Another glitch in the Covered California enrollment system has been uncovered. When a household moves to a new address and the new residence is in a different rating region, the individual or family may receive an additional bill for back premium amounts. The software quirk that allows the health insurance carrier to invoice for past months premium seems to be purely date driven by certain fields in the CalHEERS program.
Covered California date error triggers billing error
Under the right circumstances, when an applicant changes their address to a different region with a higher premium with the same carrier and health plan, Covered California notifies the insurance company that the new premium should be calculated from the first date of enrollment. In the case that I am familiar with, my client enrolled in a health plan in Region 12 during open enrollment. In September the family moved to Region 3, Sacramento, which has a higher premium rate for the same carrier and health plan type. The difference in premiums is approximately $32 per month.
Original effective didn’t change
Even though the plan change enrollment noted an October 1 effective date for the new rate, the enrollment summary page still showed a February 1st enrollment. Included on the enrollment summary page was the new premium. When this information was transferred to the health insurance company they generated an adjustment of $256 equivalent to eight months of back premium amount due. This is clearly an error of the CalHEERS system to update the original enrollment to the effective date of the new plan under the change of address qualifying event procedure.
How many families have over paid?
Had the family chosen a different health insurance company and possibly a different metal tier level health plan, the adjustment may not have been created and billed. But there is the possible scenario that a family moving from a higher priced rating region to a lower cost area, with the same plan and carrier, may receive a credit adjustment that they are not entitled to. Until an audit is performed we will never know how many date error induced credits or debits are occurring in the system.
Simple date error creates hours of work
What we do know is that this simple date error creates hours of work and wasted time. When I called the carrier they told me they were just processing the instructions they had received from Covered California. Another phone call to Covered California generates an incident ticket to correct the back dated premiums to be corrected. But it was unclear to me or the customer service represented at Covered California what they would actually transmit to the carrier to void the back premium amount created by their date error. I have faith that either I or my client will have to make more phone calls to straighten out the billing mess.