Computer Glitches And Human Error Still Causing Insurance Headaches For Californians

Problems And Solutions Ai And Human Error Human Error Solutions Gmp Training By Ginette Collazo Ph D
Problems And Solutions Ai And Human Error Human Error Solutions Gmp Training By Ginette Collazo Ph D

As California's Affordable Health Care Act expands health care coverage, many people have mistakenly switched between Covered California, the state's insured market, and Medi-Cal, the state's Medicaid program for low-income residents.

Small changes in revenue can change people's fitness, but registrars can experience major headaches when incorrect information is entered or removed from a shared computer system by two programs.

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Prolonged tensions between government officials who control Medi-Cal and district officials who do little work, such as defining a fit and registering a fit, don't help. And sometimes people who claim fitness inadvertently answer the questions so that the monitoring staff can transfer them from one program to another.

Lawyers, patient advocates, and insurance agents say computer errors are less common today than they were a few years after California introduced ACA coverage in 2013. The exchange was new and millions of people were new to Medi-Cal. Civil servants solved computer and other problems.

However, not all human and computer errors can be eliminated.

Ask Andrea Feltman, who was notified in December of canceling a subsidized health plan in California. The letter was sent to a 57-year-old in Auckland who resides on Medi-Cal. When she called the program, she learned that Medi-Cal had also been suspended for her 25-year-old son, Merlin. I had to apply again.

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Feltman, who owns a landscaping company, was confused. He made several calls and learned that the Medi-Cal Compliance Officer had logged into both accounts and somehow merged the two accounts into one. All information about her husband was erased, his work was written off, his son's income was zero, and part of the income was attributed to him.

No one called him to check on the changes.

Veltman doesn't know that human or computer errors are to blame. She suspects her son's request for food assistance and his registration as a contact person has led to an audit.

“Even if something made them look back, they still had to confirm that it was accurate information, and that it was completely wrong,” he says. “This is so valuable to us. Why don’t they ask me?”

Son Veltman only renewed his Medi-Cal coverage in mid-May. California's local coverage rebounded quickly at the end of December, but the same thing happened at the end of April. He learned last week that coverage in California will be renewed this month, but he still doesn't know if it will be covered by the Medicare bill in May.

Kevin Knaus, an insurance agent with Granite Bay, says he's heard similar complaints in recent months from residents of Alameda, Los Angeles, Orange, San Diego and Santa Barbara. "These are calls about mixing data on a computer and the impact that has on its compatibility," he says.

Perhaps the most gruesome aspect of Feltman's case is that his son's withdrawal from Medi-Cal violated a rule that prevented Medicaid members from being deported during the public health crisis declared at the start of the COVID-19 pandemic.

“It didn’t happen. It’s against the rules during a pandemic,” said Jack Daly, an attorney with the Legal Aid Society of San Diego. “We are asking people to respond immediately and they will be back to work immediately.”

The rule, which suspends annual fitness checks for enrollees, has allowed many Californians to maintain their Medi-Cal coverage during the pandemic. These considerations will continue after the health crisis is over, and millions of people may lose their Medi-Cal coverage. The health emergency is set to end on July 15, but it will almost certainly be extended.

It took Medi-Cal months to effectively implement the procedures required to comply with the rules. According to the Department of Public Health, which administers Medi-Cal, 131,000 registered people were mistakenly excluded from coverage in the first months of 2020, but were eventually rehired. Since then, these incidents have declined sharply.

They have "certainly caused less problems in the last year," says Skylar Rosellini, the chief legal officer for the National Health Program. But they still appear.

Most likely, if you make such a mistake, a quick connection to the zone monitor can solve everything. You can find a list of district offices on the Department of Health website (

If this does not work, or if you become impatient, you can seek legal advice and assistance from the Health Consumer Alliance (888-804-3536 or Insurance agents can also bring a lot of experience to solve your problem. You can find agents through the California Agents and Health Insurance Professionals Group (

If you still disagree, you can request a "fair trial" before an administrative law judge from the Department of Human Services (call 855-795-0634 or complete the online application).

You can also request a fair trial to resolve a California Subsidized Health Plan fitness dispute or challenge the amount of tax credits you were granted to pay your premium.

But before you do that, contact Marketplace Customer Service (800-300-1506) to resolve your issue. California also has an ombudsman (888-726-0840 or [email protected]).

Finally, Weltman has some practical advice: Save or screenshot the revenue information you've provided – otherwise, if it gets deleted, you'll have to list everything.

"Besides, keep calling, because sometimes they say, 'We'll call you,'" he says, "which almost never happens.

Kaiser Health News is a national health policy news service. This is an independent editorial program of the Henry J. Kaiser Family Foundation, and is unrelated to Kaiser Permanente. collect?v=1&t=event&ec=Republish&tid=UA 53070700 2&z=1654184205918&cid=609f2717 c047 4074 a575 4d01f33b94f5&ea=https%3A%2F%2Fkhn

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