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Updated Jan 9, 2014 - 11:24 am

Tucson woman fights way out health insurer no man’s land

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

Insurance companies are still 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. They 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.

The government said the problem is real but under control. Officials say they
are trying to resolve about 13,000 problem cases out of more than 1 million
enrolled through the federal insurance market that serves 36 states. They
contend the error rate for new signups 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.

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.

She started the year worried she was uninsured even though the HealthCare.gov
website told her Dec. 22 that she had successfully enrolled.

“I made all the deadlines, and then I tried to make my payment, but they
wouldn’t take it,” said Van Daele, who is in remission from a type of blood cancer.

Her case was finally 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.

A federal “reconciliation” team, including technicians, deals directly with
more than 300 insurers to resolve signup 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.

Van Daele’s previous coverage lapsed Dec. 31, and she started getting nervous when nothing
for her new coverage arrived in the mail.

“My husband told me I shouldn’t leave the house,” she said.

Insurance industry consultant Bob Laszewski said he expects to hear more
reports about orphaned files as patients begin to seek health care or start
worrying about insurance cards that have not arrived.

“As we go through the month, you bet this is going to be a problem,” he said.

Improving weather also could turn up more orphaned enrollees. The year started
with a blast of freezing weather that settled over much of the U.S. Those
conditions usually keep people indoors and out of the health care system unless
they absolutely have to use it.

Laszewski and other insurer representatives say orphaned files exist largely
because the government allowed people to sign up without first guaranteeing the
technology would work.

Insurers say it usually takes a few days for a customer’s file to reach them
after they enroll through the exchange. People who still do not receive their
insurance cards and introductory packet after that should call insurers first
for help.

If the insurer has no record of them, they must contact the government for
help.

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