Lost Obamacare enrollment data causes headaches for producers

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As consumers rush to try out their newly-minted insurance coverage under the federal healthcare law, some are hitting snags that are keeping their producers busy even past the Dec. 31 deadline for 2014 coverage.

Due to technical glitches in the operation of HealthCare.gov, an estimated 15,000 applications for health coverage disappeared into a black hole during the first three months of enrollment. The data never reached carriers, causing consumers to show up at the pharmacy or doctor’s office only to discover they aren’t listed in the system.

Other data was lost or changed during transmission to carriers, causing some consumers to be enrolled in the wrong plans.

The confusion has left producer Kelly Fristoe of Wichita Falls, Texas very busy.

“It’s total chaos. HealthCare.gov has not fully transmitted data and subsidy eligibility to the insurance company,” Fristoe said. “I’ve been fielding phone calls all day long.”

One such call came from Tony Kouri, a client of Fristoe’s who went to his local CVS pharmacy Jan. 1 to refill a prescription. Fristoe had enrolled Kouri in a bronze plan through HealthCare.gov in early December that had a $6,000 deductible and no drug card. However, when Kouri tried to pay the full price of the prescription, he ws charged only $50 as copay.

Kouri called Fristoe, who revisited the enrollment and affirmed that Kouri did indeed sign up for a bronze plan through Blue Cross Blue Shield.

“This indicates to me that the website didn’t transmit the correct data and enrolled him in the wrong plan,” Fristoe said. “Now I’m in a world of hurt because a healthcare professional is telling my client they’ve got something totally different from what I told him.”

Fristoe called the issue “just another side effect of Obamacare,” and expects his client will be billed later for the remainder of the payment.

To address these and other issues, carriers are reportedly asking producers to double back and ensure all client enrollment information is correct. Teri Gutierrez of JBA Benefits in Raleigh, N.C. said Blue Cross Blue Shield already sent out a letter to producers in the state to that effect.

“Blue Cross Blue Shield has pooled a lot of their resources into trying to verify enrollment information,” Gutierrez said. “We got an email asking us to check that our clients are in the system, and in the system correctly, because they cannot change an electronic application.”

Gutierrez said JBA Benefits was lucky enough not to have any clients with lost information, but if they had run into that problem, it would necessitate going back and reprocessing the application with that client. Due to the complications involved with the website, she said it would be virtually impossible for consumers to complete the process on their own.

“A lot of these people don’t have that kind of sophistication,” she said. “I think it’s putting a lot of people in a bad situation.”

Fortunately, popular pharmacies like CVS, Wal-Mart and Walgreens announced this week they would work with customers having issues getting prescriptions as producers and carriers help them sort out their coverage.

Until the issues are resolved, however, Fristoe said it gives him comfort to know he can help his clients appreciate the situation.

“The only thing I can do—which I’m glad I can—is to bring some sort of understanding I what’s going on,” he said. “I can say, ‘Here’s what to expect, have faith, and these problems will auto-correct.’”
  • Wally Broussard, CLU, ChFC on 1/6/2014 9:28:27 AM

    I certainly hope that your E&O Insurance is up to date.

    This appears to be the "Trial Attorneys' Full Employment Act" rather than the "ACA".

    We agents, like the physicians, are being asked to "correct" the ObamaCare mess while NOT being paid enough service fees and commissions to cover our staff and office expenses by the insurance companies.

    Maybe the Obama Administration could get back the MILLIONS of Dollars it spent on its "Navigators" and really help the American people through America's Health Insurance Agents---but NO, this current Administration does NOT believe in Free Enterprise.

    I think that the ACA is a "jobs" and "Wealth Redistribution" scheme designed to fail and place blame on us agents and the insurance companies (Capitalism/Free Enterprise).
    Good luck to all!

  • JJ SMITH on 1/6/2014 10:17:01 AM

    Wally- You nailed it! Is this really a suprise to anyone? Over worked and under paid and having to fix a mess we didn't create. AND, in the end we will probably be blamed for the mess. Ah, the luxurious life of a Health Insurance Agent. Thanks President Obama and all your pals that gave this to us!!!!! Wait, let me bend over again so I can get that for you......

  • Be Well Insurance on 1/7/2014 8:21:52 AM

    As a Independent Agent/Broker who loves what I do, this mess has tied my hands with the carriers. Have you notices that applications and quotes we submit are circumvented by the carriers now?
    For Example, I send a quote to a client for Anthem, they have to requote again and then re-request me as their agent. If they mark the box they want assistance, an Anthem Rep. calls them... What's wrong with this picture?
    Then attestations are sent "separately"!! This was never the case before. It was all electronic. They say it's going to be corrected, but unless you keep track of everyone you speak and assist (which is difficult to do as many times clients will call and later apply) they are stealing our business and using us for FREE!

  • John Spek on 1/7/2014 3:01:26 PM

    It's only a matter of time, and consumer complaints
    then
    Consumer protection organizations and Departments of Insurance will require a warning label on exchanges and exchange plans

    Exchange site disclaimer / warning label

    "You may buy this without medical questions or restrictions, but there may be large out of pocket costs, and those costs may exceed listed amounts because of the care giver you select.
    Your pricing is based on a combination of insurance premium, possible government provided subsidy, and your willingness to be held financially liable for Out of Pocket Cost Sharing amounts.
    It is your responsibility to assure that you know what you are buying and to report the information needed correctly.
    Subsidies may be available after disclosure from you as to family earnings, family status and other salient requirements, and are subject to government investigation and verification.
    Any subsidies provided under false circumstances will become your future liability with a responsibility to repay, possibly with assessed interest."

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