Covered California Constituent Case Escalation Process for Government Offices
External Affairs serves as Covered California’s liaison to federal and state government officials and is the point of contact for government offices that are presented with constituent cases involving Covered California. When a constituent case is received by External Affairs, we will work with the appropriate division within Covered California to attempt to resolve the case as quickly as possible and provide your office with appropriate updates.
How to contact External Affairs for help with constituent cases.
External Affairs maintains an email inbox that government offices should use to request assistance with a constituent case: externalaffairs@covered.ca.gov When requesting assistance with a constituent case, please email externalaffairs@covered.ca.gov and include a brief description of the nature of the case. For the timeliest assistance, please also include all of the following where applicable:
- Constituent’s Name
- Case # or Application ID #
- Constituent’s Date of Birth
- Constituent’s Telephone Number
- Constituent’s email
- Signed Information Release Form (if applicable) – see below for more details
What happens after the constituent case is sent to External Affairs?
Once the constituent case information is received, External Affairs will acknowledge receipt and determine if the case falls under its jurisdiction. If it does, External Affairs will work with the appropriate division within Covered California to resolve the issue as quickly as possible. Most cases will be handled by the Covered California’s Service Center Escalation Resolution Unit, which will work directly with the consumer to resolve their case. External Affairs will remain apprised of the status of the case, provide you with updates as needed, and notify you when the case has been resolved.
If the constituent case falls outside of Covered California’s jurisdiction, External Affairs will provide you with the contact information for the appropriate entity that may be able to help resolve the case. This may include a referral to the Department of Managed Health Care or California Department of Insurance which regulate health insurance carriers, the Department of Health Care Services which administers Medi-Cal, or one of Covered California’s qualified health plans.
Protecting consumer privacy
Due to privacy restrictions, External Affairs cannot disclose details of the case or how it has been resolved unless the constituent has signed a release form allowing Covered California to share information with you.
If your constituent would like to authorize you or a member of your office to obtain specific information about their case, you will need to send a copy of their release form to externalaffairs@covered.ca.gov. This release form will need to include language that authorizes you to discuss specific details about the constituent’s issue.
If you have questions or would like more information about how to work with External Affairs to resolve constituent cases involving Covered California, please feel free to email External Affairs’ lead staff for constituent cases, Kevin Horan, at externalaffairs@covered.ca.gov