Covered CA’s incompetence and narrow networks limit health care, cause harm

Covered CA’s incompetence and narrow networks limit health care, cause harm

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Covered California screen shot
Covered California screen shot

LOS ANGELES, February 21, 2014 — San Francisco Bay area station KPIX has been doing a stellar job covering what customers are experiencing after signing up for Affordable Health Care through Covered California. These individuals have paid their premiums, but when they try to use the coverage, they are running into problems.

On February 4, KPIX reported that customers could not find doctors on the Covered California website’s list who would accept their plans. Covered California promptly responded to this report by shutting down that portion of the website and pulling those lists.

KPIX reported on February 19 that doctors who would take insurance plans from the exchanges were limited. “But many enrollees, in both Blue Cross and Blue Shield plans purchased on the exchange said they are struggling to find even one doctor willing to take new patients due to what are now being call ‘narrow networks.’

“The narrowest networks – those with the fewest doctors – are in some of the Northern California counties with the lowest median household income and the highest number of Medi-Cal recipients. Alameda County falls into that category.”

Those with the lowest median household incomes and Medi-Cal recipients are the ones who have the fewest choices in doctors, yet these are the very people the law was supposed to help. 

Another report comes from CBS13, the local Sacramento station, on the plight of Chris and Tammy Dunn. Chris suffers from severe back pain that hinders his mobility and sleep, but his Covered California plan is not adequate to provide for his back surgery.

CBS13 reports, “In January, they transitioned from an Anthem Blue Cross Plan over to Blue Cross Covered California. She says they had to switch to avoid the premium skyrocketing, but didn’t realize their provider network would be smaller.”

Tammy investigated and found a doctor within the couple’s network. But when she contacted the doctor’s office, she was told that he would not see patients with insurance from Covered California.


“It’s like we’re a second-class citizen,” she said. “We can’t get the coverage we need.”

The Obama administration and California elected officials are touting the success of the Covered California exchange, focusing on how it has surpassed its enrollment goals of over half a million sign ups before April 1.

But paid insurance coverage is useless when you cannot receive actual care. Covered California is taking little responsibility for this.

KPIX and CBS13 went to Dana Howard, deputy director of Covered California, to ask about these cases. KPIX wanted to know who is responsible for the list of doctors, while CBS13 inquired about the Dunn’s situation. What is astounding is that Howard gave almost the exact same, and infuriating, answers: It’s the customer’s fault. They are too stupid to know how to purchase insurance, and they need to be more careful to do their research before purchasing a policy.

In terms of the faulty doctor directory, Howard said: “Yes, it is our responsibility. However, we do not have an audit that goes on 24/7 to make sure that every bit of information is indeed accurate.”

Perhaps less money on Richard Simmons dance-a-thons and more money on someone to audit this information might be in order.

When CBS13 spoke with him, Howard said he could not address the Dunn’s specific case, but he did say, “A lot of people, this is the first time they’re purchasing insurance,” and “I would suggest they contact the plan to make sure what doctors are available to them.”

Look up the word “condescending” in the dictionary, and you might just find a picture of Dana Howard.

Howard told KPIX that if you signed up for a plan and it’s not what was advertised, there is still time to switch. He said switching insurers is a lengthy and complicated process that should not be attempted online. With a website that has problems similar to those of and is down for maintenance as of this writing, that’s good advice. Howard encourages enrollees to work with a customer service representative to avoid gaps in coverage.

Many customer complaints center around long wait times on the phone with Covered California as well Anthem Blue Cross, the main insurance company that is selling these policies,.

Irene took to the Covered California Facebook page to complain. “I’ve spent countless hours trying that number. No customer service there. Take the number off as an option since you can’t even leave a message … just cuts you off. Very frustrating. I try on-line and the message directs me to call the number — yeah, right! I feel the frustration and stress is going to lead to medical problems I didn’t have before.”

And that is one of the shorter, and more respectful posts. Why anyone would voluntarily go through this process a second time? And what guarantee is there that one won’t end up with the same issue after changing plans for a second or third time?

Chris and Tammy Dunn were pushed from their insurance plan to one that complied with the Obamacare law. Is it their fault that they assumed the insurance company would give them a comparable plan? How is this failure in any way the customer’s fault?

Kaiser Health News offered more grim findings. Low-income and minority individuals who did not bother with the health care system because they could not afford it are still not signing up. The report encourages more education and outreach, as if money and time aren’t already being poured down the drain on this.

Why did we not simply focus on this group in the first place, rather than disrupting the lives of people like Chris and Tammy Dunn? In order to help one part of the population, we have effectively destroyed the peace and well-being of another. Absolutely senseless.

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