Covered California: One Hot Mess


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We don’t hear much news about “The Affordable Care Act” (Obama Care) these days. Although when we do, we are told that it’s working just fine and many Americans who were previously uninsured now have insurance. I don’t know what’s going on in other states but I follow the Covered California Face Book page, and everyday there is another “satisfied” customer posting a complaint.

Some of the complaints are about long wait times to speak with a Covered California (CC) representative. It was believed that CC reps were laid off after the enrollment period, but today someone from CC finally admitted, “… due to a high volume of complaints…,” there will be long wait times for those lucky enough to get in the queue.

Other major complaints are:

1. Monthly premiums are too high. The average deductible is $6,000 a year  per family member. (The reason people didn’t see the doctor before this law went in to effect is because they couldn’t afford to go. Now they have to come up with the money for the office visit, prescriptions and pay monthly premiums?)
2. Consumers  cannot find doctors willing to take the CC insurance.
3. Those who did find doctors who will take CC insurance, and need surgery or a procedure done, discover that the hospital the doctor is contracted with, is not in their “network plan.”
4. People who were told by CC they qualify for Medi-Cal do not have their insurance cards yet, or have yet to receive a letter from Medi-Cal stating they are working on their case.
5. Some who were told by CC they qualify for Medi-Cal, later find out they do not qualify. CC suggested they complain to “California Department of Managed Healthcare” (in fact that is the default message for all complaints coming in to CC Face Book page.) Here are two responses from Medi-Cal social workers from CC’s  Face Book page:

Allison A. wrote, “Oh coveredca, you’ve tried so hard to set counties up for failure. The huge delay in the process is that the existing eligibility systems in the county offices are receiving huge amounts of external referrals that typically work well when there is no known case for the applicant. If there is already an existing case in our eligibility system, you essentially have to go over the case with a fine toothed comb and troubleshoot the case through trial and error to see what will finally make the cases work.

Cases are broken. It’s not that there are more applications than were expected (at least not in solano county). It’s that the systems speak different languages, the minimal training provided by CoveredCA was useless because they have a completely different interface that they work from than what counties work from, and medi-cal business rules are not allowed to be built into our eligibility systems.

Sure, coveredca said you’re eligible based on what you input into their system. After we receive the referrals, we have to go through and review what was input to verify that the information is correct. We are eligibility workers, coveredca representatives are not. We know the intricacies of the various Medi-Cal programs and their regulations, we know that you CANNOT COUNT YOUR PG&E BILL as a monthly income deduction.

If you want answers, come in and re-apply in person at your local Health & Social Services office. They can check their external referrals and register your application back to that date.”

 

Brenda S. added, “Im an eligibility worker in county 36 we are so backlogged…. I understand your frustration 100%! There is people putting diapers and groceries as expenses so of course they are eligible to Medi-cal and so we get the referral but turns out that we dont allow those expenses….. Yes if you qualify for medical please apply online though your county website or go in the office pick up an app. Fill it out at home then send it by mail.”

We were also told that CC would help prevent people from using the emergency rooms as their doctor office, therefore shortening wait times for those who really need to be there. The average  ER wait time is now 6-8 hours. People still show up at the ER instead of seeing a doctor or going to Urgent Care.

There are many more different complaints coming in daily, but these are the most common ones.  If the message coming from government is that more Americans are insured, then the message is correct, but from what I read, Americans are not getting healthcare. Isn’t that why the ACA was established in the first place? Or was it to give insurance companies more customers and a bigger bottom line?


About Inge

Cancer survivor. Healthy organic food coach. Public speaker. If you have a story you want told, contact me at iscott.orangejuiceblog@gmail.com/