Is this the first moderately big tremor for O-Care on the news wires this year or did I miss something earlier? It’s been so cold in most of the country, I imagine some significant number of new enrollees decided to put off their first doctor’s appointment, which means few cases so far of people discovering technical snafus that have left them in government/insurer limbo.

But now things are warming up.

Insurance companies are still trying to sort out cases of so-called health insurance orphans, customers for whom the government has a record that they enrolled, but the insurer does not. They are worried the process will grow more cumbersome as they deal with the flood of new customers who signed up in December as enrollment deadlines neared.

The government says the problem is real but under control. Officials say the total number of problem cases they are trying to resolve with insurers currently stands at about 13,000. That includes orphan records. More than 1 million people have signed up through the federal insurance market that serves 36 states. Officials contend the error rate for new signups is close to zero.

Insurers, however, are less enthusiastic about the pace of the fixes. The companies also are seeing cases in which the government has assigned the same identification number to more than one person, as well as so-called “ghost” files in which the insurer has an enrollment record but the government does not.

But orphaned files — when the insurer has no record of enrollment — are particularly concerning because the companies have no automated way to identify the presumed policyholder. They say they have to manually compare the lists of enrollees the government sends them with their own records because the government never built an automated system that would do the work much faster.

The key word in the boldfaced bit above is “currently.” The fact that the industry’s still “deal[ing] with the flood of new customers who signed up in December” means there’s no way to really know just how many “orphaned files” — or ghost files, or files with the same ID number — there’ll be. That’s what Obama and Sebelius bought for themselves when they started moving deadlines deeper into December to help boost the monthly sign-up numbers for PR purposes. The less time insurers had last month to process new applications, the more uncertainty there’d be this month as they raced to catch up. Now they’ve got thousands of phantom sign-ups to chase down while claims have already begun to trickle in. All of the deadline-shifting was premised on the idea that Healthcare.gov was more or less fixed, which meant the industry would be able to handle applications expeditiously. Not so. In his last blog post of 2013, Bob Laszewski wrote on December 29th that “very serious back-end issues” are still plaguing the site. He’s the guy who warned from the beginning, in fact, that if HHS fixed the front end to make mass enrollment possible without first fixing the back end to make sure that insurers would get accurate enrollment information, we’d end up with a giant clusterfark of insurers trying to correct glitchy applications at the same time they’re busy fielding claims from new enrollees. This AP story is the first rumblings of that problem. (Laszewski himself is quoted in it, predicting that it’ll become a bigger one as the month wears on.)

But that’s not the only issue. Orphaned files might be the most Kafkaesque logistical headache facing the industry but there are surely more new enrollees who haven’t paid their first month’s premium yet than there are “orphans.” I haven’t seen recent data on that but several big names, including Blue Cross Blue Shield in Texas and Illinois, announced today that they’re extending the deadline for payment from January 10th all the way to January 30th. That can only mean, I take it, that the rate of nonpayment in some plans is significant enough that insurers feel they have no choice but to extend the grace period. The alternative is to void coverage, which is something they’re loath to do to a big bunch of new customers who might seek coverage elsewhere if they’re tossed. As it is, some new enrollees this month will end up incurring expensive new treatments and then cut a check on January 30th to have their new insurer cover them retroactively. That gives you an inkling of how chaotic things must be right now within the industry.