First legal complaint filed over health enrollment mistakes

First legal complaint filed over health enrollment mistakes

PORTLAND, Ore. – A man somehow got enrolled in a health insurance plan that doesn’t exist in Cover Oregon’s system.

The complaint is with the Department of Consumer and Business Services. In it, Mark Evertz claims that Cover Oregon and Moda Health and Dental took a payment for a plan on Dec. 31. Then Moda changed the plan on Jan. 2 without his knowledge or consent.

Evertz says he’s been going back and forth between Moda and Cover Oregon for the past week to try and get the situation resolved.

He says despite long phone waits with Cover Oregon, its employees have been helpful.

The problem is that Cover Oregon keeps telling him the Moda plan he signed up for and paid for isn't in its system. That means it shouldn't even be possible for Cover Oregon to sign him up for it; instead, Moda enrolled him in a plan with a deductible three times what he paid for through Cover Oregon and less coverage.

Evertz discovered the mix-up when his wife tried to get a prescription last week. Somehow her birthdate had been transposed in the computer system. He doesn't know if that happened on Cover Oregon's end or on Moda's end.

KATU has called a Cover Oregon spokesman. He’s looking into the complaint.

A spokesman for Moda said as far as he can tell the problem happened when information got transferred from Cover Oregon to Moda. However, he said he couldn't tell whether it was a Cover Oregon or Moda mistake. He said he'll look into the case Wednesday and get it fixed for Evertz.

A spokeswoman for the Department of Consumer and Business Services says it is also looking into it.