By Anna Gorman
Mon, Dec 16 2013
Every day for weeks, Kathleen Bayly checked the mailbox at her Pleasanton, Calif., home for the bill from her new insurance company.
But Bayly, 61, who signed up in November for health coverage through California's insurance marketplace, didn’t receive anything from Anthem Blue Cross.
With her insurance set to expire on New Year's Eve, she became increasingly anxious. She cut short a vacation to make sure she didn’t miss the packet. She repeatedly called both Covered California, the marketplace, and Anthem Blue Cross. She wrote letters to local politicians.
On Dec. 13, nearly a month after enrolling, Bayly finally reached someone at Anthem who gave her a way to pay online. "It certainly hasn't been easy," she said.
For all the attention paid to the troubles at the front end of the enrollment process in the nation’s new insurance marketplaces, the back end can be just as fraught. The path to receiving an insurance card, the key to receiving non-emergency medical care, can be tortuous.
Once someone signs up, the insurance exchange still has to give the information to the insurer, which must send a confirmation packet and, even more important, a bill.
Insurers and others are concerned that even highly motivated consumers will run out of time to seal the deal. Many consumers don't know they have to pay their first month's premium to be covered. And with the back-and-forth mail required, the paperwork can be easily overlooked in a pile of packages and holiday cards.
Enrollment glitches also may keep insurers from getting the applicant’s information, including a Social Security number and contact information. And some people, though they applied for coverage and have time to pay the premium, may not have the money.
"There are so many twists and turns before this [system] is humming," said Micah Weinberg, a senior policy advisor at the Bay Area Council, an employer-backed public policy organization.
Among the biggest issues, he said, is, "Will the money get where it needs to get by the deadline?"
In the end, even if consumers enroll and pay, they still could face delays in getting the all-important card. Insurance companies have up to 10 days to issue a card once they receive the payment.
If aspiring beneficiaries don’t manage to get on insurers’ rolls by the New Year, many people could show up at doctors' offices and hospitals in January believing they are insured when they're not.
Glenn Melnick, a health care finance professor at the University of Southern California, said the number of steps and agencies involved in the sign-ups is a problem. "When a single entity doesn't control all of the details of an enrollment process, there is lots of room for mistakes and handoff errors," he said. "It is going to be messy."