(SACRAMENTO) – As part of its My Patient Rights program, the California Chronic Care Coalition (CCCC) is reigniting the Choose Smart California campaign for the second year in a row. This effort will help consumers be smart health care shoppers by equipping them with the necessary tools to select the best health plan for both themselves and their families during the state’s open enrollment season of October 15, 2019 – January 31, 2020.
“Health care is a real kitchen table issue. We encourage Californians to explore their options with their families and select a health 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 health care investment and are armed with the information they need to avoid obstacles that could cause delays in treatment or denials of their vital health care needs.”
Obstacles that cause delays in or denials of care include surprise medical bills, prior authorization, 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 and undermine doctors’ medical decisions.
According to a 2019 American Society for Radiation Oncology (ASTRO) survey, 93% of radiation oncologists said their patients are delayed from receiving life-saving treatments due to prior authorization. And, this cost-saving tactic causes providers to spend more time jumping through hoops instead of caring for patients with 39% of respondents reporting spending 5-10% of their workday on prior authorization challenges alone.
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, insurance plans’ available provider networks became more restrictive following the enactment of the Affordable Care Act (2014). While this was intended to provide patients better savings and coverage, a study conducted for Physicians for Fair Coverage found that this change has led to more surprise bills. Whether they know it or not when accessing care, narrower networks cause patients to visit out-of-network providers due to a lack of available in-network providers, especially in an emergency.
Finally, everyone agrees that cost is an important consideration when choosing a health plan, but consumers need to understand that there are trade-offs that should 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. Understanding some of the key terms commonly used by health plans provides clarity to consumers about where they may be spending out-of-pocket costs and how to identify a plan that meets their needs. To help guide the process, Choose Smart California’s 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 2020 started October 15, 2019 and ends January 31, 2020, as a result of AB 1309 (Bauer-Kahan) being signed into law. Now, coverage purchased between October 15 and December 15, 2019 will be effective January 1, 2020, coverage purchased between December 16 and January 15 will be effective February 1, 2020, and coverage purchased between January 16 and January 31 will be effective March 1, 2020.
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.or
About My Patient Rights
My Patient Rights was launched by the California Chronic Care Coalition in 2015 to help people who have been denied treatment or medicines, experienced delays or are dissatisfied with the decisions made by their health plan. In 2019, My Patient Rights expanded nationally to help consumers throughout the country get the care they need and deserve. Like My Patient Rights on Facebook, follow on Twitter or visit www.MyPatientRights.org to learn more.