Navigating a New Health Plan, After the Surge

YOU’VE no doubt heard about problems some people are encountering when they try to use the health insurance they’ve bought through the federal and state exchanges. A backlog of applications, the result of a surge in enrollments at year’s end for coverage starting this month, has resulted in many people experiencing delays in getting insurance cards, policy numbers or authorization for treatment.

 

Keith Lichtman, an interior designer in Manhattan, knows the problems only too well. He had to pay out of pocket for treatment for strep throat because his doctor’s office could not verify his coverage under a plan he enrolled in through New York’s state-operated marketplace, NY State of Health. He hopes to be reimbursed, but he said a series of missteps since he enrolled has left him frustrated. “There was a real lack of organization in the New York health exchange,” he said, adding that he also got confusing information from his new health insurer.

 

Mr. Lichtman had an individual health plan that, like millions of others, was canceled because it did not meet requirements under the Affordable Care Act. After a few false starts in November — he said he encountered shutdowns at the New York website, and long waits getting questions answered on the phone — he was able to enroll in a new plan through UnitedHealthcare. He paid his first month’s premium through UnitedHealthcare’s website on Dec. 20, and arranged to have his monthly premium automatically deducted from his bank account.

 

When he called to check on his coverage, he was first told that the plan had no record of his first month’s premium, so he paid it again — only to have the first payment show up, resulting in an overpayment. (He requested a credit and has received it, he said.)

 



 

In early January, Mr. Lichtman developed a sore throat and went to his doctor, even though he had not received an insurance card. But the office could not verify his enrollment; a billing clerk tried unsuccessfully to contact both UnitedHealthcare and the New York exchange while he waited.

Mr. Lichtman ended up paying for the visit, as well as for a prescription his doctor gave him for strep. The doctor’s office said it would resubmit his bill and reimburse him once his enrollment was verified.

 

After several tries, he was able to log into the New York exchange website late one night last week to verify his enrollment. Mr. Lichtman has since received his insurance card in the mail. But he said he ran into trouble getting his plan’s computer system to recognize his choice of a primary care doctor, which is necessary before he can get referrals to specialists. He has been told it will become effective on Feb. 1.

 

Mr. Lichtman also said that he received an email notifying him of an additional charge of about $900, which turned out to be a bill for another patient that was mistakenly sent to him.

 

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