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How do I Use my Coverage if I Have not Received an ID Card?

Can I go to my health care provider starting  on my effective date if I have not paid yet?

As long as you pay by the due date (Feb. 25th for March 1,  or March 26th for April 1 or April 25th for May 1 effective dates, you can use services covered by your health plan starting on the effective date.  First, be sure the provider (a doctor or other health service provider) is participating in the health plan network you have selected. The provider may ask you to sign a statement agreeing to pay for the services if you cannot prove you have health insurance. The provider may later send you a bill (“claim”) for the care. Once you have proof of health insurance coverage effective January 1, 2014, which you will receive once you pay for the insurance, you can submit the claim to your health plan to process.

It is likely that by the time you get a bill or claim from your provider, you will have already been entered into your health plan’s system. Simply call your provider and have them re-submit their bill directly to your health plan. If you have questions about whether your provider is in your health plan’s network, or questions about your coverage, please call your health plan. Covered CA Health Plan Contact Information.

 

How can I pay my first premium bill? 

You need to pay your health plan — not Covered California – no later than Feb. 25th for a March 1 effective date.  You can pay your premium bill (the bill for your health insurance) by mail, but be sure you send it early enough so that your health plan will receive your payment by February 25. Your health plan also might accept payment through the phone or online before you get your paper premium bill, which is faster than mailing your payment.

 

 When will I get membership ID cards for my health insurance plan?

Your health plan will mail you an enrollment package and membership ID cards within 10 business days of the health plan receiving your first payment. You can still get care before you receive your ID card, but the provider may ask you to sign a statement that you agree to pay their claim if you do not have proof of insurance. Once you have your ID card as proof of insurance, the provider can confirm your insurance and send the claim to the health plan.

 

How do I find out if my doctor, hospital, medical group or clinic is in my new Covered California plan?

Check with your health plan to see if they work with your current doctor, hospital, medical group or clinic. We have created a handy reference guide with instructions on how to select the plan you enrolled in Provider Links.

 

My new health plan does not work with my doctor but I am getting treatment for a serious condition. What should I do?

Call your new health plan to let them know about your treatment. Depending on what illness or condition you are receiving treatment for, your new health plan may be able to work with your current doctor while you finish your existing treatment. Be sure to tell your current doctor that you have new health insurance. If you would like help talking to your health plan, contact the Health Consumer Alliance, which offers free local assistance. Phone numbers for the Health Consumer Alliance can be found here: www.healthconsumer.org.

 

What medications and benefits will my health plan cover?

If you have questions about medications and getting prescriptions filled, the first step is to contact your health plan to see if they have received your premium payment and can issue you an ID card or a plan identification number. Ask which pharmacies they want you to use in order to get the pharmacy benefit of your plan.

If you have not yet paid your premium bill, you will not be able to get an ID card. If you need prescription medications urgently, and you have completed the Covered California enrollment application process and selected a health plan, you may be able to receive some medications.

For example, Walgreens and CVS/Caremark pharmacies have offered to help Covered California enrollees with short-term medication needs. Check with your health plan or your pharmacy for more information about this service.

 

What do I do if I have other questions, concerns, or complaints about my health insurance?

First, call your health plan if you have questions or concerns.  If you are not satisfied after speaking to your health plan and would like to file a complaint about your health plan, you can call the California Department of Managed Health Care at 1-888-466-2219. (If your health insurance is Health Net PPO, call the California Department of Insurance at 1-800-927-4357).

majeem@healthyhalo.com'

AUTHOR - Majeem M