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My Covered California Insurance Nightmare

Updated on March 25, 2016
I got four different "welcome" letters from Blue Shield during my ordeal. Every time Covered California sent a new application, I got a new welcome letter. But they never fixed the original problem until it was too late.
I got four different "welcome" letters from Blue Shield during my ordeal. Every time Covered California sent a new application, I got a new welcome letter. But they never fixed the original problem until it was too late.

Or Why I'll Be Paying the Government a Fine This Year

In the beginning, I was in favor of the Affordable Care Act (aka Obamacare).

I understand how medical bills can devastate a family’s income. My partner is in a wheelchair due to a car accident, and even with insurance, we still spend thousands of dollars out-of-pocket every year. It is a constant source of financial stress. I can’t even imagine trying to manage those costs without insurance, so I believe everyone should have insurance.

For most of my adult life, my family had health insurance through an employer plan. But when I became self-employed, I had to buy health insurance on my own for the first time. It really wasn’t as difficult or as expensive as I had imagined. In 2013, I paid $310/month for insurance for me and our two kids. It wasn’t the greatest coverage, but we could afford the premiums and it provided a safety net if we had a catastrophic medical problem.

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The Nightmare Begins

The coverage I purchased when self-employed was terminated December 31, 2013 because the ACA was going into effect. In December, I tried to sign up for a new plan for me and the kids (my partner is covered under Medicare), but the website and phone lines were too busy. I had better luck in January. I went online and completed the application, but when I got to the plans offered, I stopped dead in my tracks. There wasn’t a single plan available for less than $600/month!! What?! I had expected and been willing to pay a little more for my insurance so everyone in the country could have affordable health care. I was willing to do my part so nobody would get sacked with the kind of medical bills that I was all too familiar with. But more than double what I had been paying?! Apparently the government thought we were rich, despite the fact that we sometimes had cloes to $10,000 in annual medical bills. Now our health coverage costs were going to go up even more.

And not only were the cheapest plans more expensive than the plan I’d previously had, the coverage wasn’t even as good. Rather than a $40 office co-pay, we now had a 40% co-pay. Our individual deductible jumped from $3500 to $4500, and the hospitalization coverage was only 40% rather than 50%.

I didn’t like any of the options, so I didn’t choose any plan at all. But when the deadline to get coverage or get fined drew near, I went back to the CoveredCA.com website in early March, bit the bullet and chose a plan. I got my welcome letter from Blue Shield in late March and I sent my first payment of $636 at the end of March. Since deadlines for earlier coverage had already passed, I assumed my coverage would become effective April 1. I didn’t think about it again.

On May 1, I went to the Blue Shield website to make my May payment and discovered that my effective date was showing up as February 1. According to Blue Shield, I owed them for three months – March, April and May. They had applied my first payment to February. Even though I had just signed up, I was already “late” on my payments.

I figured this was a simple error that could be fixed with a phone call, so I called Blue Shield. Or I TRIED to. The phone lines were jammed because everyone was trying to meet the government deadline. I sat on hold several times for at least half an hour each, only to get disconnected when the automated system told me the lines were too busy and I’d have to try again later. Time and again, I couldn’t get through. But on May 15, I got through to a person at Blue Shield who told me that they couldn’t change the effective date; Covered California had to tell them what that date should be.

Well, that didn’t seem hard. I called Covered California, explained the situation, and a man said he’d fix it. No problem. Great. I hung up feeling confident that the problem would be fixed. I paid my May payment (at least, I thought it was for May!) and assumed all was fine.

But when I went to make my June payment, I discovered things weren't fine. Covered California did change my effective date to April 1, but they did it by submitting a brand new application and canceling the old application. The problem? The cancellation date on the initial application was May 15. Blue Shield, therefore, was still applying my payments to February and March on the old plan. When I talked to Blue Shield customer service, they said it shouldn’t be a problem on their end to transfer the money into the new plan, but, once again, they needed Covered California to tell them the initial application never should have existed and they should apply my two payments to April and May in the new account.

The individual deductible jumped from $3500 to $4500, and the hospitalization coverage was only 40% rather than 50%.

Why Isn't This Problem Fixed Yet?

Thus began my long quest to get Covered California to change a date. From June to September, I called Covered California and Blue Shield repeatedly, often waiting on hold for 45 minutes or more to talk to someone at Covered California. Each time, they said they understood the problem and would fix it. Each time, they told me I had to wait about 10 business days to see the results. Each time, I called Blue Shield after the required wait time, expecting they would have better news for me. I ended up with three separate applications at Blue Shield – one with an effective date of February 1 and an end date of May 15 with nearly $1300 in payments and two with effective dates of April 1 with no payments.

In July, someone at Covered California suggested I file an appeal, so I went to the website, found the online appeal form, filled out all the input fields and thought when I pushed the button that it was submitting the appeal. When I heard nothing after two weeks, I called Covered California. They said to just wait a little longer because appeals take awhile.

In August, I called the Department of Managed Health Care and explained the problem. They said they had no jurisdiction over Covered California, but they could contact Blue Shield and try to resolve it. I never heard back from them.

At this point, I had been trying for three months to fix the problem, and I hadn’t made any additional payments because I was afraid to do it until everything was resolved. If I had made a “June” payment, Blue Shield would have applied it to April, “July” would have been applied to May and so forth. I still would have been “two months behind” on my payments. I didn’t want to take the chance of making additional payments and having my policy canceled because I was “two months behind.” My goal was to get the situation resolved and then make the back payments to catch up.

During this period, I was also afraid to use my insurance because I didn’t know if the visit would be covered. Since a “June” payment would have been applied to April, I didn’t know if a June medical visit would be covered . I was in limbo until my two payments were credited to the active account. I moved my annual exam from summer to fall, hoping to get the situation resolved in time for an October appointment.

On August 18, I called Covered California yet again. I explained the numerous calls I had made and how I’d been waiting to hear something on my appeal. The woman asked me how I had submitted the appeal. I said I filled out the form online and pushed the button at the bottom of the page. She told me the online form with the fill-in-the-blank boxes wasn’t an online form at all. I had to print it out and fax it in! I was dumbfounded. Who has an online form with text input boxes and a button at the bottom of the page if you have to fax it?? When I went back to the site later to find that page, it had been removed. There is no longer a form I can find anywhere on the Covered California website to submit an appeal. Now there is a pdf file that you can print and fax in.

I was so frustrated!! At that point, I just wanted to forget everything and start again. I asked if I could do that. The woman said no because I hadn’t had a “qualifying” event. I wanted to scream, “Really? Beating my head against the wall for three months to get a simple date changed isn’t a qualifying event?” Instead, I listened as she said she would “escalate” the problem and get it fixed. I’d heard that for months, and it had never happened. I really didn’t have much hope anything would change.

And it didn’t. On September 3, I talked to Blue Shield again to see if anything had been resolved. Nope. But this time they told me I no longer had an active policy in their system. The Blue Shield customer service rep said I should call Covered California and ask them to reinstate me. She also suggested I ask them to change the effective date at the same time. As long as the other policies were no longer active, she said it didn’t make sense to pay for all the months I was afraid to use my coverage. It sounded like a good plan to me.

So I called Covered California… again. This time, I sat on hold for 59 minutes (which surpassed my previous record of 57 minutes) before I got a real person. I made my request. He said he could submit a reactivation, but he didn’t have the authority to change the effective date, so he transferred me to a “specialist.” I reiterated my request, and she said she couldn’t change the date either. So I gave up, asked her to simply request a reinstatement for my policy and get the original two payments transferred to it so I could at least know that I was getting credit for the first two months. After putting me on hold multiple times, she eventually said she couldn’t even reinstate the policy. I spent 2 hours, 8 minutes and 54 seconds on that one call, only to be told they couldn’t do anything at all to help me. I had to file an appeal with the state. I got off the phone and cried.

Since a “June” payment would have been applied to April, I didn’t know if a June medical visit would be covered .

My State Appeal

On September 11, I filed an appeal with the state. I explained how I’d been trying for four months simply to get my payments applied to April and May, but I said I was so frustrated and angry that I now wanted to get reinstated and have the effective date changed to September 1. She told me they got a lot of complaints from people who needed their effective date changed. Why wasn’t I surprised? She told me they would send my complaint to Covered California, who would then have 30 days to resolve the problem. If they didn’t, a hearing would be set with a judge. I wasn’t hopeful.

On September 26, I got an email from an analyst at Covered California. In short, she insinuated that everything had been fine since they created the new policy on May 15 and I was simply trying to get my effective date changed to September 1 because I hadn’t made my payments since then. I was furious and insulted! If everything had been fine since May and I just didn’t want to make my payments, why would I have spent four months and hours and hours of frustration on the phone with Blue Shield and Covered California? Why would I have filed an appeal, called the Department of Managed Health Care and ultimately filed an appeal with the state? Why in the world would I have put myself through all this frustration if I just didn’t want to pay my bills?? If that’s all I wanted, I could have stopped paying Blue Shield and saved myself the pain and frustration of dealing with the bureaucracy.

She suggested I withdraw my appeal and pay Blue Shield over $3000 in backpay because everything was fixed (and always had been, according to the underlying message in her email).

The same day, I got a letter in the mail from Blue Shield, telling me I needed to make the initial payment on my new health insurance plan, effective April 1. The letter said the initial payment needed to be received by September 26 or my coverage would be canceled.

I received the letter on September 26.

Have You Dealt with Covered California?

If you purchased your insurance through Covered California, what was your experience?

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Adding Insult to Injury

If you have read all the way to the end of this article, I admire your patience. Reading this story must be nearly as mind-numbing as living through it. At this point, I am withdrawing my appeal. I am giving up. I have no fight left in me. I am paying out-of-pocket for my daughter’s doctor visit this week and I am rescheduling my annual exam to 2015 when I hope to have insurance. I have resolved myself to the fact that I will probably have to pay the government a big fine for not having insurance coverage this year.

I’m sure some people would say I should have just kept paying the premiums while I was trying to fix the problem, and maybe they’re right. Maybe I should have made the payments and hoped Blue Shield wouldn’t cancel me while I was continually “two months late.” Then I might have insurance today. But it still would have taken me five months to get Covered California to fix a single problem. That's my real frustration. I'm not upset with Blue Shield with canceling my policy. I'm upset with Covered California for putting me through this ordeal.

Every person I talked to at Blue Shield, Covered California, the DMHC and the Department of Social Services was nice and said they wanted to help. No one did. I certainly don’t blame Blue Shield for canceling my policy. After all, I didn’t make any payments for four months. I do blame Covered California for causing the initial problem that led to months of frustration and my eventual cancellation. The fact that Covered California eventually insulted me and "fixed" the problem on the same day Blue Shield canceled my coverage is also pretty offensive.

Open enrollment rolls around again in November. I hope I can actually get insurance this time around. And I pray to God it won’t require me to spend hours and hours on the phone banging my head into a wall.

I still believe everyone should have access to affordable health care. I still believe making it available to everyone is a good idea. But as for the ACA and its implementation, I am not a believer.

2015 Update - Good News, Bad News

Well, 2015 rolled around, and I'm happy to report good news -- my kids and I once again have health insurance. Yeah!! I signed up on the Covered California website without a hitch, made my payment, got our insurance cards, and everything seems to be fine. I have a new provider, and although I still think the plan is outrageously expensive ($626/month) for the the poor coverage it provides, it's better than nothing.

But....

I received my 1095-A form from Covered California at the end of January, and - surprise! surprise! - it's all wrong. According to the form Covered California wants me to file with the IRS, I had insurance coverage for 11 months of the year.

A letter enclosed with the form said to call them if you noticed any errors on the form. So I called... and the representative said she couldn't help me; I had to go to the website to file a dispute. Just once, can't they get their story straight??

So I'm sending in my dispute today and hoping that they'll get the form corrected before I have to pay taxes. Wish me luck!

If You Survived the Ordeal, Please Leave a Comment

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    • Samantha Sinclair profile image

      Samantha Sinclair 3 years ago from North Carolina

      I'm surprised there aren't lawyers there advertising assistance since this seems to be one of many stories with Covered California... Good luck on your next round!

    • LisaDH profile image
      Author

      LisaDH 3 years ago

      Ann Hinds, sorry to hear you also had a bad experience. I wish I could say I'm surprised, but I'm not. :-( I hope you've got it resolved. If not, good luck in November!

    • LisaDH profile image
      Author

      LisaDH 3 years ago

      Heather, so you had health insurance and now you don't -- just like me. The system that was supposed to help everyone have health insurance has managed to do the exact opposite for some of us.

    • LisaDH profile image
      Author

      LisaDH 3 years ago

      greenspirit, yes, the United States is definitely in a class by itself when it comes to health care, and this new approach does not seem to be the answer to our problems.

    • Ann Hinds profile image

      Ann Hinds 3 years ago from So Cal

      Let's start with Covered California sucks. Similar problems and my payments are mixed up too.

    • Ann Hinds profile image

      Ann Hinds 3 years ago from So Cal

      Let's start with Covered California sucks. Similar problems and my payments are mixed up too.

    • Heather426 profile image

      Heather Burns 3 years ago from Wexford, Ireland

      After I saw that our premiums would be more than triple what we had, and that our doctors wouldn't accept any of the plans anyway, and that the govt standard considered our previous plans inadequate so we had to give them up, we opted for the fine. Remember "If you like your plan you can keep it. And your premiums will go down. " I never believed any of that. We never wanted the ACA, because I grew up in a military family and knew first hand what happens when the govt is in charge of health care. The day it was announced that we "dependents" could go to private doctors instead of being in the Army system you could have heard the chorus of hallelujah shouts around the world. If they wanted to socialize medicine which I still believe is a good idea, they should have followed the model of France or Spain or Italy, numbers 1,2,and 3 in the world when it comes to quality of health care. (by many organizations who track this sort of thing. ) In all of those cases, the doctor patient relationship is sacrosanct and not run by bureaucratic IRS idiots who have never even gone to med school. In other words, the Government stays out of the doctor's office. This is how is should have been done, not having the IRS administer the program! Yes I am irate over this. I moved out of state and our premiums are "only" double here. UGH.

    • greenspirit profile image

      poppy mercer 3 years ago from London

      wow, I can't believe what you go through to get medical care! We moan here in the UK about the inadequacies of our national health system but it is there when and if you need it, free at the point of delivery. It isn't really free because those of us who earn enough to pay tax fund it from deductions from our income. It has short comings and sometimes real failures but I like to know that anybody, anywhere, rich or poor can turn up at a doctor or hospital and get treated when they need it whether they have money or not. It sounds like Obama care hasn't been organised and thought through properly.

    • LisaDH profile image
      Author

      LisaDH 3 years ago

      Thanks, Janiece!

    • JanieceTobey profile image

      JanieceTobey 3 years ago

      Wow. I'm so sorry you had to go through that! And now you've still got to try to deal with it again in November! Best of luck to you, Lisa!

    • LisaDH profile image
      Author

      LisaDH 3 years ago

      Karen, sorry you had a bad experience, too, but it's strangely comforting to hear from someone else who has been put through the wringer by Covered California. I hope we both have a better experience in November. The next time I'm in the Bay Area, maybe I should swing by, meet you in person and we should share a stiff drink before attempting to do this again.

    • profile image

      Karen Carlson 3 years ago

      My experience was similar... I was all for California Covered UNTIL I GOT LOOPED INTO THEIR MESS.

      It's wildly expensive. I pay $450 a month for just me... and have a high deductible, and a 40% co-pay.

      Because of their mistakes my coverage was delayed for a few months (leaving me without coverage... despite having paid).

      I signed on with Blue Shield because my doctor was registered there... once I had the coverage, I called for an appointment, and learned that she no longer accepted Blue Shield.

      So I made an appointment with the only other general practitioner who accepted Blue Shield (that wasn't associated with an inner city clinic). Irritatingly enough, she is a 30 minute drive away... and after one visit, I got a letter from the office saying that she no longer accepts BLue SHield.

      I can't change my coverage without a life changing event. YET Doctors can change their acceptance of coverage?

      Sigh

      Not sure if I'm looking forward to November or dreading the whole "starting over " thing.

      Meanwhile I've paid THOUSANDS of dollars, for essentially nothing.

      Thanks for letting me rant.