Covered California enrollee claims issues finding doctor

FRESNO, Calif. (KFSN) -- Action News continues to investigate Covered California and how new insurance plans are affecting local patients.

Last week, Action News told you about a young woman who was unable to see a doctor despite having a health insurance plan through Covered California. Haley Green, 26, was able to get surgery on her hand and is recovering. She had a severed tendon in her hand and couldn't see an orthopedic specialist until more than a week later.

Now, another patient says she couldn't see an OBGYN until she was nearly five months pregnant. Julia Hernandez, 33, is almost seven months pregnant. But she is just getting to know her current obstetrician.

"I actually did not get into a doctor until the first Monday of March and I found out I was pregnant in November," said Hernandez.

Hernandez is insured by a plan through Blue Shield -- a plan she purchased on the Covered California website. But just like Haley Green who injured her hand, she wasn't able to find a doctor that would see her, even though the insurance carrier said the doctor was contracted with them.

"From the very beginning it was nothing but heartache crying night after night," said Hernandez.

Hernandez has found a doctor in Fresno who's making an exception for her despite being out of network. She's waiving some of the fees so Hernandez can get the care she needs. But that's not the case for many people facing the same concerns. James Scullary is a public relations officer for Covered California. He says because the system is new and evolving there are still some issues to fix.

"There's 23,000 new Covered California customers in Fresno county. So that is a huge influx of people in the region. And Anthem and I'm sure the other insurance carriers are doing their best so they can align those new customers with doctors who can care for them," said Scullary.

Scullary says there are several options people have when they face this issue. They can file a complaint with the Department of Managed Health Care. Or they can contact Covered California directly and try to apply for a new plan.

"There are some concerns there for customers that they need to be aware of. It could lead to a period of time or a gap in coverage where you're not insured," said Scullary.

But Scullary says working with your insurance carrier is the first step you should take. Action News reached out to Blue Shield - the insurance company that Julia Hernandez is insured with - and they haven't responded. But a representative from Anthem Blue Cross - the insurance company that's working with Haley Green - says "Providers who decline to treat our members are doing so because they believe that they aren't being paid enough."