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Doctor’s Office Spends 2 Hours On Hold With Health Insurer For Patient’s Surgery Authorization

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Certified Enrollment Specialist, Marlene Nesmith, waits on the HealthCare. gov website that reads, "HealthCare.gov has a lot of visitors right now!" as she waits for it to allow her entry into the Affordable Care Act website at a Miami Enrollment Assistance Center on Dec. 20, 2013 in Miami, Fla. (credit: Joe Raedle/Getty Images)

Certified Enrollment Specialist, Marlene Nesmith, waits on the HealthCare. gov website that reads, “HealthCare.gov has a lot of visitors right now!” as she waits for it to allow her entry into the Affordable Care Act website at a Miami Enrollment Assistance Center on Dec. 20, 2013 in Miami, Fla. (credit: Joe Raedle/Getty Images)

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CHICAGO (AP) — The new year brought relief to some Illinois patients newly insured under the nation’s health care law. Others still weren’t sure whether they were covered, despite their best efforts to navigate the often-balky new system.

The major benefits of President Barack Obama’s health care overhaul took effect Wednesday, the first day of 2014. By Thursday, the first business day of the new insurance system, it became clear that snags in the rollout of the Affordable Care Act still remained.

On the plus side, the law’s protections mean consumers can no longer be denied coverage if they’re in poor health. New limits on how much insured patients must pay for care will mean fewer bankruptcies after catastrophic illnesses. Insurance plans must offer a minimum level of essential benefits, and care such as flu shots and mammograms will be fully covered without cost to patients.

But early problems with the federal HealthCare.gov website led many people to wait until last week to sign up, and insurers are still processing enrollment forms.

Paperwork problems almost delayed suburban Chicago resident Sheri Zajcew’s scheduled surgery Thursday, but Dr. John Venetos decided to operate without a routine go-ahead from the insurance company. That was after Venetos’ office manager spent two hours on hold with the insurer Thursday, trying to get an answer about whether the patient needed prior authorization for the surgery. The office manager finally gave up.

“I’m not a happy camper,” said Nate Zajcew, the patient’s husband. The couple signed up for a Blue Cross Blue Shield bronze plan through the federal HealthCare.gov site on Dec. 16. “I understand it’s just a matter of paperwork and yesterday was a holiday. I can be an SOB, too, at times, but since they’re going on with the procedure, it’s OK.”

Venetos, a Chicago digestive system specialist, described “tremendous uncertainty and anxiety” among patients calling his office recently. Some thought they’d signed up for coverage but hadn’t received insurance cards yet. Others had insurance policies that were canceled and weren’t sure if their coverage had been reinstated after Gov. Pat Quinn decided to allow one-year extensions of canceled plans.

Venetos said he has decided to take a risk and provide care for these patients, at least until there’s less confusion about coverage.

“We feel it’s the right thing to do,” Venetos said. “We may end up stuck holding the bag and not getting paid on these claims.”

Blue Cross Blue Shield of Illinois, which has the most customers in the state’s individual market, has been adding staff and extending call center hours to keep up with demand. “Every week we’re adding staff to our call centers and we’re also enhancing our call routing features to better serve our customers,” said spokesman Greg Thompson.

In the southern Illinois city of Benton, 61-year-old Nancy Pace spent part of New Year’s Day calling Blue Cross Blue Shield to make certain she and her husband were covered by the silver plan they chose on the troubled federal insurance website. “When you get to where it says ‘Pay for your policy,’ well, that button doesn’t work,” Pace said.

Calling the insurance company worked: Pace paid and got her member number over the phone.

“I made a phone call. I pushed the right button and got a live person,” she said.

Pace, a stroke survivor, said she hasn’t had good insurance since her husband lost his job when the mining machinery plant where he worked closed in 2005. The Affordable Care Act means better health care for her and her husband, she said, but she has doubts.

“My biggest concern is, how long is this going to last? How long can our country bear this expense?” Pace said. “It’s a benefit for us right now. But I don’t see how it can possibly be sustainable. … Am I going to use it? You bet I am. For one thing, it’s a law. I don’t have a choice.”

(© Copyright 2014 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.)

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