Health

Covered California Continues to Terminate Some Customers

Published

8 years ago

April 2, 2016

By Emily Bazar, Kaiser Health News

It wasn’t until a doctor ordered medical tests for Adriana Vitale that she discovered her Covered California coverage had disappeared.

“I was shocked. I was crying. I was depressed,” said Vitale, 61, of Downey, California

Her insurance had been dropped, even though she had paid all her premiums on time.

She’s not the only one. A number of people who have signed up for Covered California coverage have been dumped from their plans unexpectedly, without explanation — even though their premium payments were up to date.

Others were shifted into Medi-Cal without approval or consent. They found out after the fact.

It’s been a persistent, but apparently unquantified problem, since 2014.

In Vitale’s case, she went to the hospital in December for a bleeding ulcer. Her daughter called the insurance carrier, Blue Shield, to confirm that her mother’s follow-up tests would be covered.

“They said, ‘We don’t have anyone by your mom’s name covered by Blue Shield. But we have all these medical bills in her name,’” the daughter, Kathy Castilla, recalled.

It took an administrative law judge in late December to resolve the problem. He ordered Vitale’s policy reinstated.

He noted that neither Blue Shield nor Covered California could explain why Vitale’s policy had been terminated without her request.

“The failure to be able to explain these discrepancies casts doubt on Blue Shield and/or [Covered California] record keeping as it applies to appellant’s coverage,” he wrote.

Several other customers whose paid-up policies disappeared talked to California Healthline about their plight, as did health care advocates who help them unravel the bureaucratic knots.

The evidence is anecdotal. Not even Covered California knows how many people might be affected.

“We are not aware of anything that would result in the terminations of a large number of consumers without notification, or of any problems with our process of notifying consumers who are deemed eligible for Medi-Cal,” spokesman Larry Hicks said.

When pressed further on whether Covered California is aware of the termination problem and if so, how many people it affects, Hicks issued this statement: “While we want every enrollment and transition to be as smooth as possible, we know that with 1.5 million consumers, there will be times when issues come up that need to be resolved. We deal with these on a case-by-case basis as we discover them and, where appropriate, look for ways to improve our existing processes.”

No one seems to know what’s causing these terminations. Nor is it clear whether they’re a result of errors committed by Covered California or the health insurance plans — or both.

Blue Shield declined to comment on Vitale’s case, citing privacy concerns, but said there are several reasons why someone’s plan might be terminated. These include non-payment of premiums, not providing proof of citizenship and changes in income that would make the person ineligible for a subsidized Covered California plan, the insurer said.

None of those seem to apply to Vitale.

“Blue Shield is committed to providing coverage to all Californians — this includes working closely with Covered California to decrease the state’s uninsured rate,” said spokesman Clinton McGue.

Covered California’s Hicks suggested that consumers who face problems with their coverage and are unable to resolve it with their insurer contact the exchange’s customer service center at 800-300-1506.

Vitale’s daughter said she tried that. The service center acknowledged an “error,” but when she asked whose it was, “they didn’t want to tell me,” she said. The agent did tell her the problem would “take a while to fix.”

The family turned to Neighborhood Legal Services of Los Angeles County, which helped them take the case to the administrative law judge.

But Vitale still hasn’t had her medical tests, in part because it has taken so long to get her coverage reinstated, despite the judge’s order.

“I wish they would never do this again to another person,” she said. “It’s a terrible thing.”

Wendy Heath of San Diego also contacted Covered California’s help line after her policy was dropped. She said she had renewed her Health Net policy through the exchange and paid her January premium. When her February invoice didn’t show, she called Health Net.

“They said, ‘You don’t need to pay us. As a matter of fact, we’ve refunded the amount you paid for January,’” Heath, 39, recalled. “They said, ‘Your plan was canceled by Covered California.’”

When she called Covered California, she said, a representative could only acknowledge that “we’ve seen the issue” with her case. Eventually, she got her coverage restored with the help of a community service group, San Diegans for Healthcare Coverage.

In the meantime, she had canceled two physical therapy appointments, afraid she might not be covered, she said.

Health Net spokesman Brad Kieffer said policyholders having trouble with their coverage should call the plan at 888-926-4988.

“This is not the experience we want for our members,” he said. “Anybody who feels that this has happened to them can call us and we’ll look into it and resolve the matter on their behalf.”

Oakland Post

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Bay Area

Mind, Body, and Spiritual Well-Being for Women Addressed in NAACP Forum in Oakland

The Women In The NAACP Oakland Branch is proud to announce the upcoming “Total You – Mind, Body, and Spirit Women’s Health Forum” scheduled for April 27 at Acts Full Gospel Church. Running from 9 a.m.-2 p.m. at 1034 66th Ave., this forum aims to provide an empowering platform for women to engage in discussions, gain knowledge, and access resources pertaining to their health and well-being.

Published

1 week ago

April 20, 2024

Oakland Post

The panel will address various aspects of women’s health, including physical, mental and emotional well-being and relationships. iStock photo by Jorge Elizaquibel.

Special to The Post

The Women In The NAACP Oakland Branch is proud to announce the upcoming “Total You – Mind, Body, and Spirit Women’s Health Forum” scheduled for April 27 at Acts Full Gospel Church.

Running from 9 a.m.-2 p.m. at 1034 66^th Ave., this forum aims to provide an empowering platform for women to engage in discussions, gain knowledge, and access resources pertaining to their health and well-being.

The forum will feature renowned experts, healthcare professionals, and advocates from Genentech, John Muir Health, Sutter Health of The East Bay, Kaiser Permanente, and the Alameda County Public Health Department.

Our expert panel will address various aspects of women’s health, including physical, mental, and emotional well-being, and healthy relationships. The forum will encompass a wide range of topics such as breast cancer, menopause, reproductive health, nutrition, mental health awareness, preventive care, and much more.

Participants will have the opportunity to attend informative sessions, interactive workshops, and panel discussions led by experts in their respective fields. Additionally, there will be wellness activities, screenings, and informational booths offering valuable resources and support.

This forum is open to women of all ages and backgrounds, encouraging inclusivity and diversity in the conversation surrounding women’s health. Whether you’re seeking information for yourself, a loved one, or simply looking to connect with other women, this event promises to be enlightening and empowering.

For more information and to register for the Total You Women’s Health Forum, please visit https://www.naacpoakland.org/ or contact Dr. Delores Thompson. WIN chairwoman at (510) 328-3638.

The Women In The NAACP Oakland Branch is dedicated to empowering women, and young teen girls. We look forward to your participation in this important event.

To register, go to https://www.naacpoakland.org/events/the-total-you-womens-health-forum

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Alameda County

Oakland Conducts Its Biennial ‘Point in Time’ Homelessness Count

Oakland, along with other cities in Alameda County, conducted their biennial ‘Point In Time’ census count on Feb. 1 to gain a thorough understanding of the size and dispersion of the homeless population in the region. The Point In Time (PIT) count is federally required by the Housing and Urban Development Department as a requirement to receive funding and resources to tackle homelessness in the area.

Published

1 week ago

April 20, 2024

Oakland Post

Abandoned vehicles on 24th and Wood St where volunteers conducted the count and surveys. Photo by Magaly Muñoz.

By Magaly Muñoz

The Point In Time (PIT) count is federally required by the Housing and Urban Development Department as a requirement to receive funding and resources to tackle homelessness in the area.

David Modersbach, Grants Manager of Alameda County Health Care for the Homeless program, said that the methodology this time around was different, as this count had a much more personal “lived experience” aspect that previous counts did not have.

In 2022, the county relied more on statistical extrapolation and assumptions, but this year’s survey questionnaires allowed for details on substance abuse issues, how long someone has been living without proper housing, what resources people are in need of and much more.

“[The PIT count is] a critical opportunity for the county, Continuum of Care, and cities to understand the magnitude of homelessness in Alameda County. [The count] enables us to better allocate resources and implement effective programs to tackle this issue head-on in a compassionate and inclusive way,” Modersbach said.

St. Mary’s Center was one of the many meeting hubs across the county that hosted volunteers and community officials the morning of the count. The organization has been deeply involved in the effort to provide resources for unhoused people and others in need.

St. Mary’s is a nonprofit in West Oakland that helps seniors and preschool families with food and housing. Last year, the organization helped about 50 seniors find housing after they had fallen on hard times.

Sharon Cornu, executive director of St. Mary’s, said a lot of the older couples and individuals that come into the center have borne the brunt of the skyrocketing cost of living in the Bay Area. The most recent influx of seniors St. Mary’s has seen coming in for help has been made up of people who were evicted when the COVID-19-related moratorium on rent payment ended.

“Seniors are the fastest growing segment of the unhoused and the incredibly high cost of housing is driving them to the streets,” Cornu said.

Among the volunteers were workers with Operation Dignity, a nonprofit organization that helps veterans and those living on the street find shelter, transitional housing and supportive services.

“These are our stomping grounds,” Ivan Magana, program manager for Operation Dignity said.

Magana stated that his team was extremely familiar with the people residing in the encampments they were conducting the count in since Operation Dignity made many visits to these areas while doing community outreach. He said they had even informed some of the unhoused people they knew about the count a few days prior so they would not be alarmed when the enumerators showed up early in the morning to conduct the count.

Not everyone got the memo though, as the volunteers encountered an almost violent situation around the 6 a.m. when a young woman living in a bus yelled at the Operation Dignity workers to leave her alone.

Luckily, the three-year experience Mangana has working with Operation Dignity and his knowledge of therapeutic health services, equipped him with the techniques needed to deescalate the tension. The woman soon realized who the volunteers were and apologized, he said.

Another volunteer and Operation Dignity worker, Yolanda Kirkpatrick, noted that she was initially hesitant because of the early schedule. She felt the time deterred others from participating, too.

Her prediction would come true as the hours went on and they continued to walk along 24th St in downtown Oakland and there was very little activity on the streets.

The volunteers shared similar sentiments. Although the community the people they were engaging for the count and surveys encounter tend to distrust outsiders, the PIT count was necessary for the city to receive the appropriate level of federal funds to address a crisis that is spiraling out of control in California.

A full analysis and report of the count will be made available in the summer.

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Community

For Cervical Cancer Month, Medical Community Focused on Education

January was Cervical Cancer Awareness Month. Physicians, advocates and others in the medical community commemorated the month by raising awareness about a form of cancer they say is highly preventable and treatable. Cervical cancer is caused by a virus called the human papillomavirus (HPV) and it develops slowly over time but can be prevented with proper care in girls as young as 13 years old.

Published

1 week ago

April 19, 2024

Oakland Post

A Mayo Clinic article published last month stated that Black women are more likely to be diagnosed and die of cervical cancer, compared to White women in the U.S. 2,000 Black women are diagnosed every year with cervical cancer and 40% die as a result.

By Magaly Muñoz

January was Cervical Cancer Awareness Month.

Physicians, advocates and others in the medical community commemorated the month by raising awareness about a form of cancer they say is highly preventable and treatable.

Cervical cancer is caused by a virus called the human papillomavirus (HPV) and it develops slowly over time but can be prevented with proper care in girls as young as 13 years old.

Sonia Ordonez, an OBGYN and gynecology surgeon at Kaiser Permanente, stated that as soon as people with cervixes reach the maturity reproductive age, they should start taking preventative measures like getting the HPV vaccine. The vaccine involves a series of two-doses for people aged 9 through 14 or three-doses for people 15 through 45 years old.

“I see a lot of young women who can’t remember or may not have gotten [the vaccine] when they were younger, or maybe got one, but we can give them the series of vaccines and restart at any point in time,” Ordonez said.

She said that cervical cancer is not the only cancer caused by HPV. Strains of the virus can also lead to throat, anal and penile cancers.

Screening is also an effective way to check for cervical cancer and should be done every three years after someone turns 21, doctors recommend. It is best to start as early as possible to catch occurrences early.

Ordonez said that this cancer is also more likely found in people of color and has led to more deaths overall.

A Mayo Clinic article published last month stated that Black women are more likely to be diagnosed and die of cervical cancer, compared to White women in the U.S.

2,000 Black women are diagnosed every year with cervical cancer and 40% die as a result.

“This disparity is not due to genetic differences among White, Black or Hispanic women, but rather related to systemic racism, access to healthcare and socioeconomic factors,” Dr. Olivia Cardenas-Trowers, a Mayo Clinic urogynecologist, said in the article.

Ordonez stated that immigrant women are also highly susceptible to the cancer, as many Latin American countries may not have accessibility to screenings or lack of insurance makes it harder for them to get tested.

Hispanic women are 40% more likely to be diagnosed with cervical cancer, and 30% more likely to die from it, as compared to non-Hispanic White women, according to the Office of Minority Health.

Family medicine physician, Joy Anyanwu, stated that the pandemic contributed to hesitancy about getting cervical cancer screenings among some women. Other factors are people’s aversion to vaccines, parents not wanting to believe that their children are or will become sexually active, and doubt about the overall effectiveness of the vaccine.

“The vaccine is very safe — over 97% effective in preventing cervical cancer,” Anyanwu said. “Even if you aren’t having sex, the earlier you start would actually help.”

Anyanwu said she understands that parents might not want to ask questions about their children’s reproductive health, but it’s a mindset that can be a barrier to having important conversation about prevention or care.

To keep families their families and communties healthy, the doctor emphasized that people should prioritize keeping up with their vaccine series and going to screenings every year.