How do I file a Covered CA Appeal?

Check out the forms and procedures on Covered CA’s website, the materials below and to the right, our main page on Appeal & Grievances?  and the child & sibling pages.

Appeals Procedure on Covered CA’s Website 

Eligibility Grievance Form Rev 7.2016

We also need you to write out your story and including all the proofs – evidence & exhibits. See also our main page on appeals, namely how to gather your evidence and exhibits.   Here’s an example of a decision from the Administrative Law Judge for Covered CA.

We might be able to help you appeal (click for form)  errors in your application, IF you appoint us (Steve Shorr) as your Certified Insurance Agent, by  following these instructions as we are paid by Covered CA to help you, if you ask them to!

Sample Letter for Appeal
Sample Letter for Appeal

Covered CA Appeals Decision
Covered CA Appeals Decision


Subpart F—Appeals of Eligibility Determinations for Exchange Participation and Insurance Affordability Programs

§155.500   Definitions.
§155.505   General eligibility appeals requirements.
§155.510   Appeals coordination.
§155.515   Notice of appeal procedures.
§155.520   Appeal requests.
§155.525   Eligibility pending appeal.
§155.530   Dismissals.
§155.535   Informal resolution and hearing requirements.
§155.540   Expedited appeals.
§155.545   Appeal decisions.
§155.550   Appeal record.
§155.555   Employer appeals process.

July 23, 2010 OCIIO-9993-IFC: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act – Opens in a new window (PDF – 257 KB)



Article 7. Appeals Process for the Individual Exchange

Resources, Child Pages & Links

Insure Me

Prove you never got a letter?

Medicare Appeals & Grievances

Medical Necessity Grievances



Their service is the worst I have seen since earning my Degree in Insurance at San Diego State University in 1975.  I learned the word SNAFU from a guy I knew in the Dorm.  This is the first time, I’ve been able to use the word in “real” life.   Please note how many of the 8,000 certified agents are now refusing to deal with Covered CA.  See screen shots below from Ehealth Insurance and another agent.  It’s twice the work, for less than 1/2 of what we were paid last year and “criminal” support and customer service!

However, if you qualify for Medi-Cal we do not get compensated and it appears we are supposed to refer you to your local County Medi Cal Agency.

Hurry, we may well soon be FORCED to charge a fee for appeals and consultation for Covered CA.

1.29.2015 Update – Through the Covered CA Agent Portal & Email, I’m now getting pretty good service & response.

One of our friendly competitors is leaving the market





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