File a complaint against Covered California and ACA health plans

If you are one of the thousands of Californians who have suffered because of the poor coordination and planning between Covered California and the participating health plans, I hope you will consider filing a complaint against them. While Covered California is one of those bureaucracies that is comfortably insulated from being held accountable for their actions, or lack of thereof, the health insurance companies have caused enormous pain and suffering from their fumbling on a number of issues.Department of Insurance regulates PPOs (Preferred Provider Organizations) and EPOs (Exclusive Provider Organizations) health insurance plans. Their complaint form can be found at

Department of Managed Health Care

Department of Managed Health Care regulates HMOs (Health Maintenance Organizations) and they oversee the Department of Health Care Services who is a partner with California Health Benefits Exchange (Covered California). Their complaint form can be found at

Let your voice be heard

If enough complaints are lodge against the poor operation of Covered California and the health plans perhaps some legislative or executive action will be taken to protect the rights of the consumers against the monopoly of Covered California.

File a complaint against Covered California and health plans
  • JustAnotherPoorConsumer

    Hello, here is another idiotic requirement under the plan: married couples that file their taxes separately Do not qualify for the program! Can someone explain why? Isn’t that discrimination based on marital status (and more)? I greatly appreciate any thoughts on this.

    • Kevin Knauss

      Because the Advance Premium Tax Credit revolves around household income, the IRS needs to see the full income on the federal taxes. The federal taxes contain the number of dependents that may be eligible.

      If one spouse has a low income and files with the children, they might all be eligible for Medicaid, while the other spouse’s income might be over 400% of the federal poverty line and not be entitled to receive any premium assistance or government sponsored minimum essential coverage like Medicaid.

      Another scenario is a parent that has employer sponsored health insurance. Married filing separately would cut out the exchange from seeing that affordable coverage.

      So, as I see it. the Married Filing Joint requirement to keep people from gaming the system for free or subsidized coverage when they really have the means to pay for it. Plus, trying to true up the tax credits for separate returns for a household would become a nightmare…and it is already bad enough.

  • Husha Boom

    This is a complete failure.

    • Kevin Knauss

      There are many problems that no one is discussing and CC doesn’t seem to answer to anyone. Those who could make a difference, like the health plans, just don’t want to rock the boat, but they are a recipient of many of the problems with the data transfers not coming through properly or at all.

  • Angry and speaking out

    I was forced onto coveredca because my coverage doubled in cost with the initiation of affordable health care while my out of pocket deductibles also doubled. Not one of my 4 physicians is a coveredca provider, although they were on the provider list when I signed up. I was on a waiting list for 6 months to get in with my primary MD. I’ll now have to privately pay to see her. I waited 3 months to get a surgical consult only to be forced to cancel, because he too is not a provider. I called 10 other surgeons on the list given me by Blue Cross but none of those are providers either. Now my basic generic hormone perscription is being denied, which was previously covered. Lets see, no doctors, no perscription coverage …I can hardly wait to see what labs aren’t covered! So essentially Blue Cross is being paid $750 a month or $9,000 a year for NOTHING! I have responsibly, privately paid for my health insurance for 45 years. I am ready to cancel this useless plan and become one of the “uninsured Americans” for the first time in my life, at the age of 63! My coverage was just fine until they started messing with it! I have never felt so trapped and helpless before in my life. How did this happen to us as Americans?

    • Kevin Knauss

      When it rains it pours, it looks like the storm is right over your house. Some folks have certainly gotten the short end of the stick with all the reforms brought on by the new plans.

      Virtually all of these problems are occurring with the PPO and EPO plans. The HMO plans such as Sharp, Western Health Advantage and Kaiser have had no doctor issues. In attempt to shield themselves from excess claims, the PPO and EPO plans have cut the providers to the bone and good folks such as yourself are feeling the deep incision of the scalpel.

  • Tracy Taguchi

    I’m an insurance agent representing my small group client located in Southern CA. I helped them enroll in a small group health plan in January 2014 for a coverage effective February 1, 2014 and premiums were paid to Covered CA, however, as of today, May 14, 2014, Covered CA has not sent the enrollment information nor premiums to the insurance carrier, Health Net. My client does not have any coverage yet and the employees and their children have been putting off going to see doctors. I contacted Covered CA numerous times via phone, e-mails and through my GA, Warner Pacific in the past 3 months. Each time they told me that someone from SHOP eligibility team would contact me. That has never happened. Warner Pacific said I’m one of so many that are in the same position right now, but this is NOT acceptable! If this was an insurance company I’m dealing with, I’d have cancelled the enrollment and applied to other carrier. But I can’t do so due to a small group tax credit. Being a Government Agency or being busy cannot be an excuse for this. I support Obamacare but this is not acceptable and I can’t wait anymore. I filed a formal complaint to CoveredCA, and just filed a complaint to Dept of Insurance today. I don’t know what else I can do for my client.

    • Kevin Knauss

      Thank you for your comments on your experience with SHOP. My experience has been the same. In a fit of desperation I posted a plea for help with my small group through SHOP on the Covered California Agents group on Linked In. The response was that GA’s get priority for assistance.

      Your experience shows this is not the case and SHOP is completely dysfunctional. SHOP must have violated some sort of rules or regulations regarding timely enrollment and service under DOI or DMHC. If nothing else SHOP should be liable for any claims or liability incurred by their failure to effectuate enrollment.

      I also wrote a blog post called SHOP is a Flop. At this point, SHOP should be shuttered and turned over to either a private exchange like Cal Choice. I’m working on a website, California Health Agents and Brokers Guild to document some of these types of failures and advocate for the role of Certified Agents.

      The bottom line is that all the state agencies seem to be ignoring the failures of Covered California. If they were a regulated health plan they would have been fined, sanctioned and possibly had their licensed revoke to sell insurance in California.

  • Andrew Marble

    I just spent two hours on the phone with anthem blue cross and covered California. I called because I received a notice from anthem that my sons premium for the new year has not been paid. I found it very strange and thought it must be a mistake. So I called anthem and they said that covered California removed my son from our family plan which we had for all of 2014. Beginning January 1, 2015 my one year old son will no longer have health insurance because of this. Anthem blamed it all on covered California and stated there was nothing they could do and that I would have to call covered California. Which I did. When I finally got through I spoke to a lady (could have been a man) names Caroline who was absolutely helpless. She put me on hold over twenty times (not exaggerating) during my time on the phone with her. She said she would have to cancel my health plan in order to add my son back. Keep in mind I already paid my premium for Jan. there is much more to the story but the bottom line is that I wanted open a lawsuit against covered California and wanted to see if anyone else has experiences this issue. If so please email me as it may help my case and the possibility of doing class action suit. I would have thought after a whole year they would have gotten their act together. I am sick of this and am doing to something about it.

    • Kevin Knauss

      Hi Andrew, as this story from Kaiser Health News illustrates, you are not the first family to have mysterious lost a child in the Covered California system. See:

      It’s not common, but losing family members from a health plan can occur. Sometimes there are technical reasons such as the family income drops and the children are put into Medi-Cal kids. Other times the health plan just doesn’t get the data or it has been corrupted. Covered California has never released any of those statistics.

      But for the month of July, Anthem Blue Cross received virtually no enrollments from Covered California because of a data feed problem.

  • William mastreano

    Coc Calif has been a total nightmare. Tried several times to remove my wife so we could sign her up direct thru health net. H net could not activate new policy until CC notified them of cancellation of old policy thru CC. Could not get this done after several calls to CC. One moron actually said he could not notify h NWT because they are not allowed to make phone calls.YES YOU HEARD THAT RIGHT!!! I
    Is that unbelievable or what.. Whoever is managing CC needs to be stabbed in the heart with a sharp pencil.

    • Kevin Knauss

      There can be conflicts with switching from On-Exchange (Covered California) to Off-Exchange plans if the carrier is the same. This has to do with the member already having an account. What you need to do is terminate your wife’s current coverage for a 1/31/15 Effective date through Covered California. Then apply with Health Net for an effective date of 2/1/2015, but this must be done before 1/15/2015.
      This holds true if the current Health Net plan, such as the HMO, has been renewed by CC. If you wife was in a CC Health Net PPO plan, those health plans were not renewed and you should be able apply directly with Health Net. I’ve done it for a couple different clients with no problem.

      • William mastreano

        Did that scenario early decembet. Cancel CC effective 12/31 and make new policy effective 1/1. Plenty of notice but had to cancel twice and once canceled the cc agent said he could notify h/net of cancellation because he could not place outbound call. Whstbtype of office worked cannot place phone call? Real bucket shop opetation.

        • Kevin Knauss

          Health Net is the other part of the equation. I understand that they can’t close the CC plan without the data feed coming from CC. But there has to be away you can set up another plan that doesn’t conflict with the CC membership. Plus, CC can escalate the data feed that has the termination of ther health plan to Health Net.
          Covered California will bend over backwards to try and help you enroll in one of there plans, but if your are trying to terminate a plan, you are low on the ladder of priority.

  • Linda Butcher

    I appreciate having lower premiums ($450 vs $1200), and don’t even mind the higher deductible, since I am fairly healthy. What I don’t like is my tax dollars paying for a state agency that has its head up its collective butt.

    I called CC March 1, 2014 and took my husband off the policy (he went on Medicare April 1); still received bills for both of us on the policy, which I continued to pay, until July, when Kaiser finally got the cancellation from CC. To this day, I am still trying to get a refund for the overpayment for 3 months. I filed a complaint on their website in November and have never heard one word from them.
    I also filed a complaint with the Dept of Managed Care, and make it clear the problem was Covered Calif, not Kaiser, but all they could do was contact Kaiser, who refused my request for a refund because they get the information from CC and it had not been corrected yet.
    I have contacted CC at least 15 times since April about this problem and the only answer I get is that they are “working on it”. What is there to work on….you send an e-mail to Kaiser and change the month the cancellation takes effect.

    To add insult to injury, last month I received a bill for January showing $2953 due for this month; previous premiums were $453. I called Kaiser, was assured the bill
    was incorrect, and in fact, my premium had gone down. Since I am on autopay, I asked if that would be a problem and was told the correct amount was in the computer system and that is what would be charged. Well, Happy $#@^&* New Year!
    My credit card was charged $2953! Thankfully, it wasn’t from a bank account. Kaiser, of course, was very apologetic, but they have to get the authorization to credit my acct from, drumroll please….Covered California. How long do you think that might take? They have 15 days to respond to my credit card company. It is now day 13.
    One Kaiser rep I spoke to said the higher amount was because I had dual coverage. Why would I have 2 accts with Kaiser? And , if I had 2 accts, why did I never receive a bill for the second one?

    I guess my next step is to file a complaint with the Consumer Protection Agency and see where that goes.

    Someone from Covered California needs to read these reviews and try to get their act together.

    • Kevin Knauss

      If you can get into your account, you need to see when the terminate date of your husband’s Kaiser plan. Under the Summary section look at Transaction history. The transaction history tells the story of everyone who touched the account and what they did and who it was.
      There have been numerous issues with the renewal of health plans. Carriers have gotten cancellation information for an account that was really a change of plan.
      Kaiser is absolutely correct when they say they can do nothing unless they get the data feed from Covered California to make the change or cancellation. Both Kaiser and CC have told me that once a termination date is effective, even retroactive, the carrier will refund any premium payments paid past that date.
      Your evidence of what did or did not happen lies in the transaction history.

      • Linda Butcher

        The initial problem was that even though I called on March 1, 2014 to terminate my husband’s Kaiser plan thru Cov Cal, they did not send the info to Kaiser until July, even though I called every month that I got the bill showing both of us still on the policy. I continue to call Cov Cal (what a treat!) every month, including this month, and the response is always
        “they are working on it”, even though they can see from my reference numbers the times I have called and that my call in March was to remove him from the policy.

        • Kevin Knauss

          I’ve had other clients that have had the same Kaiser – CC billing struggle. If Kaiser gets the data feed correctly from CC, it will go through.
          However, I don’t trust the reference numbers I get from CC. I only care about the transaction log. You need to demand to see and get a copy if you can’t access it from your account. If it shows your husband’s plan was terminated for March 31th, and you made premium payments for April forward, Kaiser has got to refund your money.
          You can always file a small claims court case to get their attention.

  • Zee

    I signed my family up for health coverage through Covered Ca in January 2014. In September 2014, we decided to add a pediatric dental plan for our young son. I called Covered Ca and we chose a plan. It was to begin on October 1, 2014. The moment the “send” button was hit to enroll my son with Delta Dental, the lady said, “Uh oh.” The “uh oh” was that she had somehow linked the dental plan to our health insurance by accident – which made it appear to Delta Dental that we had been enrolled since January 1, 2014 – rather than actually only being enrolled for 3 minutes. After many hours of discussions with Covered CA “supervisors”, they filed a claim with their “Resolution Department” to notify Delta Dental of their mistake.

    4 months later:

    Delta Dental has sent me bills for premiums for 9 months that we were not covered as Delta believes we are in 9 months in arrears; Delta Dental has denied our claims and has stopped paying my son’s dentist because Delta Dental thinks I owe for 9 months; my son’s dentist is sending me bills every month despite the fact that Delta is supposed to pay 80%.

    I have spent hours and hours on the phone begging Covered CA to fix the mistake. They see the mistake. They have a record of every call. They admit it was their mistake. They apologize for the mistake. They say they will fix the mistake. And they DO NOTHING. NOTHING. Every time I call I start from scratch. They listen. They acknowledge. Then they say that the “Resolution Department” has had the claim since September 3, and there is nothing they can do right now – but call back in a week.

    My good credit is going to be destroyed.

    I am really, really, frustrated.

    • Kevin Knauss

      Unpaid insurance premiums rarely, if ever, get reported to credit agencies. This is because insurance is monthly contract. If you don’t pay the premium, after a certain amount of time usually 30 days, the policy is automatically cancelled retroactively to the last day of the month for which the premiums were paid. Whereas dental insurance may vary from the aforementioned scenario, it still shouldn’t impact your credit rating.
      What will affect credit ratings are unpaid dental services that the dentist puts into collections. The unpaid amounts which the insurance company was suppose to cover but didn’t.
      The fact that Covered California has not resolved this issue is pretty amazing. They have been able to correct similar issues with health insurance, but the stand alone pediatric dental insurance has been rather tricky from its inception at the beginning of 2014.
      I would suggest you escalate your complaint by attending the next Covered California Board meeting and voicing your complaints during the public comment section of the meeting. That will certainly get the attention of all concerned and bring to light the failure of the Resolution Departments customer service. You can also file a complaint with Covered California and Department of Managed Health Care. You can also file a complaint with the California Department of Insurance if the dental plan was a Dental PPO which I believe falls under their jurisdiction.

  • help me

    I have just been told by Blue Shield that my covered under covered california has been canceled sometone in November, but Blue Shold had be pay premium s through February 2015. I was overcharged when I first signed up for covered california., which why I am paid through February. Long story short, covered california has been screwing me over since November 2014. I have no insurance and suffer from depression and migraines. I cannot get coverage from medi-cal. The social worker for LA County, Nancy Ha, messed up my eligibility based conversations with covered california and the State. My 4 yr old son received a BIC card and a welcome letter from LA County of health, but no one shows him as active. I have spent hours each day since January to no avail. Does anyone know an attorney?

    • Kevin Knauss

      Blue Shield has had numerous problems with their billing system. It’s possible that the cancellation originated from Blue Shield. If the termination happened at the county level, then you should be enrolled in Medi-Cal. You need to have Covered California formally cancell the Blue Shield plan retroactive to November 1st If the cancellation occurred at the county level. That would allow you to recover the premiums you paid after November 1st or were part of an earlier credit.

      You have to get to the root of the termination. Who caused this to happen: Covered California, Blue Shield or the county social services department?