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Insurers, consumers await HHS guidance as deadline looms

From the USA Today:

Some frustrated consumers are sending premium payments to insurers who have never heard of them. Others say they will pass up federal subsidies and pay full price through insurers, while still others have given up altogether on the promise of health insurance by Jan. 1.

Consternation and confusion over applications sent through the federal HealthCare.gov website continue into the last seven days before the Dec. 23 enrollment deadline. Consumers with health issues are particularly nervous about the prospect of not having insurance at the start of the new year.

Federal assurances last week about a "special enrollment period" for people whose applications have been hung up on the site are little comfort as neither insurers nor consumers have any idea how this will work and who will qualify.

The Department of Health and Human Services recommends people call its help line with questions and concerns about applications on HealthCare.gov. But that suggestion is also proving less than helpful for many.

Janice Nelson, an unemployed photographer, was denied a federal subsidy after she put on her application that she is still paying for the continuing insurance coverage — known as COBRA — from her last employer. She's not going to wait for her appeal to be adjudicated. She plans to take money out of her IRA to pay for full-price insurance so she has coverage Jan. 1 because of a health problem that may require an expensive surgery.

"Logic tells you I'm the target population for the law," said Nelson, a Lombard, Ill., resident and Affordable Care Act supporter. But when people seek help from the call center, "you're just being shuffled back and forth nobody owns the callers."

Experts are divided on another possible solution for those hanging in the balance: sending premium payments before bills arrive from insurers. Sentara Health, which offers the Optima health insurance plans for Virginia on HealthCare,gov, is hanging onto payments it can't match with new customers yet.

But Aetna warns that consumers should wait until they get a bill in the mail before writing any checks.

"Members will know we have their enrollment when they receive a letter from us that outlines their next steps, including the importance of making their first month's premium payment," Aetna spokeswoman Susan Millerick said in an e-mail, adding that the materials should arrive within a week of enrollment. If the materials haven't arrived in the mail, concerned customers can go to the insurer's mobile site or their member Web page to access or print an image of their temporary card, Millerick said.

While HHS said the number of errors in information forms sent to insurers are now close to zero, insurers say they continue to find errors, especially duplicate enrollments and cancellations from the same consumer with the same time stamp. "The process they put in place has made a difference, but there are still some data errors that need to be addressed," said Robert Zirkelbach, spokesman for the trade group America's Health Insurance Plans.

Multiple copies of cancellations and enrollments make it "unclear whether that person is supposed to be enrolled," he said. It's still unclear how much cooperation HHS will get from insurers, who have been asked to extend payment deadlines into January, cover people's drugs and medical treatment if they are between plans and allow people to sign up later than Dec. 23 to get insurance Jan. 1.

Health industry consultant Kip Piper said HHS doesn't have the authority to enforce what he calls these "political requests." But HHS said it will consider insurers' cooperation now when it decides which ones can participate on the insurance exchanges next year. "They are simultaneously asking insurers to assume the cost and risk of non-payment, taking public credit for it, and threatening insurers with loss of business if they don't comply," said Piper, a former government and insurance industry official.

"We will have more guidance on the process soon," said HHS spokeswoman Joanne Peters. Holly Hawkins, who was quoted in a USA TODAY article last week about what she says is a mistaken Medicaid qualification, has heard from HHS three times and been told by Texas' Medicaid office that she doesn't qualify for Medicaid.

Still, she can't buy insurance on the exchange until the issue is fully resolved and the federal Medicaid office said that won't be until January. After contemplating buying a full-price plan, Hawkins said her husband Jacob plans to pay cash when her baby is delivered in February.

Theresa Cassiday, a freelance Web designer in Nebraska, worried she'd be one of the consumers without insurance Jan. 1. But after an estimated 50 hours working on her HealthCare.gov application, it was finally resolved Monday with a subsidized plan that has a premium, co-pays and deductible she's thrilled with. But it took letters to President Obama and her congressman, countless calls to HHS and her decision to give up on a mistaken Medicaid determination for her 18-year-old son that wouldn't allow her to put him on her policy. She's hoping to buy him his own plan Feb. 1. "I have spent years defending you and defending this program," Cassiday wrote in a letter to Obama last week. "I did not support this system to have it eat up hours and hours of my work time to get enrolled."

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