back-end errors still severe back-end errors still severe

Summary: Reports from multiple sources indicate that a large number of people who believe they have enrolled in a health care plan through the Federal or state exchanges have not, in fact, enrolled.


By most accounts, the parts of that users see are in far better condition than they were for the first couple months of the site's life. But the parts that users don't see, the "back-end" where the exchange gathers and sends data to the insurance carriers with whom the users enroll, remains troubled.

The New York Times on Saturday reported that many errors remain on back-end interaction with the insurers. For each user who enrolls, the site is supposed to send the user's data electronically to the insurance company in a standard format known as an 834 enrollment transaction. In some cases, the insurers did not receive the 834. "In other cases, insurers received duplicate files for the same person, files for one person were sent to an insurer in another state, or the 'relationship code' was wrong so that, for example, a man's daughter was listed as his wife."

These errors have been reported ever since the site launched on October 1. The administration has been claiming that these errors have almost completely ended in recent days. Not so, say the insurers. The Times cites insurers as saying that in recent cases they have seen errors such as the government reporting a home address for a subscriber outside the insurer's service area; children listed as the main subscriber on an application, with the parents as dependents; and the same child listed two or three times on an application. Insurers also say that errors reported earlier on to the help desk at the Centers for Medicare and Medicaid Services (CMS) remain unresolved.

Other reports echo the complaints. At a New Hampshire state legislative committee hearing last Tuesday, Anthem Blue Cross's Director of Government Relations Paula Rogers told lawmakers that Anthem isn't always receiving complete and accurate enrollment forms.

The result is that many users who believe they enrolled in an insurance plan have not, in fact, enrolled, and the insurer still has no valid data on them.

How many applications did not reach insurers? The Washington Post cites the CMS itself with a preliminary estimate of 15,000. The estimate was obtained by comparing the number of enrollments with the number of 834s sent by the site to insurers. It does not measure how many 834s were sent with errors to the insurers, and the Post says that "[t]he federal government does not have a list of people whose sign-up forms were never sent to their insurer."

On Friday the Wall Street Journal [warning: paywall] reported, citing "people familiar with the matter," that thousands of applicants "...have received inaccurate assignments to Medicaid or to the marketplace for private plans, or have received incorrect denials." As an example, legal aliens in Illinois are ineligible for Medicaid for their first five years of residency, but some were told by that they were eligible. An HHS spokesperson is quoted as saying that nearly all such problems have been fixed and that they continue to work on those remaining.

The Journal reports that Federal officials and CGI Group (the main contractor for have identified dozens of scenarios in which the eligibility determination software, which applies about 200 rules for its determination, provides inaccurate determinations. The common thread in the errors appears to be complicated family arrangements. The Journal reviewed tests which showed 14 separate scenarios in which a couple, a child and a former spouse are all counted as members of one household.

Many state exchanges are running more smoothly, but others are also still experiencing significant problems. Washington's Healthplanfinder web site, which has experienced significant downtime, has been inaccurately debiting applicants' checking accounts, according to local reports. Cover Oregon has only recently enrolled anyone in a private health planMaryland's system is so far behind in processing applications that many who thought they were insured won't be on January 1.

The main take-home from this news seems to be if you think you have enrolled, verify with your insurer, as fully as possible, that you are in fact enrolled with them. Confirm that they have the same personal data on you as you entered at the site. Even the US Senate is telling their staffers "[p]lease do not assume you are covered unless you have seen the confirmation letter from the [Senate] Disbursing Office."

Topics: Health, Government US

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  • So, why did California get it right?

    We are having no problem signing up millions in CA. Perhaps the feds should talk to the folks that did Covered California?
    • Huh?

      The State of California reported fewer than 160,000 enrollments as of December 7. That's a fair distance from "millions."
      Robert Hahn
    • Maybe more cooperation from insurers and states

      and less attempted sabotage? If an insurer or a state agency (more likely the latter, in some states) gives incorrect specs for interface formats during testing, the system is coded to those incorrect specs, passes the tests, but then does not pass in the real world. I would not put it past the "ethical" attitudes of officials or civil service techs in certain states to do exactly that, because they hate Obamacare more than they love their country or care about its customers (their own constituents).

      After all, some officials are PUBLICLY saying they will not give any more active ASSISTANCE than they are forced to give; so behind the scenes, active SABOTAGE is not entirely impossible. But Rep. Issa has no interest in investigating THAT, does he?
      • Define sabotage

        I want to keep my doctor, my hospital, my plan. I was told I could, PERIOD. Meanwhile, the Liar-in-Chief knew perfectly well that he and his minions were lying, and did it completely on purpose so as to shove the OTax down our collective throats.

        Was that sabotage? Would resistance to such tyranny be justified??

        "We have to pass the OTax to find out what's in it," said the Liar of the House. Precisely...
        • Please

          You're reading a verse from the the "Book O' Numbnuts."

          Sabotage is basically what the great majority of Republicans have done, at both the federal and state levels ever since Bill Clinton tried to do something for real to deal with our increasingly problematic healthcare system: soaring costs for mediocre at best service, and behavior by healthcare & hospital groups more suited for underhanded financial industry companies. Obama's plan was the first serious one to be passed, pretty universally supported by healthcare advocates, and Republicans have been doing everything they've could to undermine it, from deliberate disinformation campaigns to refusing to set up local state exchanges, even though the feds were paying for it. Easily suckered dummies like you are the reason we now have such a dysfunctional Congress.

          Oh, and not keeping your plan and/or doctor is really mostly a problem with underhanded insurance companies selling defective, inadequate plans to the gullible. When Massachusetts passed its plan (which including overriding 8 of Romney's vetoes -- "Romneycare" is a wholly made up nonsense), Massachusetts Republicans actually cooperated to help make it work, even when there were initial problems with the roll-out.

          The more you know, the less a dummy you are.
          • I've had my plan for 25+ years and Its proven admirable....

            and I've used it for eye glasses, surgery, illnesses, prescriptions and antibiotics.
            I've been very happy with the results, and I've always managed to pay my bills.
            Now explain why my plan is defective, for lacking pre-natal and natal care, when I a man, and my fiancé who's had a hysterectomy cannot even have more children.
            Oh and please explain how the feds can pay for anything without the taxpayers consent.
            A dysfunctional Congress?? Haven't too many "so called conservatives" already complied with the demands of liberals? From judges allowing "taxed" healthcare to passing ever more debt increasing budgets and if that's not enough REID nullifies the filibuster allowing you and the left to stack the courts in your favor as well.
            Please tell me just how more complicit anybody "supposedly" opposed should be. WELL??
          • Really?

            Why do suspect that you have no clue about how good or bad your plan is or was? And do you live in a red state? If so, chances are high that Republicans in your state have done their darnedest to screw up implementation of the healthcare reform law because, well, they count on the same dummies who voted them in to be just as clueless about everything else.

            I can tell for certain that the politicians you likely support and have supported have been on the "part of the problem" side of things, which puts you on that same side as well. Our healthcare system has long been a cautionary tale rather than a model for the rest of the world: skyrocketing costs for very mediocre at best service (we really only have a reputation for last resort cancer treatments.) It's a dysfunctional system that should have been fixed a long time ago, and very likely would have if not for Republicans: when they weren't trying to undermine any sort of reform when they were not in control of Congress and or the White House, they would simply kick the problem down the road when they were. If you don't believe me, Google can be your friend in showing how utterly useless modern Republicans have been in recent years in dealing with a healthcare system that has been in "crisis" mode since about the turn of the century. (And if you don't know how to Google stuff, find a 10 yr old who can help you.)

            How's them apples for a "WELL??"?
      • Your assumption

        is that one would sabotaging Obama care would be a bad thing. I actually want it fully implemented(something that our administrations isn't able to do) so that we can see the full problems from this system.
      • Nice try, except there is a single (fully defined) EDI transaction spec.

        As the article clearly states: "the site is supposed to send the user's data electronically to the insurance company in a standard format known as an 834 enrollment transaction". If you search for "834 enrollment transaction" there are plenty of links to the spec.
      • Your idiocy abounds...

        The insurers are getting a windfall from the signups and the government subsidies. The insurers were for this plan, the plan that forces you to buy their product?

        Wake up!
      • The only "sabotage" that is known in this whole scenario regarding

        Obamacare, is the sabotage of the healthcare system which we already had, and which was 100% better than what Obamacare offers. Even with the known problems of what existed for healthcare in the country, it was much more preferable than the mess which is being perpetrated on the American people now.

        If there were problems with the original healthcare offerings, and the problems needed to be fixed, then Obamacare was no fix at all, and it just made things much worse.

        People can't keep their doctor of choice, and they can't keep their hospital of choice, and they can't keep their medical plans. That is the same as sabotage of the healthcare system.

        If there were, as liberals claim, some 30 million people without medical insurance, then, why is it that the whole system needed to be scrapped? Why not just fix the problem for the 30 million, and not mess up the entire system. The majority of Americans didn't want Obamacare, and they don't want it today. In fact, a recent survey had people wanting repeal of the law by a majority of 62%. That's the people speaking, not republicans.

        When it comes to sabotage, the law is being implemented, and the roll-out was immensely flawed, and it wasn't as a result of sabotage. It was a result of incompetence. The incompetence comes from those in charge of the program.

        The biggest problem with Obamacare is not the online system. The biggest problem is the program itself, which is completely unsustainable. The sabotage of the program comes from the bill itself, because, there is absolutely no way that it can work. Most of those enrolling will be dependents of the program who will not be paying to support the system. And the people that the program is depending on to support the system, won't be enrolling. Thus, the sabotage is "designed" into the system itself, since it's a non-workable and unsustainable program.

        As always, liberals think they know better than the people and better than industry, but instead, they end up creating a mess, and a very costly one at that.

        So, stop your asinine comments, and start thinking for a change.
        • There is not a single thing in your post

          That indicates any real knowledge on either the state of our healthcare system, what healthcare reform advocates have been recommending for over a decade, or what attempts, if any, have been tried in the past to reform matters. With pretty much no exceptions, the more you understand the problems our healthcare system has developed over the past few decades, the more you wish Obama's plan made more changes. But given the hostile, ignorant dysfunction we have in Congress these days, a stronger plan would likely not have made it through.
  • there is no way the site is "FIXED"

    Its too big and too complex with far far too many problems to be all fixed in this short a timeframe. Despite the obvious problems reported by insurers I suspect a number of usage problems are contributing as well. People are amazing in their ability to do the wrong thing even when it doesn't seem possible and find ways to foul up.

    The site will have to shepherd people through and be resilient enough to gracefully recover and preserve data until complete and transmission confirmations are received by each intended recipient. There is no doubt we are months off from smooth operation especially given the sorry state with which it began.
    • Mistaking a daughter for a wife?

      In some of those cult communes out West, that might actually be the case!
  • Not Fixed

    Most of the Obamacare spin is aimed at press who are generally ignorant about technical issues. The problem is that too many people are having various problems or know details that contradict the White House propaganda. Also, the fact the total enrollments are at levels the make the whole program unsustainable. Insurance companies are quietly complaining that they are receiving bad data at unacceptably high rates. The overall error rate should be several order of magnitude below 1% . The reported error rates are currently reported to be 1 - 10% which means all enrollments are delayed because they all must be manually checked.
  • 'overall error rate should be several order of magnitude below 1%'

    into 5 nines territory?
    unlikely - as *users* are entering data.
    but it is clear that the back-end has been botched - not exactly a surprise.
  • No one will know

    We'll never know if the backend is broken or fixed. Since this technical incompetence has the potential to scuttle the ONLY thing the current Administration wants -- To stay in power. So, the truth will never be known, except possibly when histories are written decades from now.

    Think of it -- we do nothing about Snowden blabbing about subjects that severly harm our country and yet there is a nuclear secrets-style curtain around anything pertaining to

    Unfortunately since this is a techie site, most of the readers are aware that the simple web site could have been done by an ugly third grader as a weekend class project. And we techies are saying "$600 million? Three and a half years? Give me $60,000 and a month and I'll walk away grinning."
    • Ignorance is bliss

      You speak as one who has never done a complex integration project. They are vastly different than a "simple web site".

      Government or not, integrating multiple systems, most of which were not design for integrating, is hard, time consuming and expensive.
      • Search engines....

        and aggregating programs do this efficiently without involving government, and for at least the last 20 years! PARTISAN EMPATHY IS UNACCEPTABLE !!!
        • They could've even had a head start.....

          had they just used all the identity tracking techniques from Google, Faceook and the NSA.
          Don't you think most of the sign up could have been pre-filled out? (SARCASM)