SHOP Enrollment: Perhaps a Mistake...

bergs007

New Member
5
I have a group SHOP plan that i enrolled in april and they still have not seen any cards or been able to access any of their care. They have been paying SHOP for the last few months and still cannot be found by the provider. COVERED CA SHOP has completely fouled up this process with inefficiency and a "tower of babel" approach to interacting with the providers. My question is: can my client have the 2 months payments back, or attributed to his plan when it actually gets put in act? Are they just footing the bill for those last two months with out any reasonable coverage?
 
Bergs,

I've had a lot of clients with similar situations (on and off exchange, group and indiv). In every case, the same result: clients are covered for months they've paid premiums.

Even if they can't find them in the system, even without ID cards. If a carrier accepts payment, for a plan, on an account, then coverage is in effect. Any claims incurred are reimbursed retroactively in accordance with the plan's contract.

You won't get a refund. As far as the carrier is concerned, "you paid for coverage, and had coverage for those months, whether utilized or not". Even if you couldn't utilize it (because you're not in the system or don't have an ID number) they contest you could have just paid out of pocket and submitted for reimbursement when they got their $#!{ together.
 
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