News release

Mike Kreidler
Washington state Insurance Commissioner

Contact Public Affairs: 360-725-7055

08/07/2014

Option for Washington consumers having difficulty with health coverage

OLYMPIA, Wash. – Any consumer experiencing payment issues with their health care coverage through Washington Healthplanfinder has the option to pay their health insurer directly. Additional steps they should take are outlined below.

“We want consumers to know they have several options to pay their premiums and have the certainty they deserve that their coverage is current,” Gov. Jay Inslee said. “I encourage anyone with payment questions to contact Washington Healthplanfinder team – they can help.”

“We apologize to all of our customers in this situation and realize that behind every application is an individual or family who is seeking care,” said Richard Onizuka, CEO for the Washington Health Benefit Exchange. “It is critical that we continue to deliver on our promise of providing the best marketplace experience as expected by our state and all its residents.”

Governor Inslee, Insurance Commissioner Mike Kreidler, and the Washington Health Benefit Exchange announced this option today to provide temporary relief to those individuals and families currently experiencing issues with their health insurance purchased through Washington Healthplanfinder.

These issues have prevented payments from being correctly applied to customer accounts or distributed to insurance companies. It may also continue to result in customer notices from Washington Healthplanfinder requesting payment or insurance companies being unaware of completed payments.

“Everyone involved agreed that we needed to do everything possible to ensure consumers can access care if they need it,” said Kreidler. “We know this is a temporary solution, but hopefully it’s one that can give people immediate help today.”

Consumers who are currently experiencing payment problems may take the following steps:

  • First, contact the Washington Healthplanfinder Customer Support Center at 1-855-923-4633 to ensure they are aware of your issues.
  • Clearly communicate any medical emergencies or urgent prescription needs to the Customer Support Representative.
  •  If you have called in previously, please provide your issue “ticket number” to the representative.
  • Next, you may submit your monthly premium directly to your health insurer.  
  • If you enrolled in a Qualified Health Plan after April 1, 2014, you’ll need to submit supporting documentation to prove you’re eligible for a special enrollment period. Both enrollment information and monthly payments for these customers will not be sent to the insurance company until this information is received and reviewed by Exchange staff.

If a customer has enrolled and paid their premiums through Washington Healthplanfinder, the Exchange will work with their insurance company to ensure that their coverage start date as listed in Healthplanfinder is upheld. Even if their premium payments have not been immediately sent over, their coverage will be effective from their start date and claims for services will be covered under their plan benefits.

If you’re having trouble using your coverage, contact the Insurance Commissioner’s Office at 1-800-562-6900 or file a complaint.

Kreidler notified health insurers today of their obligation under the federal Affordable Care Act to accept direct payments from consumers.

“We cannot stress enough that resolving these system defects is the top priority for the Washington Health Benefit Exchange and our Board,” said Onizuka. “The Exchange has developed an aggressive action plan to address these issues as quickly as possible, including implementing emergency system updates, bringing on additional staff members, and engaging in collaborative meetings with our IT integrator, Deloitte, and the insurance companies to identify technical issues and define a roadmap that will allow us to achieve significant progress by the end of August.”

FAQ on payment and invoice issues (www.wahbexchange.org)

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Release No.14-39