Covered California Help Desk is slow to fix consumer problems with enrollment and eligibility.
Covered California has made great strides in reducing consumer telephone wait times and assisting individuals and families with health plan enrollments. What has bubbled to the surface is the failure of the Help Desk to resolve consumer enrollment problems ostensibly created by Covered California’s CalHEERS software. While there is no published data on the length of time to resolve a variety of consumer problems surrounding enrollment or Advance Premium Tax Credit calculations, anecdotally, the estimated two week resolution periods are turning into two month turnaround times.
Covered California Help Desk must be swamped
When a customer service representative (CSR) with Covered California can’t fix a consumer’s problem a “fix-it” ticket is opened and the matter sent to the Help Desk as it is referred to by Covered California. The more knowledgeable CSRs and Certified Insurance Agents can usually resolve most problems with a consumer’s account. Common errors CSRs and agents deal with range from the consumer incorrectly designating the primary tax filer, tax filing status, dependents, and income calculations.
Common consumer problems easily fixed
Once the complete picture of the household is known, a sharp CSR or agent can quickly scan the application in the CalHEERS program and make the appropriate changes to unclog the blockage so eligibility is properly determined. The Help Desk gets involved when the changes are made, but the CalHEERS program fails to make or recognize the changes and spits out the correct eligibility and enrollment. At this point, most of us assume that the actual computer program has bugs or glitches that are preventing it from making the proper enrollment and eligibility determinations. Some of these glitches are minor and don’t affect the actually enrollment or tax credits. Other program bugs stop the application, lock it up preventing further changes, or will ultimately lead to incorrect information listed on the consumer’s 1095-A.
Big complicated software
Simply put, the CalHEERS program is a big complicate piece of software that attempts to calculate an individual or household’s enrollment and eligibility for the ACA tax credits. While this sounds straight forward, the numerous rules of the ACA make determining a household’s eligibility anything but simple. Add to the complexity a program that must accept reported changes to a household’s composition and income, plus data from outside agencies such as Medi-Cal and the IRS, and you will invariably generate program output failures.
Pregnant woman stuck in wrong health plan
In one real world life event I have a client who gained employer group coverage for himself, but not his pregnant spouse. While the consumer followed the procedures to remove himself from enrollment in the family plan, the CalHEERS program still shows him as eligible for health insurance with a monthly premium for two people instead of one, and he has been locked out of selecting a new health plan for his wife. A fix-it ticket with the Help Desk was opened with Covered California back in April and as of June 12th the issues still haven’t been resolved. Because of the software failure his pregnant wife has been prevented from enrolling in a health plan that supports her chosen OB-GYN.
Tax credits denied
In another case, I submitted proof of income for a client back in March. In May Covered California finally got around to confirming the verification. My client’s received a welcome to Covered California letter in late May but they had been with Covered California since January. Upon investigation, Covered California had re-determined the family’s eligibility with no premium tax assistance. In addition, we could not confirm or renew their health plan selection. CalHEERS simply would not allow me or the CSR to select a plan.
Can’t renew health plan
I also learned that the application had been changed to indicate the family would NOT be filing taxes. If you don’t agree to file your taxes, you can’t get the premium tax credits. We are surmising that because the couple filed an extension, the IRS reported that they hadn’t filed taxes for 2014. Either way, the future scenario is that they will receive an invoice for the full premium amount in July or, possibly, their health insurance may be cancelled all together because the system won’t let us renew their old plan. (Anytime a consumer reports a change to income they must re-select their existing health plan. If they forget or don’t realize they need to, the plan may be cancelled. See reporting a change to income).
- Reporting income changes using special enrollment procedures
- Income changes trigger the necessary renewal of health plan
- Why are my children on Medi-Cal after updating my income?
- How income and household changes may affect ACA eligibility
Help Desk resolution times can span months
The estimated fix to this programming glitch by the help desk is seven to ten days. I have yet to experience a resolution by the help desk within that time frame. The Help Desk people don’t sit next to the CSR’s. Consumers and agents can’t speak with the Help Desk. CSRs can talk to them on the phone but usually they email a description of the problem to these mysterious code breakers. When I call to check the status of a languishing fix-it ticket I’m invariable told the issue has been escalated to another unaccountable cubicle dweller in the Help Desk department.
Additional stress families don’t need
I’m sure the percentage of Covered California consumers who are in “Help Desk Suspense” is relatively small. However, they are creating endless and unnecessary amounts of stress and anxiety for these individuals and families across California. These folks shouldn’t have to spend hours on the phone just trying to keep their health insurance just because a multi-million dollar computer program doesn’t work correctly. Californians are already dealing with a health care system that is stacked against the consumer to begin.
Incorrect 1095-As
The obscure Help Desk is similar in stealth to the department that handles the 1095-A dispute forms. I still have clients who cannot receive a 1095-A which correctly indicates the consumer’s Advance Premium Tax Credits and enrollment in a qualified health plan. The Summary section of the consumer’s Covered California account correctly shows which health plans or Medi-Cal eligibility the household members were enrolled into. But you can’t call the 1095-A resolution department and tell them, “Look at the darn account and generate a 1095-A that reflects that.” Instead, this department continues to send out the same 1095-A with the only difference being that the Corrected box is checked marked. Some people are having to pay individual mandate penalties or excess premium tax credits because Covered California has not generated a correct 1095-A for the tax payer to file with.
Help Desk needs some help
The ACA is complicate. Covered California is complicated. No one expects a completely glitch free software program. But consumer satisfaction and the Covered California brand image is compromised when there is a lack of transparency and information about seemingly trivial snafus that jeopardize a family’s health insurance. The Help Desk needs some extra help itself.