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Health Team

Providers, patients scramble to prove coverage under health law

Posted January 3

— The extended enrollment period under the Affordable Care Act means few people have proof of insurance that they can present to health care providers as major provisions of the health law took effect this week.

President Barack Obama's administration pushed the enrollment deadline back from Dec. 15 to Dec. 24 because of numerous technical problems with the HealthCare.gov website, leaving insurers with only four business days to verify information and issue 2014 insurance cards.

Veteran Raleigh pharmacist Mike James says customers seeking prescriptions without updated insurance cards – or with no card at all – is part of an annual drill.

"We see this every year, and it becomes a problem, and we have to work through it," James, who works at PSP Pharmacy inside the Carlie C's IGA supermarket on New Bern Avenue, said Friday. "We're seeing patients come in saying, 'I signed up, but I haven't gotten any paperwork, but I'm insured.' And so, we have to work through that with them."

He has spent hours in recent days trying to verify insurance coverage. Existing customers have a leg up because much of their information is already in the system, he said.

For new patients in need, James said he often works out short-term solutions until coverage can be confirmed.

"If that patient comes in and has a blood pressure medicine or blood thinner, something that's very important to them, then we're going to give them enough medicine to get them by until hopefully we can get that straightened out for them and get that processed," he said.

Larger retail pharmacies have also promised to help with the transition to the Affordable Care Act, offering 15- to 30-day supplies of necessary prescriptions for patients caught in the coverage gap. Customers are expected to pay for the medicine once their coverage begins.

James said there were bigger challenges with the transition to Medicare Part D prescription coverage in 2006. But he added that the required coverage provision of the Affordable Care Act is only 3 days old, so problems could crop up in the coming weeks.

"I don't think we're out of the woods, by any means," he said. "I think we've got a long way to go before we get to a point where things run smoothly on a day-to-day basis."

3 Comments

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  • unc70 Jan 3, 6:48 p.m.

    Note there are fewer problems than when Medicare D drug coverage was implemented. The also get a lot of first of the year problems every year as those on Medicare make annual changes to their drug, supplemental, or advantage providers and policies. Lots of people on Medicare have new cards in January. Some of you need to talk to your parents and grandparents. Really.

  • Mr. Hans Jan 3, 6:27 p.m.

    Don't let 'em off the hook. Anyone who didn't jump on board and is found without coverage needs to be fined into oblivion!

  • mep Jan 3, 6:22 p.m.

    Insurance companies wont issue the ID cards for the year until the first payment clears.... Obama and his minions knew extending the deadlines would cause this mess.