Consumers Hit Snags as Health Law Kicks In

Wall Street Journal
January 2, 2014
Consumers Hit Snags as Health Law Kicks In

Featuring: Alan Murray, CEO, North Shore-LIJ CareConnect Insurance Co.

Consumers began test-driving insurance coverage under the federal health-care law Thursday, seeking care at pharmacies and clinics, and in some cases running into hiccups as their policies took effect.

Doctors' offices, hospitals and pharmacies said they saw a limited number of people with the new insurance, which kicked in at the beginning of the year.

Consumers began test-driving insurance coverage under the federal health-care law Thursday, seeking care at pharmacies and clinics, and in some cases running into hiccups as their policies took effect.

Doctors' offices, hospitals and pharmacies said they saw a limited number of people with the new insurance, which kicked in at the beginning of the year.

Long Beach Memorial Medical Center has had a "steady stream" of patients with plans purchased through the new California online marketplace, including a few emergency-room visits and a number of appointments with primary-care doctors, said Diana Hendel, chief executive of the hospital in Long Beach, Calif.

Largely because of hitches in the rollout of the new federal insurance exchange, HealthCare.gov, the deadline for choosing Jan. 1 coverage through the site was delayed until Dec. 24. Insurers have struggled to process a last-minute rush of new consumers seeking plans, some of whom haven't begun paying premiums.

The Obama administration said Tuesday that enrollment through all government web exchanges, including the ones run by states, had topped 2.1 million. It hasn't released the latest numbers for new Medicaid enrollment. The total for the exchanges falls short of the 3.3 million-enrollee target set by the administration before the marketplaces' launch.

Insurers said Thursday they saw a few cases of consumers who weren't in their systems seeking care, including both late sign-ups and others whose enrollment data may have been lost to government marketplaces' glitches.

Health-care providers said they expected problems would likely play out over weeks, as consumers begin to file claims and seek authorization for procedures.

Tim Davis, who owns Beaver Health Mart Pharmacy and two other drugstores northwest of Pittsburgh, said one customer who came in Thursday with a card for a new plan couldn't be found in the system, but the pharmacy gave her a week's worth of the prescription to tide her over.

A few other consumers showed up with printouts of their new plans and no cards, he said, adding that the pharmacists filled the prescriptions when they could verify the coverage.

Tony Kouri of Wichita Falls, Texas, went to his local CVS pharmacy on Wednesday and requested a refill for an asthma inhaler. But when the pharmacist looked up details about Mr. Kouri's coverage with Blue Cross & Blue Shield of Texas, it was wrong, he said.

Mr. Kouri expected to pay the full cost of the drug before reaching his $6,000 deductible. However, the pharmacy said his plan's drug coverage only required a $50 copay, far short of the full cost of the medicine, a first sign he'd been enrolled in the wrong plan. He expects to be billed the difference later. "There's some obvious confusion with everyone right now," said Mr. Kouri, 57, who owns a marketing firm.

A spokeswoman for Health Care Service Corp., parent company of the Texas insurer, said it was "working hard to make sure the enrollment process and coverage implementation is as seamless as possible for all of our members."

Some hospitals and community health centers that have been treating uninsured patients all along have been helping them apply for Medicaid or subsidized plans and say they will be able to provide much more care for patients with new coverage.

At the Casey Health Institute, an integrative medicine practice in Gaithersburg, Md., family physician Kisha Davis said she had been following one patient with a suspicious skin lesion on his temple for three months, but he couldn't afford to have it checked without insurance.

"His Medicaid kicked in today. We saw him for a visit, which was now covered, and we were able to refer him to dermatology," said Dr. Davis.

A spokeswoman for the federal Department of Health and Human Services said the HealthCare.gov call center was "experiencing business as usual."

Most calls are from people seeking to apply for insurance, as well as some from people trying to verify their new coverage, she said.

Insurers and health-care providers said they had expected early problems, and are working to smooth out the transition.

CVS Caremark Corp., Wal-Mart Stores Inc. and Walgreen Co. said this week they would work with customers who are having problems getting prescriptions as they transition to new health plans by providing up to a 30-day refill for those who can show proof of insurance registration.

Shaun Greene, chief operating officer of Arches Health Plan in Utah, said a new enrollee received coverage for the delivery of her baby on New Year's Day, after Arches made arrangements with the hospital to cover its services because she hadn't yet received a membership number for her new health plan. Such cases were unusual, he said.

Alan J. Murray, chief executive of North Shore-LIJ CareConnect Insurance Co. in New York, said he personally called an irate consumer who was trying to fill a prescription Thursday before heading out on vacation.

The man had signed up for coverage through the state's marketplace, then canceled it, then resigned with CareConnect directly, and the system was showing his cancellation. The insurer got the prescription delivered to the man's home before he had to leave, said Mr. Murray, who said there had been few such cases.

—Melinda Beck contributed to this article.
Write to Anna Wilde Mathews at [email protected], Timothy W. Martin at [email protected] and Christopher Weaver at [email protected]

 

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