Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
What should be a simple task of changing from one Covered California health plan to a new one is proving to be no easy switch. The Covered California CalHEERS internet based program seems incapable of handling the switch between health plans for residents. People are complaining of retroactively cancelled policies, odd effective dates and a system unable to handle simple billing issues.
Covered California is finally scrapping their error filled doctor search feature on their ACA enrollment website. Initially conceived to help match families with health plans that supported their current physicians, it had problems from the start. Covered California announced in a press release they will be taking their provider directory offline until further notice.
Covered California has provided basic statistics and pretty pie charts on enrollment numbers into the ACA health plans that they offer. But what is left out is the statistical data that economists and demographers would like to have to ascertain if the Affordable Care Act is merely working or if it is actually fulfilling the promise to reduce health disparities in our communities with affordable health insurance.
Health Net notified all their California agents by a letter dated January 29th, that effective March 1, 2014, they will slash the sales commission by over 50% on four of their five individual and family plans offered in California. This further reduction in compensation for agents since the ACA was passed continues to make customer service oriented health insurance agents a “family of dinosaurs” who will quickly become extinct.
In an attempt to help consumers decide on the right health plan, Covered California has compiled a star rating system for the health insurance carriers based on outdated information. Even worse than basing a report on old data is the disastrous customer service that many Californians have experienced from many of these health insurance companies, including Covered California, in the last two months. The horrible customer service and nightmare enrollment process is not reflected in the new quality rating results.
The Individual Mandate of the Affordable Care Act psychologically chafes folks who don’t appreciate the government telling them what they have to purchase. Count me in that segment. If one of the goals of the Individual Mandate is to make people take responsibility for expensive health care, an alternative might be an unforgivable tax liability on those people who have chosen to forego health insurance and incur large medical expanses that go unpaid.
Covered California just announced they received another grant for more marketing of their health plans. In the words of one of the Covered California Board members, Paul Fearer, “I’m concerned about ramping up on media if we aren’t fully prepared to deal or provide excellent customer service in response.” Covered California needs to scrap the slick marketing and “one touch and done” concept to enrollment and open up walk-in enrollment centers to service Californian residents.
At the January 23, 2014 Covered California Board meeting I made public comments regarding the numerous applications for enrollment that had failed to be transmitted to chosen health insurance carriers. I have documented the numerous instances where I’ve enrolled individuals and families into a Covered California health plan only to learn the health insurance company never received the data.
Covered California continues to sabotage their customer service operations by sending out confusing eligibility and verification request letters to new applicants of ACA plans. Individuals and families receiving these letters are confused by Covered California informing them what programs and plans they aren’t eligible for, no mention of what they have enrolled in and requests for documentation they have already uploaded to the CalHEERS enrollment website.
When the insurance companies are having their risk for unexpectedly high health care expenses subsidized they should not have the luxury of creating tight doctor and hospital networks. The restrictions on network providers for cost containment purposes is exceptionally irritating when it is the plan members that are helping fund part of the risk reduction provisions by having to pay for the reinsurance fee on qualified health plans. Restricted networks and new EPOs are just a “work around” solution to allow health insurance companies to selectively limit health care like they have done in the past.
