January 20, 2014

Delay in processing health insurance applications leaves NC residents in limbo

Missing policies, lost policies, multiple policies and general confusion are plaguing legions of North Carolina residents who had rushed to sign up for health insurance by a Christmas Eve deadline. Some spend weeks trying to verify coverage so they can see a doctor, pick up prescriptions.

Missing policies, lost policies, multiple policies and general confusion are plaguing legions of North Carolina residents who had rushed to sign up for health insurance by a Christmas Eve deadline.

The latest crisis for the federal health care law is exacerbated by about 99,000 people in North Carolina signing up for health insurance in December, requiring insurers to process the applications within days and clogging networks with a crush of virtual paperwork.

Even insurance agents aren’t exempt from the chaos. One Asheville agent, who sells policies for Coventry Healthcare of the Carolinas, waited more than a month for his proof-of-insurance number, then pleaded with the company to find his policy when his wife fell ill with a sinus infection and needed antibiotics.

“I was furious, of course,” said the agent, Ron Miller. “I read them the riot act, told them my wife needed her medication. ‘She’s sick in bed and you’re playing with peoples’ lives.’ ”

The mass applications prompted insurers nationwide to push back payment deadlines several times in a bid to buy much-needed time for processing. But it’s anybody’s guess how many policies will actually clear, and how many customers will have nothing to show for their first month’s payment. Coventry’s payment deadline for health insurance effective in January came and went Jan. 17, while Blue Cross and Blue Shield’s is approaching Friday.

“This is a new situation with the health care law going into effect,” said Kerry Hall, spokeswoman for the N.C. Department of Insurance. “None of us have been through this before.”

The surge in health insurance applications in December was touted as a major validation for the Affordable Care Act, commonly called Obamacare, after chronic failures of the the federal enrollment website in October and November prevented most people from signing up.

But health insurers quickly began noticing that the electronic applications were incomplete or garbled and couldn’t be reconciled electronically with essential information in federal databases. Some policies seem to have been vacuumed out of existence.

Accounts that vanish

Both Blue Cross and Coventry are providing temporary insurance ID numbers for customers to print out from their computers, but some customers say their accounts have vanished. The insurance companies also say doctors and other providers can call to verify that patients are insured, but there’s no guarantee they won’t be placed on hold indefinitely.

Blue Cross, North Carolina’s biggest insurer, extended customer call center hours, opened its stores on weekends and brought in teams of contractors to manually process thousands of electronic applications.

In mid-December, Raleigh insurance agency Ebenconcepts started taking screen grabs of online insurance confirmations to serve as temporary validations for customers who need to see a doctor or buy medicine. The agency captured between 100 and 200 screen grabs, said David Smith, a company vice president.

“Much of it is being driven by the late enrollments,” said Coventry spokesman Walt Cherniak. “For some of these consumers, it may be that they didn’t make their payment; therefore, they’re not enrolled.

“There also are problems with ‘orphans,’ i.e., those who signed up for the exchange on the government site, but whose information does not show up in (the company’s) records,” Cherniak said.

Hours on the phone

One such orphan is James Harris of Raleigh, 60, a self-employed engineer. Harris toiled five weeks trying to get proof that he was insured, spending two to three hours on the phone many days.

Finally, he applied for another policy. And then another.

“No one at Coventry could actually call it up and see it in their system, and this was after I filed two or three applications,” he said. “We just could not believe we were having to go through all this to get insurance.”

In mid-January, Harris gave up and decided to sign up with Blue Cross.

The very same day he filled out his Blue Cross application, Harris received three communications from Coventry: an email congratulating him that his application had been approved, and two letters saying his applications could not be processed.

Even though he was now with Blue Cross, Harris had a nagging anxiety: He had given Coventry his credit card number and bank account number. Rather than take his chances canceling his Coventry policies, Harris opted for the surer route: He canceled his credit card and closed his bank account.

“What a nightmare it was,” he said. “I should write a book.”

If he needs a co-author, he might consider Dana Griffith, an Apex resident, who applied for a Coventry policy Dec. 14 and still wasn’t sure of her enrollment status as of Friday. Griffith, a veterinarian, is trying to buy health insurance for herself and her 2-year-old daughter.

She received a confirmation by email that her policy is a go, but customer service reps couldn’t find it in their system. She said she can’t pay her premium until Coventry processes the application. She was advised to apply again.

Meanwhile, she has spent “a few hundred dollars” for medications.

“I spent hours and hours and hours and hours on hold and talking to people,” she said. “They should be paying me for my time.”

‘You can’t be serious’

Brian Swajkoski, 53, a Hickory resident, waited three weeks to get his proof-of-insurance number from Blue Cross.

In the interim, Blue Cross reps suggested he pay out-of-pocket for his medical expenses and then submit a claim after his application is processed.

“And I was like, ‘You can’t be serious,’ ” Swajkoski said. “I paid for it, and I won’t be able to use it?”

Swajkoski, who owns a small business that sells packaging products to industrial manufacturers, said his income is low enough to qualify for federal insurance subsidies that cut his monthly premium by more than half.

“If I were to go and try to find insulin or even some of my heart medications, I’d be looking at $1,500,” he said. “I don’t have that kind of disposable income.”

But paying the full price upfront is what insurers and the Department of Insurance are recommending to customers who can swing it financially.

Swajkoski finally received his policy number Thursday from his insurance agent, who called Blue Cross, but Swajkoski is eager to get his proof-of-insurance card in the mail.

“I would bet you lunch that I’ll get a bill for February before I get my card,” he said.

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