Healthcare.gov appeals system not working

Summary:Tens of thousands of enrollment errors were made in the site's first months. Appeals of those errors are sitting unprocessed.

Early on in the troubled lifecycle of Healthcare.gov, the Federal government's health insurance exchange, it became known that even applications which appeared, to the applicant, to have completed successfully,  in fact sent erroneous data to the insurance companies .

Now the Washington Post is reporting that the appeals system for these and other errors made by the site is still not online, and applicants who needed health insurance are still doing without.

Completing the appeals system is not even one of the top priorities and is waiting behind other critical elements, such as the electronic payments system by which insurers receive their subsidy compensation, the computerized exchange of enrollment information with state Medicaid programs, and the ability to adjust people's coverage to accommodate new babies and other major changes in life circumstance.

According to the article:

For now, the appeals are sitting, untouched, inside a government computer. And an unknown number of consumers who are trying to get help through less formal means — by calling the health-care marketplace directly — are told that HealthCare.gov’s computer system is not yet allowing federal workers to go into enrollment records and change them, according to individuals inside and outside the government who are familiar with the situation...

A CMS spokesman, Aaron Albright, said, "We are working to fully implement the appeals system."

The Post, citing internal government data obtained by them, says that about 22,000 appeals have been filed, claiming site steered them into the wrong plan, charged them too much or improperly denied coverage entirely. But the number of application errors is likely much higher.

By December it was known that the number of faulty applications was in the tens of thousands.  The data is delivered by healthcare.gov to the insurer in a standard format known as an ASC X12 Benefit Enrollment and Maintenance (834) transaction. The Federal exchange was delivering 834s with many different kinds of errors, such as more than two spouses or children listed as the parents.

In some cases the 834 was never sent to the insurer. In such cases, neither the insurer nor the exchange may have sufficient information in order to process an appeal.

The Post reports that the Obama administration is not making public the fact that the appeals system is not functioning, even though the rules for the Exchange "...guarantee due-process rights to timely hearings for Americans who think they have been improperly denied insurance or subsidies."

According to attorneys at the National Health Law Program, in a late-December letter to leaders of the Centers for Medicare and Medicaid Services (CMS), the agency that oversees HealthCare.gov, "...there is no indication that infrastructure... necessary for conducting informal reviews and fair hearings has even been created, let alone become operational."

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Topics: Health, Government : US

About

Larry Seltzer has long been a recognized expert in technology, with a focus on mobile technology and security in recent years. He was most recently Editorial Director of BYTE, Dark Reading and Network Computing at UBM Tech. Prior to that he spent over a decade consulting and writing on technology subjects, primarily in the area of sec... Full Bio

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