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CalPERS board member fields member concerns about Blue Shield contract, provider directories and member services
Summary
At a June webinar, CalPERS board member Yvonne Walker updated members on health‑care matters — including an impending possible contract termination between Blue Shield and the UC system — and answered numerous questions about claims denials, acupuncture coverage, retiree benefits and CalPERS customer service.
Yvonne Walker, a CalPERS board member, told participants at a June stakeholder webinar that the contract between Blue Shield of California and the University of California health system is set to expire on July 9, 2025 if the parties do not reach a new agreement, and she answered members’ questions about how that dispute and other health‑plan changes could affect retirees.
Walker said CalPERS members enrolled in the PERS Gold and PERS Platinum Medicare supplement plans would not be affected by the UC–Blue Shield negotiation. “There would be no impact to CalPERS members enrolled in the PERS Gold and the PERS Platinum Medicare supplement plans,” she said. She added that Blue Shield mailed letters to potentially impacted HMO members and that members enrolled in Blue Shield’s Medicare Advantage PPO plan would later receive letters informing them of the potential termination.
The update followed a broader health‑care briefing in which Walker said the board has received preliminary premium rates and would vote on final health‑care premiums at a July off‑site board meeting. Pharmacy benefits are also up for renegotiation: Walker said pharmacy‑benefit management contracts typically drive health‑care costs and that CalPERS’ pharmacy contract will be considered this year as it approaches a five‑year term. Walker said last two rounds of HMO and PPO contracting covered five‑year periods and helped expand coverage options, including an approved 2026 plan expansion that would add more Kaiser options in Monterey pending final approvals.
Walker also described pending legislation intended to improve the accuracy of health‑plan provider directories. She said the bill would require insurers and plans to be jointly responsible for annual directory accuracy and would set a target of at least 95% accuracy over three years to reduce barriers to care and make it easier for members to find in‑network providers.
During the webinar’s question‑and‑answer session, multiple members described out‑of‑state claims problems and repeated denials for services such as acupuncture after CalPERS moved from Anthem Blue Cross to Blue Shield on Jan. 1. One participant said claims submitted by an acupuncture provider were rejected repeatedly and that only two of the claimant’s January submissions had been adjusted and paid. Another caller said Blue Shield representatives acknowledged a system error that rejected some out‑of‑state claims and that escalations had not produced consistent results.
Members also raised service issues beyond claims. One retiree said her retirement effective date had been altered after submission and that the new date might delay her cost‑of‑living adjustment; Walker replied that the retirement formula and COLA are set in law and cannot be changed administratively and advised the retiree to contact the CalPERS call center while staff investigate the specific case. Several callers described long delays getting case‑level responses from CalPERS; one said it took months to receive a first pension check after retirement because documents could not be uploaded and correspondence relied on U.S. mail or fax. Walker acknowledged the communication problems, said IT and process improvements are underway, and asked staff to look into individual cases.
Walker reiterated that CalPERS does not negotiate contracts between private insurers and provider systems; she said those negotiations are separate between the carriers and the providers, though CalPERS will advocate for members where possible. On member outreach, Walker gave participants her email (Yvonne.Walker@CalPERS.CA.gov) and asked members to allow additional time for individual responses because she expected to be away for two weeks.
No formal board action occurred during the webinar. Walker described upcoming votes: the board will vote on preliminary health‑care rates at its July off‑site and will consider the pharmacy benefit manager contract award after additional review.
