Back-End Errors at Obamacare Website Jeopardize Consumer Sign-Up

There’s no way to tell how many people have successfully signed up for health insurance through the exchange, as 1 in 4 enrollments sent to insurers had garbled or incomplete information.

INN Breaking News, December 9, 2013

Alex Wayne and Alex Nussbaum

(Bloomberg) -- There’s no way to tell how many people who think they’ve signed up for health insurance through the U.S. exchange actually have, after about 1 in 4 enrollments sent to insurers from the federal website had garbled included incomplete information.

The data transmission errors have been reduced to 1 in 10 since Nov. 30, the government said on Dec. 6. Still, the acknowledgment suggests consumers need to be vigilant about their health plan purchases. Letters from insurers confirming coverage can take a week or more, and the Obama administration now says people should call their companies if they aren’t contacted within that time.

With repairs to the front end of healthcare.gov leading to a spurt of 29,000 new enrollments in the first two days of December, U.S. officials are now focusing on what happens after customers select a plan on the website. Enrollment isn’t complete until consumers make their first payment, which is due Dec. 31 for insurance coverage that will begin on Jan. 1.

“It’s time for people to move toward locking in coverage and paying for it,” said Joel Ario, a consultant with Manatt Health Solutions, in a telephone interview. Insurers will face “a tall challenge” trying to resolve enrollment errors as the time shortens before coverage begins Jan. 1, he said.

The Centers For Medicaid & Medicare Services, which runs the federal health website, doesn’t have “precise numbers” on how many of the enrollment forms called 834s have been sent to insurers or how many have errors, Julie Bataille, an agency spokeswoman, said during a Dec. 6 conference call.

Data Improving

Insurers say the data they are receiving from the government is improving, though the process remains “a work in progress,” according to Cynthia Michener, a spokeswoman for Hartford, Connecticut-based Aetna Inc.

“We are working closely with the marketplace technical team and other carriers to help identify, prioritize and test additional issues,” Michener said in an e-mail. “We continue to receive enrollment files with some of the initial issues we saw, e.g., duplicate records.”

The files contain basic information about insurers’ new customers, including names, addresses, birth dates, gender and Social Security numbers for people who sign up and their families. While one bug causing Social Security numbers to be omitted from the enrollment forms has been fixed, offsetting about 80 percent of the data errors, work on the back-end link with insurers is continuing, Bataille said on Dec. 2.

Law’s Goal

The federal health website covers 36 states while 14 states have created their own online marketplaces for people to shop for insurance with the help of government subsidies. The exchanges are at the core of the Patient Protection and Affordable Care Act of 2010 known as Obamacare that seeks to provide access to health coverage for many of the country’s estimated 48 million uninsured. The law requires most Americans to sign up for a health plan by March 31 or pay a fine of as much as 1 percent of income.

A project the government began two weeks ago with 16 insurance companies in three states — Texas, Florida and Ohio — to allow them to enroll people directly into health plans, bypassing healthcare.gov, has improved the working relationship among the government’s technicians and those at the companies, said a person familiar with the work who asked not to be identified because the information is private. The new cooperation has helped to resolve issues with the data transfers, the person said.

Complicated System

The back end of the healthcare.gov system is “actually more complicated than the front end,” John Engates, the chief technology officer of San Antonio, Texas-based Rackspace Hosting Inc., said in a telephone interview. “The back end is where a lot of the heavy billing and transaction processing and batch processing need to go on. It’s easier to build a public website than it is to build a very large-scale billing engine and transaction engine like that.”

Michener said that when Aetna receives files with missing data, the company contacts CMS to get the information and complete the enrollment. If people call Aetna to confirm their enrollment and the company has no information on them, “they may fall into a category of missing records,” she said.

“We contact CMS for assistance and reconcile with the member as soon as we have closed the gap with CMS,” she said.

Errors with the forms aren’t uniform, and some insurers report few problems.

‘Pretty Good’

“In general our 834 files have been pretty good,” said Kathleen Oestreich, CEO of Meritus, a Tempe, Arizona, startup insurer funded by government loans. The company has seen only one “orphan” member, she said -- a person who called and said they hadn’t received an enrollment notice even though they had picked Meritus as their insurer.

More troubling are “ghosts” — people whose files never reach their insurers, Robert Laszewski, an insurance industry consultant, said. It’s unclear how many people may fall into that category or how companies will identify or reach them.

“If they enroll 500,000 people and 25,000 of them walk into the doctor’s office and nobody knows who they are, that’s a problem,” he said in a phone interview.

People may soon have the option of bypassing healthcare.gov and enrolling through the websites of the insurance companies or online insurance brokers. The results of the government’s test project in Florida, Texas and Ohio have been positive so far, companies said.

Blue Cross and Blue Shield of Florida said last week that it would start enrolling people online, through agents and brokers and at retail centers it operates in the state. The process has gotten smoother over the past week, said Mark Wright, a spokesman for the carrier.

Direct Enrollment

Health Care Service Corp., owner of Blue Cross plans in Texas, Illinois and three more states, has “seen some successes” with direct enrollment, said Greg Thompson, a spokesman for the Chicago-based company. “There have been some problems, too, but we expect to see improvement.”

For consumers, enrolling directly through an insurer means they may miss out on a chief benefit of the government’s exchange -- the ability to compare competing policies side by side, said Betsy Imholz, a special projects director for Consumers Union, the Yonkers, New York-based advocacy group. Still, consumer groups are warming to the idea given healthcare.gov’s limitations, she said in an interview. 

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