Scott Sheffield of Camas has been paying the premiums for his health plan since December. But a week ago, Sheffield learned his insurance company has received only two of those payments.
As a result, his insurance company, LifeWise Health Plan of Washington, said it won’t be covering any of his services until he’s up-to-date on his premiums. Sheffield enrolled in the plan through the state-based insurance exchange, Washington Healthplanfinder, and pays his $420 monthly premiums through the exchange, as well.
“I was never notified by the state or LifeWise, but basically, I haven’t had any insurance for months, and I didn’t know it,” Sheffield said.
Sheffield appears to be one of the thousands of exchange plan customers impacted by system defects and data issues plaguing the site for the last three months.
According to the exchange, the system defects are affecting less than 5 percent of its more than 164,000 customers. The exchange underwent a system update last weekend to address the some of the issues and has developed an internal task force to work on the remaining defects.
The defects resulted in invoices’ not being generated and in incorrect payment adjustments. They also led to customer notices from the exchange requesting payment and insurance companies’ being unaware of completed payments, said Richard Onizuka, chief executive officer of the exchange, in a news release.
The exchange determined Sheffield’s payment files were not being generated for LifeWise, so the company was unaware he was paying his premiums, said Caitlin Steffen, an exchange spokeswoman. The exchange and LifeWise are working to correct the problem, she said.
In the meantime, Sheffield is left to wait.
Since his coverage began in January, Sheffield, 64, has had several visits to various doctors and specialists. His recent prostate-specific antigen test, which screens for prostate cancer, came back with a higher-than-normal number, so Sheffield scheduled a follow-up biopsy for Monday.
But on May 9, Sheffield received a $280 bill for an earlier visit to a local clinic. The bill said Sheffield’s coverage from LifeWise had been terminated.
A LifeWise representative told Sheffield the company had received only two payments from the exchange — one in December and one in May. By March 20, LifeWise had stopped paying for his medical and pharmacy services, Sheffield said.
Sheffield was told his coverage wouldn’t resume until LifeWise receives payment from the state. The exchange records indicate Sheffield is up to date on his payments, he said.
On Friday, the exchange and LifeWise told Sheffield they were working together to resolve the problem. LifeWise reinstated his pharmacy coverage Friday, but the medical services coverage is still suspended until payment is received, Sheffield said.
The uncertainty prompted Sheffield to cancel his biopsy for fear of incurring another bill.
“I’m not planning on doing anything for several weeks,” Sheffield said. “In my case, I’m putting off biopsies.”
Even when the problem is fixed, Sheffield worries it will happen again.
“Do I need to call LifeWise before any appointments to make sure I have insurance for every move I make?” he said.
After a smooth enrollment process, Sheffield hoped his new coverage would come without problems. He was optimistic about the Affordable Care Act and wanted more people to be able get health coverage. This experience has soured his opinion.
“I don’t believe in the system anymore,” he said.
