Does Covered California Really Work?

While the mission of Covered California is to provide affordable health insurance to Californians, there may be some unexpected problems coming along with it.

Read about the projects of other 2014 California Health Journalism Fellows.

Problem 1: Limited networks 

In order to keep premiums low, some major insurance companies are limiting the scope of doctors and hospitals available to their subscribers. According to the 「San Jose Mercury News」, Blue Shield of California confirmed that they will offer only 50% of its network doctors and 75 % of its network hospitals to those who sign up for its exchange plans. As more uninsured Californians enroll in exchange plans, there may be insufficient doctors in the network to care for new patients, which subsequently will affect the quality of healthcare patients received from their physicians.

Problem 2: Misinformation 

Patients are having a hard time determining whether their doctor or hospital will accept their coverage. Consumers complain that the insurer’s directory of doctors and hospitals is inaccurate or out of date.  Some physicians don’t know if they are actually participating in the exchange’s networks. The misinformation confuses patients and affects the quality of medical care they receive.  

Problem 3: Poor customer service

Consumers have complained about extremely long wait times on the phone and about website glitches that have slowed the application process and caused considerable confusion. Covered California said that 51% of callers in December couldn’t get through and abandoned their call. The state’s goal was that fewer than 3% of calls would be abandoned. In addition, 53% of callers got a busy signal, and less than 1% of calls were answered within 30 seconds. With the limited number of bilingual enrollment counselors, the waiting time and proportion of abandoned calls for Chinese patients could be even worse.