Carrier Backlogged 9 Months on 834 Files from HC.gov

Tkruger

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While I shouldn't be surprised this one really has screwed the pooch.

So I get a call from a client stating that they were concerned about not having their payment drafted from their account for Dec nor have they received the new policy information for 2016 from the same carrier.

So I call the carrier first thing this am to see what might be going on. In what turned into a rather heated discussion I found out that the client received a refund check for all premiums paid from March - Nov. The reason?!? The carrier received an 834 file stating that the client voluntarily terminated coverage.

So now on to the Marketplace.....

During that call it's determined that the client was being double billed for the 2014 plan that auto renewed even though a different plan and carrier was selected in 2015. Client called in to the MP to have them term the plan and the CSR termed both the 15 plans at that time vs. terminating the plan that the client had for the 14 plan year.

End result on that call was an escalation (30 days) to retro the plan back effective for the entire 15 plan year.

Problem is that

1) The client is heavily medically needy and now doesn't have a plan for the 2016 plan year beginning Jan 1.

2) I have just been screwed out of 2K in commissions.

Called carrier back and they told me that they did a mass termination in Nov for all 834's.

Had the carrier updated 834's upon receipt we would have been aware of the issue and none of this would be happening now.

I wonder how many others out there will run into this....
 
I've seen similar issues, among others. The data interconnect between carriers and exchanges isn't working perfectly. Big backlogs at every carrier, customers calling incessantly for bills/ID cards that just plain don't exist yet.

I've seen people double and triple enrolled, people left active after terming 10-18 months earlier and getting huge bills and collection calls (while having another plan in force).

NY issued new naming convention requirements for this year (http://info.nystateofhealth.ny.gov/sites/default/files/2016 Invitation to Participate in NYSOH.pdf), which meant that a lot of carriers had to re-name their products.

This means, they're filed as new products and old ones can't be renewed. Everything has to be "mapped" automatically, and there sometimes isn't an equivalent. As a broker, you can't submit a plan change because it's technically a term+renew. You can't submit a new app, as the account is technically active. You have to call in and request the plan change over the phone.

If you do it on-exchange, the new choice is sent, but the plan you're mapped to stays in effect, causing double coverage issues.

It's just a nightmare.
 
Called carrier back and they told me that they did a mass termination in Nov for all 834's.

Had the carrier updated 834's upon receipt we would have been aware of the issue and none of this would be happening now.

I wonder how many others out there will run into this....

What company was this? Did it affect the 834's submitted for Jan 2016. Was it the company that did the terminations?

I have two companies (UHC and Kaiser) where everything I submitted to the before December 5th they have no record of it. The applications do not exist in their system. They have been escalated at the MD exchange. They say the missing applications issues is a problem across all of the carriers. I don't know if applications on the FFM are also affected. I didn't have the time nor brain power to check it this week.

If the carriers terminated the 834's which I did not think they had the authority to do and if some 2016 apps were included by mistake the mystery of the missing applications may not be the fault of the Marketplace and be totally the carriers fault.
 
What company was this? Did it affect the 834's submitted for Jan 2016. Was it the company that did the terminations?

I have two companies (UHC and Kaiser) where everything I submitted to the before December 5th they have no record of it. The applications do not exist in their system. They have been escalated at the MD exchange. They say the missing applications issues is a problem across all of the carriers. I don't know if applications on the FFM are also affected. I didn't have the time nor brain power to check it this week.

If the carriers terminated the 834's which I did not think they had the authority to do and if some 2016 apps were included by mistake the mystery of the missing applications may not be the fault of the Marketplace and be totally the carriers fault.

Sherota1 hit me up on PM with a number and we can discuss on Monday.

Happy New Year!
 
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