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Getting Resolution by Phone to a Ticket with Covered California

by Wendy Barnett

You may have an issue with your enrollment application, with the health plan, or with the Covered California website, etc. When you contact Covered California as a consumer (800-300-1506) or as an agent (855-777-6782), you will get one of two responses.

  • Resolution: The representative may resolve your issue right over the phone.
  • Ticket: Or, you will get a resolution ticket. That means you will get a ticket number, and you will need to wait for your issue to be resolved.

When you call back to check on your issue, you should reference your ticket number. You may be told, “There is no new news. Please call back in one week.”

When an Issue Gets Escalated

One agent called the individual consumer line and found that the issue had been “escalated.” The agent received a reference number for the escalation to the help desk / customer resolution team. This means that the ticket gets some priority over other issues that are not as urgent.

At that point, the Covered California representative said, “We need to wait for the customer resolution team to resolve the issue. If it hasn’t been resolved within 30 days we could ask for it to be ‘escalated’ again.”  In cases of escalation, the expected time frame is 30-45 days or more for an internal department to resolve it.

Health Consumer Alliance, Ombudsman and the Department of Managed Health Care

In the past, these situations were dealt with by the Health Consumer Alliance (HCA), but now it seems they are going to Ombudsman. Then, the issue sits there at this agency until it’s looked at by one of the state workers. After 30 days, you can call to escalate the issue again.

This may bring up serious concerns regarding timeliness of care. If you are waiting more than a reasonable time for health care services, the Department of Managed Health Care (DMHC) may be helpful. You can reach them by phone by calling 1-888-466-2219 or you can file an Independent Medical Review (IMR) online.