Furious after discovering that their longtime doctors weren't part of their new Anthem Blue Cross plans under the federal health care law, many Bay Area residents didn't just get mad. They got even.
They called the Covered California health insurance exchange and switched to plans that accept their physicians.
Exchange officials say it's possible to change plans even after the mid-April open-enrollment deadline because of a little-known provision under the "qualifying life events" section for special enrollment.
For the past several months, the provision has been implemented quietly as thousands of Californians complain that they felt duped by health insurance companies over inaccurate lists of doctors and hospitals listed on insurers' websites. The issue came to a boil this week when Santa Monica-based Consumer Watchdog filed a class-action lawsuit against Anthem Blue Cross of California for allegedly misleading its customers about the "narrow networks" of providers that would be available under its plans. A state agency last month also launched an investigation into Anthem and Blue Shield of California for similar reasons.
The "qualifying life events" provision allows people to enroll in health insurance outside of the sign-up period for such things as losing employer-sponsored health insurance, having a baby, getting married or divorced, or moving to another state.
But the qualifying events also include "misconduct or misinformation" that may have occurred during the enrollment period; "incorrect plan data" that may have been presented when selecting a plan and health insurers violating their contracts.
The upshot: It pays to kvetch!
"We will definitely look at each and every complaint," said Dana Howard, a Covered California spokesman. "It's not a guarantee just because you had some issues with your plan. But we do recognize that there have been instances where people have not been able to get what they consider good customer service from a plan.''
Howard said the exchange hasn't been deluged with requests to switch plans -- and hasn't tracked the number of Californians who have done so.
The potential fix to having a problematic plan comes on the heels of a newly released Commonwealth Fund survey that shows the number of Californians without health insurance has been sliced in half as the result of the Affordable Care Act -- from 22 percent to 11 percent.
Health insurers on the Covered California exchange have said the new networks that limit the number of providers represent a key strategy to help lower premiums for their customers and make health care more affordable.
Darrel Ng, a spokesman for Anthem Blue Cross of California, said the company realized earlier this year that some doctors and hospitals were inadvertently listed on its website. He said the company has since been working to improve the accuracy of its provider directory.
In the meantime, Anthem has offered to treat out-of-network claims incurred before March 31 at erroneously listed doctors as "in network," coinciding with the original date set for the end of open enrollment, which was later extended to April 15. Subsequent claims, Anthem said, will be evaluated on a "case-by-case basis."
For former longtime Anthem customers like 59-year-old San Jose resident Fred Crary, however, that offer didn't wash.
The retired Silicon Valley tech executive said he explicitly asked an Anthem representative on the phone in December if the doctors he and his wife had gone to for the last 14 years would be on their new plan.
"We were told yes," Crary said. But when he arrived at one of his doctors' offices in January for an appointment, he was told the new plan wouldn't be accepted.
When he contacted Anthem, he said, a company representative apologized and offered the solution Ng outlined. Crary said he told the representative that was unacceptable because the plan he had purchased was supposed to be good for the calendar year.
"What if I fall and break my leg and I have to get an out-of-network doctor?" Crary said. "How is this an ethical business model?"
So Crary last month called Covered California and explained his situation. He said the representative told him: "Well, you basically have a plan you cannot use."
Covered California allowed him and his wife to select a plan that would meet their needs, in this case a HealthNet plan that most of their doctors accept.
Anthem, he said, "expected me to sit there and take it" until the next open-enrollment period begins in mid-November. "But I didn't take it."
San Jose attorney Amy Carlson said she too got relief from Covered California, just this week, after showing up for a doctor's appointment Tuesday only to be told her physician would not accept her new Anthem plan.
"I almost burst into tears," said the 39-year-old mother of two. She then asked the doctor's staff which plans it would accept, and she was told Blue Shield of California and HealthNet.
She called Blue Shield, whose representative referred her to Covered California, which switched her to a HealthNet plan.
In Moraga, Therese Meuel was also able to easily switch plans through the exchange to make sure her daughter could continue to see her pediatrician. Still, Meuel worries that many people don't realize they have that option.
"We will do everything we can to try to get them the type of coverage they were expecting,' Covered California's Howard said.
After all, the goal of the exchange and the Affordable Care Act, he said, is foremost "about coverage, not about trying to keep people from coverage."
Contact Tracy Seipel at 408-920-5343. Follow her at Twitter.com/taseipel.