Nov202018

California Chronic Care Coalition Launches ‘Choose Smart California’ Campaign Encouraging Californians to Be Smart Consumers When Selecting Health Plans

Posted by Kassy Perry

It’s time to “talk turkey” about your medical needs to avoid health plan hassles in 2019

(SACRAMENTO) – As part of its My Patient Rights program, the California Chronic Care Coalition (CCCC) is launching the Choose Smart California campaign. This effort will help guide consumers to be smart health care shoppers and give them the necessary tools to ask the tough questions required to select a health plan for both themselves and their families during the current open enrollment season.

“Healthcare is a real kitchen table issue. We encourage Californians to use the upcoming Thanksgiving holiday to ‘talk turkey’ with their families about selecting the healthcare plan that best fits their needs,” said Liz Helms, president and CEO of the California Chronic Care Coalition. “We want to ensure all consumers, and particularly those with chronic conditions, have access to their doctors, get the most value for their healthcare investment and are armed with the information they need to avoid obstacles that could cause delays in treatment or denials of their vital healthcare needs.”

Those obstacles include restricted access to specialists, tiered drug formularies, reduced prescription drug benefits, high deductibles vs. low co-pays, and the new co-pay accumulators which are all used by health plans to reduce their costs. Unfortunately, these barriers also reduce consumers’ access to care. A recent survey of 600 doctors found that 89% said they no longer have adequate influence over the healthcare decisions for their patients, with 87% saying health insurers actually interfere with their ability to prescribe individualized treatments.i

Health plans also regularly make changes to coverage that can have a significant impact on care. Therefore, it is important that Californians carefully scrutinize the details as to what is and what isn’t covered in their plans before making a choice.

For example, Express Scripts and Caremark, companies that handle pharmacy benefits for more than 200 million Americans are removing more than 90 medications from their list of covered medications at the end of 2018.ii If you rely on your health plan to pay for your medications, now is the time to check and see if the ones you take are still covered.

Another area where insurers have fallen short is with their continued discrimination regarding mental illness treatment. A 2017 report shows that reimbursement rates for mental health and substance abuse treatment providers are far lower than for other medical providers.iii When insurers don’t adequately reimburse providers, many choose not to participate in the plan networks, leaving families paying the price. Given the increasing numbers of substance abuse and mental health issues among Americans, this is a growing concern and consumers should be wary if such treatment is needed.

Everyone agrees that cost is an important consideration when choosing a health plan, but consumers need to understand that there are trade-offs which should to be taken into account.

“Don’t just choose the cheapest plan, because in the long run it might not be the most economical,” advises Cindy Settles, a benefits specialist with Clinton Polley Insurance Brokers, Inc. “Although a plan may have a cheaper premium, the real question is what your total out-of-pocket expenses under the plan are, including the premium, deductible, copayment and coinsurance.”

Choose Smart California encourages consumers to be smart — because your health depends on it and not all health plans are the same. To guide the process, use the Choose Smart California checklist outlines key questions consumers need to ask when they purchase or select a plan, such as:

  • What ongoing care do I need, and is it covered?
  • Can I continue to see my current physician?
  • Are my current medications covered?
  • Can I afford the care I need?
  • When do I need prior authorization for treatment?
  • Are there caps on my benefits?

California’s open enrollment period for 2019 runs from October 15, 2018 through January 15, 2019. The last day to apply for coverage with an effective date of January 1, 2019 is December 15, 2018.

To view the Choose Smart California health plan checklist, please visit: www.MyPatientRights.org\checklist.


About the California Chronic Care Coalition
The California Chronic Care Coalition (CCCC) is a unique alliance of more than 30 leading health organizations and provider groups that promote the collaborative work of 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.californiachroniccare.org

About MyPatientRights.org
The California Chronic Care Coalition launched MyPatientRights.org in California in 2016 and is currently expanding the program to all 50 states to help people who have been denied treatment or medicines, experienced delays or are dissatisfied with the decisions made by their health plans.

i Putting Profits Before Patients: Provider Perspectives on Health Insurance Barriers that Harm Patients (Aimed Alliance 2018); See also: Who’s Calling the Shots? Doctors Worry about Insurers Overriding Their Treatment Decisions (Joanne Finnegan, FierceHealthcare 2018)
ii 90+ Medications to be Dropped by Insurance (Benita Lee, MPH, GoodRx 2018)
iii Addiction and Mental Health vs. Physical Health: Analyzing Disparities in Network Use and Provider Reimbursement Rates (Melek, et. al, Milliman Research Report 2017); See also, Insurance System Still Discriminates against Mental Illness. Time to Fight Back. (Patrick J. Kennedy, USA Today 2018)