Covered California continues to have issues

FRESNO, Calif. (KFSN) -- Heather Thomas is an independent insurance agent here in Fresno and has been licensed for eleven years.

"The majority of my clients are health insurance. Especially with this new Covered California," said Thomas.

She said she's having a difficult time helping her clients find doctors who accept insurance plans they bought through Covered California. One client needs weight loss surgery. But there's only one insurance approved doctor in Fresno and Thomas says he doesn't want to do the particular surgery she needs.

"I am having a very rough time getting that particular doctor to actually accept her. We've already filed an appeal. It's just hitting a wall, I just don't see it happening at all," said Thomas.

Another client says she's been trying to get her newborn baby on her insurance plan since mid-March.

"We are still trying to get her baby covered as of right now," said Thomas.

Thomas said the problem lies in poor communication between Covered California, the insurance groups and the doctors. The fact that doctors aren't getting paid the rates they want.

"They agreed to the terms and the regulations however they're still not accepting it. Whether that's right or wrong that's why we're here today," said Thomas.

The Department of Managed Health Care is the state agency that takes consumer complaints. Spokesperson Marta Green says every complaint is handled on a case by case basis. But says they want to know about patients who are turned away from doctors. This year they've only had one reported call from Fresno County about Covered California insurance problems.

"Certainly if you're hearing of other consumers out there who are having difficulty we would like to hear about it," said Green.

Geren says she can't comment if the DHMC has any pending investigations related to a Covered California case. She says their enforcement department hasn't taken any action against Covered California, insurance providers or any doctors at this time.