Got health coverage? Prove it!

How widespread are proof-of-coverage problems? Fort Myers News-Press took an extra step to find out.

If insurance exchange shoppers thought their trials would necessarily end once they were—finally—able to log on and do the hard work of selecting and purchasing a plan, they were mistaken. A more recent problem: new insurance enrollees unable to confirm that they’re actually covered as they wait and wait for an invoice from their carrier, or an insurance card, or, even, timely assistance from customer service. In the past couple weeks, WNYC, the Fort Myers (FL) News-Press, and the Philadelphia Inquirer have reported on customer frustrations with local Blue Cross Blue Shield carriers (the major carriers in these places), only to encounter their own frustrations in the form of less-than-forthcoming officials. All three news outlets were able to bring human faces to the problem—thanks in part to social media—if not always official numbers or even full explanations. Let’s take a closer look at the three efforts and what reporters can learn about covering this ongoing story.

In a January 14 piece, WNYC’s Fred Mogul told the story of a Long Island man who enrolled in an Empire Blue Cross plan and then “kept waiting and waiting and waiting” for his insurance card, apparently going without medical attention for a “severe stomach bug” as he waited. Wrote Mogul:

People have been complaining for months on Facebook and Twitter and elsewhere about New York’s state insurance exchange. The problems have been similar to those nationwide: crashing web pages, long wait times on phone lines, customer service representatives who promise to help and then don’t deliver.

Mogul did try to learn why the state’s biggest insurer couldn’t process applications in a timely way, but ran into a PR roadblock from Empire Blue. A spokeswoman spoke, but didn’t really say much. Empire also told Mogul that it was adding phone operators and sending letters to customers telling them they’d get the paperwork as soon as possible, whatever that meant. Mogul didn’t get much more from exchange executive director Donna Frescatore, who doesn’t say much to the media anyway and manages her words carefully. She told Mogul, rather vaguely: “I don’t have a ballpark number [of people affected by Empire’s back-end enrollment issues] but I certainly think it’s enough. We’ve heard it enough times to know that it needs immediate action.” She acknowledged the problems go back to at least November. Why didn’t she require the company to fix them? And if the exchange doesn’t know how many people have been affected, then who does? This is hardly helpful to journalists trying to write a fair story.

On January 24, the Inquirer wrote about Independence Blue Cross in Philadelphia and Horizon Blue Cross Blue Shield in New Jersey “dealing with a wave of disgruntled customers, who are complaining on social media of long waits for service and an inability to confirm coverage.” On Horizon’s Facebook page, the Inquirer found one customer who “groused that she spent 36 hours on the phone trying to resolve enrollment issues that ‘were entirely your [Horizon’s] fault.’” The rest of the piece, however, is lent to the insurance carriers, who assure readers that the backlog is “improving,” and that it stems from the Fed’s decision to shorten the enrollment deadlines. Horizon says it tripled customer service staffing and delayed the payment due date for a month, while Independence posted an apology to members experiencing delays (though the paper doesn’t say where). Independence Blue’s Brian Lobley, a senior vice president for marketing and consumer business, got ten (albeit short) paragraphs to explain away the problems, including how the carrier was “taken by surprise” at the length of the customer service phone calls. “We have folks who are new to insurance, and they are not four-to-five minute calls,” he said. No kidding. Buying insurance is a complicated business. Not addressed in the piece: What’s the scope of the problem in people terms— as in, how many people have complained? What has the state insurance regulator said or done?

Earlier this month, a reader called reporter Frank Gluck of the Fort Myers News-Press complaining of troubles getting the paperwork for newly-purchased insurance. Gluck called the health insurance navigators for southwest Flordia and they, too, had heard complaints. Still, Gluck wanted to know how widespread these proof-of-coverage issues were—something beyond a few anecdotes. An open records request to the Florida Division of Consumer Services indicated 42 Floridians had made formal complaints about Florida Blue’s back-end enrollment issues issues between December 1 and January 21. That’s not a small number, Gluck reasoned, especially when he found a total of five complaints filed against four other large insurers during that period. And what about consumers who didn’t—perhaps didn’t know to—file formal complaints? He also learned Florida Blue had been telling customers to submit their complaints to a company website. He checked it out and, yep, lots of people were complaining (as of this writing, 144 comments—including the company’s responses—have been posted since January 11). In short, the News-Press gave readers a more complete picture of what’s going on than did the Inquirer or WNYC.

Historically, when consumers have had insurance complaints, they’ve gone to their state insurance departments—and often got help resolving their problems. I phoned the New York Department of Financial Services whose insurance division I assumed knew something about Obamacare complaints. No one returned my call. I checked out the “How to File A Complaint” section of the department’s website, and learned the department gathers information on compliance with insurance rules but “cannot attempt to resolve or otherwise handle every individual complaint.” There’s not much help there.

The Pennsylvania Insurance Department did return my call, and press secretary Rosanne Placey tried to answer my questions. “Since the roll out of the exchanges, the health bureau of our consumer services unit has been receiving about 40 to 70 calls a day,” she said, adding they have been about everything from non-functioning websites to cancellation notices. “This has been a time of unprecedented confusion for healthcare consumers,” she said. The department tells consumers to first try to resolve the problem with the carrier, but if they can’t, they can contact her department. The regulator will try to resolve the complaint with the insurer. “We don’t ever offer complaint tallies from the consumer division that are company-specific.”

This little exercise suggests another under-explored story thread: What protections or recourse do Obamacare shoppers have when things go wrong? Where can they turn in this “time of unprecedented confusion,” as Placey put it, if not the insurance carriers or the state insurance regulators? I’ll discuss that in another post.

Follow @USProjectCJR for more posts from this author and the rest of the United States Project team.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman. Tags: , , , , ,