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Due Diligence – Double, Triple Checking Consumer Info

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Wednesday, June 4, 2014

The Affordable Care Act created a new eligibility system for affordable health insurance, relying primarily on electronic data sources rather than paper and pay stubs to evaluate applications.  During the first historic open enrollment, the Health Insurance Marketplace took steps to verify more than 160 million of individual pieces of information submitted by consumers from across the country, consistent with the requirements Congress included in the Affordable Care Act. The Marketplace checked to see that consumers are who they said they were, matching Social Security numbers, income and tribal status, among a host of other data points – all to ensure that folks are eligible for coverage and, in many cases, entitled to financial assistance to help them afford their plan. The typical family of four generated 21 separate pieces of information that required verification, and all were attested to under penalty of perjury. 

For most consumers, the data they submitted were immediately verified by the Marketplace. But, while most information the applicant provided lined up, sometimes a name or data point didn’t match up right away with existing records. For example, a consumer might have recently changed jobs, but the latest IRS tax return data and other data available to the Marketplace didn’t reflect that change in income. In such cases, the law requires us to double and triple check this data in another way. Those consumers were still able to enroll in Marketplace coverage – as provided for in the law – but, when they enrolled, they received a notice instructing them to submit a little bit more information.

The Marketplace is working around the clock with consumers who were asked to provide additional information in order to double check the information consumers attested to on their application for coverage. In many cases, consumers have already uploaded or mailed in necessary documentation, such as a paystub and extra information cleared up discrepancies other cases require more facts from the consumer, the spelling of a name on a birth certificate doesn’t match the spelling on a license. Our teams are processing this information as quickly as possible.

We are focused on getting this right to help consumers and do due diligence for taxpayers.  In most cases we need more facts that only individuals can provide. That’s why, over the next few weeks, we’re again reaching out to these consumers – via mail, email and phone calls – to encourage them to provide supporting documentation so we can resolve any remaining issues with their application as soon as possible. It’s an important part of the process to help ensure that consumers are getting the benefits they’re eligible for and deserve.

As part of our due diligence process and to be a good steward of taxpayer money, if consumers don’t provide sufficient proof to support the information they attested to, they will have their eligibility ended or changed to reflect what is recorded in trusted data sources.

Applying for health insurance online was a new process for many consumers, and it was always expected that some would need to submit additional data so the Marketplace can complete the verification required by the Affordable Care Act. This verification process isn’t unique to the Marketplace; in fact, it’s similar to a process that states have been administering in the Medicaid program since its inception. Under the law, consumers typically are given 90 days in which to submit additional information to verify their information on their application.  Most people who applied during open enrollment are still within that window, and, for those who aren’t, we’re giving them extra time to provide documentation as they work through these issues with us – a flexibility the Affordable Care Act provides for the start-up year of 2014. 

We remain committed to working with consumers individually – as well as our state and federal partners – to address any issues that may be impacting consumers’ ability to secure quality, affordable health coverage.

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Submitted by Frank on
I got the same letter. I sent my information three times. I was told that it takes about 30 days before they even know that I sent it. I get my income from IRA distributions, CDs, I a little part time work. I sent in copies of the distribution documents, CDs & check stubs,- along with a letter spelling out what the documents were, & how to understand them- but I got a letter that said the information couldn't be used and that I should send different documents. When I called the Marketplace, I was told that I could not talk to anyone working on the matter, but my case would be sent to the Advance Resolution Center, - and someone would call me back in 5-7 work days. When that didn't happen, I called. I was told that the call-back was cancelled, because income verification wasn't an issue that they handled there. They also said that only certain kinds of documents would be considered. Anything else gets dismissed, and shredded. I was told that nobody looks at the income documents and tries to verify the information. Then- who does? A computer? As far as I can tell, my income qualifies me for a subsidy, but my bank accounts don't provide the preferred documentation until the end of the year. Does that mean that I will lose my subsidy. If I could only talk to someone who was working on my account, I could get it taken care of in ten minutes. I have called the "HELP" line many times, and spent may hours trying to get this matter resolved, with no success. I need real help. I suspect that nobody at the Marketplace will read this. But on the outside chance that someone does and really wants to help me- just e-mail me. fstyburski@sbcglobal.net.
Submitted by carolyn on
We have sent in all documentation of all we are earning now,my husband has retired all we get is social security.We sent all the documents from s.s. and a letter showing he was retired and no longer drawing any income.It seems this is not good enough, WHAT DO WE DO??????? Oh forgot to say we have done this twice.
Submitted by Randy on
Exact same thing here....Called twice. They're looking at what we sent twice already and telling us to send it again. We asked to speak to someone who does the verifications but, no, can't do that. We've sent tax returns, passport info & brokerage statements (as I said, twice) to no avail. I don't have anything else to send. Somebody, please do something about this because it looks there are many other people fighting the same frustrating battle.
Submitted by Linda on
I received a letter asking for income verification & US citizenship. When I spoke to a representative about what could be sent to prove citizenship she said that was a mistake & was on all letters. I sent the information about income but received an email asking for the information again. I then sent the information through the system a second time so I know it was received & tonight I got a second email. What happened to the information I mailed & why do I keep getting emails?
Submitted by Bob on
I have submitted the information requested at least 4 times now and I still get the same request as though HHS has never received it. I have called the HHS line and they say they are not authorized to address why the requests keep coming. Please authorize some one to address why the information sent is not adequate and it can be cleared up instantly instead of spending hours of HHS time with staff not authorized. For example, HHS thinks there are two of me since I applied early when the system was not working. I then started over in December as instructed by HHS and it finally went through. Only one of me is sending the information requested, only one unique name, ID, email address, real address, one IRS income for 2013, one SS# and so forth yet HHS still requests more information. The HHS staff on the phone couldn't delete the old application so the system still wants to find out about that second me in the system. One human with authority to resolve an issue could end this saving hours of HHS and my time. Yet the automated system keeps wasting our time.
Submitted by Mary on
I am trying to access my account so that I can upload these documents you are requesting. After I log in, I get error 500.000888. It displays my name but no other information and no way to upload the documents. I've cleared my cache, cookies, everything, restarted the browser etc. I contacted customer service and all they could do is submit feedback regarding the problem. If you're going to ask us to submit documents you should at least make sure the system is working. The request to "send proof of yearly income for 2014" is ridiculous. We are retired but not yet receiving soc. sec. Our income varies from year to year. I can't prove my income for 2014 until I file 2014 tax return.
Submitted by Charlene on
The issue for me is a client sent their info three times and now the same request is being made a 4th time. It's frustrating.
Submitted by Stephani on
Thank you for this post. I have reviewed this link regarding documentation required to prove one's income: https://www.healthcare.gov/help/how-do-i-resolve-an-inconsistency/ However, Navigators in Illinois are wondering what to tell clients who have zero income (for example for LPRs under 5 years under 100% FPL who don't qualify for Medicaid). What documentation can they send in? Thank you, in advance.
Submitted by Mikey on
I received a letter from the Health Insurance Marketplace dated 5/24/94 stating that they need to verify that my family and I are US citizens. I had already uploaded copies of our passports to our application back in December. Now they want the exact same identical information again. The HHS.gov website states that I can upload the information to my application on file, however, the upload feature is no longer available and a (800)-318-2596 customer representative supervisor informed me that I would have to mail the information to Kentucky. The government contractors in Kentucky will probably lose the mailed information and I will have no record that I mailed the same information again. You would think that they would have fixed the website problems by now and we wouldn't be waisting all this additional time and money on the same issues we already addressed last December. I think these government contractors have no incentive to do things right the first time because they know they will get paid over and over again to perform the same data services. This is another classic government boondoggle. Please help!!!
Submitted by Richard on
There is another, important aspect to this. CMS has emphasized that the Medicare anti-duplication law prohibits the sale of health insurance to individuals on Medicare. Yet it seems checking whether Marketplace applicants are enrolled in Medicare is not part of the CMS process. This is a significant oversight, one which will be addressed very soon.