State health plan bugs remain

Problems to linger when enrollment begins in Nov.

Software defects that have dogged the Massachusetts Health Connector are significantly more severe than expected, forcing the agency to scale back its ambitions for the fall open-enrollment period, state officials revealed Thursday.

Louis Gutierrez, the Connector’s executive director, told the agency’s governing board that a six-month review had found substantial challenges and that new snags keep emerging.

For example, until recently, it was impossible to change an incorrect birthdate on an application. Just last week, Gutierrez discovered that even though some people paid their delinquent accounts, they did not have their insurance renewed.

The problems extend to the one function the Connector’s website was thought to be performing well: determining eligibility for coverage. Nearly 6,000 people ended up enrolled in both MassHealth (the state’s Medicaid program for the poor) and in private insurance bought through the Connector.

The Connector is the state agency serving people who do not get health insurance through an employer. It enrolls eligible people in MassHealth and enables others to shop for a private insurance plan.

Fixing the defects and adding functions in time for enrollment in 2016 plans will cost $47.2 million, which the Connector will share with MassHealth.

The glitches that led to double enrollments involve two separate issues. Some 5,000 people who have disabilities but are not low-income were enrolled in MassHealth and also told to sign up for a Connector plan; the state is still trying to sort out where each belongs. An additional 756 people who submitted multiple applications with slightly different information were enrolled in both programs.

Because these problems consume the staff’s attention, the website will not be able to replace the Connector’s malfunctioning payment system, a major source of consumer complaints, in time for the Nov. 1 start of open enrollment. Instead, the Connector is working to repair the existing system and seeking a contractor to replace the payment system later.

And there are diminished hopes that consumers will be able to instantly find out whether their doctors are in the coverage network of the plan they are considering.

Gutierrez took charge of the Connector a few months after it launched a new website to replace software that failed disastrously the previous year.

The rebuilt website performed better than its predecessor, enrolling tens of thousands of subscribers, but was still plagued by problems. Consumers endured hours on hold with the call center, encountered misinformed or unhelpful customer service agents, discovered payments had been lost, and found they could not access insurance they had paid for.

“These stories are painful,” said Vicki Coates, the Connector’s new chief operating officer. “They deserved better from us.”

Stephanie Barrett, 61, a retired bank customer service agent who lives in Bridgewater, told the Globe that buying insurance through the Connector was the most frustrating situation she had ever been through.

The trouble started when she tried to switch the start date of her insurance from Jan. 1 to Feb. 1. Every month, she would receive a letter saying her insurance had been terminated because she was behind in payment.

“The stress of thinking that if I ever got sick, what would happen?” she said. “Would I have to sell my house?”

It took until May to resolve the problem.

Gutierrez said that improving customer service has been his main focus since arriving in February.

“There are many bumps in the road,” he said. “We’re getting better at smoothing the bumps.” He is requiring Dell, the technology company that runs the call center and the payment portal, to start measuring customer satisfaction as people call in.

Coates said that beefed-up staffing and training had improved the call center’s performance, with wait times down to a minute or less. The Connector has resolved all but 383 of the 1,591 serious complaints brought to its attention. And a backlog of nearly 11,000 requested account changes — such as adding a newborn or a change of address — has been cleared, with new requests handled promptly, she said.

Additionally, the Connector has paid refunds to about 900 members who requested them, often because they paid for insurance but were not enrolled in a plan. Checks will be in the mail by June 19 to all remaining customers owed refunds, Coates said. Some 810 members whose payments went into the wrong account have had the money properly redirected.

Coates said those problems will not recur because the defects that caused them have been fixed.

But Kathy Butterworth, a patient advocate at Nantucket Cottage Hospital, said that problems with the Connector are far from resolved.

“Now, the Connector is answering the phone, which is great, but then nothing really happens,” she said. Butterworth has found, in some cases, that it was faster to submit paper applications than cope with the Connector website.

Many of her clients, she said, received confusing mailings, missed the enrollment deadline, and found out they were uninsured when they went to the doctor. On Monday, she called on behalf of three clients trying to enroll.

“The phone call ended with we were referred to a supervisor who will call you,” Butterworth said. “When I said, ‘When will that be?’ there is no answer.”