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August 20, 2014

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Mass of people slipping through big cracks in state health exchange

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L.E. Baskow

Jill Parker with husband Robert, daughter Mariah, 15, and son Kurt, 14, has a litany of autoimmune diseases and hasn’t been able to see a doctor because she can’t afford the cost on Friday, June 6, 2014. She needed a team of lawyers, insurance experts and a little help from the government to sign up for a health care plan on the Silver State Exchange.

Nevada’s Silver State Exchange was supposed to rescue people like Jill Parker.

Parker, a 35-year-old Las Vegas mother of three, needed health care. She was in constant pain, suffering from Graves’ and Hashimoto’s diseases and hypoglycemia.

She was relieved to see that Nevada planned to use the Affordable Care Act to help people such as her see doctors. In December, she signed onto the Nevada Health Link and paid $362 for an insurance premium.

The Silver State Exchange took Parker’s money. But for five months, despite phone calls and reassuring words from state officials, the exchange gave her nothing in return.

Parker’s story highlights one of the biggest flaws in the exchange: People who need care the most can’t get it because of software problems. The software, built by Xerox, is so troubled that health officials can’t keep track of who paid and what services they bought.

An internal audit revealed the software had 1,500 glitches. The state fired Xerox in May and ditched its software in favor of the federal system for next year.

Parker eventually got coverage, but the question remains: How many of the 36,000 Nevadans on the exchange paid for health insurance they never received?

State leaders say they don’t know. CJ Bawden, the exchange’s spokesman, directed questions to Xerox. But officials at Xerox, after three requests for the information, said they were “not at liberty” to disclose the number.

The patient’s view

Parker used to have an active life. She worked as an emergency medical technician in California, drove her children to school, picked them up from baseball practice and played nurse at home.

But in 2007, her health began to unravel. Graves’ and Hashimoto’s diseases (immune system disorders) and hypoglycemia made it impossible for her to work. She quit her job and lost her health insurance.

Without Parker’s income, the family struggled. They moved to Las Vegas in 2007 so her husband, Robert, could seek a stable job in law enforcement. That didn’t work out. Instead, Robert drove a taxi.

Parker qualified for temporary Medicaid insurance. But in 2011, Robert’s income increased, and the family lost health insurance again. Parker’s medications went unfilled, and her blood tests stopped.

For two years, she tried to buy private insurance from more than a dozen insurance companies. But each one denied her because of pre-existing conditions.

The scenario made Parker an ideal candidate for President Barack Obama’s Affordable Care Act. She was among the first Nevadans to try to enroll in the Silver State Exchange.

But the Nevada Health Link website shut down repeatedly. Robert Parker spent a day on the phone with customer service staffers. Jill Parker eventually finished her application and paid the first $362 premium Dec. 9, thinking her policy would start in January. One week later, she received a bill saying she hadn’t paid.

Robert called customer service again. The Silver State Exchange assured them the policy was paid. In February, Parker tried to make another $362 payment. The website wouldn’t let her. More letters arrived saying she hadn’t paid.

Parker and her husband called repeatedly. Sometimes, they connected with a person. Sometimes, they were put on hold for three hours. By April, Parker had enough.

She met with lawyer Matthew Callister, a former state lawmaker, and joined two lawsuits against the Silver State Exchange. One is a class action with 250 plaintiffs. The second lists Parker and 19 others with urgent health care needs. Both accuse Nevada of violating state law by accepting payments without providing insurance.

The lawsuits claim Xerox and the state colluded in a scheme to cover up the fact that customers who paid “would not in fact have such coverage.”

“I’ve got to believe that at some point the state had to become aware that these guys weren’t going to hit their targets and were still collecting premiums,” Callister said.

Unanswered questions

Parker isn’t the only person who has had trouble getting information from the Silver State Exchange. Insurance carriers that provide policies through the exchange also can’t quantify how many people paid for insurance but didn’t receive it.

The Nevada Co-Op, a nonprofit insurance provider, has 15,000 enrollees, for example, and many have had billing issues, Chief Project Officer Bobbette Bond said.

Patrick Casale, an insurance broker who worked with Parker, said 33 of his 60 clients have had similar problems. He estimates 60 percent of the 35,000 people enrolled had billing problems, even if they didn’t realize it. Casale regularly adds new clients with the same issue.

Casale said the exchange’s software doesn’t recognize the start date on policies or when a date is changed. It also has struggled to process payments if any errors occur, he said.

“The problem with the system is that it can’t understand money,” Casale said. “If you send them $10 and the bill is for $11, they don’t know how to process it.”

The next step

Parker’s hair now falls out. Rashes and blood blisters come and go. She suffers blurred vision, migraines and dizzy spells.

After one emergency room visit, doctors said she would need $24,000 worth of tests, including a lymph node biopsy. “We can’t afford a year’s salary for that,” her husband said.

Parker turned to Casale for help. He bypassed the online system and wrote letters to the exchange’s leaders, who relayed them to the governor’s office.

Parker finally received health coverage June 1.

“When they realized the severity of her illness, they got it done,” Casale said.

On June 10, Parker had her first doctor’s appointment in three years. She’s still waiting for biopsies and tests, but they are on the horizon.

With insurance, Parker imagines a world where she can be the caretaker again.

“It’s not normal for Mom to miss things,” she said. “When it happens, the kids panic. The moment that’s over, I’ll be a happy mom.”

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