Obamacare Q&A: Battling the maze that is health care

Westhill insurance consulting


But does it have to be this difficult?

Case in point: Holly Larkey of San Clemente, who signed up and paid for a new Kaiser plan through Covered California, the state's health insurance exchange, and did so well before deadline. Then she says she discovered that Covered California or Kaiser — or both — botched her coverage.

Instead of filling her prescriptions and visiting her doctor this month, as she had planned, Larkey has been trapped in a Kafkaesque game of bureaucratic pingpong, in which she is the ball.

If my inbox is any indication, her experience isn't isolated. Many of you are struggling with bureaucratic fiascos related to your new plans, and not just with Kaiser.

In today's column, I'm going to give you tips on what to do if you, like Larkey, can't get the coverage you signed up for and paid for.

Question: Can you help me?

Answer: That's how Larkey, 62, ended her initial email to me.

Back in November, Larkey was thrilled to learn that she qualified for tax credits and would save hundreds of dollars a month on her new Kaiser health plan.

But upon trying to fill one of her prescriptions this month, she learned that Covered California inadvertently canceled her new plan and enrolled her in another one with less coverage. The plan also costs more because her tax credits weren't applied.

And even though Kaiser cashed the check she wrote for her January premium, she received another bill saying she owes for both January and February.

Larkey has doggedly tried to fix the problem and estimates that she has invested at least 50 hours so far. When she calls Covered California — or rather, when she gets through its jammed phone lines — she is told to call Kaiser. Kaiser tells her to call Covered California. She has been assigned two different case numbers, which has muddled the process.

I contacted Covered California to explain Larkey's case and ask what people in her situation should do.

"Covered California recognizes there are people in this situation, and we're making it a top priority to straighten out these accounts," says spokeswoman Anne Gonzales.

Gonzales advises people with problems to call the Covered California general information line at (800) 300-1506. I told Gonzales that Larkey is doing just that, but often can't get through or is put on hold for hours.

Gonzales acknowledges that Covered California's 1,288 phone lines are typically at capacity at any given time.

"We ask that consumers be patient, keep trying and— this is important — know that once their cases are resolved, they will get retroactive coverage as long as they've met all the enrollment and payment deadlines, she says.

I'm not sure how you can keep up with payment deadlines if you're not getting billed for the correct plan or the correct amount, but …

Kaiser, too, says the best thing to do is call its main toll-free line: (800) 464-4000. (I presume other insurers would instruct you to do the same thing if you're having trouble with them.)

Like Covered California, Kaiser also is getting deluged with calls, says spokeswoman Sandra Hernandez-Millett. The best times to call are after 5 p.m. or on weekends, she advises.

It's all so simple.

In reality, it's often not, so I consulted with Anthony Wright, executive director of Health Access California.

Wright reminded me that California has two regulatory bodies that oversee health plans: The Department of Insurance and the Department of Managed Health Care (whose help center can be reached at 888-466-2219).

You should contact them if you aren't getting the care or coverage you think you're entitled to under your policy, he says.

But what if you're having trouble like Larkey and aren't getting enough help from Covered California or your insurer to iron out bureaucratic glitches?

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