Health coverage deadline may be hard to meet in Valley

The Fresno BeeDecember 14, 2013 

In the central San Joaquin Valley and statewide, a deadline is fast approaching for people to enroll in health plans so they can have insurance at the beginning of the new year.

And the pressure is on Covered California, the state's health benefit exchange, to meet an expected surge in enrollment applications before the Dec. 23 deadline.

Open enrollment will continue through March 31 for coverage in 2014, but the push is on to get as many enrolled as possible by Jan. 1.

Covered California says it can handle the anticipated demand. It plans to be open two Sundays, today and Dec. 22.

But not everyone shares Covered California's confidence that all who want insurance will have it by the deadline.

Valley insurance agents and health providers say the state's online system has slowed enrollments, and they suspect the agency will be buried by an expected avalanche of applications between now and Dec. 23.

More than 156,000 Californians had enrolled through Dec. 7, the agency reported Thursday — a greater number than in any state running an insurance marketplace or in states using the federal government's exchange.

Each day in the first week of December, more than 20,000 Californians completed applications and 7,000 enrolled and picked a health plan, the agency reported.

Updated enrollment numbers for the central San Joaquin Valley are expected this week. The latest numbers for the Valley — through Nov. 19 — showed 1,851 people enrolled.

Most of the time, electronic applications filed by enrollment counselors go through, but not always, said Stephen Schilling, chief executive officer of Clinica Sierra Vista, which runs community clinics in Fresno and Bakersfield. "Only in the last 10 days has this smoothed out to where the applications can move into the Covered California site," he said.

Even now, Schilling said, it takes staff up to an hour to complete a Covered California electronic enrollment. In comparison, a Medi-Cal enrollment takes 10 to 15 minutes, he said.

At United Health Centers of the San Joaquin, which is based in Parlier, enrollment counselors are booked with appointments to enroll people in health plans.

More people could be helped, said Norma Macedo, director of special projects, but processing applications has been laborious. Enrollment counselors haven't been able to connect with Covered California's online system and instead fill out a 36-page paper application.

"We've been doing paper all along," Macedo said. "We've had a total of three online applications we've been able to submit."

Macedo said her counselors also have been told paper applications that were incomplete would be sent back for the counselors to finish and submit electronically.

"We're hoping we have very little returned," she said, "but we need to get a tally as to how many we'll be getting back."

Covered California has acknowledged a backlog of 20,000 paper applications, but the agency said the applications were being processed.

The applications have been assigned to certified insurance agents to complete or do some electronic data entry, said Dana Howard, the agency's deputy director of communications. Half the applications have been handled and the remainder will be done "in just another couple of days," he said.

But certified insurance agents in the Valley said they're expecting long hours transferring information on paper applications into the online system.

Cala Carter of CCIS Insurance in Fresno has mailed 10 paper applications. She doesn't know if she will get those back to resubmit electronically. But when she checked their status online last week, none were in the electronic system.

Having to check and validate "where we're at on each application is frustrating," she said.

Covered California also is asking certified insurance agents to contact people who started online applications but stopped before completing them. About 40,000 electronic applications were partially completed by consumers, Howard said.

The agency has come under criticism for potential privacy violations by releasing information to insurance agents, but Howard said no violations have occurred. The agents are part of Covered California's enrollment team who have legitimate access to enrollment applications, he said.

Covered California officials also have said agents were given only contact information for applicants — not income data or Social Security numbers.

Debbie Chaffin, a Fresno certified insurance agent, said she has tried to enroll clients in insurance plans and has been locked out of the Covered California online system.

She had no luck getting help when she called Covered California. "I know they're real busy, but that's no excuse," she said.

Last week she had an appointment to help a business owner enroll in health plans offered through Covered California's Small Business Health Options Program. Covered California began accepting small business online applications this month.

"I have a lump in my stomach just knowing what's going to happen," Chaffin said. "It's just one thing after another. It's almost impossible to get someone enrolled."

Covered California has not had widespread reports of computer access problems from insurance agents, Howard said.

The online enrollment site has the capacity to handle an increased volume of consumers enrolling, he said. But people who need help will need patience, he said.

Many people need assistance — either in person or by telephone — to enroll, and waiting times to speak to enrollment counselors at Covered California have averaged 36 minutes. "They may have to put the phone on speaker and multi-task while waiting for someone to come on the phone," Howard said.

Yer Lee, 23, of Fresno, said she tried to enroll online a couple of weeks ago, but the system was so slow that she stopped the application. Last week she attended an enrollment event at the Center for New Americans in southwest Fresno.

Yer makes about $15,600 working two part-time jobs — as an in-home caregiver and at a medical counseling office. She has had insurance through her father's health plan that will end this year, and she is afraid to be without coverage.

Last year, she spent a few hours in a hospital emergency room. The bill was $2,000, she said. Insurance covered much of it, "but I still had to pay about $500 out of pocket."

Isabel Garcia, 51, of Fresno, also came to the Center for New Americans for help and learned she qualified for Medi-Cal. "It's a relief," she said.

A caregiver for her mother, Garcia said she hasn't had insurance in about nine years. Three months ago, she had emergency gallbladder surgery. She has been afraid to look at the hospital bill and hasn't scheduled follow-up doctor visits since the surgery. "It's like $90 for just a visit," she said.

Open enrollment will continue through March 31 for coverage in 2014, but the push is on to get as many enrolled as possible by Jan. 1.

The reporter can be reached at (559) 441-6310, banderson@fresnobee.com or @beehealthwriter on Twitter.

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