Enrollees at Health Exchanges Face Struggle to Prove Coverage
FORT WORTH — Paul D. Donahue and his wife, Angela, are among more than a million Americans who have signed up for health coverage through the federal insurance exchange. Mr. Donahue has a card in his wallet from his insurer to prove it. But when he tried to use it to get a flu shot and fill prescriptions this week, local pharmacies could not confirm his coverage, so he left without his medications.
Similar problems are occurring daily in doctors’ offices and drugstores around the country as consumers try to use insurance coverage that took effect on Jan. 1 under the Affordable Care Act.
In addition to the difficulties many face in proving they have coverage, patients are also having a hard time figuring out whether particular doctors are affiliated with their health insurance plan. Doctors themselves often do not know if they are in the network of providers for plans sold on the exchange.
But interviews with doctors, hospital executives, pharmacists and newly insured people around the country suggest that the biggest challenge so far has been verifying coverage. A surge of enrollments in late December, just before the deadline for coverage to take effect, created backlogs at many state and federal exchanges and insurance companies in processing applications. As a result, many of those who enrolled have yet to receive an insurance card, policy number or bill.
Many are also having trouble reaching exchanges and insurance companies to confirm their enrollment or pay their first month’s premium. Doctors’ offices and pharmacies, too, are spending hours on the phone trying to verify patients’ coverage, sometimes to no avail.
“The system wasn’t really built to handle this kind of glut of new patients,” said Dr. Curtis Miyamoto, a radiation oncologist at Temple University Hospital who is president of the Philadelphia County Medical Society. “So it’s resulting in us having some delays in getting people verified, and therefore delays in their care.”
In Los Angeles, Hilary Danailova, who is almost eight months pregnant, said she had to pay $630 for an ultrasound on Thursday after failing to get an ID card or any confirmation of coverage from her new insurer, Anthem Blue Cross. Ms. Danailova, 38, said she signed up just before Christmas and sent her first month’s premium of $410 by overnight mail on Jan. 3. She has repeatedly tried to reach Anthem to see whether the company has processed her payment.
“At this point I am facing the cold dread of not knowing whether Anthem ever recorded my enrollment at all,” she said.
A spokeswoman for WellPoint, whose plans are being sold on exchanges in more than a dozen states and include Anthem Blue Cross, said the company was “experiencing an unprecedented level of questions from our members,” with one million calls to its customer service centers last Thursday and Friday alone. The centers typically receive a million calls in a month, said the spokeswoman, Kristin E. Binns.
“It’s important to keep in mind that this is an unprecedented time of change for everyone in health care,” Ms. Binns said in a statement. “Our goal is to ensure that our members can access their benefits as early as possible in 2014. We greatly appreciate their patience during this transitional time and apologize for any inconvenience they may have experienced.”
In Langley, Wash., north of Seattle, Erin Waterman was able to see a primary care doctor on Jan. 3 with a temporary identification card printed from the website of her new insurer, LifeWise Health Plan of Washington. But when Ms. Waterman, 47, tried to fill a prescription for a new asthma inhaler, the pharmacy could not verify her coverage even though she had paid her first month’s premium on Dec. 23.
Ms. Waterman was given the option of paying full price — $187, instead of the $50 co-payment required under her new plan — and eventually being reimbursed. But she decided to wait, and hope that she does not have an asthma attack in the meantime. “I didn’t want to give them more money than I have to,” she said.
Some of the confusion stems from shifting deadlines that gave people more time to enroll and pay premiums. Moreover, insurers are still trying to untangle problems that snarled the federal exchange in October and November. In some cases, the government has a record of a person’s enrollment but the insurer does not. Insurers said they had received inaccurate or incomplete information — or no information at all — for some people who signed up through the federal exchange.
http://www.nytimes.com/2014/01/11/u...to-prove-coverage.html?hpw&rref=politics&_r=1
Health Care Website Frustrates Spanish Speakers
Mirroring problems with the federal health care website, people around the nation attempting to navigate the Spanish version have discovered their own set of difficulties.
The site, CuidadoDeSalud.gov, launched more than two months late.
A Web page with Spanish instructions linked users to an English form. And the translations were so clunky and full of grammatical mistakes that critics say they must have been computer-generated — the name of the site itself can literally be read "for the caution of health." "When you get into the details of the plans, it's not all written in Spanish. It's written in Spanglish, so we end up having to translate it for them," said Adrian Madriz, a health care navigator who helps with enrollment in Miami.
The issues with the site underscore the halting efforts across the nation to get Spanish-speakers enrolled under the federal health care law. Critics say that as a result of various problems, including those related to the website, many people whom the law was designed to help have been left out of the first wave of coverage.
Federal officials say they have been working to make the site better and plan further improvements soon. Also, administrators say they welcome feedback and try to fix typos or other errors quickly. "We launched consumer-friendly Spanish online enrollment tools on CuidadoDeSalud.gov in December which represents one more way for Latinos to enroll in Marketplace plans," said Health and Human Services Department spokesman Richard Olague in an email to The Associated Press. "Since the soft-launch, we continue to work closely with key stakeholders to get feedback in order to improve the experience for those consumers that use the website."
Still, efforts to enroll Spanish-speakers have fallen short in several states with large Hispanic populations, and critics say the translated version of HealthCare.gov could have helped boost those numbers.
In California, officials have acknowledged the need for improvements, saying fewer than 5,500 people signed up for health care in Spanish in October and November, the most recent period for which records are available. About 4.3 million California residents speak only Spanish, according to census data. It's not clear how many of these residents are without health insurance, but observers say few groups are more vulnerable.
"Spanish speakers are typically the ones who need to sign up for health insurance," said Veronica Plaza, a professor who teaches medical Spanish at the University of New Mexico. "They are the ones who could use the support."
In New Mexico, the state with the nation's highest percentage of Latino residents and where more than 20 percent of the state's population goes without health insurance, fewer than 1,000 people total signed up for coverage in October and November.
In Florida, federal health officials have not said how many of the state's nearly 18,000 enrollees for October and November were Latino, but that group accounts for about one-third of the roughly 3.5 million uninsured people in the state. About 1.2 million people in the state speak only Spanish.
Across the U.S., about 12 percent of the 317 million people in the country speak only Spanish, but federal officials have said less than 4 percent of calls to a national hotline were Spanish-only as of last month. Many blame at least some of the enrollment problems on the trouble-plagued site.
"In my opinion, the website doesn't work," said Grettl Diaz, a 37-year-old Miami gas station cashier who is originally from Cuba. Diaz said she tried to sign up at home using CuidadoDeSalud.gov. After she couldn't get the website to accept a scanned document, she called the government's Spanish hotline seeking help. However, she was repeatedly told to call back because the site was down. She got through days later and waited over an hour for an operator before she was ultimately disconnected. "I'm very frustrated," she said through a translator this month. "I've spent at least one week on the phone, and I couldn't get it done."
Diaz, who speaks very little English, finally went to a counselor for help and is now waiting for an email from health officials saying she can proceed with her application. Diaz hasn't had insurance since moving to Florida two years ago. She will likely qualify for a tax subsidy to help pay her monthly premiums and has said she wants insurance mostly for peace of mind. "Now, I am healthy," she said. "But I don't know what will happen tomorrow."
Such stories have frustrated Latino advocates, especially since the problems with the site come after an unprecedented collaboration between competing Spanish-language media outlets and Latino businesses, urging members of their communities to sign up for health care on Oct. 1. But advocates say despite promises from federal officials, the Spanish-language site was not up until Dec. 6.
http://abcnews.go.com/US/wireStory/...tes-spanish-speakers-21503559?singlePage=true
Talk about Obamacare horror stories.....
