Many consumers who have waited months to resolve insurance application issues on HealthCare.gov are finally getting help, but some are still stuck in limbo without Medicaid or insurance coverage, and many of the site's most vexing problems remain, according to insurers, brokers and state Medicaid officials.
Applications that take days, clueless customer service representatives and error-ridden or orphan files persist. Changes made to the website last week will solve many of these problems, but the fixes were made so quietly that few brokers and consumers were aware of them, says Jessica Waltman, senior vice president of government affairs for the National Association of Health Underwriters, which represents insurance agents and brokers.
Federal officials are "not consistently and clearly communicating what to do to fix tricky enrollment situations, either to affected consumers or to the certified agents and brokers who are trying to help their clients get covered," Waltman says.
It's unclear how many people are awaiting help, but Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, says many of the 22,000 people who have filed appeals of their subsidy or coverage determinations should have their problems addressed by the new fixes. Countless others who struggled without formally appealing should also be able to go back into their applications now.
As of last week, those wrongly qualified for Medicaid or unable to change their insurance application to reflect, say, a birth or divorce, can now update these things easily on their applications, CMS spokeswoman Julie Bataille says.. CMS employees are also now contacting people to let them know about the changes, she says.
Even though people can now check a box to say they've been rejected for Medicaid and otherwise edit applications, insurers report the files they get about enrollments still sometimes can't be matched with clients, creating what are known as "orphan" records.
Insurance industry spokesman Robert Zirkelbach says insurers are trying to implement the new policies as seamlessly as possible but are stymied by continued glitches.
"There are still some technical challenges that need to be addressed, including processes are being done manually that need to be automated," says Zirkelbach of America's Health Insurance Plans.
Aetna spokeswoman Susan Millerick says the new ability to report life changes is working well, as is HealthCare.gov. "It's the database that continues to need more tuning," she says.
Mandeville, La., insurance broker Anthony Cyprus says Healthcare.gov "is definitely improved," but echoing many brokers and consumers he notes, "not all the support personnel really have a grasp of what is going on."
Call center workers, Bataille says, are undergoing training on how to deal with problems and communicate the new fixes.
"A number of things have been done to try to make customer service as helpful to consumers as possible," she says.
A client in Chicago broker Jordan Wishner's office struggled for months to change her birth date on her insurance application. The matter was finally settled last Thursday once the new fix allowed people to go into applications to make changes. After weeks of waiting for call-backs, Wishner's office was connected to a special consumer assistance person in charge of life changes, he says. His client had already run out of medications that she spent thousands of dollars to refill, he says.
The Medicaid fix doesn't address all those files that are arriving at Medicaid offices or insurers missing key information, however. Medicaid-eligible people who have been bounced back and forth from HealthCare.gov -- a process known as "looping,"-- are now being told just to enroll through their states. That's because the process of transferring files to states is still fraught with problems on both sides, says Matt Salo, executive director of the National Association of State Medicaid Directors.
Some of the new changes may also allow consumers to sign up for a "special enrollment period" after the deadline and before enrollment starts again late this year. These include people who give birth, move or adopt a child outside of the traditional sign-up periods.
Broker Angela Surra, general manager of St. Mary Insurance Agency in St. Mary, Ill., says though the website is performing better, some of her brokers have to log in on three different days for error warnings to stop.
Some affected consumers say they simply couldn't wait any longer.
Holly Hawkins, due with her second child at the end of this month, bought a full-priced plan to make sure her birth is covered after trying in vain to get what she and her broker say is an erroneous Medicaid eligibility fixed. She never heard back from her Medicaid office, she says, and "I honestly got sick of messing with it."
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