Exclusive: Technical snafus confuse charges for Obamacare plans

NEW YORK Thu Sep 5, 2013 4:33am EDT

Supporters of the Affordable Healthcare Act gather in front of the Supreme Court before the court's announcement of the legality of the law in Washington on June 28, 2012. REUTERS/Joshua Roberts

Supporters of the Affordable Healthcare Act gather in front of the Supreme Court before the court's announcement of the legality of the law in Washington on June 28, 2012.

Credit: Reuters/Joshua Roberts

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NEW YORK (Reuters) - Technical glitches still plague the display of new healthcare plans to be offered to millions of uninsured Americans starting in 26 days, including how medical charges and deductibles are listed, industry officials say.

Health insurers planning to sell policies to people who are currently uninsured, under President Barack Obama's healthcare reform, say they expect the problems will be remedied by October 1, when consumers will be able to buy health insurance from state exchanges. On Wednesday, the Centers for Medicare & Medicaid Services (CMS), the lead Obamacare agency, said it was on schedule to sign final agreements with insurers between September 9 and September 11, allowing them to sell specific policies on the exchanges.

"Our timeline remains the same," said CMS in a statement, "and we are working to ensure that any issues are resolved before open enrollment."

Although the signing of agreements with insurers is a mere two days behind the original schedule, it led to speculation that there were serious technical snags. Late last week a conference call between the government's information technology contractors and insurance industry representatives revealed some of those problems, which centered on how information about health plans, such as charges for medical claims and deductibles, was displayed on a "preview" website, according to people with knowledge of the call.

An official from Florida Blue, a large insurer, was concerned that a health policy it plans to sell on the state's exchange would mislead customers: The preview website showed no charge at all for some medical services, rather than no charge after a deductible is met.

An Aetna staffer was frustrated that policies the company once intended to sell in Ohio, but withdrew, were still showing up in the preview site. Delta Dental of Wyoming reported that its plan was showing zero deductible in policies that cover parents plus children.

"That will be misleading if it pops up as a zero deductible and will put us on the hook if they go to the dentist" and expect not to pay a deductible, a Delta Dental staffer said on the call, according to a participant. "We're concerned about that."

The insurance exchanges, the heart of Obama's Patient Protection and Affordable Care Act, will allow residents of each state to seek subsidized health coverage. The government aims to sign up 7 million people in the first year. That number is expected to grow to 22 million in 2016, according to the Congressional Budget Office.

Carriers were sanguine the snafus would get addressed.

"We knew there would be IT issues going in," said Kerry Hall, chief executive of Delta Dental of Wyoming, in an interview. "We made a business decision to be in the exchange for the people of Wyoming, and we've very optimistic that CMS will get this resolved."

Aetna spokesman Matt Wiggin said his company was also confident the problems would be fixed.

IT experts said the problems should be familiar to anyone who has had to deal with an elaborate tech rollout at work, including the sometimes unsatisfying interaction with a dedicated "help desk."

"It's classic," said Rick Howard of technology consultant Gartner, which is not an exchange contractor. "When you have these large IT projects, it comes down to not having enough time to prioritize issues based on severity. If you go live with this knowing you have glitches, consumers may make decisions based on false information."

ONLINE ONSLAUGHT

For months it has been clear that IT would be both the backbone and the Achilles heel of the Obamacare exchanges. Although people will be able to buy health coverage by phone and through paper applications, most are expected to do so online. Almost everyone will seek information for policies at the website being created for their state's exchange.

As a result, if any issue could delay the start of the six-month open-enrollment period next month, experts have said, tech glitches would be it. A report last month by the inspector general at the U.S. Department of Health and Human Services warned that HHS was months behind the schedule it originally set in testing IT security.

The problems in displaying insurance information affect exchanges being built by the federal government in 34 states. Only some states were discussed on the IT conference call.

Another 16 states and the District of Columbia are responsible for their own exchanges. Among those, Oregon has said it would limit access to its exchange to residents working with an insurance broker or a state-trained "navigator" during the first few weeks of October to iron out any technical bugs. California is considering a similar approach.

Administration officials last week would not specify what IT or other issues caused HHS to push back the deadline for final approval of policies. But the IT call last Friday underlined the frustration of some carriers as they race to prepare for the launch.

Some insurance company representatives said they had asked repeatedly for errors to be corrected and still have numerous outstanding requests with the exchange help desk, according to people with knowledge of the discussion. Others said incorrect rates for certain services were on display.

After some two hours of such complaints, a federal IT representative on the call said: "I hear your frustration, and we're doing all we can."

(Reporting by Sharon Begley; Editing by Michele Gershberg and Prudence Crowther)

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Comments (11)
susette wrote:
Insurance has always been ridiculous: First your month to month premiums; then the cost of ach “Tier” of medicine and how they charge for it is different at all pharmacies; you costs UNTIL you meet their definition of out of pocket expenses, plus whatever the co-pays are, and plus whatever the “co-insurance” cost will be. Often, it costs me more to goto a doctor now because I dont have coverage for “Physician expenses.” And these costs I pay are not considered “out of pocket expenses.” You figure it out. And this is NOT the Obamacare act insurance YET.

Sep 05, 2013 7:40am EDT  --  Report as abuse
SailorJo wrote:
Americans love it complicated.
Why not offer the same as the UK does? Simple, cheap, effective.

Sep 05, 2013 9:10am EDT  --  Report as abuse
ShovelyJoe wrote:
What?? A deeply flawed and unethical law is having problems? Who could have seen this unfortunate situation????

Sep 05, 2013 9:19am EDT  --  Report as abuse
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