CalPERS PERS Platinum – Anyone in Thailand having claims denied?

[bprhodes]

I’m a U.S. citizen living in Thailand and enrolled in the CalPERS PERS Platinum PPO health plan, which switched administrators from Anthem to Blue Shield of California in January 2025.

Since the switch, all of my overseas medical claims have been denied — even ones that were routinely approved for years under Anthem. I’ve been trying to figure out whether this is a widespread problem, or something specific to Thailand, or even to my particular case.

If you’re also a CalPERS member living in Thailand (or elsewhere) and have had success or trouble getting claims reimbursed under Blue Shield since the transition, I’d really appreciate hearing from you — publicly or via DM.

I’m gathering information in case a larger issue needs to be raised with CalPERS or Blue Shield. Even a single successful case from Thailand would be helpful to compare.

Thanks in advance!

[Sheryl]

This (and most other US policies) only covers emergency care when overseas. Did your claims fit that description?

[jas007]

58 minutes ago, Sheryl said:

This (and most other US policies) only covers emergency care when overseas. Did your claims fit that description?

It sounds like only the Plan Administrator was changed, not the benefit package.

 

That happened to me recently, with my federal Blue Cross Blue Shield.  I basically have coverage anywhere in the world. But recently, the overseas administrator of the plan was charged and claims processing was slow, at first. 

[Sheryl]

1 hour ago, jas007 said:

It sounds like only the Plan Administrator was changed, not the benefit package.

 

That happened to me recently, with my federal Blue Cross Blue Shield.  I basically have coverage anywhere in the world. But recently, the overseas administrator of the plan was charged and claims processing was slow, at first. 

His plan, however, like most only covers emrrgency care abroad. Perhaps the new adminidtrator id more alert to this than prior one was. 

[eddyod]

I'm in a similar situation. I'm covered by my University of CA PPO plan by Anthem. It is world wide and covers everything, though I have a high deductible. Hopefully it doesn't go the way of what happened to the original poster. And it covers non-emergency stuff as well.

[jas007]

What Perplexity says:

 

The recent change in the administrator of the CalPERS PERS Platinum plan—from Anthem Blue Cross to Blue Shield of California, effective January 1, 2025—does not affect your entitlement to overseas (out-of-country) benefits.
Key points from CalPERS and Blue Shield communications confirm:
    •    Service Areas Unchanged: The PERS Platinum plan will continue to be available nationwide and out of country, as before. There are no geographical restrictions being introduced with the administrator change.
    •    No Change to Benefits: Your copays, deductibles, coinsurance, and pharmacy benefits remain the same with the transition to Blue Shield.
    •    Continuity of Care: For members who may be affected by provider network changes, Blue Shield will apply state and federal continuity of care guidelines, ensuring ongoing access to care during the transition period.
    •    Out-of-Country Coverage: There is no indication of any reduction or elimination of overseas benefits. The plan’s out-of-country coverage remains intact for 2025.
In summary, the administrator change to Blue Shield of California does not impact your entitlement to overseas benefits under the PERS Platinum plan for 2025.