, somehow some Coloradans signed up for both public and private health insurance. We still can’t figure out how this could happen given the process that the exchange claims to have in place. Essentially, everyone who goes to the exchange signs up for Medicaid. Those who do not qualify for Medicaid are then kicked to private health insurance plans. So, how some sign up for both is a total mystery to us. The only attempt at an explanation is here:
“The problem with double-enrollment comes later. Medicaid managers can reevaluate if people qualify. If they do, the Medicaid eligibility then goes back to the date on which the person first applied. Under federal rules, Reece said if a person has coverage under both public and private plans, private plans would have to pick up the tab for the first month. After that, it’s unclear who will have to pay any claims.”
So, after people are denied from Medicaid, its managers can go back and approve them? If that’s the case, is there a problem with the initial process denying qualifying people from Medicaid? Naturally, the exchange folks are saying the equivalent of “move on, nothing to see here”, except that this is a big freaking problem, according to some (including an exchange board member). From the article:
But Steve ErkenBrack, president of Rocky Mountain Health Plans and an exchange board member, said this is a “major, major issue.”
“One person could be a million-dollar claim,” ErkenBrack said. “This has required everyone to reach out of their comfort zones. How do we make sure members aren’t going to get caught in limbo and that their coverage will be there?”
Marc Reece, associate director of the Colorado Association of Health Plans, the group that represents insurance companies throughout the state, echoed ErkenBrack’s concerns both during the exchange meeting and in an interview afterwards.
While this is all a big deal, the article did offer some humor in one of the pictures it featured. Apparently, we were wrong when we suggested that health exchange head Patty Fontneau was overpaid. We knew she was the CEO, but we didn’t know she also moonlighted as an insurance salesman at the 16th Street Mall location. See the photo to the right. Either she’s playing Undercover Boss or this is a really lame attempt at a photo-op.
Our take? Fontneau’s time would be better spent unraveling this billing mess than selling insurance on the 16th Street Mall. Is it time for an audit yet?