Obamacare Still Has “Back-End Issues”

When the Affordable Care Act marketplace opens on Nov. 15, consumers can expect healthcare.gov to have robust technology, amped-up functions, and a shorter application form for individual plans.

What they won’t see – and likely won’t know about – are the ongoing communication problems that many on the insurance industry say continue to plague the “back-end” transfer of consumer files between the website and insurance companies.

“Everyone reports that there are still back-end issues,” says Joel Ario, a managing director at Manatt Health Care Solutions and a former Pennsylvania insurance commissioner. “That means there will be some cleaning up to do in terms of reconciling accounts and making sure payments are correct and the coverage dates are correct.”

Judimarie Thomas, senior director of external affairs for Independence Blue Cross, agreed that “issues remain” with the back end of the marketplace. She said that the insurer worked through the technology problems of last year and that “we’ll continue to make sure that consumers can enroll successfully in the plans they want.”

Aetna spokesman Walt Cherniak wrote that while his company was encouraged by improvements, “much work remains to be done, including testing and implementing a permanent, fully automatic back-end financial system to reconcile payment, subsidy, and eligibility data.”

It may be the law’s second enrollment but it marks the first time healthcare.gov will manage 7 million people renewing their policies – some of whom will change plans, carriers, or both – while enrolling about the same number of new consumers.

“This year is a different approach than what we had last year given the fact that there is re-enrollment and a new reconciliation process,” says Clare Krusing, spokeswoman for America’s Health Insurance Plans, a trade group.

Consumers will have from Nov. 15 to Dec. 15 to buy or renew their individual coverage beginning Jan. 1, 2015. Returning consumers will have three options: auto-renew in the same plan; pick another plan with the same insurer; or buy a new plan with another company.

Those choosing to auto-renew in a plan that has been discontinued will be placed in a policy with similar benefits and monthly premiums.

Whatever choice is made, it is important for consumers to revisit their application and update their income information. Slight changes in the federal poverty level may affect their subsidies. People who are renewing will have to continue using the old, longer application.

But with an estimated 25 percent increase in the number of insurers joining this year’s marketplace, renewing consumers should take the time to shop for a plan with similar benefits and lower premiums. The government’s Centers for Medicare & Medicaid Services will contact renewing consumers seven times by e-mail and telephone before Dec. 15 to remind them about buying insurance.

“If people would shop, they could find a better deal, particularly if pricing moves around as much as it is with the different carriers this year,” Ario says. “The big question is how many people will actually read the material that comes to them.”

While people are being urged to shop, switching plans is exactly what has insurers worried. Because of back-end communication issues, insurers won’t be able to tell the difference between a customer who has auto-renewed and one who has left for another company.

A termination file will not be sent from the marketplace to an insurer when someone switches companies until after the exchange closes on Dec. 15. So an insurer will not know that it has lost a customer until the reconciliation process takes place.

For consumers who switch, that can mean getting billed for two plans, or worse, getting lost in the system.

If a lot of people switch, it will be a “big workload for the exchange to process,” Ario says.

But it will be an even bigger headache for insurers who will have the tedious task of cross-checking names on each other’s lists.

To minimize the potential for losing data lost in transition, consumers should read all the information that comes in the mail, update their exchange application, and call their insurer or the exchange with any questions.

“There is still work that needs to be done on the back-end system,” Krusing says. “It’s an issue we have on the radar and working toward finding the right solution that works for consumers.”

Categories: Health Industry, Insurance, Reporting Consortium, The Health Law