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.
Conditional eligibility letters are confusing
It seems that the congratulatory Covered California conditional eligibility letters are generated from a template meant to cover several different enrollment situations. By stuffing in references to plans and programs people don’t qualify for such as Medi-Cal, the families are correctly confused to believe they have done something wrong in the application process. The general confusion leads people to phone into the call center, swamping the phone lines and further exacerbating the wait times for people who are actually trying to apply for coverage.
Important confusing news from Covered California
The “Important news about your health benefits” letter is meant to clarify whether household members
- Are eligible for premium assistance or Medi-Cal
- Are eligible for the enhanced Silver plans with lower copays, deductibles and cost sharing
- May need to submit further documentation for proof of income, residency, social security numbers and immigration status
The first problem with the letter is that it doesn’t mention which health plan or pediatric dental plan the recipient has enrolled into. Covered California has never set up a confirmation notice to be sent either by email or USPS leaving that up to the health insurance company.
You don’t qualify for enhanced Silver you didn’t apply for
The next confusing part is mentioning that certain household members don’t qualify for certain plans or programs that they may not have known even existed. To inform the family they don’t qualify for the enhanced Silver plans leads them to believe that maybe they don’t qualify for any plans. Did they do something in the application process to deny these Silver plans that they weren’t aware even existed? And why are they being told they don’t qualify for Medi-Cal when it was probably never their intent to even apply for the program.
Surprise, Surprise, your kid’s in Medi-Cal
Mud is added to the already cloudy waters when Covered California lists each household member and enumerates which plans they don’t qualify for. Some parents are shocked to learn that their children were put into Medi-Cal when they thought they were buying a family plan. Again, it is not clear from the letter why the children were put into Medi-Cal. But any household income below 250% of the federal poverty line will automatically place children 18 years old and younger into Medi-Cal.
Where was your son really born?
Some of the letters are requesting verification of income, residency, or immigration and citizenship status even though the applicant has already uploaded the documents to their account. It is unclear if a Covered California staff member actually checked the uploaded documents and decided they weren’t good enough or the request is just redundant and no one is looking at the submitted images. There are also goofy requests for people to submit their social security numbers and provide proof of income for children. Its unknown if this is a glitch in the system or if they think the applicant’s 16 year old daughter actually has a job at McDonald’s and is hiding her income.
Pay the ransom, send the documents
With respect to all the requests, all I can recommend is that you comply to the best of your ability. Even if you have uploaded documents, make copies and send them again to Covered California. If they don’t believe your son or daughter was born in the U.S.A., send the birth certificate. If they can’t figure out that the Social Security number you put on your last 1040 tax form is actually yours, make a copy of the card or last Social Security statement of potential benefits and send it to them. If you have no way to prove your daughter doesn’t have the six figure income she has been hiding from you, submit an affidavit that she is a high school student and really has no income except for the allowance you give her every week.
Did you really enroll or was it a dream?
The ultimate confusion factor comes on the last page telling people they must enroll in a health plan. This has led folks to believe that their selection of a health plan never happened even though they remember choosing one through the website. This in turn leads the recipient to call Covered California to check on their status and then wait for over an hour on “hold” to be told that they did enroll.
One touch and done
Confusing congratulatory letters and emails sent out telling people to pay health insurance invoices they had yet to receive was one of the items Yolanda Richardson of Covered California cited in her report on the “customer service” experience of Californians applying through the exchange. Ms. Richardson, Deputy Chief Operations Officer for Covered California, also revealed that their customer service strategy was built around the concept of “One touch and done”. The “one touch and done ” concept might apply to buying a book on iTunes, but we are dealing with health insurance, tax credits, estimating income, and immigration status compounded with confusing letters from the source itself. Its an IT fantasy to think Covered California would only have to make contact with the applicant once and everything would fall into place.
What happens if I fail to provide verification?
The congratulatory letters state the household is conditionally eligible for the premium assistance for 90 days subject to reviewing any submitted verification documents. No mention is made what happens in the event Covered California doesn’t like the documents you sent them. Will you and your family lose your health insurance? Will you be reported to a higher authority for non-compliance?
Lose premium assistance and maybe your health insurance
The unofficial answer from Covered California is that failure to provide proof of income will trigger the system to stop advancing premium assistance to the selected health plan. This would mean that the individual or family would have to pay the full premium amount, but the plan wouldn’t be canceled. This situation would be similar to those families that applied for health insurance through Covered California and were eligible for advance premium tax credits, but decided not to have the tax credits applied to the insurance premium, opting to take it when they filed their 2014 federal taxes.
Send in the footprint of your child
A more serious issue is not providing proof of citizenship, lawful residency or social security number. Lack of proof of any of these may cause the health insurance to be cancelled altogether because of federal regulations. So, make a copy of your child’s birth certificate with the cute little footprints on it and send it to our brothers at Covered California.