Modesto area residents enrolled with Covered California waiting for confirmations, insurance cards

kcarlson@modbee.comDecember 30, 2013 

  • ABOUT THE REPORTER
    alternate textKen Carlson
    Title: Staff writer
    Coverage areas: County government, health and medicine, air quality, the environment and public pension systems
    Bio: Ken Carlson has worked 13 years for The Bee, covering local government agencies in Stanislaus and San Joaquin counties. His in-depth reporting has focused on access to health care and public employee pensions.
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    E-mail: kcarlson@modbee.com

Laura Hunt of Modesto signed up for coverage the first week of Covered California’s enrollment period in October but last week still had not received an invoice from the insurer so she could make the first payment and be insured by Wednesday.

Modesto resident Janet Cataline did not get a payment request from an insurer for weeks after enrolling in a Covered California plan in November to replace her costly COBRA insurance. She said she had to call the insurer – Anthem Blue Cross – about two weeks ago to arrange the payment, which should trigger her coverage.

Cataline still is waiting for an insurance card and provider list from Anthem so she knows what doctors will accept the subsidized Silver plan that costs $22 a month. Family Health Care Medical Group in Modesto, where she has gone for checkups, said it won’t accept Covered California plans except for Kaiser Permanente policies.

“I hope (the medical group) will change their mind. I don’t know if I will need a card to see a doctor,” Cataline said.

The troubled rollout of the federal health program enters a crucial phase this week as consumers try to use the coverage to access doctors or cover hospital bills. Critics of the federal effort predict a mess, particularly after state leaders disagreed with President Barack Obama’s suggestion to let people keep their individual-market policies for another year.

Insurers were required to cancel coverage for about 1 million policyholders in California because their plans were not grandfathered in or did not meet the Affordable Care Act’s standards. State Insurance Commissioner Dave Jones ordered Anthem Blue Cross and Blue Shield to extend their policies until March 31 because of the timing of notifications.

But cancellations for affected Kaiser and HealthNet members take affect today, and that has forced those policyholders to accept more costly replacement plans or purchase coverage with higher deductibles. An estimated 300,000 of those with canceled policies statewide were eligible for subsidies through Covered California to lower their premiums.

It’s not known how many people with canceled policies enrolled in other coverage.

Covered California, the insurance marketplace established for the uninsured and underinsured, said more than 400,000 state residents chose health plans through the agency between Oct. 1 and Dec. 23.

“We are not releasing numbers on how many (applications) have been transferred,” said Anne Gonzales of Covered California. “We would have to tally it, and we would rather keep our resources moving on processing the applications.”

For coverage to start, the insurers need to receive the applications from the exchange and send payment requests to customers. Consumers need to send the first payment to insurers by Jan. 6 for coverage effective Jan. 1.

John Nelson, a spokesman for Kaiser, said that customers who signed up with the insurer directly were asked to make the first payment when they enrolled. For those who enrolled in Kaiser plans through Covered California before the Dec. 23 deadline, Kaiser is working with the exchange to ensure they are covered when the new year begins Wednesday, Nelson said in an email.

The spokesman said Kaiser still was getting applications from the exchange. Kaiser will try to accommodate eligible applicants who need a medical appointment this week, “even if we can’t confirm their eligibility in our system,” Nelson wrote. “In these instances, we will refrain from collecting money at that time and will instead bill for the cost-sharing once the member’s information has been processed.”

HealthNet also said it will be flexible with customers who don’t have an insurance card by Wednesday. “They can go to the doctor and receive service, and if their information is not in the system, we will have them file a claim after the fact,” spokesman Brad Kieffer said.

Anthem and Blue Shield of California – which also offer Covered California plans in Stanislaus and nearby counties – said they were current on sending payment requests to customers whose applications were transferred by the exchange.

An Anthem spokesman suggested that Hunt and Cataline were isolated cases. Because of the large number of sign-ups for Anthem plans, “my guess is most people would have received (payment requests) in the middle of December,” Darrel Ng said.

Hunt, who enrolled in early October and fully supports Obamacare, said she finally called Anthem on Friday after not receiving a payment request for almost three months. She waited on hold for an hour and 15 minutes before reaching an agent, she said. “He was able to bring up my information and take my first premium payment,” Hunt said.

It took about 24 hours to make the debit-card payment because the system kept crashing, she said.

Trish Spears of Ceres said she had to call Kaiser to arrange to make the payment, because the insurer had not sent her a payment invoice. Spears was eligible for a subsidy after her Kaiser policy was canceled. She is waiting for a welcome letter and pamphlet from Kaiser.

In Stanislaus County, about 7,000 adults who were formerly in the indigent health program are expected to shift to the Medi-Cal program, which has expanded eligibility under the federal law. County staff estimated from 3,000 to 4,000 program clients were making the transition to Medi-Cal.

“We are making every effort to make sure there are no barriers to care,” said Mary Ann Lee, director of the county Health Services Agency. She said the agency reached out to affected clients through letters, calls and workshops this fall.

Stephanie Bjorge of Valley Home said Monday her application was started in November and she has yet to receive a Medi-Cal card. She will need a refill for drugs to treat her heart condition this week, she said. “I think that it’s inexcusable that the county social-services offices were closed last week,” Bjorge said.

She reached a county worker by phone Monday and learned her application still was pending. The county was arranging to provide her with an emergency Medi-Cal card, she said.

A county pharmacy that served indigent patients closes after business hours today. Those who enrolled in Medi-Cal are being referred to commercial drugstores that contract with the health program. Lee said the drugstores can check customers’ eligibility through an online service, even for those who haven’t received a Medi-Cal card yet.

The county Community Services Agency said it has beefed up staff to provide emergency Medi-Cal cards and other assistance at six local offices. The offices on 251 Hackett Road in south Modesto, 1014 Scenic Drive in Modesto, 1405 W. F St. in Oakdale, 2413 Third St. in Hughson, 101 Lander Ave. in Turlock and 66 N. El Circulo in Patterson, are open from 8 a.m. to 5 p.m. today, Thursday and Friday.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or (209) 578-2321.

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