Connect For Health Colorado: Some Customer Enrollments Are Delayed

Summary

An error caused some customer enrollments not to be finalized before their coverage start date. Connect for Health Colorado staff expect to fix the error this week so that those customers maintain their health insurance start date. More information will come if that does not happen.

Background

Electronic Data Interchange (EDI) contains enrollment information and is automatically sent to issuers when new enrollments are submitted. The error causing this problem is preventing issuers from receiving enrollment EDI for about 5,000 customer accounts. There are 2 groups of customers impacted by this error.

1. The customer’s plan auto-renewed on Dec. 1, then the customer cancelled that auto-renewed plan, and enrolled in a new plan for 2023.
2. The customer’s plan auto-renewed on Dec. 1, and the customer enrolled in a new 2023 plan without cancelling the auto-renewed plan.

When the affected customers enrolled in the new plan, that information did not successfully transmit to their health insurance company.

Impacts to Customers

Connect for Health Colorado staff are currently working to resolve this problem. They expect to fix this error by Jan. 1 and maintain a Jan. 1 health insurance start date for the affected customers who have a Jan. 1 start date. They will provide more information if that does not happen.

Because of this error, affected customers have not yet received confirmation that they are enrolled or their policy documents. They also have not been able to make their binder payments because their health insurance company has not yet received a record of their enrollment. The “My Plans” page of Connect for Health Colorado accounts show the plan that they will be enrolled in once the error is fixed.

Affected customers have expressed concerns because they already have health care appointments scheduled and are not sure if their insurance plan will cover the cost of care. They may access coverage as needed, but will may need to pay out of pocket and later submit a reimbursement claim to their insurance company if they receive care before this error is resolved.

Impacts to Your Work

There has been an increase in calls to the Customer Service Center and an increase in escalations submitted to Customer Operations teams.  

Here are some talking points to use when working with a customer affected by this error:

• Due to an error at Connect for Health Colorado, you haven’t received your health insurance policy documents yet, but you didn’t do anything wrong.
• Connect for Health Colorado is expecting to fix the error by Jan. 1 so that your health insurance coverage will still start when it’s supposed to.
• Since you completed your enrollment correctly and on time, your coverage start date will not change, and we’ll confirm so once the error is fixed.

Customer Notice

On Dec. 30, 2022, Connect for Health Colorado sent the below notice via email to customers who are affected by this error.

Email Subject: Important Information about Your Health Insurance Plan

Hello,

Connect for Health Colorado recently discovered a system error that delayed your health insurance enrollment information from being sent to your health insurance company in a timely manner. That’s why you have not yet received your policy documents, and that’s why you have not been able to pay your first month’s premium payment. However, since you completed your enrollment correctly and on time, your coverage start date has not changed, and neither has your plan.

Connect for Health Colorado staff have identified the solution to the system error, and your policy information was re-sent to your health insurance company on December 30, 2022.

Even though you may not receive your policy documents in time for early January appointments you may have scheduled, your coverage is still in effect. If you have early January appointments, you can do the following:   

1. 1. Attend your in-network appointment(s) and get the care you need.
   2. After you do receive your health insurance policy information, submit a claim for reimbursement for any covered medical expenses you incurred.
   3. In mid or late January, contact your health insurance company directly to pay your first month's premium. By that point, your insurance company will have confirmed your enrollment.

We apologize for and regret this error. If you have any concerns or questions, or if you do not receive your plan documents in January, we encourage you to contact us at 855-752-6749. We are here to help.

Thank you for your patience as we work through this system error. We deeply apologize for any inconvenience this may cause you.

Sincerely,

Connect for Health Colorado

If you have any questions, call us today at 866-568-9649!