As consumers rush to try out their newly-minted insurance coverage under the federal healthcare law, some are hitting snags that are keeping their producers busy even past the Dec. 31 deadline for 2014 coverage.
Due to technical glitches in the operation of HealthCare.gov, an estimated 15,000 applications for health coverage disappeared into a black hole during the first three months of enrollment. The data never reached carriers, causing consumers to show up at the pharmacy or doctor’s office only to discover they aren’t listed in the system.
Other data was lost or changed during transmission to carriers, causing some consumers to be enrolled in the wrong plans.
The confusion has left producer Kelly Fristoe of Wichita Falls, Texas very busy.
“It’s total chaos. HealthCare.gov has not fully transmitted data and subsidy eligibility to the insurance company,” Fristoe said. “I’ve been fielding phone calls all day long.”
One such call came from Tony Kouri, a client of Fristoe’s who went to his local CVS pharmacy Jan. 1 to refill a prescription. Fristoe had enrolled Kouri in a bronze plan through HealthCare.gov in early December that had a $6,000 deductible and no drug card. However, when Kouri tried to pay the full price of the prescription, he ws charged only $50 as copay.
Kouri called Fristoe, who revisited the enrollment and affirmed that Kouri did indeed sign up for a bronze plan through Blue Cross Blue Shield.
“This indicates to me that the website didn’t transmit the correct data and enrolled him in the wrong plan,” Fristoe said. “Now I’m in a world of hurt because a healthcare professional is telling my client they’ve got something totally different from what I told him.”
Fristoe called the issue “just another side effect of Obamacare,” and expects his client will be billed later for the remainder of the payment.
To address these and other issues, carriers are reportedly asking producers to double back and ensure all client enrollment information is correct. Teri Gutierrez of JBA Benefits in Raleigh, N.C. said Blue Cross Blue Shield already sent out a letter to producers in the state to that effect.
“Blue Cross Blue Shield has pooled a lot of their resources into trying to verify enrollment information,” Gutierrez said. “We got an email asking us to check that our clients are in the system, and in the system correctly, because they cannot change an electronic application.”
Gutierrez said JBA Benefits was lucky enough not to have any clients with lost information, but if they had run into that problem, it would necessitate going back and reprocessing the application with that client. Due to the complications involved with the website, she said it would be virtually impossible for consumers to complete the process on their own.
“A lot of these people don’t have that kind of sophistication,” she said. “I think it’s putting a lot of people in a bad situation.”
Fortunately, popular pharmacies like CVS, Wal-Mart and Walgreens announced this week they would work with customers having issues getting prescriptions as producers and carriers help them sort out their coverage.
Until the issues are resolved, however, Fristoe said it gives him comfort to know he can help his clients appreciate the situation.
“The only thing I can do—which I’m glad I can—is to bring some sort of understanding I what’s going on,” he said. “I can say, ‘Here’s what to expect, have faith, and these problems will auto-correct.’”