Health website appeals hit wall

Government unable to fix sign-up errors

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WASHINGTON -- Thousands of people who discovered that HealthCare.gov made mistakes as they were signing up for a health plan are confronting a new roadblock: The government cannot yet fix the errors.

About 22,000 Americans have filed appeals with the government to try to get mistakes corrected, according to internal government data obtained by The Washington Post. They contend that the computer system for the new federal online marketplace charged them too much for health insurance, steered them into the wrong insurance program or denied them coverage entirely.

For now, the appeals are sitting, untouched, inside a government computer. And an unknown number of consumers who are trying to get help through less formal means -- by calling the health care marketplace directly -- are told that HealthCare.gov's computer system is not yet allowing federal workers to go into enrollment records and change them, according to individuals inside and outside the government who are familiar with the situation.

"It is definitely frustrating and not fair," said Addie Wilson, 27, who lives in Fairmont, W.Va., and earns $22,000 a year working with at-risk families. She said that she is paying $100 a month more than she should for her insurance and that her deductible is $4,000 too high.

When Ms. Wilson logged on to HealthCare.gov in late December, she needed coverage right away. Her old insurance was ending, and she was to have gallbladder surgery in January. But the website would not calculate the federal subsidy to which she knew she was entitled. Terrified to go without coverage, Ms. Wilson phoned a federal call center and took the advice she was given: Pay the full price now and appeal later.

Now she is stuck.

"I hope," she said, "they really work on getting this fixed."

The Obama administration has not made public the fact that the appeals system for the online marketplace is not working. In recent weeks, legal advocates have been pressing administration officials, pointing out that rules for the online marketplace, created by the 2010 Affordable Care Act, guarantee due-process rights to timely hearings for Americans who think they have been improperly denied insurance or subsidies.

But at the moment, "there is no indication that infrastructure ... necessary for conducting informal reviews and fair hearings has even been created, let alone become operational," attorneys at the National Health Law Program said in a late-December letter to leaders of the Centers for Medicare and Medicaid Services (CMS), the agency that oversees HealthCare.gov. The attorneys, who have been trying to exert leverage quietly behind the scenes, did not provide the letter to The Post but confirmed that they had sent it.

A CMS spokesman, Aaron Albright, said, "We are working to fully implement the appeals system."

Three knowledgeable individuals, speaking on the condition of anonymity about internal discussions, said it was unclear when the appeals process will become available. So far, it is not among the top priorities for completing parts of the federal insurance exchange's computer system that still do not work. Those include an electronic payment system for insurers, the computerized exchange of enrollment information with state Medicaid programs, and the ability to adjust people's coverage to accommodate new babies and other major changes in life circumstance.

The exchange is supposed to allow consumers who want to file appeals to do so by computer, phone or mail. But only mail is available. The roughly 22,000 people who have appealed to date have filled out a seven-page form and mailed it to a federal contractor's office in Kentucky, where the forms are scanned and then transferred to a computer system at CMS. For now, that is where the process stops. The part of the computer system that would allow agency workers to read and handle appeals has not been built, according to individuals familiar with the situation.

In the meantime, CMS is telling consumers with complaints about mistakes to return to the website and start over.

"We are inviting those consumers back to HealthCare.gov, where they can reset and successfully finish their applications without needing to complete the appeals process," said Mr. Albright, the agency spokesman. The rationale is that, since the computer system is working better now, it's less likely to make mistakes.

Agency officials have no way of knowing how many people have taken that advice, according to two individuals familiar with the situation. The computer system containing the scanned appeals forms cannot yet communicate with HealthCare.gov's enrollment database.


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