Consumers who signed up for private health insurance through the District’s new insurance marketplace are experiencing lengthy delays in getting coverage, in some cases two to three months long, because of problems processing their applications, according to residents and enrollment personnel.
In some cases, delays are forcing people without insurance to postpone doctor and dental visits.
The delays seem to be affecting coverage through CareFirst, the dominant carrier in the region, and Kaiser Permanente, according to consumers and enrollment personnel. Insurance and exchange officials have declined to say how many people are affected.
Mark Andersen, his wife, Tulin Ozdeger, and their two children enrolled in a CareFirst medical plan and another company’s dental plan in mid-March, well before the April 30 deadline. They expected to receive notice of coverage from CareFirst and an invoice for the first month’s premium.
Instead, the family received clearly erroneous communications by mail and e-mail from D.C. Health Link, the District’s health insurance exchange. One said the 9-month-old daughter was not eligible for health coverage because she was incarcerated. Another asked that they provide documents to prove their Native American heritage, even though no such claims were made in their application.
For weeks, D.C. Health Link told Andersen and Ozdeger that the application had been sent to CareFirst. CareFirst said it didn’t have it. They turned to their council member’s office for help. Finally, on May 29, they received word that their application had made it to the insurer.
“My understanding of the way our application finally went through is that it was manually done, not through the normal system,” Ozdeger said. “They said we were on a VIP list.”
Ozdeger said she and her husband never found out what caused the delays. “I can’t imagine what it must be like for other people” who are also waiting for coverage, she said. “How in the world are they ever going to get their insurance?”
The family is still without dental coverage. But Ozdeger, 41, said she can’t postpone a trip to the dentist any longer because she needs to have a filling replaced.
Linda Wharton-Boyd, a spokeswoman for D.C. Health Link, said this week that reports of problems, “if true, were isolated incidents.” She said the exchange has enrolled more than 48,000 individuals and families; about 11,000 are enrolled in private plans.
When problems arise, Wharton-Boyd said in a statement, “they are immediately looked into and handled appropriately.”
Insurers suggest the problems are occurring at the exchange.
In a statement, CareFirst said: “There have certainly been situations in which a person thought they had enrolled through DC HealthLink where, for whatever reason, that enrollment did not reach CareFirst. . . . Once we are made aware of such situations, we work with DC HealthLink to determine why the person’s enrollment did not reach us successfully.”
A spokesman for Kaiser Permanente’s Mid-Atlantic region said the insurer is experiencing “some delays, in limited instances, with receiving consumers’ applications” in the region. He said “the marketplaces are working closely with Kaiser Permanente to ensure timely resolution and processing so that consumers may quickly have access to health care.”
The enrollment records generated by online health insurance exchanges have been a major concern to insurers since last year. Thirty-six states are participating in the federal exchange, Healthcare.gov; 14 states and the District set up their own exchanges.
In all cases, the records are supposed to be sent regularly to participating health plans to notify them of new customers. Then, insurers send each customer a bill. After that, consumers must pay the first month’s premium before coverage begins.
In the District, information does not seem to be reaching the insurer in some instances, or it is being transmitted with flawed data.
Robert Laszewski, a health industry consultant, said he doesn’t know what the specific problems are in the District. But applications that take longer than three weeks for insurers to process indicate that something is wrong. When more than one insurer is experiencing delays, “that suggests the problem is with the exchange’s ability to get enrollment data to the insurers.”
Betel Aklilu, one of four D.C. enrollment assisters with Mary’s Center, a community health nonprofit group, said sometimes the consumer may not have supplied all of the verification documents. In other instances, the exchange is sending mailing addresses — without the apartment numbers — to insurers, she said.
“I’ve never seen an explanation as to why the apartment number would be missing,” Aklilu said. The information is properly filled out when she helps consumers enroll; the information also appears on printouts that are generated automatically. But for some reason, “when the file gets sent to insurers, it’s missing that information.”
She has five cases of individuals or families waiting to receive notice of coverage from insurers. One of them, Workinesh Beye, 36, a part-time jewelry store cashier, enrolled in a CareFirst plan before the deadline. No one has been able to tell her what the problem is, she said. In the meantime, she has a June 30 doctor’s appointment for a pressing health matter.
Michaela Carmen Kristan, 42, also signed up for a CareFirst plan at the end of March. She initially chose an HMO plan, then canceled it and chose a plan that allows her to choose her doctors. She received verification of the cancellation and was assured by D.C. Health Link staff that she would have no problems obtaining coverage effective May 1.
Weeks passed. Eventually, CareFirst informed Kristan that the D.C. exchange had not deleted the HMO application, so her second application couldn’t be activated. Numerous conference calls ensued with supervisors from the exchange and CareFirst. At one point, the exchange staff said “it was an IT problem and my case is still in process,” she recalled. “I have asked again and again. How hard can it be to delete the first application?”
By mid-June, Kristan, who had postponed some medical appointments, began to worry. She was able to receive treatments from her chiropractor because he charged her a discounted price. He told her many of his patients were in similar circumstances, she said.
A few days after a reporter from The Washington Post asked about her case, Kristan received notification from CareFirst that she had coverage.