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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.


Medical Expenses Without Membership Card?

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Question: I managed to reach Anthem by phone and paid my premium for January. They processed the payment last week. I still have not received any membership information, card or number. My pharmacy will not honor this plan without a card. Will Anthem will reimburse me for these prescriptions when I file a claim?

Answer: As long as you pay Anthem by January 31st, you can use services covered by your health plan starting January 1. First, be sure the provider (a doctor or pharmacy) is participating in the Anthem "Pathway" network.Once you have proof of health insurance coverage effective January 1, 2014, you can submit the provider's bill to Anthem to process.

4 Comments

Despite the claims of CoveredCA CSR’s who insist that CoveredCA is forwarding enrollments on a daily basis to both Medi-Cal and the various insurers (but when asked to document that in an email or other correspondence, reply, “We’re not permitted to send emails”), phone calls to County Medi-Cal agencies and insurance companies alike indicate this is not happening as we are being told.

My IFP rep at Blue Shield told me just yesterday (1/22) that BSCA upper management has sent a memo explaining that even they cannot get answers from CoveredCA as to why enrollment data is not flowing to the insurers (or in some cases is being received in unusable form). She also confirmed that they have innumerable numbers of applications for January 1 that have yet to be processed, let alone those for February 1. No one knows where anything is, or when they will get to it, or how coverage dates will be handled.

The implementation of CoveredCA is seriously lacking despite the pats on the back they are giving themselves in the public media. I don’t know what they were smoking as they were putting together their systems, but whatever it was, it certainly interfered with rational thought.

Just more evidence that the information blackout at CoveredCA is deliberate, and the lack of transparency is their shield.

I was approved and enrolled in a Kaiser plan on Jan 2, for Feb 1 start-date. Kaiser still hasn’t sent my bill; 5-plus hours of trying to reach Kaiser today and they just say they don’t have it from CoveredCalifornia yet, so I should call back in a week. A week is the due-date! And if it took me five hours to get through a week ahead of the due-date, how long would it take then??? Considering the apparent slowness in processing, has the payment due-date been moved back from Jan 28?

I would add one thing to Phil’s comment. I would recommend you take the extra step of calling Anthem and giving notice of your drug benefit claim over the phone. Contractually, you are obligated to notify the insurer of your “loss” within 20 days (or as soon as possible if you were reasonably prevented from giving notice). Not knowing you were supposed to notify them is not a reasonable excuse, and could allow them to deny payment for something that should be covered otherwise.

Once you give them notice of your loss, they have 15 days to send you a claim form or they must accept your claim in any form you choose to present it.

When you send in your itemized receipt for your prescription, be sure to write a letter of explanation, and DO NOT FORGET to include your health plan ID number, name, address, and telephone number, so they can contact you if necessary.

Doing these things will ensure payment of your claim. The insurance company is supposed to pay the covered claim within 45 days of receiving your “proof of loss” (your pharmacy receipt). If they are going to deny a claim, they must also notify you immediately, and inform you of the procedure to appeal the claim denial if you believe it is a covered expense.

s anyone signed up with Anthem getting ID cards? I signed up in Oct and everything looks good on the Covered California site and I made payment through Anthem website(although they have not credited my credit card) but no ID card has been received. Anthem not taking calls because phone limes are over loaded. Very frustrating.

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