December 6, 2013
Enrollment Errors Put Medical Coverage at Risk
By ROBERT PEAR
WASHINGTON — The Obama administration said Friday that the enrollment records for roughly a quarter of all the people who signed up for health insurance on its website in October and November could contain errors, raising questions about whether those consumers would get coverage in time to pay for their medical care next month.
Even now, the administration said, it may be sending incomplete or erroneous information to insurers for one in every 10 people who enroll.
The disclosure added yet another complication to a long list of technical troubles that have hampered the rollout of President Obama’s health care law. A federal website, HealthCare.gov, is the main marketplace that consumers can use to compare policies and sign up for plans.
Julie Bataille, a spokeswoman at the federal Centers for Medicare and Medicaid Services, said the agency was working with insurers to correct the errors and resolve discrepancies in records kept by the government and by insurers.
In some cases, the government did not notify insurers of people who enrolled online at HealthCare.gov. The government refers to these people as orphans because they completed the application process and selected health plans, but the information did not make its way to insurers.
An administration official said the government would do everything possible to “rescue the orphans.”
In other cases, Ms. Bataille said, the government sent more than one enrollment notice for the same person to an insurer. And in still others, she said, the information sent was incorrect. For example, a child may have been listed as a parent, a name may have been misspelled, or an address may have been wrong.
Some people who signed up for a health plan are listed in insurance company records but not in the government’s records, officials said. In those cases, consumers may have chosen a health plan and then canceled the enrollment, but the government failed to inform the insurer of the cancellation.
While consumers may have been responsible for some of the mistakes, officials said, most of the errors and omissions resulted from technical problems that crippled the federal website for several weeks after it opened on Oct. 1.
With hundreds of hardware upgrades and software changes, Ms. Bataille said, the site now works well for the vast majority of consumers who use it. However, insurers said they were still seeing problems in “back-end systems,” which are supposed to deliver consumer information to insurers.
“The enrollment files are getting better, but there is more work to do to ensure that consumers are covered,” said Karen M. Ignagni, the president of America’s Health Insurance Plans, a trade group.
To be sure that coverage will start on Jan. 1, Ms. Bataille said, consumers must pay the first month’s premium. If they have any doubts, she said, they should call the insurance company to confirm enrollment. The insurer is supposed to send information packets and insurance cards to those who enroll. If consumers have problems or questions, they can ask the government for assistance by calling 1-800-318-2596 toll free, Ms. Bataille said.
Getting and verifying enrollment data is crucial for two reasons: to make sure that policyholders receive coverage and that insurers are paid.
If insurers spot errors in the enrollment files they receive from the government, they are supposed to contact consumers to get more information. Federal officials said that insurers could modify some data in the government files, like the relationship between two members of a household, but could not alter other elements, like the amount of federal subsidies to be paid by the government to insurers on behalf of policyholders.
The government’s overall goal is to maximize coverage and enrollment. Ms. Bataille suggested that cleaning up the enrollment files would be a herculean task for insurers and the government.
“We have to very methodically and precisely go through individual transactions at a very granular level directly with insurers to reconcile the information,” she said.
The federal website serves 36 states. Other states run their own exchanges, where their residents can buy insurance.
So far this week, Ms. Bataille said, 3.7 million people have visited HealthCare.gov, and the site has been stable, with an error rate of eight-tenths of 1 percent.