Many who enrolled in health plans still await confirmation

Expecting their first child early next year, Brett Winton and his wife, Maria-Elena Kolovos, are waiting to receive confirmation of health coverage.
Expecting their first child early next year, Brett Winton and his wife, Maria-Elena Kolovos, are waiting to receive confirmation of health coverage.
(Francine Orr / Los Angeles Times)

Thousands of Californians have overcome long waits and website glitches to sign up for Obamacare insurance, but now enrollment snags may prevent some of them from actually having coverage starting Jan. 1.

Some people who picked a health plan as far back as October through the Covered California exchange say insurers are telling them they still have no record of their enrollment. As a result, bills haven’t gone out and consumers can’t pay their initial premium to ensure coverage takes effect in less than three weeks.

Thomas Gallo of Glendora signed up his wife and son on the second day of enrollment in October. After hearing nothing for weeks, he said, he was told by the state in late November that his application and some others had been lost.


Gallo reapplied over the phone, but he said he still has no confirmation from Blue Shield of California about his family’s Silver plan. Gallo, a retired accountant, has Medicare for himself.

“The back end is so backed up, and no one can give me an answer,” said Gallo, a strong supporter of President Obama’s healthcare law. “What happens if we don’t get coverage by Jan. 1? There are real problems here.”

Consumers’ anxiety has grown as they endure long waits on the phone, computer errors and conflicting answers from the state and insurers about their coverage. The average wait time at the state’s call centers climbed to 36 minutes last week, and California is still trying to clear a backlog of paper applications filed in October and November.

State officials say the huge demand for insurance is a positive sign for the rollout of the Affordable Care Act. They acknowledge there have been delays, but they say the vast majority of people are enrolling smoothly and getting their first insurance bills. The state said it didn’t have exact figures on how many customers are still waiting for proof of insurance.

“With the large numbers we are dealing with, there will be some individuals who don’t get ideal service,” said Peter Lee, executive director of Covered California. “We are committed to make sure everyone who wants insurance gets it Jan. 1.”

The California exchange and insurance companies are dealing with a surge of new applicants who are rushing to meet a Dec. 23 deadline to have insurance in place at the beginning of the year. Open enrollment continues through March 31.

Thursday, Covered California said more than 156,000 people had enrolled in private health plans through Dec. 7. An additional 179,000 Californians have qualified for an expansion of Medi-Cal, the state’s Medicaid program for the poor.

In a nod to the ongoing sign-up problems nationwide, federal officials announced several steps Thursday aimed at helping people who get stuck in healthcare-law limbo. The Department of Health and Human Services said patients enrolled in special insurance plans for people with preexisting conditions would be able to stay on that coverage until the end of January. About 17,000 Californians were enrolled in such plans earlier this year.

In California, insurers are working with the state exchange on how to address the potentially thorny problem of patients who applied in time but don’t have proof of insurance when they need to visit the emergency room or get a prescription filled in early January.

Insurance companies typically won’t cover any medical bills until a customer pays the premium. The deadline for payment was recently extended to Jan. 6.

“There are certainly some people who have enrolled or think they have enrolled and haven’t received confirmation,” said Paul Markovich, chief executive of Blue Shield of California. “It’s our version of Black Friday right now and that is what we are coping with.”

The stakes are big for people with chronic health conditions and serious medical issues. The loss of coverage could pose significant problems for them financially and for their health.

Jim Arenson, 60, a self-employed engineer in Woodside, Calif., enrolled himself and his 23-year-old son on the state website Oct. 16. But it wasn’t until Thursday, eight weeks later, that Covered California told him his application had been sent to Blue Shield and the company confirmed he was in its computer system.

“I was very scared I wouldn’t have health insurance,” said Arenson, who needs follow-up care after cancer-related surgery this year. “The exchange and the insurance company were pointing fingers at each other. There could be a lot of people falling through the cracks.”

State Sen. Ed Hernandez (D-West Covina), chairman of the Senate health committee, said he worries that time may be running out to address some of these enrollment issues. “The question now is whether we can meet that demand. Everything seems to be bottlenecked until we open more lanes,” he said.

Lee, head of Covered California, said exchange employees are working overtime to process applications, and the state’s call centers will be open the next two Sundays to help meet increased demand. He said the exchange is sending customer files daily to the 11 insurers participating in the state marketplace.

The separate federal exchange for 36 other states has been trying to fix errors in the customer files it has sent to insurance companies. In contrast, the California Assn. of Health Plans, an industry group, says the information from Covered California has had a “high rate of accuracy.”

If Jan. 1 is a concern for some people, consider the anxiety for Brett Winton and his wife, Maria-Elena Kolovos. They’re expecting their first child shortly after the new year begins. “I can’t suddenly fall off insurance,” said Winton, 34, a self-employed financial consultant in Venice.

The couple’s current insurance is being canceled Dec. 31 along with individual policies for about 1 million other Californians because their coverage doesn’t meet all the requirements of the healthcare law. Insurance companies have offered to automatically enroll many of those customers into a new health plan to avoid any disruption in coverage.

Brett Winton said he ran into repeated glitches and delays on the state website before eventually enrolling in a Blue Shield plan. In late November, he wanted to switch to an Anthem Blue Cross policy after finding out their doctors and hospital wouldn’t be covered by Blue Shield.

He called the exchange and got a recording saying the call center would contact him in 240 minutes. Winton said the exchange never did. Then he waited an hour for an online chat, and a Covered California representative told him he would have to wait 14 days to reapply.

Monday, the couple called Anthem Blue Cross directly to enroll in a Platinum plan costing $796 a month. But Winton said the company told him it couldn’t send an email or letter verifying his purchase until after Jan. 1.

A spokesman for Anthem said Winton’s situation appears to be an isolated case, and bills should be mailed to customers within a day or two of their enrollment.

“What happens when I get my first medical bill in January?” Winton said. “This is absolutely crazy.”

Twitter: @chadterhune

Times staff writer Noam N. Levey in Washington contributed to this report.