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Members raise complaints after CalPERS shifts PPO to Blue Shield; board rep outlines recourse
Summary
CalPERS changed its PPO to Blue Shield following a five‑year contract procurement, prompting member complaints about provider access, telehealth, acupuncture reimbursement and large premium increases; Yvonne Walker described how members can escalate issues for CalPERS staff to address.
CalPERS members at a virtual town hall reported problems after the system’s PPO moved to Blue Shield under a five‑year contract; members said some providers are now out‑of‑network, telehealth access questions persist and at least one retiree reported a 30% premium increase for the PERS Platinum plan.
Yvonne Walker, a CalPERS board representative, confirmed Blue Shield was selected after CalPERS’ request‑for‑proposal process and a five‑year contract awarded last year. “We won’t be returning to Blue Cross at least within the next five years,” Walker said, and acknowledged that “anytime you go through a change of that magnitude, there are always going to be blips and problems.”
Members described several specific issues: one member said their acupuncturist who previously billed Blue Cross was now out of network with Blue Shield and that paperwork delays risked large unpaid bills; another described telehealth access questions for members on certain Medicare combinations; and multiple members described confusion and hardship after a 30% premium increase for the PERS Platinum plan this year.
Walker told members how to seek help: start with the carrier, request escalation to a manager if the initial representative cannot resolve the problem, and then contact the CalPERS call center so the CalPERS health‑care team can engage with the carrier. “If you get no relief from that person … ask for it to be sent to a manager… then call the call center for CalPERS,” she said. Walker provided her CalPERS email for follow up and encouraged members to send details to stakeholder relations.
Why it matters: Network changes and premium increases affect members’ access to care and out‑of‑pocket costs; members must know escalation pathways to pursue coverage or reimbursement disputes.
Ending: Walker said CalPERS healthcare staff will monitor access complaints and urged members to call the CalPERS number, escalate to carrier managers when necessary, and submit case details to CalPERS so staff can intervene.
