Jan. 06--Many consumers who rushed to buy health insurance ahead of last month's federal deadline are learning that they can't see a doctor this week because their application has not been processed.
The Affordable Care Act has pushed enrollment into a very compressed time frame and some people waited until the last minute to apply. Other factors affecting the crunch: More and more New Mexicans moved to group insurance plans to keep a choice of providers or switched insurance companies altogether, applying for coverage as new customers.
The federal law requires most Americans to have health insurance by Jan. 1 or pay a fine of $325 or 2 percent of their annual income when they file their 2016 tax return -- and there was a rush to purchase plans in December.
"Every carrier is experiencing this," said Amanda Coe, an independent insurance broker in Albuquerque. "This is not uncommon right now. There is delay in all carriers across the nation. There is just a lot going on right now."
Still, her office is getting one or two calls a day from consumers looking for insurance ID cards. She understands the frustration. "I get it," she said. "All people can do is wait, pay out of pocket [and get reimbursed] or just reschedule their appointments."
Sherry Breedlove, a self-employed insurance broker on Luisa Street in Santa Fe, said she still hasn't received her insurance ID card. "Because of open enrollment and the carriers being inundated with numerous applications, they're working overtime to process everyone as fast as they can."
"I wouldn't blame individual carriers," she added. "They're doing their best to get everything out. It's not their fault that Obamacare put this time frame on the market."
New Mexico Health Connections said none of its staff took vacations over the holidays as they worked to process new customers. All of its group insurance customers are now in their system with an identification number and a Jan. 1 start date, a spokeswoman said.
That said, not all the member packets and ID cards have been mailed, said Patty Padon, an executive with the non-profit New Mexico Health Connections.
"Naturally it is a very high volume for us," she said. "We were expecting it. We thought we were ready. It's still a little bit overwhelming."
She said group members who used a broker should call that person for a customer ID number that can be used to access services at a pharmacy or medical office. Some individual customers are not yet in the system, but that is expected to be completed in the coming days.
Part of that problem, she added, is waiting for file transfers from the federal healthcare.gov website operated by the U.S. Health and Human Services Department.
"We have to wait for them to send us the people who sign up with us," Padon said. "I think they are just as overwhelmed as everybody else. We expect that everything will get back to normal and all the ID cards are out in the mail."
Blue Cross Blue Shield of New Mexico sent out an advisory to brokers urging patience.
"We have experienced an unprecedented amount of new small group submissions for 2016," wrote Denise Kawas, director of small group and account management for Blue Cross Blue Shield of New Mexico. "Historically, normal processing times have averaged about two weeks for implementation. However, due to these extenuating circumstances, turnaround times have more than doubled. Taking this into consideration, we ask that you advise your respective employer clients accordingly in order to set appropriate expectations."
She added that customers should not assume they have coverage until the application is accepted.
"Until a group is fully implemented in the system, [Blue Cross Blue Shield of New Mexico, including account executives and Customer Service] cannot verify the group's benefits. Therefore, members may be responsible for costs related to prescription drugs, provider or hospital services and fees.
"Once a group is fully implemented, members may submit claims forms for reimbursement of approved prescription drugs, provider or hospital services and fees. These forms are available on the BCBSNM website."
Janice Torrez, a Blue Cross Blue Shield vice president in New Mexico, confirmed that delays in processing applications involve group plans. She said group plans require more certification and there has been an upswing in those seeking group coverage for 2016.
"This year we've seen a number of individual members enrolling as a group," she said. "It is common to see delays with small groups at the start of the year. We are working through those. We are confident we will get through them."
Unlike Health Connections, the non-profit insurance co-op, she said the groups have to be certified before the company can issue identification cards for health care. Once that is done some of the claims might be reimbursed to the Jan. 1 start date. But that is based on the group being certified and legitimate.
"Once the group is approved, then we'll let them knew they can request an ID card and we'll go from there," Torrez said.
The Office of the State Superintendent of Insurance has, in fact, rejected group status for some individuals applying with Presbyterian Health Plan. Those customers were given the option to switch to individual plans, said Lisa Reid, director of the agency's Life and Health Division.
"You can deem your family members as part of the group if you want to," said Reid, "but groups of one are not allowed."
Breedlove said she moved a lot of customers into group plans when they qualified with other family members or employees.
But she personally would not go see a doctor until she had an insurance ID card, as there is always uncertainty about what is covered.
"If it were me personally, I would just wait until they get their ID cards," she said. "If they haven't gotten an ID card there is no guarantee they will bill the claims correctly."
Contact Bruce Krasnow at 986-3034 or brucek@sfnewmexican.com
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