Just Over 500,000 People Enrolled in Covered California in 2013 -- Some Report Problems

In issuing a final tally of 2013 enrollment, Covered California reported Monday that 500,108 people signed up for one of its health plans. Another 125,000 people enrolled in a health plan during the first two weeks of January, said Peter Lee, executive director of the agency.

"The momentum we have from the end of last year is still going strong," Lee said in a press conference.

Medi-Cal, California's public health insurance program for people who are low income or disabled, also showed strong enrollment -- 584,000 additional applicants to Covered California appear to be eligible. When adding that number to the 630,000 Californians who transitioned to Medi-Cal from the Low Income Health Program on Jan. 1, more than 1.2 million Californians are newly insured in Medi-Cal. "Powerful numbers," Lee said. "We are touching millions of Californians."

Covered California released a boatload of demographic data, but Lee spotlighted a couple areas in particular. First, the coveted 18-34 group (coveted because youth is a proxy for healthy) now makes up 25 percent of all enrollees, up from 21 percent at the end of November. But 36 percent of California's subsidy-eligible population is 18-34. Lee acknowledged that Covered California has more work to do to increase the enrollment of younger adults.

Latinos are also a coveted group (again, because Latinos as a group are younger than the population as a whole and presumably healthier). Of the 78 percent of Covered California applicants who reported their ethnicity, nearly 19 percent said they are Hispanic. While that number seems like a big improvement since early December, when 4.6 percent of enrollees said they spoke Spanish as a first language, it requires a bit of parsing of the data to compare apples to apples.

Yes, as of Dec. 31, 18.7 percent of enrollees checked the box "Hispanic" when enrolling on Covered California, but just 5.5 percent of enrollees said they preferred to received Covered California information in Spanish. Statewide, nearly 29 percent of Californians speak Spanish at home. This low enrollment of people whose first language is Spanish suggests that Covered California needs to improve its outreach to immigrants -- an effort Lee says the agency is working on.

Problems accessing insurance

Of course, enrollment in a health insurance plan is of little use if people cannot use it to see a doctor. Sue Kearney of Oakland says she is self-employed, and until she enrolled in Covered California was "paying $550-plus a month for a really crappy $5,000 deductible plan." She signed up for the only PPO plan she found in her area -- Anthem Blue Cross. After her subsidy, she's paying about $65 a month. She says she enrolled in late October or early November.

Kearney has had health problems and was careful to make sure her doctors were in her plan's network of providers before she enrolled. She then made doctor appointments for early January. But at the first appointment, she was told that the practice was not taking any Covered California plans. Kearney says she called her other doctors and got the same response. Then she visited Anthem's online provider database, which showed her only those doctors who were in her network. She says she called eight or 10 of those primary care doctors. Even though they were all listed as taking her insurance, when she called each doctor's office, she was told that they were not taking any Covered California plans.

Last week, I contacted Darrel Ng, spokesman for Anthem Blue Cross. Kearney, Ng and I ended up on a conference call while he tried to sort out the problem. As of Monday afternoon, Kearney says Ng had connected her with a specific customer service representative who is working to determine what doctors in her area do take her insurance. It's unclear right now if there's a glitch in the system or if Kearney's network of doctors is limited. We will report back as it unfolds.

In the meantime, Kearney needs lab tests. She says the customer service representative assured her that a specific laboratory group takes her insurance. Both Covered California and the California Association of Health Plans have repeatedly stressed that anyone who is covered should not put off care, that coverage will be honored. But Kearney is leery.

"I only have his word for it that I can have this long list of labs drawn," she said. "I don't have it in writing."

In addition, Kearney has paid her January premium twice. She paid it by mail, but when the check didn't clear, she worried she would be uninsured. So she called Anthem and paid over the phone. As of Monday afternoon, neither payment had cleared her bank account.

Problems confirming enrollment

Kuei Lin Liu of Richmond signed up on Nov. 11 with Blue Shield. She was "very interested in coverage," she says. She and her husband are expecting their third child on May 31. She provided "all supporting documents," she says, and got an application number confirming her application had been submitted.

Then she waited. And waited some more.

In early December she started making calls to both Covered California and Blue Shield. Blue Shield said it had no record of her enrollment, but said her application should be uploaded from Covered California soon. She says every time she talked to Blue Shield, they would "push the day forward" by which her application would be transferred.

"By the end of December, I got really anxious," Liu said. "No one could tell me where my application was." Covered California and Blue Shield "were pointing a finger at each other."

In desperation, Liu reached out to insurance broker Kevin Knauss. He submitted a new application for her and got a confirming case number and application number. But again, when Liu called Blue Shield, they still had no record of her. A customer service representative promised to investigate and call her back by a certain date, she says. But she received no follow up call.

"I was hoping I would get coverage like I was promised," Liu told me. "Every time I call, it's a couple hours' wait."

Sean Barry, a Blue Shield spokesman, said by email that privacy laws barred him from commenting directly on Liu's case. "We are loading thousands of applications and payments into our systems daily," he said in his email. "So an individual's status in our systems is not static by any means. In the cases where an enrollee cannot be verified, it is usually because his or her information is still being processed -- but we are typically able to verify within a couple of days."

But it's been more than two months since Liu first enrolled. Since she can't get anyone to confirm her enrollment, Liu hasn't been able to pay her January invoice. She considers herself uninsured and signed up for an off-exchange plan with no subsidy. "I gave up on Covered California," she says.

Knauss says that of the customers he has helped apply, two more have confirmation of enrollment, but are not recognized by their plans.

Better payment options coming

Peter Lee acknowledged that "the plans and Covered California itself was slammed by huge volume," which he said surprised "all of us." He said health plans are working to bring down their call center hold times.

Covered California will not have specific premium payment data until mid-February -- that's because some plans have extended their Jan. premium payment due date to later this month. Lee said that "our early indications are that well over three-fourths of people" have paid their January premiums. That could leave 125,000 people who have enrolled but not paid. It's hard to know whether people like Kearney and Liu are included in the count.

Three plans -- Contra Costa Health Plan, Western Health Advantage and Chinese Community Health Plan -- have established an online payment option, and others are improving their payment systems, he said. "When we hit March, every plan will have a better (payment) plan in place."