Speak with a Covered California certified agent! Call (888) 413-3164 or Shop Online Now

Shop and Compare

California Health Insurance Plans and Rates

It's easy. Just enter your zip code.

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.


Enrollment Extension for January 1st?

By on | 71 Comments

Question: Peter Lee is quoted in the Wall Street Journal saying if you made a good faith effort to start, you can finish up later. What is actually being offered in the way of an extension beyond December 23rd?

Answer: Covered California’s Certified Insurance Agents have been notified that they can continue to assist consumers to enroll for a January 1st effective date of coveragefor applications keyed into the CalHEERS system by 6:00 p.m. on December 28th.

71 Comments

With all the confusion and misinformation that HHS and the news media have caused here in CA by reporting on the problems with www.healthcare.gov — which have absolutely nothing to do with CoveredCA, the federal government should simply have said a long time ago, “Just enroll. We don’t care when you do it in 2014, just get yourself enrolled in health insurance. We’ll waive the shared responsibility payment for 2014, because we screwed up so badly, as long as you enroll in a health plan by December 1, 2014.” Hey! There is still time for HHS to do that.

The mistaken impression appeared to be higher up the management chain. Not wishing to speak for Michael, I’ll let him explain how far up it went or how much work it took to correct it. But the problem has been corrected, at least for now. I wonder how persuasive this problem is at other clinics though. I’m going for my own check up at the same medical center in a few days. Then I’ll see since I have the same Blue Shield family insurance card.

Daniel, I’m happy to see that Michael Freedman was able to help straighten out the confusion.

Did you figure out what the problem was? Was it just that the receptionist at the doctor’s office was mistaken and poorly trained?

I’m just thinking that understanding how your problem was resolved might also help others who are running into similar barriers.

You wrote, “Incredibly there are still health care providers who think that a Blue Shield medical card with the Covered California logo is to be treated differently than one without the Covered California logo” — so it sounds like Michael might have had to really do some legwork to educate the people at your medical group.

Just a warm thanks to Michael Freedman for his help in getting our Blue Shield insurance through Covered California sorted out. My wife went in for her new doctor’s appointment this last Thursday without a problem. Incredibly there are still health care providers who think that a Blue Shield medical card with the Covered California logo is to be treated differently than one without the Covered California logo. I’ll be going to my own doctors appointment later this week but since my wife and I are on the same policy that shouldn’t be a problem. Here’s hoping.

I submitted my first months premium after receiving a letter from Amthem saying that they have my application. I ca8lled and they told ME I was in the system but had not received the check yet. This was 3 weeks ago, mid December. I have called to no avail only to get a recording saying that they cannot take any calls because every rep was busy. It is not Jan 8 I have NO insurance covereage due to Aetna, My former ins. co. dropping all their ppos in California on December 31. I did what I was suppose to do, met all the deadlines, and have NO INSURANCE!!! When do I know if I have it or not and what happens if I have to go the doctor or worse yet, hospital!!

Michael, I called Anthem and they said there is a Prior Authorization process for the Silver plan, and the Select Drug List. Will now have to see if I can get the drugs preauthorized. If they do not get preauthorized, then we have to pay full retail price, which does not get applied the deductible or annual out of pocket. Nexium is a Tier 2 drug. Her other drug, I won’t mention, is a Tier 3 drug, and the most expensive. I am fairly confident the Tier 2 Nexium drug will get preauthorized, but not so confident about her Tier 3 drug.

To clarify, both drugs combined are around $1000 total per month (not $2000). So we are about breakeven on just these two drugs. But wife has a lot of doctors, and all of them are in network with her grandfather plan, and out of network in the Silver plan.

Stanford Hospital is our hospital of choice, which is in the Silver network, and grandfathered network.

Once we get through the preauthorization process this month, and see what is, and is not covered, we will then decide which plan to drop.

Daniel wrote:

“Obviously I’m not the only one who has been victimized by sloppy and downright deceitful insurance officials who still think they can victimize a helpless citizenry without consequence.”

Why do you assume that it is the insurance officials who lied to you with their lists — rather than the medical group or particular doctor and that doctor’s staff?

If a doctor was not on the network, they would say so— that is, they would say that “we aren’t on the Blue Shield (name of network)”.

When someone makes a statement such as “we don’t take Covered California” or “we don’t take Obamacare” — that sounds to me more like a political statement, and suggests discrimination. (They’ll take patients who are financially well off enough to pay out of pocket for premiums or who have employer-subsidized insurance, but not anyone taking money from the government).

You could be right and the problem may lie with the insurance companies, but I am skeptical that the company would list doctors on their networks without any basis for doing so. These doctors may be violating their agreement with the insurance company.

I think that your case with the legislators will be a lot stronger if you do your homework and start, as I suggested, by contacting an administrator at the medical group. Try to get statements in writing (email is acceptable) — if not, get the full name of the person you talk to along with job title, and note the date and time of your conversation, and try to write down exact quotes. Look at your Blue Shield card and ask if they accept the plan by the name Blue Shield has given it (not the Covered California) name. If they say no — then ask why they are listed on the Blue Shield site as being in-network — ask for specifics, like when they notified Blue Shield that they were withdrawing from their network.

If they say that they do take the plan, but not Covered California — then you would have an admission that they are violating their agreement with Blue Shield and possibly violating the law.

Max wrote: “Unless it is a large group plan, the so-called grandfathered individual plans ended in California on December 31, 2013. “

That statement is NOT TRUE.

There are many individuals on grandfathered plans going forward — if a plan was grandfathered, and that individual had been on that plan since prior to March 23, 2010, the date of passage of the PPACA - then that person has grandfathered status.

The people who received termination notices (myself included) were those who had changed plans on the individual market after March 2010.

The relevant date is when the person was first enrolled in the individual plan. In the group market, a later-enrollee could have the benefit of the earlier enrollment dates of other group members — that is, a new employee hired in 2012 could sign onto a grandfathered plan, so long as it is the same plan that the company was using in early 2010.

But on the individual market, each plan stands alone, except for within families. If a family had a plan in 2010 and children born in later years were added to the same plan, then all would be grandfathered.

Please be careful about your choice of words. I understand your frustration but it is not going to help if you cause more confusion — such as causing confusion for individuals who do have grandfathered status on non-ACA plans.

Hi Joey.

Yes, you’re spending $1,000 in premiums for the Grandfathered plan to save $2,000 in drug costs.

Are you also certain that you are both eligible for tax credit and cost sharing reduction assistance with a Covered California plan? It seems likely you are as Grandfathered plans are not minimum essential coverage. If other minimum essential coverage is available then a tax subsidized Covered California plan is not.

Prescription Rx drugs are not covered by the plan if you go out-of-network. There is generally no need to buy your prescriptions from an out-of-network pharmacy or mail order pharmacy as there are many many in-network pharmacy options/locations.

There is also then no additional $5,000 out-of-network deductible at issue with regard to Rx drug coverage.

Drug co-pays or drug co-insurance amounts (15% co-insurance under the Silver 87 plan) DO get applied to your plan’s annual out-of-pocket calendar/plan year maximums, but not to your plan’s $500 each deductible.

If the drugs are covered, they’re covered under your plan.

And that IS the rub, “if covered…”

As to Anthem’s Select Drug List and its conflicting language, you do give me pause… and re-open issue of my past inquiry with Anthem about “Anthem has criteria that permits a member to obtain a non-covered medication in a closed drug list plan.” I now wonder if I spoke in haste that Anthem will cover drugs under any Anthem ACA-compliant plan. Anthem’s language does leave me with some doubt.

Anthem’s Select Drug List clearly states that if a prescribed drug is not on the Select List then: “If your doctor prescribes a drug that’s not on the Select Drug List, you will have to pay the amount described in your policy for non-formulary drugs.” Well, that sounds okay. The implication is that any prescribed drug is still covered, at minimum at the non-Formulary co-pay or co-insurance amount.

However, and this is important to note, further Anthem language conflicts with Anthem’s statement, which is that: “Please note: In selecting medications for the prescription drug list, the therapeutic efficacy and cost effectiveness are addressed for each category. All therapeutic categories are represented on the drug list by at least one medication. When a closed drug list is in effect, only medications that are included on the drug list are a covered service. In certain clinical situations, a member may require use of a non-covered product. Anthem has criteria that permits a member to obtain a non-covered medication in a closed drug list plan. If specific criteria are met, a member can receive a non-covered drug for a drug list co-pay. The criteria preserves the clinical integrity of the drug list and provides a process by which deviations from the drug list may be allowed. An appeals process is in place for any medications that do not meet the criteria.”

Your doctor(s) can make requests to Anthem to have your drug added to the Select Drug List.

There is an appeals process of “which deviations from the drug list may be allowed.”

Additionally, pre-approval and appeals process requirements seem also they could potentially conflict with Anthem’s statement where it says that if your prescribed drug is not on the Select Drug List then “you will have to pay the amount described in your policy for non-formulary drugs.” Again, the implication of this wording is that the Anthem Select Drug List is a closed drug list, yet if a drug outside of this List is prescribed it will be covered at the health plan’s stated cost for “non-formulary drugs.”

I’ve previously inquired with Anthem about their Drug List information, and received unsatisfactory Covered California type answers, meaning that the conveyed information was not appropriate to fully address the inquiry. Previous requests for the Evidence of Coverage (EOC) for each health plan were also denied because they were not ready or yet to be published. Maybe with health plans now becoming active as of January 1st, Anthem finally has EOCs, where the finer details of plan benefits and coverage are conveyed. I have yet again to inquire for these EOCs to be sent to me.

Maybe others here have some clear answers to clarify the situation.

I am very interested in what Anthem will have to say and relay to you when you call to inquire about your and your wife’s drug coverage under your new Anthem plan.

Good lucking in speaking with them. Please relay your findings.

Max, regarding all Individual/Family Grandfather plans being forced to cancellation on Dec. 31, 2013, this is NOT the case. Anthem Blue Cross, as well as Blue Shield of California, as well as Kaiser ALL have members who will continue coverage with an Individual/Family Grandfathered plan. I have clients on Grandfathered plans with all three carriers.

Health Net, however, did cancel all their plans as of January 1st, 2014, even the Grandfathered plans.

“Get it?”

Yes, of course I “get it”. I was simply trying to point out that your post made it appear that premiums were included in the annual out-of-pocket expense limit — which is not correct.

There is no good reason for a person to have two health plans. It happens when husbands and wives cover each other and/or their children under group insurance plans, but coordination of benefits provisions determine which plan is primary, so one cannot pick and choose which plan to use on which occasion or for which benefit.

And if a person has employer-sponsored coverage, then they are ineligible for premium tax credits, so applying for additional health insurance through CoveredCA is inappropriate.

“keep the Grandfathered plan”

Unless it is a large group plan, the so-called grandfathered individual plans ended in California on December 31, 2013. The five potentates otherwise known as the CoveredCA Board of Directors decided that none of the IFPs can be continued in 2014, refusing to follow the desire of their leader, Mr Obama.

I am correcting my previous post. The Silver 87 plan has an in-network $500 deductible, and $5000(not $10k) out-of-network deductible.

The annual out of pocket in-network max is $2,250, and $10,000 max out-of-network.

Because of “Balance Billing”, everything I said in my previous post, regarding my possible options, still apply.

Because Balance Billing amounts are not applied to the $10k out-of-network maximum, the potential out of pocket payments are limit less.

Michael, Thanks for the offer to help.

You probably know this, but by law, Pathway X and Pathway must have the same network of doctors. Doesn’t matter if the plan is Bronze/Silver/Gold, or purchased directly from Anthem.

Cheng and Weissman both currently show in-network. Not sure why you couldn’t find Cheng. In Find a Doctor, type in zip 94539, 5 miles distance, and Cheng will show up.

Weissman only practices at the Menlo Clinic. The Crane St address is the Menlo Clinic. On the Anthem website, the Menlo Clinic isn’t mentioned, but Weissman shows his Affiliation with Stanford Hospitals and Clinics (Menlo being one of the Clinics). He also shows Affiliation with University Healthcare Alliance, which Menlo Clinic is a member.

My only confusion is how the drugs are dealt with. If I buy a brand drug, I don’t believe the difference I pay above the generic price will be applied to my in-network deductible. It might apply to the out-of-network deductible, which is $10,000 for the Silver plan, but I am not sure.

Also, the new Anthem Select Drug List document makes it appear that there is no way to get a drug preapproved. It appears prior authorization is not available for drugs not on the Select Drug List.

Per the Select Drug List Q&A

Question. What if my medication is not on the Select Drug List? Answer. You may want to first check with your doctor about prescribing a drug that is on the Select Drug List. If your doctor prescribes a drug that’s not on the Select Drug List, you will have to pay the amount described in your policy for non-formulary drugs.

There is no mention of prior authorizations. I need to call Anthem to find out if we can continue to get prior authorizations for drugs not on the Select Drug List. And if the drug is not pre authorized, how is the amount paid applied to the deductible, if any.

As an FYI. We are enrolled in the Silver 87 plan. We only pay $83 per month, with a $500 in-network Deductible, and $10,000 out of network Deductible. My wife currently pays $977 for her $1500 deductible grandfathered plan. With the $977 plan, she still keeps all her doctors in-network.

Two of her brand drugs cost a little over $1000 per month. If we can get prior authorization on these drugs, then it might make sense to cancel her grandfathered plan and keep the Silver 87 plan, and pay the out of network prices for her doctors, even with a $10000 deductible. If the prior authorization doesn’t pan out, then we will likely cancel her Silver 87 plan.

Thanks for the comments and support. I am preparing for battle tomorrow to get satisfaction for me and my wife. I have sent my post to president, governor, senate and representatives on both fed and state level. Also to Covered California consumer protection and FTC and anyone else I can think of. Obviously I’m not the only one who has been victimized by sloppy and downright deceitful insurance officials who still think they can victimize a helpless citizenry without consequence. The ACA is now the LAW and I fully expect someone will pay attention to me if I scream loud enough. I will hang on the phone and internet tomorrow. I still have several ideas on how to get my wife the care she needs. We paid we get service, simple as that. If I can’t get a fair resolution I will definitely contact you.

Max, the point is that if Joey and his wife are buying two (2)different health policies just for her, then if her Grandfathered plan is costing them $500/month, it likely makes sense to move-on from the Grandfathered plan, and take that $500 out of their pocket each month they’d be spending anyway and apply it toward the one single Covered California Anthem plan as the annual out-of-pocket limit under the CovCal plan has a maximum of $6,350 anyway. Get it? Drugs ARE covered under a CovCal Anthem plan. Just buy the drugs at higher co-pays or percentage instead of paying $500 a month in premium for another plan which covers the drugs.

Usually the best reason to keep the Grandfathered plan is access to providers as Grandfathered plans maintain the same previous and larger 2013 provider networks.

Anonymous Agent wrote: “An issue is that Health Net offers only the weak Bronze plan in Southern California.”

Actually, in the areas where their plans are offered, HealthNet does NOT offer a BRONZE plan, but DOES offers SILVER, GOLD, and PLATINUM plans. In fact, HealthNet’s Silver plans tend to be the lowest-priced plans. Almost all of my Inland Empire clients who selected silver plans chose HealthNet.

HealthNet does seem to have a somewhat smaller provider network than either Anthem or Blue Shield, but does includes some of the better hospitals in certain areas. In Southern California, the smallest networks belong to Molina and LA Care — owing mostly to the fact that they have concentrated on serving Medi-Cal patients until now.

Michael Freedman wrote: “If your wife’s Grandfathered plan costs more than $500 per month, that’s already $6,000 in annual premium, so rather have your Covered California Anthem plan, with an annual out-of-pocket annual maximum of $6,350 or $4,000 be your maximum financial exposure.”

Premiums are NOT included in the annual out-of-pocket expense, and it appears that the statement above is comparing apples to oranges.

What is true is that persons with significant health care expenses CAN reduce their out-of-pocket expenses by selecting a gold or platinum plan — the extra several hundred dollars in premiums can be offset in part by the $2350 reduction in maximum out-of-pocket limit, but is also reflected in substantially reduced copays and coinsurance which makes reaching the out-of-pocket limit even harder (meaning total annual expenses can be much lower in exchange for the added premium).

As Michael stated: DO THE MATH! Don’t just look at the raw premiums.

Joey -

It looks like David S Cheng is not in the Anthem Pathway PPO Network at all, through Athem’s search tool.

Seth Weissman is in the Anthem Pathway PPO Network, yet keep in mind that doctors contract with more than one medical group, and not all medical groups contract with an insurance carrier’s specific carrier provider network. Even Anthem’s search results for Dr. Weissman do not list his association with a medical group.

Yes, many to most people are losing access to some or all of their doctors. Goes to show that “affordable care” is neither necessarily affordable or predominantly about care. The arrangement IS very much about benefit to insurance companies. Same with Romney Care, same with Hilary Care. It’s “insurance company care.” The ‘care’ and ‘affordability’ for members are seemingly secondary.

Yes, in addition to provider networks being pared back very significantly, so have drug formularies. And particulary Anthem’s drug formulary which has been reduced VERY significantly, meaning more drugs will cost more.

For you however, is it worth the cost to pay for a Grandfathered plan for your wife in addition? Your Covered California health plan has a maximum annual out of pocket maximum of $6,350 for the Bronze, Silver or Gold plan, or $4,000 for the Platinum plan. Maybe purchasing a stronger Covered California health plan with stronger Brand drug co-pay coverage (and higher monthly premium) will be better? Do the math. Her drugs, if medically necessary, WILL still be covered under any Covered California plan. Platinum and Gold plans have no Brand Drug deductible and Platinum plan’s Brand Drug co-pays are quite low.

If your wife’s Grandfathered plan costs more than $500 per month, that’s already $6,000 in annual premium, so rather have your Covered California Anthem plan, with an annual out-of-pocket annual maximum of $6,350 or $4,000 be your maximum financial exposure.

As for pre-authorization for drugs, this procedure is required and supposed to be “expedited” to a few days only if deemed medically necessary by a physician.

Feel free to contact me to discuss if you like. My contact info through Covered California top-of-page Find Help Near You blue link. Then ‘Find an Agent’, search for me by name, my contact info is there.

I don’t know about the accuracy of Blue Shield’s on line list of doctors in/out of network, but Anthem Blue Cross’s is very inaccurate.

There is no way anyone can depend on BC’s “FIND a DOCTOR” look up feature. When clicking on their FIND A DOCTOR, there is a momentary message that flashes by and says “Y00711418323_R CMS Approved 12/23/2013 Last Updated 12/23/2013”

Example 1 - David S Cheng 39275 MISSION BLVD STE 203,
FREMONT, CA 94539 Alameda

FIND A DOCTOR says he accepting the “Anthem Blue Cross Silver Direct Access, a Multi-State Plan-CA” I call his office and I am told “We do not take Obamacare insurance”.

Example 2 - Seth Weissman 1300 CRANE ST,
MENLO PARK, CA 94025 Anthem’s website says he is accepting “Anthem Blue Cross Silver Direct Access, a Multi-State Plan-CA”.
Seth Weissman is one of approximately 50 doctors that work at the Menlo Medical Clinic. The Menlo Medical Clinic is affiliated with Stanford Hospitals and Clinics.

Per an insurance administrator at Stanford Hospital, Stanford Hospital IS in network with CC, but not any of the Stanford Doctors or doctors at the Menlo Clinic. Per his email on Dec 19 - “Pathway X and Pathway have the same network of providers. Stanford doctors and the Menlo Medical Clinic Doctors are not in network for either network.”

Pathway X is the CC network, and Pathway is the network for 2014 policies sold by Anthem on Anthem’s website.

The shrinking networks is a disaster for me and my wife. All of our doctors have been switched to out-of-network.

Besides the limited Network, the new Select Drug List is a disaster. Brand name drugs are no longer on the Drug List, such as Nexium. Nexium used to be on Anthem’s PPO formulary drug list, but is still on the Medicare drug list. Go figure. But Nexium has been removed from the new 2014 Drug List. We will now be in a waiting mode as we try to get preauthorization for all my wife’s drugs.

The drug costs alone are more expensive than her Anthem grandfathered insurance policy. So right now she has two policies, the Anthem CC policy, and her Anthem grandfathered policy which covers all her drugs. If she cannot get the drugs preauthorized under the CC plan, then she will have to keep her very expensive grandfathered plan.

Thanks Freelancer, and yes, you’re correct.

Yet it is better to be thorough, in particular for other readers with varying situations.

To Michael Freedman —

You’ve made some very good suggestions to Daniel as to how to get medical care — but I have verified that the medical group where he made his appointment is listed as being on the Blue Shield 2014 PPO network. There are no EPO’s in Southern California — for Blue Shield most of the EPO’s are in Northern Cal plus a few regions in the central state — so Daniel would have a PPO.

Daniel, is there an administrator you can talk to at San Bernardino Medical Group? I also have Blue Shield via Covered California so I checked the provider listing for my policy- and you are absolutely correct — that medical group and doctor ARE listed as accepting all of the 2014 Blue Shield plans.

So either that receptionist was poorly trained and should be reprimanded, or else the Medical Group is trying to do something that is probably illegal: discriminate against Blue Shield policy holders who purchased their policies via Covered California, while serving those who bought identical policies from the company. I know for a fact that the insurance cards for the plans bought on and off-exchange look identical except for a slight variation in group number, and the Covered California logo in the upper right corner of the CC plans.

I’d suggest that you start by calling the phone number of the medical group at http://www.sbmed.com/contact/ and ask to speak with some one with knowledge of insurance coverage. Explain to that person what you have posted here: that you are newly insured, that their group listed on your insurance company’s web site as being in-network, but when your wife arrived for her appointment, they refused to accept her insurance card or allow her to see the doctor. Don’t get angry: try to use the phone call to either confirm or deny whether they accept the plan — refer to the plan by the name printed on your card (that is, the name that Blue Shield has given it).

I think that if they accept the Blue Shield plan but are turning away patients with the Covered California logo on their cards, then that is something to take up with Blue Shield, Covered California, and the state insurance commissioner. If they are not accepting Blue Shield plans, then you should notify Blue Shield of your experience. The phone lines are jammed now, but that should dissipate— I think you will be able to reach someone if you call later in the week.

Hi Daniel Palacios.

Sorry to hear of your and your wife’s experiences with coverage for Jan 1st.

A couple plus things:

1.) make sure to FIRST select the appropriate and correct PLAN or NETWORK when searching for providers at Blue Shield or with any health insurance carrier. DO NOT currently rely upon the Covered California provider search function. Search for providers only at each carrier’s website (which it sounds you did do). If you have a Blue Shield EPO plan, then you must first select the ‘2014 Individual and Family EPO Plans (including Covered California)’ option, or if you have a Blue Shield PPO plan, then you must select the Blue Shield ‘2014 Individual and Family PPO Plans (including Covered California)’ option. ANY metallic level sub can then be selected.

2.) if your wife is unable to make a timely and necessary appointment with any doctor, then to meet her immediate medical needs you may want to go to Urgent Care, which will be timely, and will cost you a flat-dollar co-pay under any metallic level health plan you may have enrolled in. The Bronze plan Urgent Care co-pay is $120 (not the greatest, but still decent for Urgent Care) and the Silver plan has a $90 co-pay for Urgent Care. Gold and Platinum plans have even lower Urgent Care co-pays.

3a.) you may also want or need to change carriers depending upon which actual health insurance carrier provider network your and your wife’s doctor is contracted with (if at all). In the manner in which it sounds your wife’s doctor’s office treated her, you/she may want to find another doctor anyway…? (not sure, of course).

3b.) you can change your health plan and health carrier, or do so by re-applying altogether (Covered California does not even know which at this point, so says the manager I spoke with on the Covered California agent-only phone line), and you can do this plan change or re-application through Covered California while the current Initial Open Enrollment is still open through March 31st, 2014.

4.) you may be right about your consideration of fraud, I’m not certain. At minimum any information incorrectly or in error given to you, upon which you base your decision for health plan enrollment, and is somehow substantiated, constitutes (upon a claim and/or some sort of proof) a Qualifying Event with a 60 day window opportunity to change plans and/or carriers outside of Open Enrollment. Yet, we’re still in the Initial Open Enrollment which currently does give you latitude through March 31st, 2014, to change health plans.

5.) if you’d like to discuss your options I’d be glad to assist. You can search for me through the Covered California website (best when logged-in). Go to the top-of-page ‘Find Help Near You’ blue link, type/search for an Agent with my name, Michael Freedman, and my contact info is there.

Best to you.

Dan.

Gratefully, Health Net now DOES post clear and useful information on their homepage at healthnet.com.

An issue is that Health Net offers only the weak Bronze plan in Southern California. And in most California counties (like Alameda, Santa Barbara, Sacramento, Ventura, Fresno, and more) Health Net is not offered at all.

And then still, for all the time consuming hard work agents do to assist clients with enrollment into a Bronze plan, Health Net pays only $30.00 to an agent. That’s it, nothing more… ever. This is equivalent to $2.50 a month for the first year, with not a cent more, ever. It’s really quite incredible.

I and my wife Patricia signed up for Covered California early to avoid a last minute rush to get medical insurance coverage under the ACA. We qualified for a subsidy and chose a plan under the provider Blue Shield of California. In December of 2013 we were finally registered and paid our January premium and received our insurance cards. We sensibly made appointments early with doctors listed under our selected plan at the Blue Shield web site. My wife’s appointment was on Jan. 3, 2014 with Tamseela T. Awan MD at the San Bernardino Medical Group-1700 Waterman Ave, San Bernardino, CA. My wife went to her appointment at the specified time and was told by the receptionist that “we don’t take covered california!” My wife pointed out what we are insured by Blue Shield not Covered California but the receptionist repeated her claim and refused my wife to see her doctor at the appointed time under insurance that we and the federal government have paid for. My wife left the medical center in tears. She is a diabetic and desperately needs to see a doctor. We spent the rest of the day trying to communicate with Blue Shield but phone lines and websites are not working. One person that was in the cashier section we managed to get on the phone couldn’t even find our records and could not refer us to anyone with authority. My wife is getting no support for rescheduling an appointment and it may make weeks to reschedule a new doctor appointement. If she cannot get to a doctor in January it means we have paid our first months premium for medical services that were not delivered. I believe this constitutes fraud. The government should be concerned since under the ACA they pay the majority of our medical premium as a subsidy. We are people of modest means and I am retired but not yet qualified for Medicare. My wife is self employed. We simply cannot pay for medical insurance without help. Covered California was an answer to our prayers but now it’s a nightmare. Please help!

The information I provided previously with regard to Kaiser offering a different premium payment deadline for each enrollee, who each will then have sufficient time to make payment —deadline based upon when Kaiser actually processes each enrollee’s application— comes from speaking directly with the Kaiser IFP Broker Services unit. I also inquired if this general rule could extend some premium payment deadline dates into February, and the answer replied was ‘Yes.’

Maybe Kaiser Broker Services got it wrong, maybe Kaiser Membership got it wrong, or maybe Kaiser Membership gave you a Jan 15th premium payment deadline date specific to you and your specific enrollment situation.

We’ll see.

Kaiser has extended the payment deadline for the January premium to January 15th. This appears to be a blanket extension, not an extension on a case-by-case basis.

This info comes from a call to their general Member Services line at 1-800-464-4000. Any call to that number begins with a message apologizing for long wait times and then the above info on the extension.

Dan …

I understand your frustration. The insurance companies bear some of the responsibility for this, but you also have to realize that CoveredCA changed the game on them at least twice with only two weeks to go in the year — moving the original deadline from December 15 to December 21, then December 23, and extending even that to December 28 for certain folks who couldn’t exactly beat the system on December 23.

Now, with thousands of new, last-minute enrollees, they have to contend with a multitude of issues not of their own making.

Yes, this whole thing has be a PR nightmare on all levels. There definitely needs to be better communications from the top down. But at this point in time, most of the players continue to do what they have been doing all along — point their fingers at other who they say are to blame.

CoveredCA bears the largest share of the blame as far as I’m concerned. They are understaffed and their systems could not handle the traffic. What staff they have — especially the CSRs — were poorly trained and many were not empowered to do more than give answers that seemed to come from a playbook. At least the ones I talked to were pleasant, and I tried hard not to take out my frustrations on them — they are very minor players in the bureaucracy.

But as they did with the SHOP program, CoveredCA should have acted as the single payment receiver for all of the health plans. One place for everyone to pay, one set of instructions, and CoveredCA should have been responsible to provide temporary ID cards to those who paid premiums. Unfortunately, they chose not to do this on the individual side.

I have no explanation for why Anthem cannot find a person who has made a payment in their “system” and issue them ID cards. ID cards themselves are no guarantee of coverage, but they give people peace of mind. And that’s what many of you are missing at the moment.

Insurance is not supposed to create that opposite effect.

Given the current situation I can not believe that insurance companies web sites do not post upfront a CLEAR MESSAGE with instructions for payment (link , phones) , if you are insured after payment how to manage without ID, if they are waiting for subsidy from government and process everything in late spring, I mean what are the current steps to follow and what to expect. What are they thinking these CEOs and their vice presidents and managers??? Are they living on a different planet and they think their company phones are working??? Are they expecting that several hundred of thousands of people should find the info on various blogs??

To make a payment for the first month’s coverage for ANY Covered California insurance company, see https://www.coveredca.com/PDFs/HowtoMakeaPayment.pdf for instructions. You might need to be “in the insurance company’s system” in order for the payment to be accepted.

Max,

The website https://service.healthplan.com/ is redirected from https://service.healthplan.com/blueshieldca/binder

This is the same site given by Blue Shield on the phone when you call 1-888-256-3650. Just the short one. By an extraordinary coincindence this “false” site knew the monthly payment-CC subsidy with two decimals for my insurance. On the bank CC statement is ” Blue Shield pending”

So just call the Blue Shield number above, choose the payment option and they will give the http address above. The long one which is the same as the short one.

Health Net has also now extended Covered California Health Net plan first premium payment deadline to Friday, January 10th, 2014.

Confirmed!

Freelancer,

Thanks. I found another way to pay for Blue Shield insurance.
https://service.healthplan.com/

This is a site just for billing. I was able to register without insurance ID just last four SSN numbers. The system recognized me (Yupii!) and posted the right amount to pay for the monthly premium. I paid by CC. I am relieved for now…

Both Blue Shield of California and Anthem Blue Cross have extended the premium payment deadline to Friday, January 10th, 2014. Confirmed!

Blue Shield is making automatic robo-calls to each enrollee and supplying a phone number to call to make payment. Blue Shield payment can be made online as well (recommended).

In order to make premium payment with Blue Shield, you must be processed in their system first so that when you register online as a new member you and your information can/will be recognized. Blue Shield is to mail an invoice to each enrollee with the enrollee’s new member number and payment information (you could call them after their processing but before your invoice arrives in the mail, but likely difficult to reach them). Blue Shield expects by January 3rd, 2014, to have everyone who applied by the Dec 23rd, 2013, enrollment deadline to be processed, and invoices to be mailed out.

To make your Blue Shield payment online, go to: .. http://service.healthplan.com/blueshieldca/binder

Here is a direct number for Blue Shield which MAY help to make a payment: ….. — (855) 836-9705

Anthem is sending out an invoice to each enrollee, and on this invoice will be an Application Control Number. This Application Control Number MUST be used to make premium payment with Anthem, and no later than January 10th, 2014. Anthem has a url to go to make payment:
https://shop.anthem.com/sales/eox/payment/enroll/landing/CA

or mail your Anthem premium payment paper check (though not recommended for time and proof sake), with a copy of your invoice letter (if you have it) and your App Control Number written on your check to:

Anthem Blue Cross P.O. Box 9041 Oxnard, CA 93031-9041

Kaiser has extended the deadline for each enrollee, and on a per enrollee basis. Kaiser will send out an invoice to each Kaiser enrollee based upon when Kaiser gets to processing each application. Kaiser will send out a mailed invoice to make premium payment with a payment date unique to each enrollee, and with sufficient time for each to make such payment.

._______________ . .

I have yet find out about Health Net payments procedures, or other carriers.

Please DO NOT make your payments payable to Covered California. Make premium payments payable to your health insurance company only.

You’re buying health insurance from a private health insurance company, NOT from Covered California.

If you applied after the Dec. 23rd deadline, yet before and up until the additional Dec. 28th 6PM deadline, likely allowances will be made for enrollees to make later payments to still receive a January 1st, 2014, plan effective date.

Good luck all!

Quote: ” I LEFT THE COUNTRY. I WANT TO PAY NOW I CANT FIND WHRE ONLINE TO DO THAT”

Blue Shield will accept a credit card payment by phone and provide you with a confirmation number.

The number is (800) 393-6130, Monday – Thursday 8 a.m. – 5 p.m. PST, Friday 9 a.m. – 5 p.m. PST.

You have at least until January 6th to make payment. I would recommend that you call as soon as possible, and prepare to be on hold for awhile. (I always use a phone that can be set to “speaker phone” so that I can put down the handset and do other things while waiting on the call).

imy group # is X0001000 effective today but I have been out of the country til midnight last night. I need to make my payment that was due yesterday but I didnt get the notice before I LEFT THE COUNTRY. I WANT TO PAY NOW I CANT FIND WHRE ONLINE TO DO THAT

i tried to get to service.healthplan.com/blue shieldca/binder and cant find the pay here…..

Dan, I hate to put you through the horrors of hold again, but if you have a credit card, I’d suggest that you call Blue Shield again and put your binder payment on the card. That’s what I did in December — they never did bill me.

I did call Blue Shield today and I think the hold time was only about 45 minutes for me, so maybe it’s a time of day thing. (Or maybe I lost track of time). Anyway, I’d suggest that you try on Thursday or Friday (Jan 2 or 3). Jan 6th is a Monday and Mondays are always the worst for getting through on the phone.

Blue Shields seems to be a mess. It was impossible for me to contact them today , all day including waiting two hours on the phone. Just to see if CC delivered my enrollment data from December 18 to them. I have to pay by 6 January still no invoice no bill I have no idea if I am really enrolled although in the CC account I am.

Max Herr wrote:

“The statements that have precipitated all of this seemed to indicate that ANY application submitted by an agent before the 12/28/2012 6:00pm deadline would be honored as a 1-1-2014 start date. So I will simply leave everything alone and help my clients to argue their cases after the fact.”

I certainly did NOT have that understanding — i thought it was VERY CLEAR that the only applications that the agents could be submitted were applications that had been initiated by the Dec. 23rd deadline, but had not been completed due to technical issues.

My friend who had that problem tried unsuccessfully to submit on 12/23, called CoveredCA on 12/24 and was signed up for a policy effective 2/1, and then saw his policy start date reset to to 1/1 at around noon on 12/27 - the transaction data on his account shows the changes being made by a CoveredCA agent (or at least by someone with a different name than the insurance agent).

Obviously I can’t see the “Job Aid” that was sent out — and it’s unclear from your post whether you were trying to help a client who had started an online app within the time frame. I have been told by CoveredCA that the procedure for the reset is to “terminate” the previous request and resubmit, but I can also see that the transaction log shows the sequence going back to the date of signup.

I understand your frustration but, at least from your post, it is not clear whether the client you were trying to help met the criteria or not. If so, then obviously the client should be entitled to the same benefits as my friend and everyone else who was online on or prior to 12/23 trying to enter data and select a plan for themselves.

After spending over an hour and thirty minutes on hold with CoveredCA, then speaking to a “su pervisor”, I was told, unequivocally, that only applications begun prior to December 24 that inadvertently show 2/1/2014 start dates were eligible for application date resets, and that resetting the dates on any other applications I was told by this supervisor “is lying, and I hope you don’t do that, but it’s your choice.”

So I have no idea who to believe.

I do know that through my agent portal I can create an application with any submission date I want. But I don’t want an innocent client to be railroaded out of the system, and I certainly don’t want to jeopardize my license. So I am at a complete loss as to what I am really supposed to do.

The statements that have precipitated all of this seemed to indicate that ANY application submitted by an agent before the 12/28/2012 6:00pm deadline would be honored as a 1-1-2014 start date. So I will simply leave everything alone and help my clients to argue their cases after the fact.

This will be better, at this point in time, than doing something that could officially be labeled a crime.

Max Herr wrote: “IF COVERED CA CANNOT DELIVER the enrollment information within seven days, then I’ll know for sure exactly how screwed up things are in Sacramento.”

But step #2 is the INSURANCE COMPANY taking that information, getting it set up in their own database, and generating an email and paper invoice. Yes, it is theoretically possible for that process to be automated on the insurance company end and done very quickly — but that was not my experience with Blue Shield last fall. I enrolled in early Nov. but never received an invoice from BS, and only received a written notice that they had my app around the 2nd week of December — also, no emails and BS said that they didn’t have my email address.

I know you are telling your clients to call in, but if the insurance company doesn’t have the account set up at the time of the call, then they won’t be able to accept payment.

CoveredCA sent out a “JOB AID” to insurance agents late yesterday (after 6:00pm) with instructions that purport to give step-by-step instructions on how to change application dates to 12-23-2013, which effectively require resubmission of the entire application.

Except that the directions provided do not work. As a result of following the instructions, which failed at the point of “Terminate Participation” by not “dynamically displaying” the carrier authorization. Continuing on my own to try to terminate the coverage applied for, now the client has a start date of 2-11-2014 instead of the 2-1-2014 he previously had, which should be 1-1-2014 as promised by CoveredCA for all enrollments submitted before 6:00pm today 12-28-2013.

It’s now 1:10pm, and after about 15 redials, I finally made my way into the Customer Support phone line at 12:00 noon, and will try to resolve the issue with someone on the other end of a phone line.

This completely SUCKS! Heads should roll in Sacramento. However, I’m sure Monday’s press release will exude honey and syrup about how many wonderful people have signed up for health insurance (which is probably far short of expectations prior to October 1).

Freelancer wrote: “I’m not an agent, but if I were — I wouldn’t be taking calls from new clients wanting January coverage right now.”

Well, I AM an agent, and I will be happy to take your calls today, December 28. (909) 865-7873.

You may also call me any other day, but the earliest your coverage will start will be on February 1.

Freelancing Family wrote: “what if our child qualifies for medi-cal but we the parents do not and we would like our child to remain outside medi-cal, how do we go about that?”

Your only choice in this situation is to forgo premium tax credits entirely and apply for coverage outside the exchange. But even then, the agent and/or insurance company is supposed to let you know when you/your child is eligible for Medi-Cal and recommend that to you first.

But outside the exchange, you have the freedom to do as you choose — the government could care less because you will not be eligible for tax credits, and you will relieve them of the responsibility for your child’s health care expenses.

If you need the tax credits, however, then you will have to estimate your 2014 income as being above the 266% children’s Medi-Cal threshold (using at least 270% FPL as Phil suggests), knowing full well that when the 2014 verification cycle comes around in October that your child may once again be subject to forced Medi-Cal enrollment.

People have to understand that the PPACA was intentionally designed to (1) deny tax credits to many upper middle income families under the assumption that these persons are employed and have group health insurance available to them, and that this is patently unfair to self-employed persons, and more importantly, (2) to add as many people to the Medi-Cal/Medicaid rosters as possible.

This latter purpose was really the only need the PPACA should have ever addressed — but that would have clearly exposed the much larger welfare nature of the PPACA to public view, and the realization that this can only be accomplished with massive income tax increases — not the petty taxes on tanning salons and durable medical equipment. And the tax increases are sure to come in the next few years.

When a substantial number of persons are added to the Medi-Cal/Medicaid rosters across the country, those folks are more likely to continue to vote for politicians who promise not to take away their “freebies” — similar to the campaign-donating seniors who belong to the AARP and protest most loudly whenever there is talk of modifying Medicare benefits. Keep them happy and your reelection is assured.

Freelancer wrote: “are all of these consumers who waited until the third week of December to apply now going to become so proactive that they call the insurance companies on their own?”

I have been telling my late enrollees the last two days to call on January 2 or 3 to make their payment arrangements — that the insurance company should have their enrollment information by then. And if not, they are to call me and I’ll check directly with the insurance company.

IF COVERED CA CANNOT DELIVER the enrollment information within seven days, then I’ll know for sure exactly how screwed up things are in Sacramento.

Michael Freedman wrote: “I asked for this as a clear statement and/or in writing from Covered California, yet he said this was not up to him and is not available.”

Just like the words of an insurance agent who says anything necessary to make the sale, including outright misrepresentations, without something in writing, you cannot rely on the spoken words of anyone at CoveredCA.

The agency is making up its own rules on a day-by-day basis and announcing nothing in an affirmative manner on its own. The Board of Directors is its own little empire of shameless non-accountability.

Freelancing Family, Use 270% of FPL just to be on the safe side. That’s $52,700 for a 3-person household.

Michael wrote:

“Payment needs to be in by Jan 6th as the “binder payment” in order to effectuate coverage. “

That deadline was set with the idea that the deadline for enrollment was Dec. 23rd. Now we have things pushed out to Dec. 28th.

I don’t see how the insurance companies are even going to have the information on hand in order to accept payment. I suppose it is possible that they have now perfected the handling of data transmission and automated their systems to the point where all the insurance databases will be updated with correct and complete information from CoveredCA when the phone lines open at 8 am on Monday morning Dec. 30th…. but I am not so optimistic. I have a feeling that there are going to be a lot of people who don’t receive invoices or any other communication from the insurance company until after the January 6 (or 10th?) deadline has passed.

I completed my app with CoveredCA around Nov. 1, and had not received any sort of correspondence from Blue Shield or invoice by mid-December. I ended up calling their customer service number to arrange a credit card payment by phone. But are all of these consumers who waited until the third week of December to apply now going to become so proactive that they call the insurance companies on their own? And even if they do, are the phone lines going to be open?

They’ve got to add at least 5 days to the payment deadline to compensate for the 5 extra days CoveredCA has now granted to complete the unfinished apps from Dec. 23rd— they simply need to create sufficient turnaround time to allow the insurance companies to receive and process the info, and to mail out invoices to their new customers.

Freelance… I think you’re guessing wrong about insurance carriers sending out nag letters. Payment needs to be in by Jan 6th as the “binder payment” in order to effectuate coverage. Carriers quite clearly state that without binder payment one will not become active and one will have to fully reapply.

Yet in speaking with someone on the agent ‘Bridge Line’ about a couple weeks back, he stated repeatedly when asked (asked several times), that should an applicant not be able to make payment by the deadline of January 6th, 2014, as no fault of their own, then such applicant could still make payment and would be able to still make later payment to have coverage initiate retro-actively to January 1st, 2014.

I asked for this as a clear statement and/or in writing from Covered California, yet he said this was not up to him and is not available.

Freelancing family asked, “If we were to estimate on the high side to just avoid the three of us falling into medi-cal, how much would that need to be?”

If you estimate a household income above 138% of the FPL, then the adults will qualify for subsidies. The child will still qualify for MediCal under CHIP.

Here’s a link that shows the FPL rates by household size: http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html

If you do the math, you’ll see that that the 138% cutoff for the 3-person household is a little under $27,000

” Also, what if our child qualifies for medi-cal but we the parents do not and we would like our child to remain outside medi-cal, how do we go about that?”

That depends on the child’s age — see http://www.ihps-ca.org/resources/cach_programs.html for a summary of California

If your income is truly variable across a broad range from year to year, you might just want to estimate on the high end — for example, if you could make $60,000 in a good year and $15,000 in a bad year, just guess the best case scenario, as long as it doesn’t put you outside of subsidy range. Otherwise you could have a bigger problem on your hands with the clawback provisions, requiring you to pay back the subsidies down the line.

” Ideally we would like to be able to have the Gold Blue Cross EPO for ourselves and our child or the Gold Blue Shield PPO for our child”

I’m confused by your posts because you seem to have expensive tastes in insurance policies but are worried about family income being too low. Unless you have significant assets, you might find yourself signing onto plans you really can’t afford. A cost-sharing Silver (available to those with lower income) can be a lot better deal than the Gold.

“If we buy our child’s policy seperately from ours, directly from the carrier, do we only enter 2 for our household?”

No, you are still a 3 person household, but you would pay full cost for your child’s coverage.

“Finally, we read that only an insurance agent can get the application backdated, how do we go about getting an agent to do this for us?”

Did you set up a Covered California account and begin an application on or prior to 12/23? If you didn’t at least get started on the app by then, you would be too late to get coverage for January 1.

Assuming that you did have an in-progress app at that time, then you really should be contacting an agent ASAP instead of posting questions to an online blog. The deadline to complete the application is Saturday, Dec. 28th, at 6pm.

I’m not an agent, but if I were — I wouldn’t be taking calls from new clients wanting January coverage right now. This last extension is meant to help the many who were online trying to finalize their applications by the Dec. 23rd deadline, but ran into technical problems (like my friend who did everything but wasn’t able to complete the final step of submitting a signature). It’s not really meant for people who are still in the process of exploring options post-deadline.

But there are agents who apparently still are hungry for business, so you can call around and try.

Keep in mind that the rush is for coverage to begin on January 1st. You still have until January 15th for coverage to begin on Feb. 1st. I do think you should find an agent to work with you. Just go to the Coveredca.com web site and click the “Find Help Near You” button.

Also, since you seem to be waffling on the MediCal decision, you don’t have to worry about the start date if you get MediCal — in fact, with MediCal you can get payment retroactively for expenses already incurred.

If we were to estimate on the high side to just avoid the three of us falling into medi-cal, how much would that need to be? Also, what if our child qualifies for medi-cal but we the parents do not and we would like our child to remain outside medi-cal, how do we go about that? Ideally we would like to be able to have the Gold Blue Cross EPO for ourselves and our child or the Gold Blue Shield PPO for our child (his doctor is on this one and ours is on the epo). If we buy our child’s policy seperately from ours, directly from the carrier, do we only enter 2 for our household? Finally, we read that only an insurance agent can get the application backdated, how do we go about getting an agent to do this for us? We’ve been doing this by ourselves until now.

Dale asked:

“And how can people pay for their premiums prior to receiving a letter from the carrier?”

I think that everyone needs to contact their carrier directly to arrange for payment.

I anticipate that there will be a lag time between when the policy is set up via CoveredCA and when the insurance company has information on hand to accept payment, but that the insurance companies will figure out a way to deal with that.

Insurance companies are already equipped to deal with retroactive reinstatement of policies for nonpayment - if you’ve ever seen a cancellation notice based on nonpayment you’ll know the routine. The letters usually say something like “your insurance has been cancelled due to nonpayment of premium; payment of past due amounts must be received by (future date) in order to reinstate your policy effective (past date).”

So I am guessing that around the 2nd week of January, the insurance companies might send out nag letters to anyone who signed up but hasn’t paid — and maybe even send out a second round of letters into the month of February to try to catch up the January payments. The companies understand what has been going on — they are going to want to keep their customers.

While insurance companies have historically not been particularly good in the customer relations department, I would hope that some would also realize the value of engendering a sense of customer loyalty in a new marketplace where it will be easy for people to switch during the next open enrollment period. I’d also note that if a person “loses” their policy due to nonpayment because they couldn’t figure out how to pay in time, that in itself is reason to allow them to select a different policy from the exchange. Some will be in the unfortunate position of having major medical expenses in January that are uncompensated because of the insurance problem, but the majority will be able to transition to a policy effective February or March.

Spoke with a few contacts at CovCal.

Work-around to be sent or posted this afternoon to this evening. Some issue with the work-around instructions yesterday, so was not posted.

Looks like the work-around will be for agents only, not for consumers. And it is to make the APPLICATION DATE prior to Dec 23rd. So Dec. 22nd. Change plan effective date right near beginning of the application.

If already signed by consumer, then no access, of course, because info is locked, so will then have to withdraw and re-start application.

Work-around application can be initiated AND signed by agent, or if already started by consumer, then finished and signed ONLY by agent.

Good luck!

Spoke with a few contacts at CovCal.

Work-around to be sent or posted this afternoon to this evening. some issue with work-around instructions yesterday, so was not posted.

Looks like the work-around will be for agents only, not for consumers. And it is to make the APPLICATION DATE prior to Dec 23rd. So Dec. 22nd. Change plan effective date right near beginning of the application.

If already signed by consumer, then no access, of course, because info is locked, so will then have withdraw and re-start application.

Work-around application can be initiated AND signed by agent, or if already started by consumer, then finished and signed ONLY by agent.

Good luck!

Dale wrote: “Where is the promised guidance on how to shift Feb 1 enrollment to Jan 1 prior to the Jan 28, 6pm deadline? I can’t find it. Does anyone have a link to that information?”

My agent was told by a Covered Cal rep that although they originally planned to post a workaround for agents to get back the Jan 1 date, the people who run Covered Cal changed their minds and plan to fix it all themselves instead.

I can tell from the transaction log on my friend’s account that someone from Covered Cal made the changes shortly before noon today. Physically they did this by “terminating” participation in the selected plan and then reinstating the same plan with the earlier start date — which is the procedure that a Covered Cal rep told me yesterday needed to be done. Given the evidence of a manual entry from Covered Cal, it might take a while before the changes show up for everyone (though it also is possible that the transaction data I am seeing is part of a bulk entry). I have a feeling it’s being done manually, one-by-one however — that’s just my gut sense, because bulk changes to a database can end up causing even greater problems, so it would be more prudent for them to set up a system that requires a human being to review the file at some point before effectuating the change.

Max wrote:

“‘Freelancer wrote: “the reason the site was down appears to be for the purpose of setting it up to enable backdating of applications that were pending as of 12/23’ “I know this to NOT be true, because an application that I had to wait until the site came back up at 4:30-5:000 yesterday, which resulted in a Silver 94 enrollment, shows a start date of 2-1-2014, not 1-1-2013 as promised.”

I saw the same thing on my friend’s account YESTERDAY - but when I checked again TODAY (roughly 12:45 pm) - the effective date of his policy is now showing as 1-1-14 (not 2-1 as yesterday).

I know that my friend was planning to simply wait it out and contact the insurer (Anthem) to arrange payment next week. It’s possible that our agent did something in the interim to effect the change— but it’s also possible that there was a multistep process. That is, the site needed to go down yesterday while backend changes were made to to allow for backdating of policies — but then additional steps had to be taken after it went up again to enable the changes to be pushed through.

So my friend’s account is evidence that the change CAN be made (I’ve got screenshots to prove it) — but it is very possible that these changes may not happen all at once.

Dale …

There is no known way to alter the stated coverage effective date from 2-1-14 to 1-1-14 at this time. We are all operating under the assumption that applications submitted with a health plan choice by 6:00pm on 12-28-13 will have a coverage effective date of 1-1-14.

As for making payment to an insurer, this must be done directly with the carrier. While the SHOP enrollees’ employers will pay premiums to SHOP, there is no companion plan for individual and family coverage premiums to be paid to CoveredCA. Some of us see this as a critical flaw in the bureaucracy — they want everyone to enroll through the exchange, but they don’t want the responsibility of paying premiums to insurers, commissions to agents, and maintaining collections from insureds.

CONTACT YOUR CHOSEN INSURER as soon as possible to arrange payment of your first premium before 1-6-14. An initial payment by Credit Card or Debit Card will be most efficient. Many carriers will accept future payments by automatic draft from your bank account (ACH debit).

Where is the promised guidance on how to shift Feb 1 enrollment to Jan 1 prior to the Jan 28, 6pm deadline? I can’t find it. Does anyone have a link to that information?

And how can people pay for their premiums prior to receiving a letter from the carrier? The CC links to carriers don’t provide the ability to pay….

Freelancer wrote: “the reason the site was down appears to be for the purpose of setting it up to enable backdating of applications that were pending as of 12/23”

I know this to NOT be true, because an application that I had to wait until the site came back up at 4:30-5:000 yesterday, which resulted in a Silver 94 enrollment, shows a start date of 2-1-2014, not 1-1-2013 as promised. I have advised the client to assume that coverage begins on 1-1-2013 and to contact the insurance company on or before 1-3-2014 to arrange his first payment just to be on the safe side.

So whatever the reason for yesterday’s shut down of the website, CoveredCA dropped the ball by failing to communicate the reason for the “unplanned outtage”.

Freelancer wrote: “But I still fault the web site for any part of its design that is not absolutely intuitive to users. You’ll never hear anyone complain that they couldn’t figure out how to complete their order on Amazon.”

I agree with you 100%. As far as I’m concerned, the website was designed by someone who was never going to have to use it and who probably never asked someone who was for their opinion or feedback.

That’s the problem with a bureaucracy with no accountability. You have to do what they want, no matter how ridiculous or impossible it may be to try to comply.

It’s also apparent that the online application is somewhat different than the paper application. Why the two are not the same probably means they were designed by two different persons as well.

Freelancing family …

The maximum “clawback” is limited to 1/2 of the excess credit obtained, but not more than $1500. It is factored against the tax one owe for 2014, and if paying quarterly taxes, you can make additional deposits to limit the amount that would be owed with your final return ($375 per quarter, at most).

As for proof of residency for an infant, submit a copy of the child’s Social Security Card if you have it, or a copy of the child’s California-issued birth certificate. As an alternative, you can write a statement (title the document “Affidavit” at the top of the page) that the child is age “0” and resides with you and that the child has no income. Sign and date the document. It can be “witnessed” by an unrelated person but that is not absolutely necessary. Such an affidavit needs to be uploaded twice — once as proof of residency, once as proof of income — you do not have to write two statements.

We our finding it impossible to predict our families 2014 income and are stuck at this point in the application. The income we made last year and this year will not be any predictor for the income we will make this coming year. What is the penalty if our family of three gets medi-cal and it turns out we underestimated our income and should have been paying for a subsidized health plan instead? Also, for the proof required, how do you prove residency for a baby, and what documentation would serve for the proof of income requirement?

Max wrote: “On top of everything else, today the website went down at about 11am and no one has any idea why or when it will be restored”

As I posted, the reason the site was down appears to be for the purpose of setting it up to enable backdating of applications that were pending as of 12/23. That is what I assumed when I saw it was down, and that is what my agent was told when he called Covered Cal and talked to a rep.

I am waiting for confirmation from my friend. If he can log in and see that his effective date for coverage has fixed itself (from 2/1 back to 1/1) — then we will know that the rep who told my agent that was happening was correct. My friend is not particularly reliable, so I don’t know if and when he might actually get around to logging in and reporting back to me.

Max Herr wrote:

“It’s 5:12pm. The website continues to be inaccessible.”

Actually I was able to easily log into my user account at 4:30 - and emailed my friend with instructions as how to go back in and check his own status. So at least for consumers the site is back in.

As to the other details you provided, my friend’s situation is different, but as I wasn’t seeing what he was doing, I can’t be sure where the issue arose. He did do enough to get a case number — he said that what happened is that after he got to the plan selection page he was looking for a “continue” button but could not find one anywhere on the page. He was just stuck. Maybe there’s something else he needed to do, maybe not.

I’m encouraging him to let his agent figure things out from here — my friend is not very computer savvy — so it’s hard for me to rely on his explanation. But I still fault the web site for any part of its design that is not absolutely intuitive to users. You’ll never hear anyone complain that they couldn’t figure out how to complete their order on Amazon. Part of designing a web interface is to make it about as intuitive and consistent as possible: if someone has been clicking a “continue” button on every page and there’s some sort change or the button is moved to a different part of the page, or is a different color or label, that’s a problem.

But it could also be a situation of the system becoming overloaded and the page not fully loading — followed by caching errors in the browser he was using. Again, not really the fault of the consumer - you shouldn’t need to be a rocket scientist to use the site.

On the other hand, no one forced my friend to wait until 12/23 to try to apply. He has very significant and chronic health problems, has been talking for months about how anxious he was to have insurance, and then was “too busy” to do anything until the very last day.

Michael Freedman wrote: “They rarely seem to post anything or notify agents early in the day when the whole day is still available.”

That would be too logical. Don’t forget, we’re dealing with civil servants who work for a new state-based agency that is not accountable to either the governor or the state legislature which authorized its existence. They even thumb their nose at the President of the United States.

The people of California should not let this pass unnoticed.

Freelancer wrote: “I also called CoveredCA, waited on hold forever, and was told something different”

That’s par for the course. The lack of training and knowledge of the CSRs is pathetic. Some of the ones I’ve talked to admit that they can’t get answers from their supervisors and don’t like having to tell agents they don’t have an answer. So, what I think happens sometimes is that the CSRs are simply making things up as they go.

I have gotten all kinds of conflicting information in the past three months. I completed all of the agent certification process on Sept 11. It wasn’t until late October that I finally received my certification notice. I knew at that point, this was not going well.

“It would take CoveredCA 5 minutes to simply write a short, clear statement as to what they are doing and POST it as announcement on their main web site”

While 100% true, it also presupposes that someone at CoveredCA actually cares about stuff like this. I have not yet found that person.

It’s 5:12pm. The website continues to be inaccessible. I received an email from the Community Relations Division Manager, Mary Watanabe, which stated: “Hi Max, The application should be back on-line. Thank you for your patience.”

Obviously, she did not try it herself before she sent the message. That’s what I mean about someone actually caring.

Freelancer …

On top of everything else, today the website went down at about 11am and no one has any idea why or when it will be restored. As for your friend, he most likely experienced a time-out while moving from one page to another.

The issue could be related to the document upload page. After uploading documents, that step is not actually complete until the applicant returns to the main document submission page and scrolls to the bottom — thanks to the crappy website design, there are no instructions to do this — and must click on the “Submit” button below the “Comments” box.

Without entering a comment, clicking the submit button returns an error message that no comment was posted. Why you need to post a comment is beyond me if you have nothing to say. So you type a character in the box (I tend to type the word “uploaded”) and then click submit.

The health plan selection can be made from the “Eligibility” page without submitting documents. That step was also supposed to be completed by midnight on Monday. After selecting a plan, one needs to go to their “Cart” and accept the transaction. If the page time out or resets, the transaction may NOT have actually completed, even though it appears as complete. This, too, is a functional flaw in the website design, and your friend should not be “penalized” with a late start date as a result.

The only workaround to that which I’ve found is to go back to one’s home page and click on “Report a Change”, make no entries, navigate to the “Eligibility” page and submit the application again. Then you can go to the “Choose a Health Plan” page and confirm that the plan enrollment is or is not complete.

I think in reviewing one’s application, you should see the signature/submission date in the summary. If that shows 12/23, then your friend needs to initiate an appeal, claiming that CoveredCA incorrectly set his start date as February 1 instead of January 1.

Now, if your friend has no current health challenges and is unlikely to use his insurance in the month of January, he could let things go and start his coverage on February 1. There’s no penalty to do this. At most, he will lose 1/12 of his annual premium tax credits — but he will only pay 11 months of premiums, so that’s a wash.

I started two applications at the same location on Monday at 5:30pm. The website was in such turmoil that it took over FOUR HOURS to complete the two applications and upload documents — something that normally takes me about 15-20 minutes each to do. Then I drove home and started one more application at 10pm but did not complete that one until 12:05am on Tuesday. Thankfully, it was a Medi-Cal app, so the deadline didn’t actually apply.

Once past midnight, one of two things happened. Either the traffic suddenly fell off or an artificial restriction on the pipeline was lifted — either way, it was like flipping a light switch. Documents uploaded within 20-30 seconds without trouble, page navigation never timed-out. These four applications ended up being the single worst experience with CoveredCA that I’ve had. At least until today’s “unexpected outtage”.

As I previously posted, the lack of accountability on the part of anyone at CoveredCA is astounding, and the flow of information is regrettable (they manage to pat themselves on the back with no trouble whatsoever).

I complained to the SHOP sales executive today and told her that CoveredCA had better involve some agents in the debrief in early 2014 to make the process actually work next October.

Here’s the word from my insurance agent:

After an excruciatingly long wait time while the site was down, he got through to CoveredCA and they said that as long as the applicant started an application by the 23rd and it was finished by the 28th, the computer will back date the coverage to Jan, 1, and that is one of the reasons the site is down, for a system update that will allow that fix.

However, I also called CoveredCA, waited on hold forever, and was told something different — but I think that the statement above has the appeal of being more logical than what I was told — so I’m not going to add to the confusion by giving the alternate reality version.

It would take CoveredCA 5 minutes to simply write a short, clear statement as to what they are doing and POST it as announcement on their main web site (the one that works) — and they could post a similar announcement on the maintenance page for the enrollment site (the one that is down half the time). And then everyone would know what is going on, instead of having to speculate in blog posts and comments.

We’re waiting for specifics of the Dec 28th extension work-around to be posted on the agents section of the CovCal website, so says CovCal to be posted today. Maybe it will come via e-mail too. They rarely seem to post anything or notify agents early in the day when the whole day is still available.

Max,

I have a friend who created an account at Covered California on Monday, 12/23 - submitted financials, selected a plan, but then could not proceed to finalize the selection on the site. (He claims that there was no continue or submit button on the page after he he made the selection). He called Covered California the next day to finish the enrollment, explaining the problem - and they signed him up for coverage to begin Feb. 1st, even though he claims he made it clear that he wanted the coverage for Jan 1st.

I’ve put him in touch with my own agent — but I’m confused as to what is going on.

Obviously from your comment, you are equally skeptical — but why the disconnect between Covered California’s public statements and what people are actually experiencing. I told my friend that if he started his application on Monday, then the system will show that in the “transactions” screen - and it should be a simple matter to rectify the problem.

I don’t know that I would trust CoveredCA to honor any extension, and I am not making any promises to the folks I am working with today or tomorrow. As far as I’m concerned, the deadline has passed and coverage start dates are now February 1.

If their coverage actually is effective on 1-1-2014, then I guess I’m a hero for getting their applications in under the wire. If not, they already are prepared to start in February, and I’m still their hero.

The fact that there is no one accountable at CoveredCA for right answers leaves everything in the shadow of doubt.

Leave a comment

Do You Have California Health Insurance Questions?

Ask An Expert

View Previous Questions
Call Us at (888) 413-3164


© 2019 California Health Benefit Advisers, LLC
Home / About / Start Shopping / Ask a Question

“Covered California,” “California Health Benefit Exchange”, and the Covered California Logo are registered trademarks or service marks of Covered California, in the United States. This web site is owned and maintained by California Health Benefit Advisers, LLC, which is solely responsible for its content.