While the Administration has given itself passing grades on its self-imposed December 1 deadline, the real problems lie under the surface, in what is known as the back-end. In short, just because someone thinks they have signed up, doesn’t mean the correct information has been sent to the insurance company.
A detailed report in the Times explores what will be a huge problem come 2014: People who thought they signed up, were not properly signed up. And they probably won’t realize it till they go to the doctor’s office, and are denied coverage.
Insurers said they had received calls from consumers requesting insurance cards because they thought they had enrolled in a health plan through the federal website, but the insurers said they had not been notified.
“Somehow people are getting lost in the process,” the insurance executive said. “If they go to a doctor or a hospital and we have no record of them, that will be very upsetting to consumers.”
Think about that. People manage to sign up, but because garbled data is sent to insurance companies, their policy may never be registered. How would the mandate penalty/tax work in such cases?Or, they may sign up for one plan, but they are actually signed up for another plan. That’s the type of problem you don’t find out until there is a dispute.
As it stands now, the information being sent to the insurance companies is not complete. And this is bad news for the few people who have managed to actually sign up.
The problem is that so-called back end systems, which are supposed to deliver consumer information to insurers, still have not been fixed. And with coverage for many people scheduled to begin in just 30 days, insurers are worried the repairs may not be completed in time.
“Until the enrollment process is working from end to end, many consumers will not be able to enroll in coverage,” said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group.
The issues are vexing and complex. Some insurers say they have been deluged with phone calls from people who believe they have signed up for a particular health plan, only to find that the company has no record of the enrollment. Others say information they received about new enrollees was inaccurate or incomplete, so they had to track down additional data — a laborious task that would not be feasible if data is missing for tens of thousands of consumers.
In still other cases, insurers said, they have not been told how much of a customer’s premium will be subsidized by the government, so they do not know how much to charge the policyholder.
But neither Mr. Zients nor the Department of Health and Human Services indicated how many people were completing all the steps required to enroll in a health plan through the federal site, which serves residents of 36 states.
And unless enrollments are completed correctly, coverage may be in doubt.
For insurers the process is maddeningly inconsistent. Some people clearly are being enrolled. But insurers say they are still getting duplicate files and, more worrisome, sometimes not receiving information on every enrollment taking place.
“Health plans can’t process enrollments they don’t receive,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.
How bad is it?
Thomas W. Rubino, a spokesman for Horizon Blue Cross Blue Shield of New Jersey, which says it has about 70 percent of the individual insurance market in the state, said the company had received “some but not a lot” of enrollments from the federal exchange.
Federal officials are encouraging insurers to let consumers sign up directly with them. But in the middle of this online enrollment process, consumers must be transferred to the federal website if they want to obtain tax credit subsidies to pay some or all of their premiums in 2014.
In a document describing problems with the federal website in late November, the administration said some consumers were “incorrectly determined to be ineligible for” tax credits. In some cases, it said, enrollment notices sent to insurers were missing the amount of the premium to be paid by a consumer, the amount of subsidies to be paid by the government and even the identification number for a subscriber.
In some cases, according to the document, government computers blocked the enrollment of people found eligible for subsidies that would pay the entire amount of their premiums. In other cases, the government system failed to retrieve information on a consumer’s eligibility for financial assistance.
Plus, the mechanisms to actually pay the insurance companies is not even complete.
Insurers said they were alarmed when Henry Chao, the chief digital architect for the federal website, estimated that 30 to 40 percent of the federal insurance marketplace was still being built. He told Congress on Nov. 19 that the government was still developing “the back office systems, the accounting systems, the payment systems” needed to pay insurers in January.
While insurers will start covering people who pay their share of the premium, many insurers worry the government will be late on the payments they were expecting in mid-January for the first people covered.
“We want to be paid,” said one executive, speaking frankly on the condition of anonymity. “If we want to pay claims, we need to get paid.”
And this line is brutal:
Whether Mr. Obama can fix his job approval ratings as well as the website is unclear. Public opinion polls suggest he may have done more political damage to himself in the last two months than Republican attacks on the health care law did in three years.