At some point you get tired of dealing with idiots. At some point you need to complain with the full understanding that nothing changes because government bureaucracies and private corporation sucking off a government contract never change. As my phone showed I had been on hold for over four hours with Covered California’s agent support Pinnacle Management, I was able to finish writing the following complaint forms to Covered California.
Covered California breach of consumer privacy
On November 6, 2015 my client received an eligibility letter from Covered California that was triggered by our renewing the family health insurance for 2016. In the eligibility letter she was informed that one of her adult daughters, who is over the age of 18, either was or had been in jail. This is a breach of an adult’s reasonable expectation to privacy regarding their personal life.
The letter stated, “We need proof you are not incarcerated. The records show you are incarcerated (in jail or prison).” Covered California has essentially slandered a member of this household based on data the letter readily admits may be wrong.
How was the mother to react when she read her daughter was in jail when she thought she was in college? It is not the place of Covered California to reveal personal information about adult household members to one another.
Covered California should remove any reference to jail and in its place instruct the household member to contact Covered California.
Eligibility demands with no verification reference
My client received a confirmation and eligibility letter from Covered California in early November. In addition to wanting proof that one of the household members was not in jail, the letter stated that the adult household member also had to provide proof that she did not have any other coverage, and verify her social security.
When I, as the agent, opened the families Covered California, there was no place under Manage Verification/Submit Verification to upload any of those documents. There were requests for verifications for other household members that had the appropriate documents uploaded last year, but nothing for the new verification.
The second issue revolves around proving something that doesn’t exist. The adult in question had never been in jail. What proof do you want that she is a good citizen? How should she prove she doesn’t have other health insurance? She has always been on the family plan even while in college.
The Covered California letters are generating a tremendous amount of stress for families and many wasted hours trying to fulfill your demands. Consumers and agents want to comply with the requests outlined in the letters, but you need to give us the explanations and links to upload what you are demanding.
Pinnacle Management failure: hours on hold
On November 10th and 11th, 2015, I had to wait on hold for over two hours to speak to a SHOP customer service representative. I started out as sixty-six in the hold line at 8:15 am. By 12:30 pm I was down to number fifteen in line.
After two open enrollment experiences has Covered California and Pinnacle Management learned nothing about staffing a support center?
When I’m on hold, I can’t help clients renew their Covered California health insurance or answer other questions for clients. I’m not paid by the hour and I don’t have a guaranteed salary.
The email requests for assistance generate nothing more than a canned response.
If it is the goal of Pinnacle Management and Covered California to dissuade health insurance agents from helping consumers enroll in Covered California health plans, they are inching toward the finish line. I can’t spend hours on hold, getting no work done, for the eroding commission levels paid on Covered California enrollments.
These intolerable wait times on hold just push agents to avoid and leave Covered California behind. But I suspect that is what Covered California, Pinnacle Management, and the health plans want.
Western Health Advantage split commissions
In a letter dated October 30, 2015, Western Health Administration informed agents that they had split commission structure of individual and family plans. If an agent enrolled a consumer through Covered California in order to receive the Advance Premium Tax Credit (APTC) he or she would be paid $22 per member per month. If that same agent enrolled the same consumer in an off-exchange WHA health plan he or she would be paid 5% flat commission.
In my recent training for the Federally Facilitated Marketplace participation the documentation mentioned that the Affordable Care Act prohibited the health plans from paying split or dual tier commission structure – a commission structure that discriminated against the Marketplace exchange.
Western Health Advantage should not be able to discriminate against Covered California and under-value my time as an agent. There is far more work involved to complete the enrollment application for Covered California than the application directly with a carrier. Agents need to understand not only the Covered California streamlined application; we have to be familiar immigration forms, MAGI, and taxes to competently enroll a family.
Agents should not be punished by carriers for helping their clients enroll in a Covered California qualified health plan. But this is exactly what is happening when a carrier like WHA informs me that I’ll make more money by enrolling people directly with them and by-passing Covered California.
Download Complaints and Official Covered California Complaint Form
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