In the most vivid detail yet, Minnesota's top insurers have laid out a list of technological problems that they say may keep people who've enrolled in a health plan from being covered on Jan. 1.
Insurance carriers selling plans on the state's insurance marketplace say enrollment information they're getting from MNsure, is inaccurate and incomplete - and that time is running out to fix these problems.
Some of the problems are similar to ones that the federal exchange, healthcare.gov, is having in the 36 states where it runs the enrollment program.
"At this late date, the health plan companies do not have most of the names or information on individuals who have enrolled through MNsure," Julie Brunner, executive director of the Minnesota Council of Health Plans wrote in a letter to MNsure Executive Director April Todd-Malmlov and Lucinda Jesson, Minnesota Commissioner of Human Services.
The organization represents Medica, Blue Cross and Blue Shield of Minnesota, HealthPartners, UCare and Preferred One - all insurance carriers selling products on the exchange.
One Person But More Than One Application
Some of the enrollment problems appear to be connected to the design of the MNsure site.
At first, people were able to submit multiple applications. That means the insurers have multiple enrollment documents for the same individual.
Brunner's letter provided two examples:
1) "John Smith has multiple records and the records do not match. He has selected two different silver plans and one gold plan."
2) "Jane Doe has two or three records. She has chosen the same product two or three times so her intent appears clear. The health plan must then select which record to use."
Some child-only policies list dependents. Other enrollment documents omit vital information. For instance, if an enrollment form has an incorrect address or leaves out an apartment number, the insurer can't bill the new customer - and withot payment, that new customer isn't covered.
All these flaws mean the insurance companies have had to do a lot of manual work with the files - a big change for an industry that's used to automated operations, Brunner explained.
In a statement, MNsure said, "We have launched a focused effort with the carriers to address these issues quickly. We appreciate their help and expertise to ensure that those that want coverage on January 1, 2014 will have it."
Minnesota Human Services Commissioner Lucinda Jesson, who sits on the MNsure board, said she was surprised by the level of concern the insurers have expressed about the enrollment problems.
"I reached out to the plans to talk to them about working very closely and very hard together together to address each and every one of these concerns."
Everyday, Closer To Jan. 1
Jesson said people who are getting Medical Assistance or MinnesotaCare - the state's programs for the poor, which include Medicaid - can count on coverage on Jan. 1.
Brunner said that there's still time to clean up the data, "but every day that we don't make progress on this list, we are closer to January 1."
To get coverage on the first of the year, people need to sign up for coverage by Dec. 23 and need to pay by Dec. 31.
"The primary concern of MNsure and of the health plans is that people have coverage beginning on January 1," Brunner added. "One of the first components of that is to make sure that the information that is coming from MNsure to the health plans is accurate and complete so that the plans can turn around, reach out and get all the materials out to consumers."
"They can't continue to do this because we expect that there's going to be quite a wave of enrollees coming through this month," she said. "If the numbers ramp-up at the rate MNsure is expecting, there's no way the plans are going to be able to process that many enrollments and do all this manual clean up as well."
Brunner said that the insurance carriers are also concerned that MNsure hasn't been quick enough to tell consumers when they need to pay. She hopes MNsure will do a better job of communicating that in the next few weeks.
Brunner said she was prompted to write the letter after MNsure sent a letter to a slate of Republican state lawmakers who had concerns about MNsure enrollment.
Brunner said that the insurance companies have recommended more frequent meetings with MNsure to tackle these problems and better communication to consumers about where their applications stand.
Last week, MNsure did email many enrollees outlining next steps.
And Brunner made this clear: if people have paid for their plans already - through the MNsure website, for instance - they will be guaranteed coverage on Jan. 1.
People have until March 31 to secure coverage and avoid a tax penalty for being uninsured.
This story is part of collaboration that includes NPR, KHN and Minnesota Public Radio News.