Source: USA TODAY
Insurers struggling with garbled and missing information on applications from the federal healthcare site report the quality of the information is improving, but they’re still grappling with missing and duplicate applications that could hamper their ability to enroll people by Jan. 1.
The mixed news comes as insurers, regulators and consumers rush to meet a Dec. 23 deadline for people to sign up for insurance on the federal HealthCare.gov site if they want policies that take effect Jan. 1. The Department of Health and Human Services said today that it is encouraging insurers to allow consumers to pay premiums late, to cover prescriptions filled after plans expire and to let people with urgent health needs use doctors who may not be on their new health plan during the transition to new plans. Aetna said it would give people until Jan. 8 to send premiums.
Insurers for the first time Wednesday got an accounting from HHS on everyone who enrolled for their plans on HealthCare.gov from Oct. 1 to Dec. 10. This data is the government’s attempt to reconcile the files it has on consumers who have signed up with the files received by insurers in the daily feeds from HealthCare.gov. Industry officials refer to it as a “mini-reconciliation” because the system that would automatically reconcile files is, perhaps not surprisingly, down.
Instead, regulators are trying “to make sure we’ve loaded every person they are aware of,” says John DeGruttola, senior vice president of marketing at Sentara Healthcare, which sells Optima Health insurance plans in Virginia.
HHS has acknowledged one out of four transactions on its website could have had errors before the fixes, and it believes nine out of 10 are now accurate. It is still verifying information with insurers.
“We are working closely with issuers and have an intensive and meticulous process currently underway to compare enrollments between (the Centers for Medicare and Medicaid Services) and insurers to make sure that everyone who has selected a plan knows the steps to take to ensure their coverage starts Jan. 1,” HHS spokeswoman Joanne Peters said in an e-mail. “If consumers are not sure if they are enrolled, they should call our call center or the insurer of their choice so they can get covered by Jan. 1.”
While insurers all agree the information flow from HealthCare.gov has improved, at least one said it’s not by enough.
“The data, while it has improved, is not where it needs to be to get us where we need to be on Jan. 1,” said one official with a major insurer, who asked to remain anonymous so he could be more candid. “We are still seeing errors. The ones that trouble us the most are the orphan ones.”
So-called orphans are described by industry officials as people who think they have signed up for insurance, but the insurer, HHS — or both — don’t have a record of the application.
Consumers have been calling Sentara wanting to pay for the new Optima Health plans they think they signed up for, but in many cases the company has no record of the application. The company has accepted some of the payments and is hoping to find the consumers in the new HHS data it is combing through.
In a comment echoed by other insurers, DeGruttola says people are calling and trying to pay Sentara for plans the company has no record they purchased.
“We don’t know who we don’t know about,” says DeGruttola. HHS is “trying to put a little more clarity to those unknowns.”
Aetna, Cigna and Optima all say the files they are receiving from HealthCare.gov have dramatically improved since fixes to the website Nov. 30.
“Happy to say we’ve been successfully enrolling customers through healthcare.gov in all five states where we’re participating on the exchanges,” Cigna spokesman Joseph Mondy said in an e-mail. Cigna is selling policies in Arizona, Colorado, Florida, Tennessee and Texas.
But Aetna notes there is a way to go.
“The website is still a work in progress, and we are working closely with the marketplace technical team and other carriers to help identify, prioritize and test additional issues,” spokeswoman Susan Millerick said in an e-mail.
Problems seem most common on files involving couples or families with dependents, insurers say. Insurance brokers have told USA TODAY applications for dependents and couples have tended to be the ones most likely to be inaccurately qualified for Medicaid.
“It’s a mess with the files, period,” says health care consultant Kip Piper, a former insurance company official and state regulator. “With anyone applying for more than one person at a time, this reconciliation process is unable to give a clean and correct file for every individual.”
At one point, so many children were being listed as spouses that “the joke early on was that there was an epidemic of polygamy,” says Piper.
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