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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.


Kaiser Enrolled Me in a Different Plan?

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Question: I had enrolled in KP HMO Silver 87 Plan through Covered CA website. I received my first billing from Kaiser Permanente indicating that I was on their KP CA Silver 2000/45 Health Plan. I was charged the same premium as quoted by Covered CA for the KP HMO Silver 87 plan. Copays/Deductible for KP 2000/45 plan a lot higher. What should I do?

Answer: Don't be concerned. Kaiser knows that you are on an enhanced version of the Silver 2000/45 Plan as evidenced by the correct premium. They apparently lack the ability to reference the enhanced version of a Silver in their billing system.


18 Comments

We were able to get one of our KP children’s accounts backdated to Jan, when I started my new employer. For our second child, though, Cov Ca and Kaiser have been passing me back and forth, and now 9 months later, they say due to their system they can’t backdate the termination. We had to terminate effective October, but that’s just wrong. The website (we can no longer reach it without an account) said to call for retroactive termination. We called many times, them and KP. KP said to wait, bills would stop. We paid no premiums. It should have cancelled itself in 3 months, right? nope—bills through August. What can we do? A response to an appeal to CC says to contact KP and ask for forgiveness for their mistake. KP says it must be cancelled through CC, they made no mistake. We don’t want to get a tax burden on a low income individual on ‘income’ of over $2000!

We signed up for the kaiser enhanced silver 94 but we are not being billed correctly. Our premium is $227 (I thought it would be $271?). We just got out first bill for services and so etching is DEFINITELY not right. Under the silver enhanced we are supposed to pay a co-pay of $3 for labs, but we just got a bill for lab work for $109! The $109 is what is due AFTER the insurance paid their part. Am I missing something?

Thanks,

C

I have chosen kaiser thru cc and their enhanced silver 87; like someone else who posted here, I have received paperwork congratulating me on my new deductible policy.

I processed my paperwork in mid-January to be effective March 1. I paid two months’ premiums via cc website because cc didn’t seem to have a record of the first being paid in january; so i’m ahead re payment but have yet to receive any bill w confirmation what policy they actually have me signed up for.

I have tried contacting member services but cannot get a live person.

Any suggestions?

Donald, all I can suggest is talking to an Anthem rep or retention specialist and citing that specific internal email I mentioned before. I’d contact CC also and ask them to get the back office to follow up. I’d also try posting and messaging via both entities’ Facebook pages. And I’d tweet at them too if you can. Sometimes you her faster responses via social media. Good luck!!

Joe, I’ve tried contacting Anthem several times again this week using a variety of phone numbers including the HPA and Member Retention department numbers. But none of the reps that answer after a long hold time on any of the numbers seem to be aware of this incorrect silver level plan issue. They can only claim I have to have Covered California fix it (which is wrong its an Anthem issue) or they just transfer me and I end up on hold for a long time again apparently just routed to the regular Anthem number again. Keep going in circles with no help at all.

I need a way to contact a special Anthem rep or supervisor that is aware of this specific incorrect silver level plan issue and can resolve it quickly and who I can reach easily to follow up on my case and not have to start over from scratch if nothing changes. Joe can you provide a direct way to contact the individual who resolved your same issue? Going thru the regular Anthem phone lines reps just is not working for me, and they don’t seem to be able to transfer me to a supervisor either - just get routed back to the main phone menu system…

I received a generic letter from Anthem at the beginning of February saying the problem was affecting all Silver70 and Silver94 signups and they were working to fix it. They have since corrected my plan to Silver94 and sent me a new card. If you’ve heard nothing at all, I’d suggest contacting them again.

Any updates on this important issue? Its been nearly a month and Anthem has still not fixed the incorrect level Silver plan they assigned me, applied thru CoveredCA. Should be Silver 94 not Silver 73. I haven’t received any letters from Anthem either about this, weren’t they supposed to be sending them out to all those with this problem by now?

Thanks for the update Joe! At least it sounds like Anthem internally is finally recognizing the problem of their assigning many of us the wrong level Silver plan now and not blaming or directing us to Covered California like an Anthem rep did when I called them a couple weeks ago for this problem. I hope the regular Anthem customer service reps are getting this memo.

Does this imply that Anthem will be correcting all the incorrect Silver level plans for us with this problem automatically perhaps later this month (Feb) without everyone having to call and report it individually? I wonder if they will also do the compensation automatically for extra charges due to incorrect copay/deductible this past month like from buying a prescription at a higher price? Will this perhaps end up as a credit towards future premium payments? I figure so far the excess cost is about equivalent to two months premium payments for me.

No change in status yet. However I just talked to a California Anthem rep who says there is a memo circulating there about this issue. Something like “due to a coding error, Silver level 3 members were assigned to Level 1, and Level 1 members were assigned to Level 3.” The memo says the errors are being corrected (the rep guessed this might take a few weeks) and that letters are going out now to everyone affected. People who have been overcharged as a result of the error will be reimbursed, while people who have benefited from it will be billed for the difference.

Joe, please give us a report next week if this process actually worked with Anthem. I haven’t seen anyone report yet that their incorrect Silver level plan has actually been changed to the correct Silver94 plan yet with Anthem. I’m eagerly awaiting for someone to actually report their plan is correct now (benefits show no deductible, etc) verifiable at the Anthem website and new member ID card.

Someone with the same issue with Anthem (Silver73 plan instead of Silver94 0 posted at the CC facebook page today that they were able to get it fixed thru a special Anthem HPA department line. Here is what was posted, though I haven’t tried it myself yet:

“Ok folks - I managed to get my issue with receiving the wrong plan from Anthem fixed. It is a known issue and if you get to the right person it can be fixed. First - do a screen print of your Covered California enrollment screen and have it saved in an email. Then call the Anthem HPA Department at 855-817-4402. the wait is not long. Tell them you have this issue and that there is an internal email to confirm it. They will fix it for you. They may ask you to send the copy of your Covered CA enrollment info as backup.”

Okay, I managed to reach a rep at Anthem today who researched the problem and give me the following advice. Call the Membership Retention Department at 877-807-0691. Tell the rep you’re signed up for the wrong plan: you’re on Silver 73 and you should be on Silver 94. This has to be fixed on Anthem’s end, not Covered California’s. Tell him to ask his supervisor about this issue or to look for an internal email with the subject line “System Issue — Member Enrolled On Wrong Plan.” The rep told me he had sent my documents to the billing office to make the change and to allow 5 business days for it to take effect. Fingers crossed, good luck to all.

Someone with the same issue with Anthem (Silver73 plan instead of Silver94 0 posted at the CC facebook page today that they were able to get it fixed thru a special Anthem HPA department line. Here is what was posted, though I haven’t tried it myself yet:

“Ok folks - I managed to get my issue with receiving the wrong plan from Anthem fixed. It is a known issue and if you get to the right person it can be fixed. First - do a screen print of your Covered California enrollment screen and have it saved in an email. Then call the Anthem HPA Department at 855-817-4402. the wait is not long. Tell them you have this issue and that there is an internal email to confirm it. They will fix it for you. They may ask you to send the copy of your Covered CA enrollment info as backup.”

I called Anthem a week ago about them giving me the incorrect level Silver plan (Silver73) instead of Silver94 that my CC application qualified for. The Anthem rep couldn’t change the policy claiming only CC can do that - so Anthem alone is a dead end on this issue. However a few days ago I was recommended a special CC phone number on the CC facebook page and I called it yesterday. I got thru right away, no holding and the agent there was immediately able to fix a couple things on my CC application including incorrect request for a SS card. He was also able to record all the info I told him about the incorrect level Silver plan from Anthem and that others have posted they too have the same problem. He contacted his supervisor and gave me a special incident number for my case and handing it to a special “external coordination team” that is tasked with working between CC and the insurance companies on such issues. He expected that Anthem would change my plan to the correct Silver94 plan soon after the team works on the case and that I might even get credit/reimbursement for any extra medical expense since Jan 1 due to the incorrect deductible and copay amounts - I filled one prescription this week and had to pay a higher amount than the copay would have been with the proper Silver94 plan. The agent took my phone number and email address for contact as needed. I’ll wait until the end of this month and if no contact or change I can call them again with my incident number as a reference. At least there appears to be a special group at CC for issues of miscommunication or incorrect data transfer between CC and the insurance companies. Maybe if they see enough of this same problem they will work deeper with their database experts to find the cause of the issue, probably an incorrect encoded or decoded data field for the Silver level.

Donald, yes, it’s happening with every Enhanced Silver 94 plans. They’re all showing Silver 73 plans although the invoiced premium is that of 94 plans. I have e-mailed Anthem about this but no reply yet (calling Customer Service won’t get you anywhere). This is not a glitch and Anthem really needs to address this issue ASAP. Meantime everyone who is affected by this problem has to make their voice heard.

Me too. Signed up with CC for Anthem Silver94 but was enrolled by Anthem in Silver73. Called Anthem: they say CC must have transmitted the wrong code. Finally reached someone at CC who said “the back office” would try to resolve the issue but so far no change. Meanwhile only the Silver73 benefits. Will Anthem ultimately reimburse the difference?

I’m noticing everyone enrolled on Enhanced Silver 94 plans through Covered CA is getting their card showing Enhanced Silver 73 plan instead. Other agents are noticing the same thing. This is not an error for some but is happening with everyone with Silver 94 plan. Anthem says the error is with CC but it is not since it’s happening only with 94 Plans (87 plan members are getting the correct ID cards) Anthem needs to address this issue publicly.

Actually there is a reason to be concerned. This same issue occurred with my application thru CC to Anthem. Anthem assigned me the Silver73 plan (evidenced by the $1500 deductible listed on the member ID card) where it should have been the NO deductible Silver94 plan at the Covered California application and qualification. I confirmed on the phone with an Anthem agent that they see “Silver73” at their end, so there clearly a miscommunication of data between CC and Anthem regarding the level of the silver plan. Anthem can only say you need to have Covered California change the plan, but CC says its Anthem’s problem. So nothing gets fixed at either end! I’ve confirmed the benefits I’m getting are those of the Silver73 plan not the Silver94 plan since I had to pay the full price for a prescription this month since the Silver73 has a $250 drug deductible, but I should have had a reduced price copay immediately with the Silver94 plan since it has NO deductible. Its already costing me extra cash due to this. Even with Anthem charging the correct lower premium thats the right one for the Silver94 plan, I still only have the Silver73 plan benefits! Is there anyone who can be contacted to work on this problem between CC and some of the insurance carriers, since several people have reported this same problem on the CC facebook page this month.

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