A Rush To Reconcile Health Enrollment Data, By Hand
Affordable Care Act navigator Nini Hadwen helps Floridians shop for health insurance in October.
With just a few weeks left before a deadline to get health coverage, lingering bugs lurk in the part of HealthCare.gov that you can't see. And since time is running out to get things right, health officials on Thursday urged insurance companies to cover some enrollees even if their premium checks haven't come in.
Under the law's guidelines, consumers have to sign up for a health insurance exchange â and pay their first month's premium â by the end of December if they want coverage in January.
"The short time period presents a number of challenges," says Robert Zirkelbach, a spokesman for America's Health Insurance Plans, an industry trade group.
The 834 forms â electronic files sent from HealthCare.gov's back end to insurance companies â must have accurate and complete data in order for a consumer to be considered fully enrolled.
The White House projected confidence this week: "We have a team of experts working both through technological fixes but also through some elbow grease, going through and confirming that that information is conveyed accurately and completely, to confirm that they'll be signed up for health care and eligible to get covered on Jan. 1," White House Deputy Press Secretary Josh Earnest said Wednesday.
But the Obama administration estimates that 1 in 10 forms is still problematic, an improvement from 1 in 4 bad forms in October and November. And late Thursday, health officials pressed insurance companies to grant consumers a little more leeway.
Since health plans weren't supposed to start coverage until they're paid, anyone mailing in a check will have to get it in quickly. So the Department of Health and Human Services issued new guidelines, encouraging insurers to go ahead and cover people in January even if their payments don't come in until later in the month.
"So far, the health plans I have spoken to have seen only about 20% of their enrollees pay their premium," health industry consultant Bob Laszewski wrote in his blog Thursday.
"The situation everyone wants to avoid is a situation in which consumers think they're enrolled when they're not. Or the situation where they find out that they're not enrolled when they try to schedule an appointment to see a doctor," Zirkelbach says.
Then, there's the work of reconciling the government enrollment records with the data received by insurance companies.
"I don't think you can be confident that everyone who is enrolled will have a plan until we can do a reconciliation between the government records and the insurance company records," Laszewski told NPR.
The work of reconciling files just got started Wednesday, when health officials sent spreadsheets of their latest enrollment data to insurers to cross-check records. Zirkelbach says it's a significant step.
"It will for the first time give us the size and scope of the technical challenges that exist," he says. For all the focus on technology in recent weeks, Health and Human Services Secretary Kathleen Sebelius says that reconciliation work is getting done manually.
"We are in the process of actually hand-matching individuals with insurance companies," she told lawmakers in a Wednesday hearing.
With the deadlines getting closer and December enrollments surging ahead of the deadline, whatever remaining challenges exist will need to be resolved in a hurry.
"You should probably call your insurance plan, the one you believe you've enrolled in. Just verify that you've in fact enrolled," Laszewski says.
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Transcript
MELISSA BLOCK, HOST:
With the clock ticking for Americans to sign up for health coverage, the Obama administration turned to the insurance industry to help more Americans get covered. Insurers are being to urged to give people more time to make their first payment. That could boost enrollment somewhat. And while HealthCare.gov has improved lately, some bugs remain in part of the system we cannot see. NPR's Elise Hu reports.
ELISE HU, BYLINE: Perhaps you've heard 834 at least a few times lately. It's a number popping up a lot in the news.
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UNIDENTIFIED MAN #1: Eight thirty-four...
UNIDENTIFIED WOMAN: Eight thirty-fours...
UNIDENTIFIED MAN #2: Eight thirty-four form...
HU: Eight thirty-four is just government code for an electronic file sent from HealthCare.gov to an insurance company, after a consumer picks a plan. The file is supposed to include the enrollee contact information and which plan was picked so that insurance companies can formally enroll the user and bill him for payment.
White House spokesman Josh Ernest admits they were problematic.
JOSH EARNEST: In October and November, we saw that the 834s were not functioning and not being transmitted with a lot of accuracy.
HU: The administration says about 1-in-10 of the files coming from HealthCare.gov in December are no good. For applications completed before December, 1-in-4 forms were bad. Despite those numbers, the White House says it's confident everyone who wants coverage will have it next month.
EARNEST: We have a team of experts who are working both through technology fixes, but also through some elbow grease going through and confirming that that information has been conveyed accurately and completely, and to confirm that they'll be signed up for health care and eligible to get covered on January 1st.
HU: Time is running out. Consumers have to sign up by December 23rd if they want that January coverage.
Robert Zirkelbach represents America's Health Insurance Plans, an insurance trade group.
ROBERT ZIRKELBACH: The short time period presents a number of challenges.
HU: Since health plans won't start coverage until they're paid, anyone mailing in a check would have to get it in quickly. But realizing time is tight, health officials today urged insurance plans to go ahead and cover consumers in January, even if they don't pay their first month's premium until later in the month.
ZIRKELBACH: A situation everyone wants to avoid is a situation in which consumers think they're enrolled and they're not. Or that they find out that they're not enrolled when they try to schedule an appointment to go to the doctor.
BOB LASZEWSKI: You should probably call your insurance plan, the one you believe you've enrolled in, and just verify that you've in fact enrolled.
HU: That's longtime industry watcher Bob Laszewski.
LASZEWSKI: I don't think you can be confident that everyone who is enrolled will have a plan until we can do a reconciliation, between the government records and the insurance company records.
HU: The work of reconciling those files, making sure data entered into HealthCare.gov matches the information received by health plans just got started yesterday. Zirkelbach says it's a significant step.
ZIRKELBACH: It will, for the first time, give us a very clear picture of the size and scope of the technical challenges that exist.
HU: And for all the focus on technology in recent weeks, Health and Human Services Secretary Kathleen Sebelius says that reconciliation work is getting done manually.
SECRETARY KATHLEEN SEBELIUS: We are in the process of actually hand-matching individuals with insurance companies.
HU: With the deadlines getting closer and enrollments surging, whatever remaining challenges exist will need to be resolved in a hurry.
Elise Hu, NPR News, Washington.
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You're listening to ALL THINGS CONSIDERED from NPR News. Transcript provided by NPR, Copyright NPR.
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