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Insurers under fire as Obamacare kicks in

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Obamacare's biggest problem isn't the troubled HealthCare.gov website anymore.

Consumers are easing up on criticism of government exchanges and turning their frustration and fury toward some of the nation's biggest health insurers. All too often, new policyholders say, the companies can't confirm coverage, won't answer basic questions, and haven't issued identification numbers needed to fill prescriptions or get medical care.

Day after day, people say, they contact insurance company call centers waiting hours at a time with no response. Meantime, insurers have already taken many customers' payments for coverage intended to take effect Jan. 1.

But without proof of insurance, patients are having to pay hundreds of dollars out of pocket for medications and doctor visits, if they can afford it. Insurance agents say dismal service has become commonplace across many companies.

These industry problems pose the next major hurdle for what's already been a flawed rollout for President Obama's signature law. It could further sour public opinion on the overhaul and hamper enrollment efforts through March 31, when the first sign-up period ends.

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Alan Sager, a health-policy professor at Boston University, said the insurance company fiascoes are another barrier to overcome after the government website problems.

"There's equal opportunity for incompetence by the public and private sector in administering such a large new program," he said. "People are deservedly angry and resentful."

Some insurers have begun to apologize this week, acknowledging a lackluster response amid an unprecedented surge of applicants for the individual insurance market. Nationwide, more than 2 million people enrolled in private health plans by the end of last year, either through HealthCare.gov or state-run marketplaces.

Industry officials say the disastrous launch of the federal exchange and the ever-changing rules from the Obama administration have complicated their job and contributed to the backlog.

"Health plans have gone above and beyond to protect consumers from disruptions caused by the ongoing problems with HealthCare.gov" and some state exchanges, said Robert Zirkelbach, spokesman for America's Health Insurance Plans, an industry group. "The last-minute changes to deadlines and rules have made the process more complicated and time-consuming."

But some consumers think big insurers had plenty of opportunity to get ready.

"Insurance companies of this size should have been far better prepared. They knew it was coming," said Katherine Kokko, 34, a public-health consultant in New Hampshire.

She easily signed up for an Anthem Blue Cross Blue Shield policy through HealthCare.gov on Dec. 20 and soon after paid her $325 monthly premium. But after waiting on hold more than 10 hours in all this week, a company representative said she didn't have an identification number. As a result, Anthem wouldn't authorize physical therapy she needs after knee surgery last month.

These problems are particularly acute for families with ongoing medical needs, such as cancer treatment, pregnancy and other chronic conditions.

Bill Strong of Santa Barbara has a 6-year-old daughter who requires 24-hour care for a rare disease, spinal muscular atrophy. The family's previous plan was canceled because it didn't meet all the requirements of the Affordable Care Act. The family enrolled with Blue Shield of California on Dec. 23 and paid its $1,000 monthly premium for a Platinum plan.

But Strong said he hasn't heard anything from the company despite two weeks of phone calls. Strong already paid for one prescription himself, and his daughter is scheduled to get a $4,000 injection Friday. Also, his wife is nine months pregnant.

"The company is not set up to handle the volume coming through," Strong said. "It's creating a lot of stress on us we don't need."

Blue Shield of California apologized to customers for its "unacceptable" performance on its Facebook page this week.

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"While we anticipated and planned for increased traffic, the sheer volume of enrollments has swamped all major health plans," the San Francisco insurer said.

WellPoint, the nation's second-largest health insurer and parent of Anthem Blue Cross, has drawn the ire of many customers in California and 13 other states where it's selling policies on and off government exchanges.

The company said it responded to more than 1 million customer calls over two days last week, equal to the amount it typically receives over an entire month. It said it has more than 1,000 employees answering calls.

Recent government changes to the law's implementation and deadlines "are impacting the timeline for us to process customer applications, issue billing statements, process payment and issue coverage ID cards," said WellPoint spokeswoman Kristin Binns. "We greatly appreciate patience during this transitional time and apologize for any inconvenience they may have experienced."

Insurers say the inability of many people to enroll through HealthCare.gov in October and November, coupled with deadline extensions to get Jan. 1 coverage, created an unexpected bottleneck of applications in late December.

The wave of policy cancellations for millions of Americans this fall added to the upheaval, and industry officials have also complained about lost or delayed delivery of enrollment files from the federal and state exchanges.

Blue Shield of California said it is still getting applications for Jan. 1 coverage from the state exchange.

A spokesman for HealthCare.gov said "we have fixed most of the issues that may impact a consumer's enrollment with a health plan."

In light of the lingering problems, California's exchange extended the payment deadline to Jan. 15 for coverage starting Jan. 1, and some insurers across the country have granted even more time.

Many people have taken to social media to vent and seek help from their insurer. Helen Syrpes of Denver was incensed that Anthem posted a photo of a baby in the bathtub to wish customers on its Facebook page "Happy Bubble Bath Day!" and told them it's a great way to reduce stress.

"Please stop posting on your Facebook page about bubble baths, and reply back to your members. Answer your phones, you are CAUSING STRESS," the 36-year-old said on the company's Facebook page.

Syrpes paid to renew her existing coverage and thought she would avoid all the hassles of the healthcare law. But her drugstore had no record of her Anthem plan when she tried getting prescriptions filled a week ago.

Some consumers are demanding partial refunds on January premiums that were paid weeks ago. Jeffrey Morgan, a marketing consultant in Lakewood, said Anthem Blue Cross rejected his refund request after waiting on the phone more than two hours Thursday.

Morgan has paid his January premium of $1,200 for his family's coverage, but the company erroneously sent him a member ID card showing his coverage isn't in effect until March 1.

"I enrolled well before the deadline and paid well before the deadline and I need prescriptions that are critical to my healthcare," Morgan said.

Even insurance agents say they can't get through to the companies to assist their clients.

"This whole law is a gift to insurance companies," said Helena Ruffin, a health insurance agent in Venice. "They owe us good customer service."

chad.terhune@latimes.com

Twitter: @chadterhune

Copyright © 2014, Los Angeles Times
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InsuranceEducationMedia IndustryConsumersAffordable Care Act (Obamacare)Healthcare ProvidersMedicine
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