HealthCare.gov Appeals Process Broken
Appeals of tens of thousands “sitting untouched inside a government computer”
According to internal data gathered by the Washington Post, an estimated 22,000 Americans find themselves stuck in the appeals process after signing up for a health plan through HealthCare.gov. “They contend that the computer system for the new federal online marketplace charged them too much for health insurance, steered them into the wrong insurance program or denied them coverage entirely,” according to the Post. CMS spokesman Aaron Albright was quoted as saying, "We are working to fully implement the appeals system." But while CMS is attempting to fix the problem, thousands of Americans are stuck waiting for their health insurance.
In the meantime, CMS is informing its customers to log back on to Healthcare.gov and start over, saying "We are inviting those consumers back to HealthCare.gov, where they can reset and successfully finish their applications without needing to complete the appeals process."
Reuters reports CMS issued a statement after the Washington Post published its story, stating, "CMS Is working to fully implement an automated appeals system. Until we have that functionality, we are putting in place a manual review process wherever possible and expect hearings to begin soon. In the meantime, CMS is reaching out to these consumers to provide assistance so they can successfully complete their application without the need to complete the appeals process."
According to The New American,” state Medicaid officials and those at the Centers for Medicare and Medicaid Services, consumers are dealing with what have been dubbed “loopers.” These are instances where individuals apply for health coverage and are told that they qualify for Medicaid, but when those individuals report to their state Medicaid agency, they are told that they in fact do not qualify for Medicaid and must pursue private health insurance through the marketplace.”
Analysts have said that the appeals process must begin before March 31, the final date of the Obamacare open enrollment period after which anyone without health insurance would be penalized.
Joe Pitts, chairman of the House Energy and Commerce health subcommittee, expressed his frustration with the appeals breakdown, telling the Reuters, “Over four months after launch, the administration still does not have its act together. They appear to be incapable of addressing Obamacare's failures, unfairly leaving Americans on the hook."