Vermont to Pay $1.6M to Blue Cross Blue Shield After Exchange Errors

August 18, 2015

The administration of Vermont Gov. Peter Shumlin will pay Blue Cross Blue Shield of Vermont $1.6 million to cover past due premiums and incorrectly paid claims because of technical problems with the state’s once-beleaguered health care website.

Lawrence Miller, Shumlin’s chief of health care reform, said on Aug. 14 that the state and BCBS signed an agreement.

Vermont Health Connect lacked a key function — automated change of circumstance — when it launched in October 2013 so workers had to manually process customers’ changes to their personal information, which caused a backlog, the Times Argus reported. The insurance carriers in many cases were not notified that they should stop billing customers or not pay claims for coverage that was terminated.

The state recently upgraded its software with an automated change of circumstance function, allowing staff to process changes quicker.

BCBS spokesman Cory Gustafson said the $1.6 million payment agreement is to cover unpaid premiums and “unrecoverable claims” that were paid out incorrectly.

“There was an extensive reconciliation process and it got to a certain point where we needed to reach an agreement on the numbers, and we did,” Gustafson said. “We basically wanted to wrap up 2014 and focus on this year and get a more regular reconciliation process in place.”

The deal does not cover discrepancies for the 2015 plans. Miller said it was too soon to know how much the state might pay BCBS for those plans.

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