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California health insurance  -  Individual California health insurance  -  Delays of California health insurance enrollment

What can slow down the Individual health insurance enrollment process?

IMPORTANT UPDATE:  Since the ACA law, almost all enrollment is done by phone and only takes 5 minutes.  Call 800-320-6269 or get more enrollment information here

The California health carriers have made significant progress in speeding up the application and enrollment process over the past decade. Health insurance used to be like other types of insurance where you essentially submitted your paperwork and figured it would take a month to process (because it did!).

These days, depending on the carrier, it can be a matter of days and sometimes, an approval is automatically generated by the system. Anthem Blue Cross has led the pack in terms of expediting underwriting but the other carriers will follow suit or find themselves to be less competitive in the market. First, let's look at the general timelines.
Medical records request for an Individual health insurance application is the major question mark that affects how long the process takes. If a person is healthy and there are no health issues on the application that the carrier wants to look into, this is the fastest scenario. With Cross, we will usually have a decision in 5-7 business days.

Other carriers may go two weeks or more. If medical records are requested, the carrier typically contracts with a third party company (WFI is the major company) to go out to the doctor's office and copy the needed records. The doctor's office usually requires a pre-payment in advance (the carrier pays) and schedules an appointment to come in. A good doctor's office will typically turn around this process in a week's time but it can take weeks if not more than a month for an office that is too busy or not organized. As the patient, you can put some gentle pressure on the doctor's office to move along and you always have the right to get your own medical records. Kaiser is notoriously slow in providing these records. Once the records are in house with the carrier, we usually have a decision in the 5-7 business days that we mentioned earlier.

These are the most common issues that can slow down health underwriting.

1. Missing information on the application.

Probably the most common issue is that the information on the application is not complete. This is more of an issue with the hard copies as the online application forces you to complete each section before moving on. Plan selection, health history follow-up sections, signatures, and billing information are key areas to double-check.

The health history section makes up roughly half of the application so this is especially important to review. Make sure that for every "yes" answer, you have corresponding information in the following sections where details are listed. Missing information can also affect your policy in the future so make sure to include all pertinent information.

2. Incorrectly answering question.

A common mistake is to rush through the application and inadvertently answer questions incorrectly. For example, we commonly see the female last period question answered incorrectly by women who are in menopause. A "no" answer there needs to be explained.
3. HIPAA authorization not included.  

All California health carriers are required now to attain your authorization in order to request medical records from a third party. They will not proceed without this authorization. It is typically a separate sheet that requires your signature and authorization.
4. Online application issues.

  There are still some areas in the online application where people get hung up. With time, these applications will improve but contact us if you find yourself getting stuck. Typically, there is a checkbox or needed information with a scrolling window which is not readily apparent.
5. Application times out.

This is usually the result of medical records not being received or only partially received. It's very frustrating because in most situations, a new application has be to submitted depending on how old the signature date is. Really try to keep the medical records request moving along with your doctor.
With the above issues successfully avoided, you can expedite the processing of your California Individual health application.
 

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