Friday, April 08, 2016

KYNECT: My Experience with Kentucky's Health Exchange Network

It's not my habit or even inclination to write about local or state issues. I usually try to leave that to those who have the interest and, frankly, the connections. As the editor of Another Opinion, I try to keep the focus on the "big picture"; national and international events which affect everyone. I least of all like to write about myself. To be honest, I don't think I'm that interesting. But I must make an exception this time. This is a personal story which has to be told, not for my sake but the sake of others affected by Kentucky's health exchange, KYNECT, which has often (and erroneously) been billed as "America's Model Health Exchange" by former Governor Steve Beshear in response to the Affordable Care Act or as it's more commonly called, "Obamacare"; the healthcare law that isn't. This isn't my first go around with KYNECT, only the most recent. I will try to avoid using identifiable or real names of those I've dealt since many, if not all, are still employed and I have no bone to pick with any of them or desire to cause them harm in any way. Most were simply trying to do their job to the best of their ability and simply either lacked the proper training or authority. However, it was the system itself and the bureaucracy built around it which plays the primary role as villain in this little drama. So, with further ado, let's begin.

Like most Americans, one of the first projects I begin working on following New Year's, is gathering and sorting through piles of receipts, notes, and other documents in order to file my taxes; an annual ritual that most Americans both curse and gleefully anticipate like kids at Christmas in the hopes that dear ole "Uncle Sam" will be sending them money for new washers or dryers, or down payments on cars, boats, vacations, or whatever with stopping to realize that it's their money in the first place that they were denied use of for a year, but I digress. After dutifully gather all my paperwork together for 2015, I headed off to a professional tax preparer on February 13th. After dropping everything off and quick review, I headed home knowing that's one more problem off my plate and secure in the knowledge that they'll be done right while I focus on more mundane tasks like cleaning the garage. Alas, that wasn't to be this year. By the time I had arrived home, the tax preparer had called and left a message for me to call back. "That can't good" I thought, and I was right.

It turned out that KYNECT had sent a 1095A form, which meant nothing to me. As the tax expert matter-of-factly explained, it meant that we had been enrolled in a insurance program for which we didn't qualify for based on my wife's part time job and income reported on her W2. She recommended that I call KYNECT and get a corrected 1095B form, which is what KYNECT should have provided based on the insurance program we were enrolled in. Sounded simple enough. So, I called and after a brief hold spoke with a rather chipper customer service representative named Shayne. I explained the problem to Shayne, who politely said they would correct the problem and get a 1095B out to me as soon as possible. A few days later, almost miraculously I received a 1095B and immediately I dropped it off at the tax preparers' office. Once more, I had a phone message waiting for me by the time I got back home. So, feeling like a kindergartener who got caught skipping down the hall, I called her back. As it turned out, the 1095B they sent went with the 1095B and so it's wrong too. She explained that the 1095A should be zeroed out since we never received supplemented coverage KYNECT was showing and the 1095B should reflect the policy we actually did have. So, on February 23rd, I called and spoke with Jasmine at KYNECT and gave her my story. Jasmine promised to review with her supervisor and send a corrected 1095A and 1095B, but again, I received the same incorrect forms a few days later.

On March 2nd, I called an explained the situation again to the poor unsuspecting customer care representative who had the misfortune to answer the call. She reviewed the notes in the system and refreshingly admitted that this was above her head and then politely asked if she could place me on hold while she spoke to her supervisor. Jackie. No problem. I explained to Jackie the situation and my justifiable frustration. Jackie said she had reviewed the notes and thought she understood the problem and had a possible solution. According to Jackie, either the system or someone, had entered our annual income into the wrong column. The yearly income, based on my wife's part time job, was mistakenly shown as our January 2015 income. This automatically kicked us out of our insurance plan and into a supplemented insurance plan, at least for a few weeks when the mistake was probably caught by someone reviewing the data. The system showed that we were placed in plan which showed no income for January 30th to February 1st, and then back into our original plan starting February 2 through the rest of the year. Confusing, but at least we had an explanation. All that was needed, according to Jackie, was to transfer me to the folks who handled 1095A forms and have them zero out the January 1st through the 30th. That would automatically generate a corrected 1095A form and would generate a correct 1095B form. Jackie also said she would make sure this would be amply detailed so everyone would know what happened. Hallelujah!

So, Jackie transferred me to the folks who handled those dreaded 1095A forms. As it turned out, I spoke with a very sympathetic Amanda. Amanda asked for my claim number and as I started to explain, she said she had just read Jackie's beautifully detailed notes and knew just what to do. Amanda said she had already entered a ticket to have the 1095A form, the bane of my existence at this point, zeroed out. I should receive a new, and hopefully correct, 1095B form. To be sure, Amanda transferred me to Shasha in the 1095B department. Again, they were on the ball. Shasha had the information from Jackie and Amanda, and assured me a new and accurate 1095B should be generated and on its way to me shortly. For the first time in weeks, I had a good feeling about this. I immediately called and let my tax preparer know the good news. Actually, I think she was almost as pleased as I was (probably because she knew she was going to get this off her desk and paid).

On March 7th, I received a call from Jackie at KYNECT to make sure everything was taken care of. I brought her up to date and thanked her for help. I deeply appreciated everything she had done. On March 10th, I called to confirm that everything was proceeding as discussed and there were no hiccups. John, another one of the customer care reps, was a bit less friendly (personally, I think he saw all the notes and was afraid I was going to ask him a question). John confirmed that the revisions were being processed and there was a ticket to expedite the handling of my claim. "Excellent" I thought, and that's when the other shoe dropped...with a dull pain-in-the-pit-of-my-stomach thud.

On the morning of March 17th, I received a phone call from Jeanette at KYNECT. Apparently she must work in the 1095A department since she said he supervisor had asked her to call me and see "if I really wanted to have the 1095A form corrected". What? I asked Jeanette if she or her supervisor had read the notes, and she said her supervisor had but was wanting to know if I really wanted to do this? She went on to say that their system showed that we didn't qualify for the program we were in due to our "substantial income for the month of January 2015" and that's why we were placed in the other supplemented insurance plan which generated the 1095A. I think that for a moment I was actually numb. How could this be happening...again? Didn't anyone actually read the notes? Why were they just now working on this---10 days later? I explained as rationally and briefly as I could what the error was and what had been done, but somehow I don't think I was getting through. In her eyes, I was making the claim that their system was wrong; it was flawed, but I suspect she was thinking that it was I who was wrong.

Immediately, I gathered up all my documentation and notes and called KYNECT. Enough was enough. The unfortunate soul who answered for KYNECT was Jaz. She dutifully asked for my claim number and then...silence. I think she was just as stymied by all the notes as I was in knowing where to begin. As I started to explain, she very politely asked to place me on hold while she spoke with her supervisor. After a brief hold, Jaz came back on and in a refreshingly honest tone said that this was over her head and recommended I speak with her supervisor, and so I spoke with Dannie. Dannie introduced herself and asked if she could place me on hold for a few minutes while she read all the notes. "No problem" I said. I let her know that I wanted someone who knew the facts before we went any further. After about five minutes, she came back and said she had read through the notes. She asked if I had ever been referred over to Community Based Services (CBS), which oversaw our insurance plan. I said no and she said that she hadn't seen anything either. She explained that she understood everything that had happened but was flabbergasted that I hadn't been referred to CBS since they had oversight over our plan. She went on to say that only CBS could make the correction which would then flow over to KYNECT's 1095A and B departments where new forms could be generated. Until CBS made the change, the system would keep editing out the corrections and perpetuate the original error. This was now March 24th and I had started the process on February 15th. I had wasted weeks of effort.

So, Dannie transferred me to Community Based Services where, after an hour and a half wait, I spoke with a cordial Jane. Jane read through the mass of notes and was surprised that no one---not customer service reps or supervisors or their supervisors---no one had thought to refer me to them. We discussed the problem in detail and she issued a ticket for an immediate correction. She said the 1095A would have to be backdated, if possible since we never had (or knew of) the tax credit, as a result of being bumped out of our original insurance plan, and in fact, had never enrolled new plan. The insurance company which underwrote the new plan didn't have a new member ID number for us, and obviously we never received a new insurance card. We never even received notice of a change in plans. Nothing. As I advised Jane, we, in fact, had continued to use our original insurance card as always with no problems. The problem, however, for us was whether the system would allow a backdating of the entry to correct their error. She also pointed out that this wasn't a system error. It was human error in making a data entry. Some minimum wage summer help goofed and now I'm paying the price I thought to myself. Jane promised to follow up, however reminded me that nearly the public safety net for the State of Kentucky was in turmoil due to errors generated by the recent mergers of social programs which had caused thousands of individuals to bumped out of programs on which they depended, such as food stamps, housing assistance, natal care, and so forth. My problem, as important as it was, would not be considered priority. Jane suggested that I give KYNECT a call in a few hours. By then they should had the change from her side and could reprint a corrected 1095A and B. She added that KYNECT could read their notes since they were on the same system (besides, CBS can read KYNECT's notes).

About three hours later, I called KYNECT and spoke with Aretha. She said there were no changes showing; nothing. I asked her to check with her supervisor who may have a higher access. She came back and said that KYNECT was unable to read anything from CBS. Jane had recommended that I request a letter from KYNECT explaining their error for my tax records. Aretha said that under HIPAA guidelines that was not possible, even with a oral or written request. In short, KYNECT wasn't going to step up and own their mistake. At that point, I was fed up. I was tired. I had done everything in my power to get this resolved but nothing I did worked. I was dealing with a bunch of apparatchiks that would have made the Soviet Union proud. Since I know a few people on the executive side of State government, I felt the time had come to reach out for assistance. I contacted someone I knew and as briefly as I could explained what had happened and asked if there was anything he could do to help. I made sure this was done formally to both protect each other as well as to give it the weight of a formal request for assistance.

On March 30th, I was pleasantly surprised with a call from the Kentucky Cabinet of Health and Human Services. After a bit of clutter about what their system was still showing, etc, I was able to explain what had happened and needed to happen. I was told I would need a special letter of exemption, which she would discuss with her boss about providing. However, she never had heard of a problem quite like this before and acknowledged that she didn't know what, ultimately, they could do. I was promised a call back as soon as she knew something. I was hopeful that this bureaucratic nightmare was about over but I knew better than to get my hopes up again, and as it turned out, I was right.

Approximately a week or so later, I received another letter from KYNECT. It was the same incorrect forms as before showing the same incorrect coverage and the same incorrect income. After all this time, nothing whatsoever had been accomplished. I phoned my contact at CHHS to ask what had happened. She said that coverage apparently became available as a result of the income entry error. There was no coverage actually provided, though the company which had picked us up did, apparently, received payment from the State. I reminded her that no new member number was ever assigned. No notice of the change in coverage was ever provided. There had been no contact from either the new insurance provider or by me with KYNECT. In fact, I had received a notice from KYNECT in December 2014 advising that my coverage would continue as before for 2015. After the error was ultimately caught and corrected late January, the money was returned by the new insurance company to the State and we were resigned our original coverage as if nothing had happened, except for the incorrect 1095A and 1095B.

I asked how we was assigned the new provider and was advised that either I or someone else had selected them since the system doesn't automatically assign individuals (at this point, I don't think they know what the system actually does and doesn't do). I reminded her that I hadn't contacted anyone at all with KYNECT in 2015 and I keep very detailed notes of my dealings with KYNECT. They had caused me enough problems once before, in 2013, so the less I had to deal with them the better as far as I was concerned. So, apparently someone at KYNECT---perhaps that same minimum wage summer help---made the selection for us. As for backdating the system to correct them original program, they can't. There is no mechanism in the system to allow this type of correction. After nearly two months of dealing with this so-called "health exchange model", I was stuck with their mistake. No ability to correct data errors. No letter of exemption. No letter acknowledging their mistake. Nothing.

Most of those I dealt with were helpful, and like many State and local government employees overworked, stressed, and often underpaid while the department administrators are very well compensated and usually have linebackers to keep them separated from the common riff-raff. Of course some entry level employees are rude, unproductive, and unprofessional. I didn't find that here, though some were obviously totally lost. I didn't get what I needed, a correction of KYNECT's original, a correct 1095A and 1095B form, or written acknowledgement of their error, I wouldn't describe this as a "loss". I was successful in exposing the often ignored individual employees who went above and beyond to help me address a problem not of my making as well as highlighting failures in KYNECT's employee training, in its bureaucratic roadblocks designed to protect KYNECT's administration, and perhaps most importantly, in revealing a flawed system which lacks the proper programming to allow its users the ability to correct errors. I am sure there will be those who won't care one bit for this being exposed to the public. That's too bad since it's our tax dollars which are paying for this. If KYNECT is a "model" of a healthcare exchange, it's the model of what could be a successful exchange rather than of one that is.

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