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Confusion, delays frustrate health insurance providers, consumers

Last month’s race to sign up for health insurance under the Affordable Care Act left North Carolina’s insurers swamped by a crush of virtual paperwork and many consumers confused about whether they actually have health coverage and how to use it.

About 108,000 North Carolinians signed up for insurance through the federal online marketplace – about 99,000 in December alone. It’s anybody’s guess as to how many policies have been processed and how many customers still have no proof they’ve paid their first month’s premium.

The late surge of applications prompted insurers nationwide to push back payment deadlines several times to buy time for processing. Coventry Health Care of the Carolinas moved its deadline to Jan. 17 to pay for insurance that would take effect Jan. 1. The deadline for Blue Cross and Blue Shield of North Carolina is 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.”

Even insurance agents aren’t exempt from the chaos. One Asheville agent, who sells policies for Coventry, had signed up for a Coventry plan Dec. 10 but was still waiting for a proof-of-insurance number when his wife fell ill with a sinus infection and needed antibiotics. The agent, Ron Miller, went to the pharmacy Jan. 8 but didn’t buy the medicine because without proof of insurance, it would have cost $195. After multiple calls to Coventry and threats to contact state officials, he finally got his ID from a member services representative and got the covered antibiotics for $46.

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

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

Health insurers quickly began noticing that some electronic applications were incomplete or garbled and couldn’t be reconciled electronically with essential information in federal databases.

Both Blue Cross and Coventry are providing temporary insurance identification 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.

“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.”

Cherniak said Coventry has collected premiums from 70 percent of the people who have enrolled in the company’s plans. But “there are people who have paid us, and we have received their premiums, and they have not yet received their membership cards.”

“One thing we have said is, ‘If you can wait to go to the doctor or hospital until your membership card arrives, do so.’ 

But he said Coventry will cover claims for people who have paid even if they don’t have membership cards.

“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. “For whatever reason, they’re not showing up. We are working on a lot of those cases on a one-on-one basis.”

Hours on the phone

Mollie Bangert of Concord spent hours on the telephone trying to get proof of insurance even after she sent Blue Cross a check for $455 to cover the premium for a policy that would take effect Jan. 1. In the meantime, she had to pay upfront for heart medicine.

Bangert, 45, a house cleaner, signed up for a Blue Cross policy Dec. 17 through the federal online marketplace, and she paid her premium Jan. 4, three weeks before the deadline. With her heart pills running low, she called Blue Cross to find out what she should do.

“I was panicking,” she said. “Blue Cross said they couldn’t help me at that time, even though I’m, like, I’ve already been accepted and enrolled. But because they haven’t gotten all the payments processed or whatever they had to do, … they said they were behind, and it could take up to the end the month.”

Under the new insurance plan, Bangert’s heart medicine will cost her $30 a month. But without insurance, it’s $600 a month. Failing to take the pills causes chest pains and headaches, she said. She bought five days’ worth for $100 while she tried to figure things out.

When she called the state Insurance Department, Bangert learned she could get a temporary insurance card from the Blue Cross website. But when she went online, she couldn’t get the card without having her member ID. After several days and multiple calls to Blue Cross – including long periods on hold and one hang-up – Bangert spoke to a woman who gave her the ID.

Bangert’s pharmacy refunded the $100 she paid earlier, and it then sold her the remainder of the month’s supply under the insurance contract for $30.

“I’ve clawed my way out,” Bangert said. “I was worried what would happen to me if I got in a car accident and you have nothing to show you have insurance.”

‘You can’t be serious’

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

In the interim, Blue Cross representatives 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 a federal subsidy 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 Insurance Department are recommending to customers who can swing it financially.

Swajkoski finally received his policy number last week 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.

Some successes

Not all insurance agents – or consumers – have run into so many problems.

Bryan Hough, co-owner of Carolina Health Insurance Market in Gastonia, said the enrollment process has improved in recent weeks. “The biggest problem right now is that some people have mailed checks, but they have not been posted. Both Blue Cross and Coventry are processing as fast as they can.”

Some people may think they signed up for insurance starting in January, but if they didn’t pay the first month’s premium in time, they’ll have to re-enroll by Feb. 15 to get insurance starting March 1, Hough said.

He speculated that many of these people may have enrolled without assistance from an agent or one of the special navigators who have been trained to help people sign up for insurance this year. Some may never have had insurance before and don’t understand the process.

“People who don’t work with a broker, who are doing it online themselves, they can make mistakes,” Hough said. “For your insurance to be in force, you have to pay for it. It’s just like buying a car. They don’t give it to you first.”

Madison Hardee, a lawyer with Legal Services of the Southern Piedmont and one of the navigators in Charlotte, said she has “spoken with many consumers who are already using their new insurance successfully.”

For example, Hardee cited Stanage Elling, a south Charlotte woman who had major surgery Jan. 10 even though she hadn’t yet received her new insurance card.

Elling, 50, lost her job in October and paid for “wickedly expensive” insurance under COBRA for the remaining months of last year. With help from Hardee, she chose a Coventry plan and made her first premium payment Dec. 13 for insurance that would start Jan. 1.

She also scheduled her much-needed surgery, even though her doctor’s office and hospital contacts knew it would be “a mad scramble” during the first week of January because of so many new insurance policies.

“It took some doing,” Elling said. “It took quite a lot of phone calls and some pressure from my doctor’s office. They really needed that authorization.”

At first, when the doctor’s office called Coventry, “they said, ‘Oh, we don’t know who she is, and she doesn’t have insurance with us.’ ” After some back and forth, Elling was able reach someone on the phone at Coventry who sent an email, and from that she printed a temporary ID card.

“That made everything a little bit easier,” Elling said. “I took that to my pharmacy to get my medicine.”

About a week after the surgery, Elling got her official laminated insurance card in the mail. But she didn’t mind the wait. Instead of paying $500 a month for the COBRA coverage, she now pays $70 a month, thanks to a $359 premium subsidy from the federal government.

“Being able to have coverage under the Affordable Care Act allowed me to go ahead and have the surgery,” Elling said. “Without it, I would have had to stop my COBRA and have nothing. It’s been a godsend.”

Garloch: 704-358-5078; Murawski: 919-829-8932

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