Ask Emily

Obamacare Q&A with Emily Bazar

Ask Emily: Does Covered California really have you covered?

08/26/2014 2:53 PM

08/26/2014 5:26 PM

Ask Emily is a biweekly column by Emily Bazar of the CHCF Center for Health Reporting, answering questions about the Affordable Care Act. Read all her columns at sacbee.com/askemily.

A worrisome trend is emerging among some Californians who thought they were safe and secure under Covered California: Their plans are being canceled without consent and sometimes without notice.

Take Ricki Manahan, who lives in Truckee. Manahan and her husband signed up for an Anthem plan from Covered California early this year.

They paid their premiums, but out of nowhere last month, the couple received new insurance cards in the mail for Medi-Cal, the state’s Medicaid program, which provides publicly funded insurance to low-income residents.

Manahan is still trying to figure out what happened, but she does know that her Covered California plan was canceled without her input or permission.

She also worries about Medi-Cal, a stressed program that will soon cover 30 percent of Californians. Finding doctors who accept Medi-Cal is even more challenging than finding doctors who participate in Covered California’s limited networks, and Manahan fears she’ll have to pay cash outside of Medi-Cal to get seen.

“They’re doing things without notifying anyone and canceling people,” she says. “I’m confused and upset.”

I don’t blame her.

A growing number of Californians with Covered California plans are learning – sometimes through happenstance – that their plans no longer exist. Some, like Manahan, are getting shunted into Medi-Cal. Others are dropped outright.

All of them say they feel helpless and betrayed.

“You think your health insurance is there, that you already took care of it,” Manahan says. “Now all of a sudden, you don’t know what you have.”

We have three clients who received cards and letters from Medi-Cal for no reason. Their Covered California plans were discontinued or will be. We never applied for this change, and their incomes are above the income threshold for Medi-Cal. What’s going on?

Evette Tsang, who submitted this question, is an insurance agent in Sacramento who is certified with Covered California, and whose firm has helped about 200 families sign up.

She did some digging and learned that the cancellations had something to do with the state’s verification of income levels.

“My biggest problem is we don’t know what income standard they’re using,” she says.

Covered California acknowledges that it is yanking some people off of its plans and putting them on Medi-Cal, months after they signed up or submitted income information.

We’re “in the process of manually verifying the documents provided by individuals who were conditionally eligible for obtaining health care coverage through our agency,” says Covered California spokesman James Scullary. “Through that process, some customers will receive notices indicating they are now eligible for no-cost or low-cost Medi-Cal coverage.”

Covered California won’t say how many people it has switched. Whatever the total, expect it to multiply. I have already heard from insurance agents in Sacramento, Orange County and the Tahoe area whose clients have received surprise Medi-Cal cards.

Many of these people already have paid thousands of dollars in deductibles and co-pays, and some have even met their out-of-pocket limit under their Covered California plans.

Will they get any of their money back?

Nope. “The customer is responsible for their share of the services rendered while under Covered California,” Scullary says.

There’s another category of people whose Covered California plans were canceled without notice. It includes Sandra Williamson, also of Truckee, whose Anthem plan was mysteriously canceled even though she paid all her premiums.

Williamson learned about the cancellation when her local pharmacy called to report that her prescriptions were ready but that her insurance policy was no longer in force.

Unlike the people who were sent Medi-Cal cards, Williamson was cut loose completely. She called Anthem, which informed her that Covered California told the insurer to cancel her policy. Covered California says it is investigating her case.

“I’m in no-man’s land here,” says Williamson. “They can’t just cut people and not even send you a notice.”

Unfortunately, it seems they can – or at least do. Covered California’s Facebook page is littered with comments from dozens of people who are frustrated about being canceled without consent.

By law, health plans can’t cancel coverage without notice, says Rodger Butler, spokesman for the state Department of Managed Health Care.

But through July, DMHC has received 131 complaints from consumers about cancellations this year.

“If an enrollee has been paying their premium, then their health plan must give them at least a 30-day notice,” he says.

If you’re someone whose plan has been canceled without notice, there are some steps you can take:

•  If you were taken off Covered California and placed on Medi-Cal but don’t agree, file an appeal with either of those agencies, Scullary says. Best bet: Start with Covered California’s website, www.CoveredCA.com, where you can find a link to a form requesting an appeal or call (800) 300-1506 (and be prepared to wait on hold).
•  If you have been canceled outright like Williamson, file a complaint with DMHC. (This also applies to people who have plans purchased from the private market.) Call (888) 466-2219 or go to www.HealthHelp.ca.gov.

And speaking of Facebook, it doesn’t hurt to take your complaint to social media.

Qu esti ons for Emily: AskEmily@usc.edu

Learn more about Emily here .

The CHCF Center for Health Reporting partners with news organizations to cover California health policy. Located at the USC Annenberg School for Communication and Journalism , it is funded by the nonpartisan California HealthCare Foundation .

About This Blog

Emily Bazar writes for the California HealthCare Foundation Center for Health Reporting, answering questions about the Affordable Care Act. The center partners with news organizations to cover California health policy. Located at the USC Annenberg School for Communication and Journalism, it is funded by the nonpartisan California HealthCare Foundation.

Questions for Emily: AskEmily@usc.edu

Learn more about Emily

 

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