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Enrollees at Health Exchanges Face Struggle to Prove Coverage
The New York Times ^ | 10 Jan 2014 | ROBERT PEAR and ABBY GOODNOUGH

Posted on 01/11/2014 8:45:15 AM PST by Theoria

Paul D. Donahue and his wife, Angela, are among more than a million Americans who have signed up for health coverage through the federal insurance exchange. Mr. Donahue has a card in his wallet from his insurer to prove it. But when he tried to use it to get a flu shot and fill prescriptions this week, local pharmacies could not confirm his coverage, so he left without his medications.

Similar problems are occurring daily in doctors’ offices and drugstores around the country as consumers try to use insurance coverage that took effect on Jan. 1 under the Affordable Care Act.

In addition to the difficulties many face in proving they have coverage, patients are also having a hard time figuring out whether particular doctors are affiliated with their health insurance plan. Doctors themselves often do not know if they are in the network of providers for plans sold on the exchange.

But interviews with doctors, hospital executives, pharmacists and newly insured people around the country suggest that the biggest challenge so far has been verifying coverage. A surge of enrollments in late December, just before the deadline for coverage to take effect, created backlogs at many state and federal exchanges and insurance companies in processing applications. As a result, many of those who enrolled have yet to receive an insurance card, policy number or bill.

Many are also having trouble reaching exchanges and insurance companies to confirm their enrollment or pay their first month’s premium. Doctors’ offices and pharmacies, too, are spending hours on the phone trying to verify patients’ coverage, sometimes to no avail.

“The system wasn’t really built to handle this kind of glut of new patients,” said Dr. Curtis Miyamoto, a radiation oncologist at Temple University Hospital who is president of the Philadelphia County Medical Society.

(Excerpt) Read more at nytimes.com ...


TOPICS: Culture/Society; Government
KEYWORDS: aca; coverage; exchanges; healthcare; healthexchange; insurance; obamacare; obamacareenrollment

1 posted on 01/11/2014 8:45:15 AM PST by Theoria
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To: Theoria

Truly breathe taking! The left hand has no idea what the right hand is doing.


2 posted on 01/11/2014 8:50:57 AM PST by SIRTRIS
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To: Theoria
Vicar It's about this letter you sent me regarding my insurance claim.
Devious Oh, yeah, yeah - well, you see, it's just that we're not...as yet...totally satisfied with the grounds of your claim.
Vicar But it says something about filling my mouth in with cement.
Devious Oh well, that's just insurance jargon, you know.
Vicar But my car was hit by a lorry while standing in the garage and you refuse to pay my claim.
Devious (rising and crossing to a filing cabinet) Oh well, reverend Morrison...in your policy...in your policy...(he open the drawer of the filing cabinet and takes out a shabby old sports jacket; he feels in the pocket and pulls out a crumbled dog-eared piece of paper then puts the coat back and shuts the filing cabinet)...here we are. It states quite clearly that no claim you make will be paid.
Vicar Oh dear.
Devious You see, you unfortunately plumped for our 'Neverpay' policy, which, you know, if you never claim is very worthwhile...but you had to claim, and, well, there it is.
Vicar Oh dear, oh dear.
Devious Still, never mind - could be worse.

(Monty Python)

3 posted on 01/11/2014 8:52:17 AM PST by ClearCase_guy
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To: FReepers

Click The Pic To Donate

Support FR, Donate Monthly If You Can

4 posted on 01/11/2014 8:54:43 AM PST by DJ MacWoW (The Fed Gov is not one ring to rule them all)
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To: All

Are we sure this sucker wasn't dropped on his head as a baby?

After all, his sainted mother was color-blind.

The poor dear thought she was marrying a red-headed Irishman---Brendan O'Bama.

Color-blind Mom coulda dropped baby Barack on a black coal stove---thinking it was his white crib.

5 posted on 01/11/2014 8:55:54 AM PST by Liz
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To: Theoria

The never happened when private insurance companies ran things. And some people think there will be calls for universal (I.e., government controlled) healthcare?


6 posted on 01/11/2014 8:56:01 AM PST by Cowboy Bob (They are called "Liberals" because the word "parasite" was already taken.)
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To: Theoria

I think that the GOP needs to hit hard on this in 2014, 2016, and beyond. And what I’m thinking is that Obamacare shows that big government, bureaucratic, top down “solutions” to our problems just don’t work they way the liberals promise they will.

Whenever any liberals propose any big government solution to anything in the future, we should pounce and say, look what happened with Obamacare — so many unintended consequences, so many new taxes and regulations which we didn’t know about, etc. We should pounce and use this as an example of what the liberals want to do in energy, education, the environment, and other areas of life which they seek control over.

Obamacare could well make the case for conservative principles, in showing how liberal ideas work in the real world, and how things don’t work the way the liberals promise they will.


7 posted on 01/11/2014 9:05:04 AM PST by Dilbert San Diego
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To: Dilbert San Diego

I welcome the GOP opining on solutions. There are many solutions out there, but it involves slaying many problems the GOP helped to create, ie EMTALA.


8 posted on 01/11/2014 9:11:42 AM PST by Theoria (End Socialism : No more GOP and Dem candidates)
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To: SIRTRIS

This is also affecting people who have private insurance. Neighbor who has Anthem Blue Cross ? Went to the doc this week and was told they couldn’t verify her insurance. She went home and called the insurance company and they told her her old insurance card expired Jan 1 and she should be getting a new one any day. I said that shouldn’t matter you still have insurance. They told her the number had been changed so the old one didn’t work. That’s all, wait for the new card. Lol


9 posted on 01/11/2014 9:15:22 AM PST by sheana
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To: SIRTRIS

The left hand doesn’t even know what the left hand is doing.


10 posted on 01/11/2014 9:17:30 AM PST by MrEdd (Heck? Geewhiz Cripes, thats the place where people who don't believe in Gosh think they aint going.)
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To: Theoria

Cause = Vote for Democrats.

Effect = Healthcare gets messed up.

Now I wish I had faith that the Democrat voters could understand this simple principle.


11 posted on 01/11/2014 9:36:14 AM PST by Presbyterian Reporter
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To: Theoria

This is happening right now with a friend of mine. The very person this is supposed to cover- a financially challenged single mom with a 100% disabled child. She ‘has coverage’ but doesn’t. There is no insurance card, she needs medical care and BCBS said she has to go through the exchange (or something like that) to get a card and can’t go to her doctor without it.

‘Gee’, said the democraps, ‘too bad, so sad’.


12 posted on 01/11/2014 9:37:25 AM PST by Cowgirl of Justice
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To: Cowboy Bob

It hadn’t even kicked in when there was a huge meltdown.

How can anyone in their right mind think that this was meant to work in any shape or fashion.

The dems sold the public a car with no engine, no frame and no way to put gas in it, knowing everyone would have to start taking the bus.

Mission accomplished.


13 posted on 01/11/2014 9:39:33 AM PST by Cowgirl of Justice
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To: Theoria

So much for the hope and changie thingy.


14 posted on 01/11/2014 10:06:16 AM PST by bikerman (Obama! if his lips are moving he's lying.)
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To: Theoria
Health Care Reform by John Mackey, Whole Foods CEO

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness. Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan's costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

• Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.

Here is one FR link: http://www.freerepublic.com/focus/f-news/2313920/posts

15 posted on 01/11/2014 10:36:15 AM PST by Balding_Eagle (Damn ObamaCare, full speed ahead!)
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To: sheana
They told her the number had been changed so the old one didn’t work. That’s all, wait for the new card.

This is what I was hearing the other day while sitting close to the check-in desk. Lots of people being told their old membership number wasn't working and they need to get the new one.

16 posted on 01/11/2014 10:45:47 AM PST by steve86 (Some things aren't really true but you wouldn't be half surprised if they were.)
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To: Theoria

Their medical ID’s are safely filed away with King Obama’s college transcripts and real birth certificate.


17 posted on 01/11/2014 12:08:09 PM PST by Iron Munro (Orwell: There are some ideas so absurd that only an intellectual could believe them.)
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To: Liz
Are we sure this sucker wasn't dropped on his head as a baby?

Proof that years of smoking mass quantities of dope at the Choomer Level can turn one into an air-headed, babbling, idiot.


18 posted on 01/11/2014 12:12:06 PM PST by Iron Munro (Orwell: There are some ideas so absurd that only an intellectual could believe them.)
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To: Iron Munro

Heh-—yeah-—sounds more like it. LOL.


19 posted on 01/11/2014 12:54:49 PM PST by Liz
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To: SIRTRIS

All part of the plan to bring about Single Payer.


20 posted on 01/11/2014 12:56:24 PM PST by dfwgator
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To: Balding_Eagle

Thanks for the post!


21 posted on 01/11/2014 2:32:45 PM PST by 4Liberty (Mr President 'If you Like your college transcripts...can we see them?')
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To: Theoria

Did the NY Slimes leave out an important detail about this guy?

What insurance program connected with ObozoCare will be providing drugs and flu shots?

Would that fall under the new very large deductibles each enrollee would have as an individual or as a family.

Reminds me of the fake story of the clinic/hospital in N Va. supposedly turning down a woman re X Rays of her chest. That non new event boiled down to the reality of the Unaffordable Care Act, huge deductibles.

The hospital was more than glad to X Ray the woman after she agreed to pay for the X Rays as part of her deductible.

This probable Obama Voting woman tried to say the hospital refused to care for her.


22 posted on 01/12/2014 9:01:03 AM PST by Grampa Dave ( Obamacare is a Trinity of Lies! Obamaganda is failing 24/7/365! Obamaganda will fail 24/7/365!)
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