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.