r/CAStateWorkers • u/polishedchoice • 8h ago
Health & Safety / Medical Leaves New health plan says primary care doctor is covered, online calpers form says he isn’t. Anyone else run into this issue before?
I have united healthcare which is ending, so I need to switch health plans.
Health Net Salud y Mas covers my existing doctor and medical group. I called my medical group and they say they are accepting it for 2027 as well. I also called health Net and they did say my doctor is on their list of being covered for 2027. He was also covered in 2026 under the same health insurance.
The only issue is when I go to the calpers website to switch my health plan, it asks if I want to select my pcp. I put in his info and it says my doctor is not available under the health Net Salud y MAs plan.
It does say he is available under some other plans like blue shield access plus.
Does anyone know if I should trust the health insurance and my clinic, or I should verify with calpers?
Why would calpers say he’s not available when both the health insurance and medical group say they take that insurance? Is calpers using outdated info?
Anyone run into this issue before?
5
u/kristenbl 7h ago
Yes, when I switched us from PERS Gold to Access+, my husband’s UC Davis PCP was technically covered but could not accept anymore Access+ patients. So even though he was already established with him, the doctor was already at his max HMO patient load and could no longer see him, which is why he couldn’t be selected in CalPERS as his PCP.
1
u/polishedchoice 7h ago
Yes but I’m seeing my same doctor it says available on the other HMO blue shield access plus. But on the health Net hmo it says not available
3
u/kristenbl 6h ago
I was just giving an example and answering your “Anyone run into this issue before?” question at the end of your post.
It wasn’t the same plans you’re talking about, but similar situation. When switching plans it happened to us, too, and in the end my husband was not able to see his original doctor. Everywhere else it said his PCP was covered, when we called UC Davis they said his PCP accepted it, but on the CalPERS website to switch we couldn’t select him as a PCP. When we tried to have the insurance assign his PCP, they said he was not able to take any more patients from that particular plan.
2
u/polishedchoice 4h ago
I know. But in your situation you were switching from a PPO to an HMO plan and your doctor wasn’t taking any more HMO plans. What you are saying makes sense for your situation.
I am already on an HMO plan and just switching to another HMO plan.
The weird part is, on the calpers website, it says my doctor is available on other HMO plans, just not the one I intend to enroll it.
So if I were to apply your situation to mine. That would mean I can’t continue with the PCP I already have because they are not taking any more health net HMO patients but they are taking blue shield HMO patients.
Makes no sense. I’m going to call calpers tomorrow to verify.
2
u/tgrrdr 2h ago
Call the health plan and ask if the doctor is covered. I switched to PERS Gold a few years ago. During open enrollment I confirmed online that my primary and my kids' pediatrician were both covered. When we got our new insurance cards in December we were assigned to random doctors I'd never heard of (mine was like 20 miles away, at least the one my kids were assigned was only in the adjacent city.
It turned out that neither of our doctors was covered and we had no recourse.
1
u/polishedchoice 2h ago
Who did you confirm with? Because I called Scripps medical group and they say they accept health Net for Scripps clinic doctors. I called health Net and they said they cover Scripps clinic doctors. So both the doctor and health insurance say they accept each other.
I’m going to call my doctors office specifically and ask about existing patients under a new hmo plan.
And then I’ll call calpers
1
u/tgrrdr 1h ago
I only checked online during open enrollment. I don't recall if it was the PERS website or the health plan website that I checked. I probably should have called the medical group - I think that's where I messed up.
In my case it wasn't a huge deal. I paid cash for my kids to see their original pediatrician for their annual checkups and I used a specialist to renew my medications.
1
u/gavinhater 7h ago
Had same issue. Best to call the doctor you want and ask if they take it. Hnet is good insurance.
1
u/polishedchoice 7h ago
The doctors office said they accept it
1
u/gavinhater 7h ago
If doctor office said they take hnet, then should be no provlem
1
u/polishedchoice 7h ago
Well it’s more of a medical group saying they take it, and the pcp doctor is within that medical group. Shouldn’t be an issue right?
1
u/SeaweedTeaPot 2h ago
Call and ask the physician’s office directly.
2
u/polishedchoice 2h ago
Going to try that tomorrow. They should know better whether or not they are accepting new patients and any rules they have about that
1
u/Bethjam 1h ago edited 24m ago
I have to switch and will have to find all new doctors and specialists. I have called the providers accepting new patients, but they really aren't. They had to stop accepting new patients and expect a delay of several months. I can live with going to urgent care until I can secure a PCP. I found a specialist for my daughter and will have to cash pay ($400 initial visit and $325 follow-ups). Still cheaper than the Blue Shield plan. I am pretty upset about this honestly. It is damn near impossible to navigate health care with chronic illness and change like this is just insane. Make the calls of course, but i would recommend a backup plan because you really can't trust anyone or that things will be the same in 3 months.
2
u/polishedchoice 32m ago
Yeah I feel like no one wants to do their job. If the state forces us to change health insurances at least educate us and their employees on how to navigate the change.
I just call people and they tell you one thing but they sound so unsure that you don’t know whether to trust them or not.
All they say is that it “should” be fine until it’s not.
•
u/AutoModerator 8h ago
All comments must be civil, productive, and follow community rules. Intentional violations of community rules will lead to comments being removed and possible bans, at the discretion of the moderators. Use the report feature to report content to the moderator team.
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.