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Life Health > Health Insurance > Health Insurance

Exchange board hears customer service complaints

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Exchange plan members called in to a Covered California board meeting Thursday to complain about problems with utilization-related customer service.

Consumers, insurance agents and certified application counselors were asking about missing insurance cards and other types of difficulties with using private exchange plan coverage for medical services.

Robin Nydes, for example, called the directors of the state-based exchange to say that he and his wife paid his premiums for a private “qualified health plan” Dec. 10.

Even though the premiums are much higher than the premiums he used to pay, Nydes said he still has not received an insurance card. When his wife and children have needed medical care, the family has had to pay the bills in cash.

“What is the penalty for the insurer taking our money, then not providing coverage?” Nydes asked.

A certified application counselor asked what her organization should do when consumers who have enrolled in QHP coverage through the organization call it for help with the coverage.

Diana Dooley, the board chair, said the insurers selling the QHPs have to take responsibility for orienting the new enrollees.

“It’s going to take years and years to get all the bugs worked out,” but the issuers do have obligations to help guide consumers, Dooley said.

Peter Lee, the executive director, said he’s seeing QHPs working “like a dog on a bone” to help consumers get the care they need.

Because of heavy call volume, “we’re not hitting the service levels we aspire to,” Lee said.

The QHP issuers are facing the same kinds of challenges, but they have to do what they can to guide members, Lee said.

“Our first step is to look to our plans,” Lee said.

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