It's been a rocky road to health reform in Vermont. Despite repeated assurances from the governor of a fairly smooth launch, the state's online exchange barely worked on its first day in October. Two full months later the site functions, but not fully.
"We've been working really hard in the last week to get as many Vermonters as we can covered for January," Vt. Health Access Commissioner Mark Larson said.
Larson says setbacks should not cause coverage gaps thanks to alternatives unveiled in November and flexibility offered by the state, insurance carriers and health service providers. But of the 52,000 covered under exchange plans, Larson can't say how many received invoices and actually have policies in place.
"Every Vermonter who confirms plan selection should be receiving an invoice," Larson said.
Insurers are also unsure. In a written statement, MVP Vermont Vice President Bill Little said, "We continue to receive enrollment reports from VHC on a daily basis; however because of the recent extensions of both enrollment and payment deadlines, we are not able to provide an accurate membership count at this time."
The state reports 23,000 individuals have used the site to select a plan on their own, though many payments aren't due for another week.
Representatives for Blue Cross Blue Shield, the state's largest insurer, say about 1,300 members enrolled with them through the state website and paid their bill.
"Early December I filled out the phone application; I'm still waiting for the invoice. I called to check on it. They couldn't tell me when I would get the invoice and I'm in limbo," said Brady Toensing, a frustrated customer.
Toensing says he may lack coverage for the first time in his adult life through no fault of his own. Toensing is the vice chair of the Vermont Republican Party and represented the governor's neighbor in a controversial land deal, but says his complaints aren't politically motivated.
"Well, the facts don't lie and I'm sitting here without coverage," Toensing said.
"If there's a Vermonter out there that has that question, then we want to hear from them so we can help," Larson said.
Larson says invoicing issues should not be a problem for the 29,000 Vermonters enrolled in exchange plans through small employers. Those who need medical care but experience a temporary gap in coverage can still get bills paid. Hospitals have agreed to delay billing in such circumstances, but some Vermont patients may need to pay out of pocket and get reimbursed by insurance carriers later.