At first glance, the Covered California exchange enrollment system seems to be functioning better — and more transparently — than the federal exchanges' HealthCare.gov enrollment site.
The California exchange site has managed to bring in about 179,000 coverage applications since enrollment opened to the public Oct. 1.
But agents and brokers in California warn against assuming that Covered California is working the way it ought to work.
Problems with the California enrollment system include a faulty provider directory, continuing delays with agent certification, continuing delays with final plan approvals, and software bugs.
Before the Patient Protection and Affordable Care Act (PPACA) exchange program came along, health plans were not always quick to make individual health plan provider directories available at point of sale. Consumers often had to call their favorite doctors and hospitals to make sure the providers were in network. But consumers generally knew they were dealing with large, well-established carriers with big provider networks.
Today, the carriers selling "qualified health plans" (QHPs) through Covered California are holding premiums down by using new, narrow provider networks. In some cases, providers may not know whether they're in those provider networks. Looking at a QHP's online provider directory may be the only practical way to find out which providers are in a network without filing a claim.
Managers of Covered California added a provider directory to great fanfare shortly after the enrollment site launch, then uncovered directory system errors, including inaccurate profiles of doctors and hospitals.
Covered California took down the directory component of its site for maintenance. At press time, the directory was still not routinely available.
Neil Cosby, director of sales at Warner Pacific Insurance Services, said in an interview that the persistence of a huge backlog of agents awaiting certification as exchange agents is another dire enrollment system problem.
To get certified, health agents must take an eight-hour class in person, then take a four-hour online class and an online test. Currently, the delays between these steps can last as long as a week or two.
Cosby, who teaches certification courses on behalf of Covered California, said exchange managers are working to fix the problems, but thousands of agents who have completed the certification process are still waiting to be integrated into the Covered California system.
Alison Gordon, a self-employed health broker in California, said the rollout of the certification process for brokers has been an abomination.
"The class I was a part of was not even taught by a broker," Gordon said. "The instructor knew nothing about health. It wasn't the case for all classes I hear, but it was in mine."
Meanwhile, the agents who are certified may find that they lack the details they need to recommend plans to consumers.
The California Department of Insurance, the agency responsible for approving QHP prices and benefits, has failed to issue final approvals.
