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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Coverage Denial

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Question: I am suffering from metastatic breast cancer and have been treated for several months. Now I am being told that my insurer will only pay for 4 office visits and 300.00 of lab work a year. Can they suddenly change my coverage like this after my deductibles have been met?

Answer: Thanks for your question. Your insurance company cannot change your coverage as a result of claims submitted. There are several possibilities regarding what's happened here and I'll run through the ones I can think of. First, it may be that your insurance company has withdrawn your old plan from their portfolio and placed all members in a new similar plan type, i.e. they have not targeted you specifically. If this is the case they would have written to you to give you notice of the change, usually 60 days prior to the change. Second, and this is the most likely scenario, your plan has always been structured in this way and you need help from your broker or your insurance company to understand how it works. In actual fact, this should be part of the education process when you buy a plan. I can get you started on understanding your plan if you can give me the names of the plan type and insurance company.

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