The new year brings the most personal test yet for President Barack Obama's health care overhaul as millions of patients begin to seek care under its new mandates. The burden for implementing the law now shifts to insurance companies and health care providers.
Dr. John Venetos, a Chicago gastroenterologist, said there was "tremendous uncertainty and anxiety" among patients calling his office.
"They're not sure if they have coverage. It puts the heavy work on the physician," Venetos said. "At some point, every practice is going to make a decision about how long can they continue to see these patients for free if they are not getting paid."
New York is allowing a grace period for those whose policies start Jan. 1 but whose premiums are not due until later. In those cases, state health officials and insurers say people should pay the doctor's bill and then submit it for reimbursement.
It will not be known for a couple of weeks how many of those who signed up for coverage in the exchanges follow through and pay their premiums or how many are stuck in backlogs of unprocessed applications.
In California, employees of the state health exchange were still going through some 19,000 paper applications sent in the early days after Covered California launched on Oct. 1, spokesman Dana Howard said. He could not say how many were outstanding.
The entire tracking system was "in a sort of chaos" Thursday as consumers tried to use or confirm their new insurance, said Kelly Fristoe, an insurance agent in Wichita Falls, Texas.
"I've got pharmacies that are calling in to verify benefits on these new plans that are getting incorrect information," he said. "I have people that are calling to make their initial premium payment, and they've been on hold for maybe three or four hours at a time and then they get hung up on."
People who signed up on the federal website have until Jan. 10 to pay premiums for coverage retroactive to Jan. 1, while consumers in some states have until Jan. 6.
Premiums paid after the deadline will be applied to coverage starting Feb. 1 or later. Consumers have until March 31 to sign up in time to avoid a federal tax penalty for remaining uninsured. That fine starts at $95 for an individual this year but climbs rapidly, to a minimum of $695 by 2016. There is an additional fine for parents who do not get health insurance for their children.
Medicaid, the state-federal health insurance program for the poor, already was experiencing problems in some states.
In Pennsylvania on Thursday, Gov. Tom Corbett's office cautioned that people who applied for health insurance through the federally run website and were found to be eligible or potentially eligible for Medicaid might not have coverage. The state was still waiting for the federal website to transfer electronic files for more than 25,000 applications.
"We are doing everything we can to ensure these individuals receive the coverage they've applied for as quickly as possible," said Eric Kiehl, spokesman for the Pennsylvania Department of Public Welfare.
Anticipating disruptions, major drug store chains such as CVS and Walgreens as well as smaller pharmacies have announced they will help customers with coverage questions, even providing temporary supplies of medications without insisting on up-front payment.
Associated Press writers Patrick Condon in St. Paul, Minn., Susan Haigh in Hartford, Conn., Carla K. Johnson in Chicago, Kelli Kennedy in Fort Lauderdale, Fla., Marc Levy in Harrisburg, Pa., Wilson Ring in Montpelier, Vt., Michael Virtanen in Albany, N.Y., and Gosia Wozniacka in Portland, Ore., contributed to this report.