Months later, Gresham woman still wondering if she has health insurance

Months later, Gresham woman still wondering if she has health insurance »Play Video
Laura Sandgren is still not sure if she's enrolled in a health insurance plan. Her insurance provider, Kaiser Permanente, blames Cover Oregon's transfer process for the holdup.

GRESHAM, Ore. – Laura Sandgren thought she did everything right to get health insurance through Cover Oregon, the state’s health insurance exchange. She applied before the deadline, frequently checked the status of her application and even sought the help of an insurance broker to expedite the process.

But Sandgren’s run into problem after problem. After months of waiting, she’s still not sure she’s enrolled.

Sandgren, of Gresham, finally thought her insurance would kick in this week after Cover Oregon confirmed it sent her application to her chosen health insurance provider, Kaiser Permanente.

“The agent had told me that when he spoke to Cover Oregon, they had said, on (March) 11th, my information was sent to Kaiser and they just had to process it,” Sandgren said.

Processing her application would take two weeks, Cover Oregon told Sandgren. She marked her calendar, expecting coverage to kick in March 26.

But on the morning of March 26, when Sandgren called to double-check she was enrolled, Kaiser had no record of her application. Sandgren was dumbfounded.

"I'm just not sure what to do at this point," Sandgren said. "If I get ran over by a random car, I'm supposed to pay for that then?"

Sandgren was counting on Cover Oregon to pull through and start the first of April since she was recently laid off and subsequently about to lose her former employer's insurance on March 31. She didn’t want to be left in the lurch.

"I'm a planner. I don't like relying on other people and their foul-ups," Sandgren said. "It's nerve-racking. Nobody has the answer. The left hand doesn't know what the right hand is doing."

So what happened? Why didn’t Kaiser have her application?

Kaiser believes Cover Oregon’s transfer process is to blame.

See, normally in the insurance world, when someone like Sandgren buys insurance, her information is automatically and securely transferred to the insurance carrier, said Aaron Patnode, Kaiser Permanente's executive consultant regional manager.

But Cover Oregon isn’t set up this way.

“Insurance carriers use a standardized transaction format called an 834 transaction to handle enrollment in health insurance products,” Patnode said. “Unfortunately, Cover Oregon is unable to use this format at this point in time and is using a hybrid process to transmit enrollment information to all carriers selling through the exchange. Due to the nonstandard nature of this process, carriers are having to spend more time than usual processing enrollments from Cover Oregon.”

Instead, Patnode said Cover Oregon transfers this sensitive information through Excel spreadsheets. Not only does that lead to mistakes by manually inputting data on spreadsheets, Patnode said that some applications don’t show up in Kaiser’s system at all.

Cover Oregon spokeswoman Ariane Holm refused to speak to KATU on camera. Instead, she emailed a statement:

“Our service center is looking into Laura's case and will reach out to her if needs be once we know more," Holm said. "As I said before, I cannot give you personal information about her particular situation."

Holm continued, "Our carriers are working hard to process all of the enrollments they've received. They receive thousands of enrollments at a time though."

Luckily for Sandgren, Kaiser said it would take care of people vying for Kaiser insurance plans who had problems enrolling with Cover Oregon.

“Consumers that purchase Kaiser plans through Cover Oregon will receive the full benefits of membership, regardless of whether or not the insurance carrier is initially able to verify consumers' coverage in our systems …,” Patnode said. “People should contact Kaiser Permanente Membership services to schedule appointments and receive services that are available to all members.”

Patnode added that Kaiser still encourages anyone who has yet to purchase coverage for 2014 to also still sign up through the Cover Oregon website.

Gov. John Kitzhaber announced Wednesday that Oregon received an extension to the open enrollment deadline to April 30. Previously, the deadline was March 31. Holm said Oregonians would have time after April 30 to enroll, which she said would give Cover Oregon enough time to process all applications it receives.

"I just want my coverage,” Sandgren said. “That's all I want. I just want my coverage."

Click here for Cover Oregon Q&A about information about application deadline extension.


Full coverage of the troubled Cover Oregon website: