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Health agent sues Covered California for damages

 

 

 

Health agent sues Covered California in small claims court.

Health agent sues Covered California in small claims court.

It is no news to the first wave of Covered California Certified Insurance Agents in 2013 that Californias online health insurance exchange was not ready for business. The number one complaint from agents was they were not receiving credit, and ultimately commissions, from the numerous individual and family enrollments they were performing. One health insurance agent is taking Covered California to small claims court for damages he suffered during the chaotic and mishandled launch of Covered California.

Health Agent sues in small claims court

Southern California health insurance agent John Dickey felt he was following all the rules when it came to Covered California. He went through the online training, attended the in-person training, and eventually became certified with Covered California. Mr. Dickeys experience with Covered California is no different from many other agents in California. Even though agents successfully enrolled individuals and families with either a paper application or online enrollment, the carrier did not show the agent as the Broker of Record. No Broker of Record, no commission.

Covered California mishandled broker designations

Some agents were able to spend the days and weeks necessary to eventually get appointed with the carriers, get the Broker of Record noted at Covered California and the carrier, and finally start receiving commissions. However, the delay cost agents an enormous amount of money from lost incomeand alsothe time wasted to set the record straight. Mr. Dickey created a meticulous spreadsheet that documents what he claims as the total lost monthly commissions because of Covered Californias mishandling of connecting agent enrollments with the specific health insurance carrier designated.

Spreadsheet details losses

Mr. Dickeys spreadsheet of lost income shows just under $1,000 per month from individual, family and SHOP enrollments that Covered California has failed to give him credit for. But instead of me trying to accurately recount the history of Mr. Dickeys grievances, I present a modified version of the complaints he filed with his attorney in May of 2014 that has ultimately led to the filing of his small claims court case against Covered California that will be heard this spring in Alhambra, CA.

From Mr. John Dickey May 2014

I could write 10 pages, but here are the main points, excluding that I unnecessarily wasted well over 200 hours over the past 6 months due to their abysmal web site, which did not work at all for three consecutive weekends in late Feb. and early March! My clients will ALL gladly document the multiple visits I had to make with them to get them enrolled. I averaged 9 hours per enrollment because of this website, plus at least 2 additional hours per client helping them figure out how to upload documents and make their payments because those features of the website NEVER worked properly.

1) Covered California never once mentioned any need or requirement for us agents to become appointed with the carriers. To the contrary (their E-mail last week clearly shows that they knew it) C. CA made it appear from day one that all we had to do was get appointed by our client as their designated agent and then later separately (outside of the client’s application) accept that appointment.

2) When I called the 6 participating carriers many times over the past 5 months, every time they replied that they “show no record at all of me as the agent of record”, nor otherwise in their system. I tried to report this every time to a Covered CA supervisor, but the C. CA representatives would either refuse to put me through or would drop my call after I held for 15 to 45 minutes! Those few times I was lucky enough to get through to a supervisor, he/she would blame the carriers every time and tell me to “take it up with the carriers as they are who pay you”.

3) Now, all of the carriers have told me that they will not pay me any commissions on any policies that I gave to them prior to the date (within the last 5 weeks) that I finally got appointed with them. And one carrier, Molina, is refusing to pay me any commission (not even going forward) because I was not appointed with them when I gave them a C. CA policy.

4) And some of the carriers, such as Blue Cross, are now requiring me to fax to them “Agent Designation” forms on all C. CA policies I wrote for each of them because they have no record from C. CA of my being the agent of record on any of those policies.

5) C. CA never provided us with the support we were rightfully entitled to and had a reasonable expectation of receiving after the 20+ hours of certification training/education that C CA put us through to become Certified Covered CA agents. In early March, 2014, I spent (have written proof) over 10 hours trying to simply get onto the “list of local representatives who can help you enroll in C. CA” that was passed out to all attendees of a 3/10/14 C. CA educational seminar at a community health clinic in San Gabriel, CA. Although I initially had the full support of the person in charge of this seminar, C. CA executives in Sacramento thereafter blocked her from including me; instead including only the contact information of local C. CA “enrollment counselors”. I have proof of this because I actually attended this “community educational workshop” and picked up all of the handouts.

6) C. Ca never gave us any neither leads nor referrals, and refused to pay for any of our marketing materials. And, for a 5 week period in Feb. and March, their radio (KNX1070 and KFWB 980) and TV ads (Ch. 9 in LA) said to “seek out a C CA enrollment counselor” if any help is needed, with no mention whatsoever of us agents.

7) As pointed out in the recent LA Times article, it is very well known among us agents that C. CA instructed its own call center representatives to not take calls from agents; and to put those agent calls that did manage to get through on hold for hours, only to be subsequently dropped. The only way I was able to ever get through during 12/15/13 through 4/30/14 was to call right at 8:01 AM and pretend that I was an individual (non-agent) calling in to get enrollment help on my own and only then identifying myself as an agent. C. CA representatives were invariably uninformed, rude and dishonest to us agents: the agents I network with found that we would get different answers to the exact same critical question and/or request for help depending on what C CA. representative we talked to. And on more than one occasion I was given a bogus call reference number (per a supervisor who I later would give the number to) by the C. CA. rep. I spoke to and they all refused to give out their name or ID number!

8) I went through all the proper channels and on-line procedures in January, 2014 to request one of the specially-trained C CA local educational speakers (as touted on their website to supposedly be available to us agents) to come to the location of one of my business clients (a large restaurant chain in Pasadena) to do a presentation. I re-sent that request 5 times (and 4 phone calls) during 1/5/14 – 3/26/14 because I never got any reply to it, other than E-mails acknowledging that my E-mail requests were received by Sacramento headquarters… I have still not received any reply.

9) On 12/23/13 I similarly exactly followed the specified C. CA procedures in faxing an appeal on behalf of one of my clients to challenge that her children were being put onto Medi-CAL (a huge and frequent calamity with the whole process for enrolling families). I used the officially-designated C CA. form for this appeal and faxed it to the number on the form. I retained the Office Depot confirmation that the fax successfully went through. I followed up on this appeal 6 times during Jan. – March, 2014, even getting through to a special representative at the State of CA Appeals Office (supposedly totally separate and independent of Covered CA) that was given the authority to handle, hear and process all C CA appeals. This representative told me that my original fax was lost and so she had me re-fax this appeal directly to her, which she E-mailed me confirming receipt. During three of our phone conversations, she assured me that she would “look into my appeal and have somebody call me on the status of it”. More than 5 months after my initial 12/23/13 fax of it, NOBODY has ever contacted me!

10) I believe that C CA further demonstrated its disdain of us agents, further defrauded us, and breached its fiduciary duty of fair dealing by hiring their “enrollment counselors”. Why did they even invent that W-2 role when they had plenty of us agents who went through their charade of required training and “certification”?!

11) We were taught in our Covered CA training that we would be paid $58 for each qualified Medi-Cal enrollment done through Covered CA, which I have never received one cent of for the 8 that I did; and

12) We were promised that we would be paid for SHOP enrollments on a timely basis, which has also turned out to be a blatant lie.

Mr. Dickey will have his day in court against Covered California at 8am on March 24th, 2015 in Alhambra, CA. He invites other agents that have similar problems to contact him about possibly testifying at the small claims hearing. Mr. Dickey can be reached through email at jdickey254@sbcglobal.net

Health agent sues Covered California in small claims court.
  • paulette lofton

    I know and they keep delaying this Medi-Cal payment whats up with that? I hope you get somewhere with that.

    • John Dickey

      I fully intend to aggresively go after them for Medi-cal and SHOP payments. Small
      claims courts exist mainly in “equity” in that one of their main objectives is to achieve
      basic fairness; that hopefully will include preventing carriers (including those that get Medi-cal clients assigned to them) from being “unjustly enriched” with premium payments since 10/15/13 that they did not pay us agents one cent (in far too many cases) for steering to them! I also hope the Judge will give me enough time to expose the blatently-illegal conspiracy between Covered CA and their carriers to prevent us from getting the paltry commissions we deserved… Thank you for your reply and please spread the word.

      John Dickey

  • http://www.HealthReformQuotes.com Steve Shorr

    Here’s some of the pages I set up about all the problems getting going….

    http://individuals.healthreformquotes.com/covered-ca/historical-agent-info/snafu-pay-bill-get-id-cards/

    One of the worst things is Covered CA cancelling the policies written between 3.2010 and 10.2013 that President Obama said we could keep in 12.2013. His Video has disappeared, sounds like “1984.”

    http://www.isitdownrightnow.com/coveredca.com.html

    http://steveshorr.com/steveshorr/individual_and_family/Covered.CA/how.to.complete.the.application.htm

    I resent their ads asking everyone to go direct and bypass the agent

    Saying they would accept paper applications, then not.

    Small Claims Court Guides & Info http://generallaw.steveshorr.com/

    How about posting the Case # so we can follow some of the updates…

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