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Some find health insurers have no record of them



Published: Fri, January 10, 2014 @ 12:00 a.m.

Associated Press

INDIANAPOLIS

Record-keeping snags could complicate the start of insurance coverage this month as people begin using policies they purchased under President Barack Obama’s health care overhaul.

Insurance companies still are trying to sort out cases of so-called health insurance orphans, customers for whom the government has a record that they enrolled, but the insurer does not.

Government officials say the problem is real but under control, with orphan records being among the roughly 13,000 problem cases they are trying to resolve with insurers. But insurance companies are worried the process will grow more cumbersome as they deal with the flood of new customers who signed up in December as enrollment deadlines neared.

More than 1 million people have signed up through the federal insurance market that serves 36 states. Officials contend the error rate for new sign-ups is close to zero.

Insurers, however, are less enthusiastic about the pace of the fixes. The companies also are seeing cases in which the government has assigned the same identification number to more than one person, as well as so-called “ghost” files in which the insurer has an enrollment record but the government does not.

But orphaned files — when the insurer has no record of enrollment — are particularly concerning because the companies have no automated way to identify the presumed policyholder. They say they have to manually compare the lists of enrollees the government sends them with their own records because the government never built an automated system that would do the work much faster.

“It’s an ongoing concern,” said Robert Zirkelbach, a spokesman for the industry trade group America’s Health Insurance Plans. “Health plans can’t process enrollments they haven’t received from the exchange.”

Julie Bataille, communications director for the federal health care rollout, disputes the industry’s view.

“We have fixed the issues that we knew were a problem, and we are now seeing nearly zero errors in the work moving forward,” she said.

A federal “reconciliation” team, including technicians, deals directly with more than 300 insurers to resolve sign-up problems, she said, while the government’s call center has caseworkers to help consumers directly.

Insurers use the term “orphan” for the problematic files because they are referring to customers who have yet to find a home with the carrier they selected. The files have cropped up since enrollment began last fall through HealthCare.gov. The site was down an estimated 60 percent of the time in October.

Since then, the front-end interaction between customers and the website has largely been fixed.

But insurers worry that the back-end problems will grow more acute as they process the wave of customers who signed up at the end of 2013. More than 2 million people had enrolled by the end of the year, either through HealthCare.gov or state-run websites.

Aetna spokeswoman Susan Millerick said orphaned files were “manageable over the short term.” But she added that manually comparing enrollment files will not work over the long term and that the federal website needs a permanent fix to eliminate the possibility of orphaned files.

Bataille said the administration is working the issue with every tool at its disposal, from software fixes to picking up the phone and calling insurers.

Among those who got lost in the paperwork confusion was cancer survivor Sharon Van Daele of Tucson, Ariz., who went back and forth between her insurer and the federal government for more than a week after her confirmation failed to arrive. Unable to get answers, she said it felt as if she had fallen into a black hole.

Her case finally was resolved after an official from the federal Centers for Medicare and Medicaid Services contacted Van Daele directly, after an Associated Press inquiry to the agency’s Washington press office.


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