Reminding CalPERS Employees and Retirees to Shop Around During Open Enrollment

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Reminding CalPERS Employees and Retirees to Shop Around During Open Enrollment

Before choosing a plan, consumers should know what they are buying

Similar to most major purchases, people will go to great lengths to determine the best value for the best deal. Choosing a health plan should be no different. Yet a disproportionate number of patients in California are having issues receiving the care they need because they didn’t examine the fine print.

The California Chronic Care Coalition (CCCC), an alliance of more than 30 health organizations warns CalPERS employees and retirees to shop around this open enrollment period.

“Patients, especially those with chronic, rare or complex conditions, continue to struggle to get the care they need in California,” said Liz Helms, president and CEO of the CCCC. “Through My Patient Rights (MPR) we are getting a significant number of stories from patients unhappy with their plans. We urge consumers to review benefits, compare costs and choose a plan that best meets their needs.”

As one of the more than 16 million Californians with a chronic condition, Helms has been fighting for patient rights for the past twenty years. She was a leader in the creation of the Office of the Patient Advocate (OPA) and the Department of Managed Health Care (DMHC). Liz Helms and the CCCC launched MPR to help patients navigate their health plans and get the care they need and deserve.

Recently, MPR has heard from a significant number of Californians who are experiencing problems accessing the treatment they need due to coverage denials, step therapy and prior authorization. The site has also received stories from Kaiser Permanente members who are unable to receive the mental health treatment needed due to long wait times and other hurdles put in place by plans to deter patients from accessing costly care.

“Unfortunately, many of the problems experienced by California consumers are a result of them not fully understanding what plan they signed up for. We strongly encourage consumers to take the time to shop around; compare available plans’ benefits, costs and quality,” said Joan Werblun, board chair of the CCCC.

During open enrollment, CalPERS employees and retirees are facing tough decisions and they need to know what they’re buying. CCCC and other patient advocates urge consumers to:

  • Compare health plans to determine monthly premium costs, what treatments are covered, what the deductible is, if your current doctor is within network, etc.
  • Review the plan’s summary of benefits to know the risks (gaps in care, prior authorization, high deductibles) and benefits (lower premiums, coverage of needed therapies and treatments) associated with choosing a different plan.
  • Understand that chronic, rare and complex conditions make choosing a plan much more difficult. Individuals within this population are often likely to experience denials and increased barriers to care (non-medical switching, price caps, step therapy) which can drive up costs for the patient and plan.

If you have experienced denials, delays or interruptions in care with your current health plan, visit My Patient Rights.

About The California Chronic Care Coalition

The California Chronic Care Coalition (CCCC) is a unique alliance of more than 30 leading consumer health organizations and provider groups that engage policy makers, industry leaders, providers and consumers to improve the health of Californians with chronic conditions. We envision a system of care that is accessible, affordable and of a high quality that emphasizes prevention, coordinated care and the patient’s wellness and longevity. http://www.chroniccareca.org/

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