California Chronic Care Coalition Launches ‘Choose Smart California’ Campaign Encouraging Californians to Be Smart Consumers When Selecting Health Plans
"Healthcare is a real kitchen table issue. We encourage Californians to use the upcoming
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 treatmentsi.
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 2018ii. 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 providersiii. 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
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
To view the Choose Smart California health plan checklist, please visit: www.MyPatientRights.orgchecklist
About the
About MyPatientRights.org
iPutting Profits Before Patients: Provider Perspectives on Health Insurance Barriers that Harm Patients (
ii 90+ Medications to be Dropped by Insurance (
iii
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