Healthcare.gov back-end errors still severe

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.
Written by Larry Seltzer, Contributor

By most accounts, the parts of Healthcare.gov 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 ""=""> As an example, legal aliens in Illinois are ineligible for Medicaid for their first five years of residency, but some were told by Healthcare.gov 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 Healthcare.gov) 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."

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