Enrollees at Health Exchanges Face Struggle to Prove Coverage

The New York Times ^ | 10 Jan 2014 | ROBERT PEAR and ABBY GOODNOUGH

[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.

[4Liberty]

Thanks for the post!

[Grampa Dave]

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.