appeals system not working 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, 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’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 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, "...there is no indication that infrastructure... necessary for conducting informal reviews and fair hearings has even been created, let alone become operational."


Topics: Health, Government US

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  • HHS waiting for the algo fairies...

    On the Daily Show it didn't take long for Nancy Pelosi to throw HHS and Sebelius under the bus..

    I just wonder right now how many Oracle sandboxes they have going to rewrite and recode a lot of the site along with another group of engineers to keep the system gimping along...and they have already replaced some modules..but you know Oracle works with all insurers and has there 834 duh?

    It became more complex as CMS decided to change a little mapping there too..

    Hopefully now with a former Microsoft executive working with it, things might improve, when who knows..why HHS bit on writing everything up from scratch with open source is beyond me when you have a very tight time frame to meet...
  • OBAMACARE! This Generation's Hoovervilles!

    Difference is, all the people expecting the government to fulfill its promises about health-care reform can't truck themselves to Washington DC to build shacks to live in while waiting to have their appeals heard. Not enough room in the Metro DC area. And this time around I think the Army would join with them in protesting.
  • Caught in so many lies

    Obama has been caught in so many lies I am not sure he really knows the truth from the lies. I think he has people around him that do him no favors and convince him everything is just fine.
    Personally if it was me I would have cleaned house and put people in place who could do the job.
    But because the President has not fired one person. It leads me to believe he is incompetent to govern and that's very bad for American's. After all he was elected to lead and manage. I don't think he knows how to mange a lemonade stand. Let alone a Country.
    • Obama knows quite well the difference between truth and lies,

      but, his world is one where lies are a form of life. It's one full of people who need to lie, in order to get government and people to go for the specific ideology of socialism, with the intent of eventually "fundamentally transforming" the country. To transform the country to socialism, lies are the only method to get the job done. If people were ever told the truth about Obama's real intentions, he would never even have become president; heck, he never even would have become senator, not even from ultra-liberal Chicago.
  • Not surprised

    Accenture is already scr?wing things up.