Health Insurance Complaints Skyrocket in CA, says DMHC (Department of Managed Health Care)

Apparently, insurance companies don't want to let customers cancel policies.

"Kaiser, the state’s third largest provider, doesn’t allow users to post directly to its Facebook page. It’s also where some callers complained they were receiving a pre-recorded message that ended with a dial tone when they called customer service."

Sadly, long before the new health care law went into effect, Kaiser was preventing patients from making complaints.

DMOC isn't likely to do much. There's a long history between DMHC and Kaiser.

Health Insurance Complaints Skyrocket in CA
Having trouble reaching your health insurance company? You're not alone. State regulators say in January alone, they've seen a 53% jump in complaints, in part because calls about Covered California. A little known state hotline can help
By Vicky Nguyen, Felipe Escamilla, Liza Meak, and Scott Pham
NBC News
Apr 22, 2014

The Investigative Unit has learned complaints to state regulators have skyrocketed as people find themselves unable to reach anyone at several major health insurance companies. Vicky Nguyen reports in a video that aired on April 21, 2014.

Even if you aren’t one of the 1.2 million people signing up for Covered California, chances are you’re feeling the pinch when calling your insurance company. The Investigative Unit has learned complaints to state regulators have skyrocketed as people find themselves unable to reach anyone at several major health insurance companies.

For some health insurance companies, the influx of calls is so bad, they’re hanging up on customers after a pre-recorded message, while others put callers on hold indefinitely.

“I’ve been put on hold anywhere from 15-40 minutes,” said Don Tran, a full-time grad student at San Jose State.

Tran said he wanted to cancel his individual health plan with Blue Shield of California because he was eligible for less expensive coverage through his employer. But getting in touch with Blue Shield turned out to be much more difficult than he anticipated. “It’s been over a month and a half and I still haven’t been able to reach anybody,” Tran said.

Tran's story is a familiar one to Marta Green, spokeswoman for the California Department of Managed Health Care. The agency regulates [or at least, it collects a lot of money from the taxpayers in exchange for promising to regulate] health care plans and protects consumers.

“We have seen our call volume go up quite a bit,” Green said. She attributes much of the increase to the sudden spike in health insurance enrollment due to Covered California.

The rise in complaint volume was so extreme, the department began tracking the number of complaints from people who said they couldn't even reach their insurance providers.

“It was never an issue before this year,” Green said. But the department is only tracking “can’t reach plan” complaints for customers enrolled in Covered California. Of the roughly 1,000 complaints received between January and March of 2014, 1 in 10 people said they were trying to cancel or couldn’t reach their plan.

Green said there’s little consequence at this point for health plans that aren’t responsive to consumers. “If a health care plan is found to have violated the law, they can face enforcement action…[but] there is no specific law in relation to wait times.” Green said consumers can call, email or even send postal mail to the department regarding any issues with their health insurance. She said the department is committed to helping consumers resolve their problems, a process that can take anywhere from a day to a month.

“Every complaint we receive is investigated,” Green said. She encouraged consumers to call the department’s hotline, 1-888-466-2219, where they are guaranteed to reach a human being during business hours.

Don Tran took his complaint online, joining dozens of others NBC Bay Area found on social media, who are posting pictures of their wait times and airing their complaints on Facebook and Twitter. A check of the Facebook pages for the two largest providers in California—Anthem and Blue Shield – revealed new complaints daily.

Kaiser, the state’s third largest provider, doesn’t allow users to post directly to its Facebook page. It’s also where some callers complained they were receiving a pre-recorded message that ended with a dial tone when they called customer service.

“It’s a real hassle,” Tran said, adding that Blue Shield only responded after he posted several comments on social media. Now, more than 2 months later, he finally has his cancellation notice, but didn't get a reimbursement check until a few days ago.

Blue Shield of California spokesman Sean Barry said via email the company has expanded its customer service staff, adding, “We’re committed to delivering a high-quality customer experience. We have put several measures in place to reduce the delays in resolving issues by phone, receiving new ID cards and making payments.”

He directed customers to this customer service home page with a list of contacts to help resolve issues.

Darrel Ng echoed a similar sentiment. In an emailed statement, the Anthem Blue Cross spokesman said, “At the beginning of the year, hundreds of thousands of Californians were added to the insurance rolls on Jan. 1 as our nation’s health care delivery system went through a complete transformation. Because of that, in the first two business days of January, our company received a million calls nationally. Since then, we hired and trained hundreds of additional customer service agents and reassigned hundreds of other internal assets to assist on our phone lines. Through those efforts, the average hold time for customer service was under 3 minutes in March and is down to less than 90 seconds thus far in April.”

Kaiser Permanente spokesperson Karl Sonkin emailed this statement. "Prior to the deadline for Affordable Care Act Kaiser Permanente experienced a higher volume of calls to our Member Services Call Center during peak hours than we typically receive in the first part of the year, and that had resulted in longer than normal hold times. However, now that the enrollment deadline has passed our call volumes have returned to more typical levels and we are no longer experiencing delays."

[Maura Larkins' comment: This seem to be Kaiser's way of saying that patients will be experiencing the same treatment that they received for years before the Affordable Care Act.]

State fines Kaiser $4 million for mental health violations

The California Department of Managed Health Care ignores almost all complaints from Kaiser patients, but this complaint came from Kaiser providers, so the DOMHC couldn't look the other way.California officials have fined healthcare giant Kaiser Permanente $4 million for problems related to patient access to mental health services.

State fines Kaiser $4 million for mental health violations
The California Department of Managed Health Care fined Kaiser Permanente $4 million Tuesday related to problems it found with patient access to mental health care.
Los Angeles Times
By Chad Terhune
June 25, 2013

California officials have fined healthcare giant Kaiser Permanente $4 million for problems related to patient access to mental health services.

The fine announced Tuesday stems from deficiencies the California Department of Managed Health Care identified in March that were found during a routine medical survey. This marks the agency's second-largest enforcement action after a $10 million fine against Anthem Blue Cross in 2008 related to improper policyholder cancellations.

"The Department's actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them," said Brent Barnhart, director of the Department of Managed Health Care.

"The Department is taking this action to ensure that Kaiser promptly corrects these deficiencies and provides its patients with the mental healthcare promised to them by their health plan," Barnhart added.

State officials said Kaiser's problems covered a variety of issues affecting patients. It found that Kaiser needed to better track and monitor the availability of providers.

The health plan needs to ensure that appointments are offered in a timely manner and improvements to care are made when deficiencies are identified, according to the state investigation.

Regulators also said that Kaiser's educational materials and its "frequently asked questions" included inaccurate information that could dissuade a patient from seeking care.

John Nelson, a spokesman for Kaiser, said each of the state's findings "has already been corrected or is very far along toward resolution."

In light of that, the company said the "amount of the proposed penalty is unwarranted and excessive."

Agency officials said they would conduct a follow-up survey in October to ensure Kaiser has corrected the deficiencies and is complying with the law.

Anthem Blue Cross Drops Cedars-Sinai, UCLA From Health Plan

Anthem Blue Cross Drops Cedars-Sinai, UCLA From Health Plan
Bob Herman
Becker Hospital Review
September 24, 2012

Anthem Blue Cross in California is shutting out two of the largest healthcare providers in the Los Angeles area — Cedars-Sinai Medical Center and UCLA Health System — from one of its health plans because the health systems are "too expensive," according to a Los Angeles Times report.

All physicians affiliated with Cedars-Sinai and UCLA will be eliminated from Anthem's Select health plan, effective Jan. 1, which is offered to roughly 60,000 employees and dependents in Los Angeles. The city said Anthem's plan would save $7.6 million in annual premiums. It is expected that roughly 2,200 city employees and family members will lose in-network access to their physicians, according to the report.

In response to the move, the health systems said their high costs are associated with their medical research and innovative treatments that "benefit the entire community," according to the report. Cedars-Sinai and UCLA also said Anthem's maneuver will only shift costs onto those who still receive care at the facilities.