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Utah insurers still struggling with Obamacare delays

Published December 13, 2013 4:46 pm

Federal health reform • Carriers are reporting back-end problems verifying applications and handling payments.
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The Obama administration has fixed the front end of its online health insurance marketplace, improving the shopping experience for consumers.

But the back end of healthcare.gov is still dysfunctional, say Utah insurers, who fear application errors and a looming Dec. 23 enrollment deadline risk leaving some people without coverage on Jan. 1.

Brokers are still hand-entering paper applications left over from the early days when the site wasn't working, creating a bottleneck, said Judi Hilman, chief member advocate at Arches Health Plan, among half-a-dozen insurance executives to report on enrollment this week at a legislative Health Reform Task Force meeting.

Working through the backlog while processing an expected influx of last-minute enrollees poses challenges as insurers rush to issue insurance cards over the holidays.

"We're all shortening our holiday times. … The end of the year is going to be pretty chaotic," Hilman said.

Enrollment, meanwhile, is still far short of expectations.

Arches has received about 700 applications, said Hilman.

Regence BlueCross BlueShield, or Bridgespan, reports 114 enrollees, none of whom enrolled through the federal exchange, said the company's lobbyist, Frank Pignanelli.

Utah's largest insurer, Select­Health, is sitting on 1,726 applications, but it has received payment on just 500, said the carrier's chief information officer, Bob White.

The deadline to pick a heath plan for January is Dec. 23. But for coverage to kick in, consumers have to pay their first month's premium by their insurer's deadline — Dec. 31, according to federal rules issued on Thursday.

'Orphans and ghosts' • The HealthCare.gov website has a prompt confirming completed applications and warning consumers that payment must be made for coverage to be activated. It features a payment button that takes consumers to their insurer's website.

But carriers suspect some don't understand that they need to take this extra step. And they're still receiving incomplete and mismatched data on enrollees, making it impossible to verify enrollment, much less payment.

"We're seeing orphans and ghosts where the data are not assigned to the right person, or we get data where people have not been assigned at all," said Molina Healthcare's Utah vice president, Chad Westover. "This could be a problem for consumers who find out when they get to the doctor that they're not covered."

It also jeopardizes the health of the exchange, which needs a broad mix of consumers to keep prices in check.

"We were hoping for a large insurance pool, because we need a good cross-section of consumers," said Westover. "We have an insurance puddle at this point."

The U.S. Department of Health and Human Services (HHS) is asking insurers to let consumers sign up and pay later for coverage that's retroactive to Jan. 1.

HHS officials announced Thursday that anyone who tries to sign up for an exchange plan by Dec. 23 and runs into problems will qualify for a special, secondary enrollment period.

Should barriers continue, federal officials are also considering pushing back the Dec. 23 deadline.

A hurdle for Utah's sickest • Delays are particularly worrisome for Utah's sickest and poorest residents.

Tens of thousands of Americans with severe health problems, those enrolled in state and federal insurance pools for the "uninsurable," will soon lose their coverage and have to transition to the marketplace.

To avoid coverage gaps, federal officials are extending coverage through the end of January for enrollees of the federal high risk pool, including hundreds of Utahns.

But no such extension has been given to 3,000 enrollees of Utah's risk pool, HIPUtah, whose coverage expires on Dec. 31.

The HIPUtah board will likely take up the matter prior to its next board meeting, but any extension would hinge on financing, said Sally Burns, HIPUtah's associate director.

Because these Utahns can bypass the exchange and enroll directly with insurance companies, the health reform task force on Thursday rejected a Democrat-pushed proposal to recommend an extension.

But those who qualify for tax credits to put toward their purchase must still be routed through the exchange, which has thrown a wrench in direct enrollments, say insurers.

"It does not work as advertised," said Arches chief operating officer Shaun Greene.

Mixed Medicaid messages • Another vulnerable group are low-wage workers and families.

The exchange interface with Utah's Medicaid eligibility system is still not functioning, said Kevin Burt from the state Department of Workforce Services.

The exchange has compiled a list of about 10,000 Utahns deemed eligible for Medicaid or the Children's Health Insurance Program (CHIP), but it's merely a list of names, said Burt, noting his agency has no way to verify eligibility.

Meanwhile, many exchange shoppers with incomes under 200 percent of the federal poverty level are being determined eligible for Medicaid, even when they're not, and barred from buying a plan or applying for subsidies, said Lloyd Coleman, president of the Utah Association of Health Underwriters.

"Or they're being told they have kids who are CHIP eligible ," Coleman said, "when they're not."


Twitter: @KStewart4Trib Deadline is approaching for exchange shoppers

Shoppers on the federal health exchange HealthCare.gov are being told to confirm enrollment with their chosen insurer. Consumers must pick a plan by Dec. 23 and pay their first month's premium by Dec. 31 for coverage to take effect in January. —

Utah's option for small businesses

Utah runs its own "shop" exchange for employees of small businesses, Avenue H. Enrollment data won't be available until after Christmas, but the online shopping tool is reportedly glitch-free.

To avoid confusion and to coincide with deadlines for the federal individual exchange, Avenue H has extended its enrollment period. Employers who choose to join have until Monday to register, and employees have until Dec. 23 to pick a health plan.




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