Blue Shield and Covered California ignore a lost enrollment.
One of the most feared aspects of health care reform on the part of consumers was placing their health insurance in the hands of unresponsive bureaucrats. On this point, health care reform has not failed to deliver. Most recently, I enrolled a family into a Blue Shield of California health plan through Covered California under the Special Enrollment Period. While the Covered California enrollment system shows they successfully enrolled, Blue Shield says they have no record of the enrollment. This is despite the fact that Blue Shield shows that the family has paid for their first month of health insurance.
Blue Shield can’t find lost Covered California enrollment
As is typically the case with enrollment disputes, Covered California says it is a Blue Shield problem and Blue Shield points the finger at Covered California. Blue Shield further states that they must wait 30 days before they request another transfer of the enrollment data from Covered California. So where does this leave the family? They have paid for health insurance in July for which they have no enrollment.
Enrollments fall through the cracks all the time. No software program is perfect at transferring all the data perfectly every time. What I found disturbing is that I had enrolled another individual in a Blue Shield health plan, after the first family, and this individual’s enrollment went through to Blue Shield with no problems.
Tale of two SEP enrollments
On June 14th I enrolled a Northern California family in health insurance under the Special Enrollment Period with a qualifying event of loss of coverage. The family had recently had an increase in household income and Medi-Cal was terminating their coverage as of June 30th. After the enrollment had been submitted and confirmed, I assisted the family in making their first month’s health insurance premium through the payment portal embedded on the Covered California website. We received a confirmation for the health plan to start July 1st, and a confirmation of the payment. (I grab screen shots of all such data in case Covered California or the carrier can’t find the information.)
A few days later I helped a Southern California individual also enroll a Blue Shield plan under the Special Enrollment Period. This person also had a qualifying event of loss of coverage. We also made the first month’s premium payment through the web portal. We also received confirmation of the July 1st enrollment and payment. This person’s enrollment is properly displayed in my Blue Shield client portal.
30 Day ignore period
When I contacted Blue Shield, they confirmed that they had received the Northern California family’s premium payment, but they had no enrollment data to connect it to. I was told they had to wait 30 days from the effective date of the enrollment before they could request another enrollment data transfer from Covered California. When I said this was not acceptable for a family who needs to see health care providers in July, they told me to contact the Blue Shield Issue Resolution Team.
I sent a detailed email to the Issue Resolution Team about the enrollment in question. They replied, “Our records do not indicate that you have an open case with the Issue Resolution Team.” Arrgh! I was trying to open a case. I was doing what the Blue Shield’s Producer Services representative told me to do.
Why can’t anyone take responsibility?
Why won’t anyone take responsibility for the lost enrollment? Covered California promises people that they can facilitate enrollment into qualified health plans. But when the enrollment goes sideways, for no apparent reason, Covered California just points the finger at the carrier. The Blue Shield bureaucracy just points to the rules they’ve been handed by Covered California of waiting 30 days to request another data transfer.
The people who can resolve this issue are behind thick walls. The Information Technology (IT) departments of both Covered California and Blue Shield can work to correct the lost enrollment. Why won’t they? Are they just overwhelmed by all sorts of other IT issues? Are they lazy? Do they not care? What’s the problem? Why does one person have their enrollment go through smoothly while another applicant’s enrollment is lost in cyber-space?
Anxiety and frustration grow over Covered California enrollment snafus
Regardless of why neither side will work to fulfill the promise of the health insurance enrollment, the net result is that consumers, and agents, grow frustrated and suspicious. We have developed a constant and nagging anxiety over interacting with the health insurance carriers, Covered California, and Medi-Cal. All of the people at these bureaucracies continue to receive their monthly paychecks. Consumer’s caught in their IT failures must deal with tremendous stress and anxiety of not having health insurance.
Eventually, the Northern California family will get their enrollment straightened out. But they will most likely have to pay out-of-pocket for health care services and then start another bureaucratic challenge of getting Blue Shield to reimburse them for those expenses. It is so easy for the employees of private health insurers or a government agency, who have group health insurance, to cavalierly tell the consumer, “Don’t worry, your health insurance will eventually reimburse you for those health care expenses.”
I don’t think these people realize the cost of visiting a doctor and having to pay for those services out-of-pocket, when a family is already on a tight budget. Again, more stress and strain on the consumer while the bureaucratic facilitators of the health insurance shrug their shoulders, turn-off their computers for the day, and go home.
