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."
Full coverage of the troubled Cover Oregon website:
- State granted one-month extensioin for Cover Oregon enrollment
- First Data report: Cover Oregon didn't have federally required backup plan
- Watch: Your Voice Your Future Town Hall: Cover Oregon
- Cover Oregon confessions: Are they playing games with your health?
- New report answers many Cover Oregon questions - often for second time
- Cover Oregon directory Goldberg resigns; Governor releases investigation findings
- Cover Oregon: Still pushing for deadline extension
- Oregon tied for last in nation for young-adult health-insurance sign-ups
- Cover Oregon: Apply now if you want health insurance this year
- Federal government announces Cover Oregon investigation
- Former Cover Oregon director says 'all of us' share blame for failures
- Top Cover Oregon official refuses to discuss Lawson resignation
- Official: Oracle not allowing Cover Oregon probe access to 6 employees
- Trouble with Cover Oregon? You may still get federal tax credits
- Cover Oregon website developer pulls 100 worker off project
- Ex-Cover Oregon website chief: 'I stuck to the talking points ... they were not accurate'
- High-level IT consultant on Cover Oregon: 'They didn't know what they were doing'
- New Cover Oregon allegations: 'If it's true, someone's going to prison.'
- Paging Dr. Kitzhaber: What did the governor know about Cover Oregon collapse?
- State rep., U.S. Senate candidate calls for the end of Cover Oregon
- Cover Oregon head: State might scrap all or part of failing website
- State lawmakers to grill Cover Oregon chief
- Family struggles to sign up for insurance through Cover Oregon
- First legal complaint filed over health enrollment mistakes
- Democratic state lawmaker believes Cover Oregon can be saved
- Contractor plans to examine why Cover Oregon failed
- 'We look like fools:' A history of Cover Oregon's failure
- State rep: Ditch Cover Oregon in favor of federal exchange
- Video: Exclusive Interview: Gov. John Kitzhaber - Cover Oregon 1/9/2014
- Gov. denies prior knowledge of Cover Oregon failure, exits exclusive KATU interview
- Kitzhaber outlines Cover Oregon's next steps: 'I can't give you a date'
- Kitzhaber: Firm will review Cover Oregon failures
- Cover Oregon applications left in limbo?
- Man with cancer waiting on Cover Oregon, gets insured
- Man with cancer still waiting on Cover Oregon
- New calls for Cover Oregon to take responsibility for project failures
- Rocky King, director of troubled Cover Oregon, resigns
- Salem man says Cover Oregon error left him in health care limbo
- Some question if they'll be covered by Cover Oregon in the new year
- What doomed Cover Oregon? 'Mismanagement,' say former employees
- After resigning, Lawson not talking about Cover Oregon website failures
- Ore. health official in charge of building Cover Oregon website resigns
- Fewer enrollments challenge Oregon exchange budget
- Executive director of Cover Oregon taking medical leave
- Cover Oregon considers new solutions
- Kitzhaber calls for independent review of Cover Oregon
- New emails show Cover Oregon unraveling in days before launch
- Emails: Cover Oregon executive knew about website problems in May
- Cover Oregon complicated by state's grand vision