Dealing with the Red Tape of Filing an Appeal with Covered California

Posted: July 21, 2016

by Wendy Barnett

At times a consumer has issues with their Obamacare California health plan or their application, and they need to file an appeal. Perhaps you were denied coverage for some reason that you thought was not legitimate. In cases like these, you can go file an appeal either by email or by phone.

In one case, one of our agents, Wendy Barnett, filed an appeal on behalf of a client. The agent said, “It was a long, drawn out process that involved a judge. The judge responded back with an order that was missing some information critical to the appeal.”

Ms. Barnett followed up by calling the California Department of Social Services (CDSS), a Health and Human Services Agency, who is in charge of appeals. She explained that the answer was vague, and she asked the judge to review the decision. The judge quickly responded with a revised order stating that Ms. Barnett’s client would get a two month refund, which was the desired outcome.

However, Covered California did not give the authorization to the health plan as ordered by the judge. Barnett tried to contact the Covered California representative who was assigned to this appeal to no avail. When there was no response from Covered CA, she reached out to the CDSS again. They responded in a timely manner and said that the order given by the judge should have been carried out within 30 days.

CDSS followed up with the State Exchange, Covered California called back in one week, and within one more week the issue finally got resolved.

In the process, Wendy Barnett learned that the California Department of Social Services (CDSS) can be helpful in situations like this. CDSS can be reached by calling 855-795-0634, or visit their website at www.cdss.ca.gov.