The vast majority of people who enrolled in new health plans effective 1/1/14 do NOT have their new ID cards yet. Whether you enrolled through Covered CA or directly with a health plan, chances are, you don’t have a new ID card. But you’re being told that your coverage is effective 1/1/14. So what do you do now? And what if you need to see a doctor before you pay your bill or get your cards?
When you enroll for coverage, your identifying information, and that of your dependents, is put in to a computer system at your health plan. This includes your name, social security number, date of birth, etc. Your personal information is used to identify you and verify the plan you’ve selected. Usually, this data shows up very quickly and when it does, it generates your ID cards and policy information to be sent to you. However, these are not normal times, so many of you are waiting (patiently and otherwise) to receive your enrollment confirmation, and ID cards and policy information.
Here’s what you need to know if you have to go to the doctor or hospital before you get your coverage confirmation or ID cards:
1. You may be asked to pay for services and submit a claim to your health plan. Most private providers will ask for payment up front before services are rendered, so be prepared to pay for services and submit the claim after the fact. You may also be asked to sign a waiver form that states that you agree to pay in full for any/all treatment. If this happens, you will still be able to submit a claim to your new health plan.
2. Your provider may be able to confirm your enrollment by contacting the health plan and providing your name, DOB and SSN. If so, they should be willing to accept a copay or partial payment from you at the time of service. However, some providers still ask for the entire cost up front.
3. Try to avoid paying the entire cost of the visit. If you are covered under a PPO or EPO, your provider has agreed to a discounted payment for services. If you pay too soon, you may pay too much! And then you would have to file a claim AND possibly get a refund from your provider too. It is worth asking your provider to accept a partial payment at the time of service.
4. Kaiser will sometimes allow patients to tell them what their copays should be. (This may change in 2014). We have heard of members who explained to Kaiser that they are newly enrolled, and that their plan has a specific copayment for office visits. The Kaiser representatives let the member pay just the copay for services rendered. This practice can vary from facility to facility, so if you are asked to pay more, don’t be surprised.
5. If you have other coverage that you have not yet cancelled, your provider may bill your old health plan. This can cause problems later when you retroactively cancel your existing policy as all claims incurred after the cancellation date are re-processed and payments to providers are taken back. You will need to make sure that any claims that are re-processed by your old plan are then sent to your new plan for processing.
6. If you need prescriptions filled, you may have to pay cash for your prescriptions and have them re-processed once your enrollment is entered in the system. This can be extremely costly as prescriptions are often more expensive than people realize. If you have to pay cash but can’t afford to pay for the entire prescription, ask your pharmacist if you can obain a small supply of your medication to last you for a few days or a week until you can verify your new coverage is active. Keep in mind it takes up to 48 hours for pharmacy systems to be updated from health plans. Data is transmitted daily from the health plan to the pharmacy systems, but it takes a couple of days for everything to show up in the system.
7. If you’ve enrolled through Covered CA and you need to see a provider before you get your ID cards, take along a simple benefit summary to show the provider which plan you’re on. Kaiser will often honor your copays based on having this documentation.
- CoveredCA_HealthPlanBenefitsSummary-Sliding Scale – This is a chart of the “Cost Sharing” plans available through Covered CA.
- CoveredCA-HealthPlanBenefitsComparisonChart – This is a chart of the basic plans available through Covered CA.