New Year's Day marks the official start of Obamacare coverage, but the problem-riddled rollout of the online federal exchanges is having another unintended consequence: Some who signed up won't be able to go to the doctor or get the prescriptions they need in early January.

The Obama administration over the last month has worked to ramp up enrollments in the online health care marketplace by extending the deadline to sign up by a week. But those deadline delays and the late surge in applications caused headaches for many insurance companies who couldn't process all of them quickly enough for coverage to begin on Jan. 1.

Many of the insurance companies involved are taking unprecedented steps to compensate for the enrollment backlog, offering to extend the deadline that consumers must pay for their first-month premiums for days or weeks while they rush to get the first bills to customers.

As of Monday, only about half of enrollees for plans offered by more than 100 insurers had paid their first month's premium, the Wall Street Journal reported. Over the last two days, payment premiums have been flooding in, making it difficult to assess what percentage of people can be confident of their coverage.

“At this point we've sent out all the invoices for January,” Mark Waterstraat, chief strategy officer for Benaissance, a third-party billing firm that works for more than 100 insurers in 17 states, told the Washington Examiner.

He said his company is working overtime to process enrollees' checks and take online payments by phone.

“The last two days we've been slammed, and the payment processing center has had record volumes,” he said.

As a general rule, insurance companies don't provide coverage until consumers have paid their first premium. Because of the backlog, however, many companies are instructing people to continue going to the doctors and getting prescriptions as needed even if they haven't received confirmation of their first payment as of Wednesday.

The insurance companies will spend the next days and weeks determining whether people paid their first month's premiums and will provide payments to doctors and hospitals afterward. If consumers don't pay their premiums by the new deadlines, however, they likely will face a hefty bill for any January doctor visits.

The backlog and new deadlines are causing widespread confusion among those who waited until late December to sign up on the federal exchanges. Waterstraat is urging any consumers who are unsure of their status to make sure they've paid their bill — either online or through regular mail — so they can be confident they have “turned on” their insurance.

“Any consumer who believes they have finished their [health care] shopping experience and has not had an opportunity to pay” needs to make sure they have done so in order to be confident of their coverage in January, he said.

While the Obama administration has spent the last week touting the late surge in enrollments, officials are nervous about January snags.

Health and Human Services Secretary Kathleen Sebelius on Tuesday said 2.1 million people had enrolled so far but declined to say how many Americans had actually paid for their coverage.

Before the botched launch of, the administration originally had the goal of signing up 3.3 million Americans by the end of December and 7 million by the end of March.

The current enrollment numbers are more than a million short of that goal, but the administration's more immediate public relations concern is whether those who signed up encounter confusion and problems verifying their coverage when they go to the pharmacy or the hospital.

The administration is encouraging people who signed up to call their insurers to verify their coverage but also has set up a call line staffed by 10,000 agents to help people who encounter problems.

“If anyone is having problems tomorrow, if they go to a pharmacy, if they go to a hospital and there's no record, they should call that number; the insurer could call that number; and we'll be able to determine in five minutes whether or not they properly enrolled,” White House health policy adviser Phil Schiliro told MSNBC on Tuesday. “If they have a bigger problem, then we will assign a caseworker to it, and we'll try to get a resolution as quickly as possible.”

The White House this week launched a new public relations social media blitz touting positive anecdotal stories of those who already benefited from Obamacare to help boost numbers.

“Today, lifetime limits are gone, those with pre-existing conditions have protection, and there are millions of newly insured Americans,” Sebelius tweeted Wednesday.

Insurers and other health industry groups,, however, were encouraging people who signed up to make sure they have coverage.

“Most of the marketing has been about getting people to come and shop because there have been challenges in getting large number of people ... there has been such a focus on shop, shop, shop, sometimes the basic blocking and tackling — the ‘oh, you have to pay’” has taken a backseat, Waterstraat said.