Insurance broker warns of 'mistakes' in Cover Oregon health insurance applications

Insurance broker warns of 'mistakes' in Cover Oregon health insurance applications »Play Video
Lisa Lettenmaier (right) says she's frustrated with a growing trend of mistakes she’s discovering on her clients’ health insurance enrollments.

PORTLAND, Ore. -- A Portland insurance broker sent KATU News a "May Day" call about mistakes on her clients' health insurance enrollments. With the letter, she got Cover Oregon’s attention, claiming most of her clients haven’t even heard from them even though they applied by the December deadline.

"I don't like to take things to this level,” said Lisa Lettenmaier, an insurance broker with Healthsource Northwest.

Lettenmaier told KATU News on Monday night that she sent the open letter, which you can read here, to the media and government officials because she is frustrated with a growing trend of mistakes she’s discovering on her clients’ health insurance enrollments.

"The heart breaking thing for me is watching the stress of my clients," said Lettenmaier.

Lettenmaier said she has applied on behalf of 74 clients. Of those, only 19 are enrolled. And of the 19, Lettenmaier said seven are enrolled in Medicaid when they shouldn’t be.

"The first case, I thought that's really odd. She wasn't supposed to go on Medicaid," Lettenmaier said.

Lettenmaier lays out the income levels of her clients who got put on Medicaid in her letter. On one end of the spectrum she explained that a family of two, with an estimated income of $72,000, got signed up for public assistance. On the other end, a family of one, with an estimated income of $22,400, got signed up for public assistance. She said neither client wants to be on Medicaid. She also provided clarification why they shouldn’t be on it, according to training she received from Cover Oregon.

  • A family of (2) would need to be at or below $21,404 to be eligible for Medicaid
  • A family of (1) would need to be at or below $15,856 to be eligible for Medicaid

"And then when we got to the third and the fourth and we got seven of them, I thought, you know this isn't an accidental incident,” explained Lettenmaier.

She’s disappointed and concerned about how many more mistakes, like the mistakes she’s discovered in her clients’ cases, might be out there, and how these types of mistakes could affect more than her individual clients.

"If we're enrolling people in Medicaid that shouldn't be there, we're going to tax even further a system that's intended for people that are at low income,” Lettenmaier said.

It also means some of the people enrolled in Medicare by mistake should have gotten a subsidy to purchase private insurance, which Lettenmaier claims puts lower prices into question.

In her letter, Lettenmaier also questions the Cover Oregon enrollment numbers Governor Kitzhaber announced at a press conference last week. She said it’s inaccurate for Cover Oregon to claim that the 170,000 people they say they have enrolled with paper applications is a success.

Lettenmaier explains that 150,000 of those are on Medicaid; 115,000 were rolled over from other state programs, totally bypassing Cover Oregon; 35,000 enrolled in Medicaid through Cover Oregon and 20,000 enrolled in private insurance plans through Cover Oregon. She also said that some of the people who enrolled in private insurance plans through Cover Oregon already had insurance before they switched.

Lettenmaier told KATU News that Cover Oregon has heard her call for help. She’s meeting with a representative on Tuesday to sort out her clients’ cases. A Cover Oregon spokesman confirmed to KATU News that meeting will happen, but he didn’t say if there is a widespread problem with mistakes or how those could affect the enrollment numbers Cover Oregon has reported.

When asked what it means to have Cover Oregon respond to her letter, Lettenmaier said, "It means that sadly, I had to take it to this level to get somebody who was at ability who could immediately jump on files.”

She also wants Governor Kitzhaber to do something.

“I want him to look at this. I know he’s called for an independent review of the website, but again this is a different problem.”


The following is a letter from Lettenmaier to the media and government officials:

Fellow Oregonians,
 
I write this letter not only as an Insurance Professional who is very concerned with how the rollout of the Affordable Care Act in Oregon has affected my clients and all Oregonians but also as a very concerned tax payer.
 
From the time period of 10/16/13 to 12/04/13, I have submitted (74) applications to Cover OR on behalf of my clients.   As I write this letter, I am only aware of (19) clients who have received information on their eligibility status. Of those, (7) have been inaccurately enrolled in Medicaid based upon their projected income for 2014.  That is an error rate of 36%.  In addition, these clients do not want to be enrolled on Medicaid and are now going through the process of having their applications reviewed so they can be corrected and the clients given a subsidy to enroll in a private health plan thus further complicating their desire to get correct coverage effective 01/01/14.
 
In addition, one client should have been enrolled on Medicaid based on her projected income for 2014 but was advised by Cover OR that she could adjust her income projection and receive a subsidy instead of enrollment in Medicaid.  Another client was so upset by the way Cover OR customer service treated him he withdrew his application for assistance and has enrolled with a carrier direct.
 
Per numbers that have been in several articles last week, OR has enrolled 170,000 people into health plans as of 1/1/14.  Of that number, approximately 150,000 were enrolled in Medicaid. 
 
How accurate is that number? 
 
How many more files have been processed incorrectly? 
 
I have heard similar stories of clients being incorrectly enrolled in Medicaid from other agents. 
 
What is the estimated cost for such errors?  A cost that is paid by our tax dollars, both State and Federal.

The following is a list of examples from my client files:
 
•    Family of (2) applied to Cover OR with an estimated income for 2014 of $72,000 – enrolled in Medicaid
•    Family of (2) applied to Cover OR with an estimated income for 2014 of $37,303 – enrolled in Medicaid
•    Family of (2) applied to Cover OR with an estimated income for 2014 of $31,907 – enrolled in Medicaid
•    Family of (2) applied to Cover OR with an estimated income for 2014 of $28,600 – enrolled in Medicaid
•    Family of (2) applied to Cover OR with an estimated income for 2014 of $26,105 – enrolled in Medicaid
•    Family of (1) applied to Cover OR with an estimated income for 2014 of $23,832 – enrolled in Medicaid
•    Family of (1) applied to Cover OR with an estimated income for 2014 of $22,400 – enrolled in Medicaid

To clear up any confusion, according to the Cover OR Agent training:
•    A family of (2) would need to be at or below $21,404 to be eligible for Medicaid
•    A family of (1) would need to be at or below $15,856 to be eligible for Medicaid

 
We still have many clients waiting to hear back from Cover OR so in the meantime, we have had to scramble to extend coverage as of January 1st or in many cases, help clients purchase coverage for January since they needed assurance of coverage that Cover OR could not give them.
 
I have been an Insurance Broker for (11) years and the majority of my client base is made up of Individual and Family health plans, Small Group health plans and Medicare Supplement plans.  I expected there to be confusion and errors as Oregon and the Nation embarked on a new system of purchasing health insurance plans but I did not expect to see the level of problems that I have encountered over the last (3) months, especially in the last few weeks. For these reasons and many more I felt it was my responsibility to bring these issues to everyone’s attention. 
 
As you may notice, I have chosen to email my concerns to the following people or agencies:
 
•    Governor Kitzhaber – posted to his website directly
•    My State Senator – Fred Girod
•    My State Representative – Vic Gilliam
•    Cover OR
•    The Oregon Insurance Division
•    NAIFA OR Board of Directors
•    The Oregonian
•    KOIN News
•    KATU News
•    KGW News
•    I Spy on Salem Radio Station
 
We can and should expect better stewardship of our tax dollars and a better experience for Oregonians looking to gain or retain health insurance. 
 
Respectfully,
 
Lisa Lettenmaier