10/25/2014

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KATU Investigators

Man gets Cover Oregon problem fixed but dozens more waiting

Man gets Cover Oregon problem fixed but dozens more waiting

SALEM, Ore. -- Hal Demarest started the new year in limbo, with no health insurance.

He said Cover Oregon, the state's health insurance exchange, mistakenly wrote down the wrong salary on his application. That error denied him tax breaks and subsidies he needed to pay for his vital medications. One day after learning about Demarest's predicament, the On Your Side Investigators pressed Cover Oregon and successfully help the man get health insurance.

"It's a blessing in disguise to have this situation all worked out after the whole mess. Thank you," Demarest said.

Demarest is one of thousands of Oregonians trying to enroll for President Barack Obama's federally mandated health care coverage in a state that's had one of the worst roll outs in the country. Despite a grand vision, an earlier start and millions of dollars from the government, the state's health insurance exchange website, Cover Oregon, has been in shambles for months. More than three months after its Oct. 1 launch date, Oregon's online enrollment system still hasn't enrolled a single person online.

Cover Oregon staffers resorted to hiring more than 500 people to process health insurance applications the old-fashioned way, on paper and through call centers, which staff 125 full-time workers.

While helping Demarest, KATU learned there are dozens of others just like him - people like Ike Anttila.

When applying for health insurance through Cover Oregon, Anttila did everything right. After unsuccessfully applying online, he said he faxed his application to Cover Oregon in early November, confirmed it was being processed, and regularly checked back on the application's progress.

But by December, Anttila learned through a staffer at the Cover Oregon call center, that his application had been held up by an unknown error.

"I finally find out that somebody in the system messed up and they now have to put it through a manual process of re-entering the data," Anttila said.

He further explained, "They told me that there had been an error in the actual entry into the database and the person on the phone - a really nice lady - tells me I am not the only one. There have been a lot of calls about people waiting and waiting and waiting."

Anttila was told his application was stuck in the "eligibility phase” – the phase where applicants are reviewed for state benefits like tax breaks and subsidies through Cover Oregon. He was told that phase is a requirement. However, he no one could identify the source of the problem. That same month, he asked to speak to a supervisor and was told he'd receive a call back. He never got a call back.

Now, two days after the new year, Anttila feels like his application is in a black hole with no idea when it will be processed.

The On Your Side Investigators went back to Cover Oregon for answers. We wanted to know, what happens when errors are made?

Cover Oregon spokesman Michael Cox said, "Any time an error is made, we work hand in hand with the customer to make sure it's resolved. We prioritize those cases where there's an emergent medical issue or a pregnant woman involved."

When asked if Cover Oregon categorized which errors were made, Cox said, "There's no indication that there are any systemic issues or that there's any operational processes that are to blame.”

But Anttila, and others, has been waiting more than a month for a resolution. So if application delays are not due to an error, what causes them?

"There were a number of applications returned to us by Dec. 4, so on time, but they were missing information," Cox said. "We've been contacting customers over the past weeks trying to get information. In those cases, coverage begins at a later date."

Of the 38,000 Oregonians now enrolled with health insurance through Cover Oregon, Cox said fewer than 100 appealed - claiming they had problems with their application and wanted to change information.

For Anttila, it's a disappointing process. He's from Sweden and lived in Canada for many years and he's used to universal health care that works.

"It's a letdown," Anttila said.

If you're applying for health insurance through Cover Oregon, Cox says to call this hotline: 1-855-COVEROR.


Full coverage of the troubled Cover Oregon website:

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