Archive for the 'Health Insurance' Category

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BCBSNC Bariatric surgery policy for morbid obesity

Published on February 20, 2011 in BCBSNC and Health and Wellness. 1 Comment Tags: , , , , , , .

Bariatric surgery, also called “weight-loss” surgery, is performed to help extremely overweight people to lose weight, attain better health and heighten their quality of life. In the United States alone, morbid obesity has almost risen to epidemic proportions, causing around 11 million to suffer from its crippling effects.

Morbid obesity is defined by a body mass index (BMI) of more than 40 kg/m2 or 35 kg/m2 with related complications such as diabetes, hypertension or obstructive sleep apnea. Those who suffer from morbid obesity are at a substantially  higher risk for different types of cancers and even a shortened life span.

For the Corporate Medical Policy on morbid obesity with Blue Cross Blue Shield of North Carolina, click http://docs.healthplansofnorthcarolina.com/page7/files/Surgery%20for%20Morbid%20Obesity.pdf

BCBSNC initiates customer market research panel

Published on February 2, 2011 in BCBSNC. 0 Comments Tags: , , .

BCBSNC is currently embarking on creating a customer market research panel. This panel will supply an organized, cost-efficient system for getting in contact with customers directly to perform research on health care and health insurance matters.

Members from three different divisions were sent invitations to participate during the last week of  January 2011. The process of enrolling members will continue through the end of February. If members desire, they will have the opportunity to cancel any e-mail communications associated with this program.

The minimum amount of members that they hope to enroll in the program are:

  • 2,000 individual members ages 18 to 64
  • 2,000 group members ages 18 to 64 (750 of these will be small business group administrators)

BCBSNC employees, Federal Employee Program members, and State Health Plan members will not be summoned to participate in this program.

In early March, panel members will start to receive surveys. These surveys will be directed to members who are picked by customer segment and /or demographics as needed. Every time a member finishes a survey, they will get the chance to enter a drawing for a gift card. These gift cards will differ in value, depending on the survey.

Those with questions concerning the customer market research panel are asked to call the Agent Contact Center.

BCBSNC and UNC Health Care to initiate innovative patient-centered practice

Published on January 24, 2011 in BCBSNC. 0 Comments Tags: , , .

On January 11, 2011 BCBSNC and UNC Health Care announced their partnership to work together and form a totally new type of medical practice where patients will be the main focus of care. This cutting-edge type of medical practice will reach beyond what is known as the ‘medical home’ and will allow teams of health care providers to work together with patients and families to provide excellent coordinated care.

This new type of practice is expected to open sometime in the fourth quarter of 2011 and will most likely be located in Orange or Durham county. This practice will be the first product of an ongoing team effort for BCBSNC and UNC Health Care. They will be working with each other to improve health care quality, efficiency and effectiveness and bring down health-care costs.

BCBSNC President and CEO Brad Wilson said that “the team approach to care emphasizes patient involvement and allows more time for clinical interaction and patient education and support. We believe this approach will result in improved health and fewer complications – both of which will help control rising health care costs.”

Around 5,000 BCBSNC members will be able to use this new practice. It will focus on patients with chronic conditions such as hypertension, diabetes, obstructive lung disease, coronary artery disease, major depression and asthma.

Continuous care will be available with the new practice, because coordinated care will extend across a variety of settings and provider types. The practice was created to allow more effective patient-provider interactions, resulting in increased patient satisfaction and better health. Also, this practice will supply an extended set of services and better access to these services which include:

  • On-site mental health
  • On-site pharmacy and medication management
  • On-site nutritionist
  • On-site laboratory
  • Non-traditional visit formats (e-visits, tele-visits, home monitoring)
  • Case management and coordination of care for patients requiring hospitalization
  • Extended weekday and weekend hours
  • Group and educational visits
  • State-of-the-art information technology

BCBSNC and UNC Health Care will share the cost of leasing and equipping the practice.

Individual members will no longer get Health Assessment

Published on December 14, 2010 in BCBSNC. 0 Comments Tags: , .

Beginning January 1, 2011, individual under-65 BCBSNC members will not have the option anymore to take the Health Assessment. This said, the over-65 and group members will still be able to use this implement.

This new change is one of the ways BCBSNC is continuing to keep administrative costs down with little impact on their members. In the past twelve months, only 250 out of 500,000 eligible members actually completed the Health Assessment.

There will not be any direct communications to members about the change. In January, members who are affected by the change will not see a link for the Health Assessment when they log on to Member Services.

BCBSNC releases new product offering lower premiums and most-requested benefits

Published on November 16, 2010 in BCBSNC. 0 Comments Tags: , .

Have you been searching for a lower-cost health plan? Well if you live in North Carolina, you now have new options to think about from N.C.’s top health insurer. BCBSNC has revealed a new product that has low premiums and streamlined benefits. It is called Blue Advantage Saver. Not only does it have low premiums, but it provides peace of mind to its consumers because they know they are covered if they encounter a tragic health event.

BCBSNC President and CEO Brad Wilson explains that “many consumers have told us they want a plan that offers a low premium, gives them some ongoing value and protects them financially from an unexpected health event. He said “Blue Advantage Saver is a bridge between the rich benefits of our traditional PPO plan, Blue Advantage, and the customer accountability of Blue Options HSA.”

There are three plan designs to choose from in the Blue Advantage Saver and they all cover preventive care at 100 percent with no cost sharing. Consumers are now able to purchase Blue Advantage Saver to get coverage that is effective January 1, 2022.

All three of the Blue Advantage Saver plans give the customer protection from unforeseen medical expenses, but the customer’s share of the cost differs with each plan. Here is a brief description of each plan design:

Blue Advantage Saver 1 – Customers can have unlimited non-preventive visits to a primary care physician, with a $25 co-payment each time.

Blue Advantage Saver 2 - Customers can go to a primary care physician for up to four non-preventive visits per year, paying a $25 co-payment each time (extra visits would be subject to deductible and coinsurance).

Blue Advantage Saver 3 – There is no limit on non-preventive visits, but each visit is subject to deductible and coinsurance.

ER visits, urgent care visits and specialist visits are all subject to deductible and coinsurance on all three Blue Advantage Saver plans. With Blue Advantage Saver 2 and 3, customers can get generic drugs for only $10, but it does not offer coverage for brand-name drugs. Blue Advantage Saver 1 does have coverage for brand-name drugs, but they are subject to deductible and co-payments or coinsurance.

Currently Blue Advantage Plan B is BCBSNC’s most popular individual plan. Compared to Blue Advantage Plan B, the Blue Advantage Saver 2 can save customers around 30 to 38 percent on their monthly premium. Blue Advantage Saver 1 could save customers around 13 to 19 percent. Deductibles for Blue Advantage Saver plans range from $1,000 to $20,000.

Blue Cross and Blue Shield of North Carolina is a leader in providing unprecedented health care products, services and information to more than 3.7 million members. For 77 years, they have offered health insurance at a competitive price and have also served the people of N.C. through support of community organizations and programs and events that encourage good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. You can obtain BCBSNC online at BCBSNC.com.

Consumers interested in the new Blue Advantage Saver plan can now get a free quote for the plan that is best for their needs by visiting NC Healthcare Coverage.

Blue Cross reveals their first iPhone app and it’s free

Published on October 12, 2010 in BCBSNC. 0 Comments Tags: , , , , .

On Monday, October 11, 2010, Blue Cross and Blue Shield of North Carolina announced its very first iPhone application. This new application helps customers compare drug costs, locate urgent care centers and reach customer service. Officials from the company announced that the free app is attainable for customers to download who have an iPhone, iPod Touch or iPad.

According to John Roos, who is a senior vice president, this app could save a family from paying too much or waiting too long, by directing them to the right urgent care center for their needs. The app will also help people look fro cheaper alternatives after comparing drug costs. It offers a one click access to get a Blue Cross customer service representative. In addition, the app  can store your notes about personal and family health.

John Roos noted that Blue Cross is also contemplating more abilities for its app in the near future. Editions for Blackberry and Android phones are currently being augmented.

Blue Cross is North Carolina’s largest health insurer, consisting of more than 3.7 million members.

Symptoms of heart attack are often different in women

Published on September 20, 2010 in Health Insurance. 0 Comments Tags: , , , , , .

An astonishing 35 percent of all heart attacks in women go unreported sometimes, because women’s symptoms are often different than men’s. A lot of women encounter nausea as their main symptom. They may also have some chest discomfort. Women should also be aware that heartburn that is not relieved by antacids or other prescribed medicine, may indicate the presence of a heart attack.

Some of the symptoms to look for are:

  • discomfort in the chest that lasts for more than a few minutes or goes away and returns; may feel like uncomfortable pressure, squeezing, fullness or pain
  • upper body discomfort in one or both arms, the neck, the back, the jaw or stomach
  • unusual fatigue, weakness or light-headedness
  • shortness of breath
  • nausea or vomiting, cold sweats, dizziness

If you feel any of these symptoms, reacting quickly is extremely important!. Call 9-1-1 for help within five minutes if you believe you are having a heart attack. Do not drive yourself or others with symptoms to the hospital unless you have no other choice. Chew an aspirin (325 milligram) while you are waiting for the ambulance to come. Lie down and breathe slowly. Doing all these precautions may decrease the damage done to your heart.

In women, the risk for heart disease increases with a waist measurement of over 35 inches. Women who have abdominal obesity may develop a condition called metabolic syndrome (sometimes referred to as insulin resistance syndrome). This puts them at a higher risk for stroke and diabetes, as well as heart disease.

The most efficient way to prevent and treat metabolic syndrome is to make health changes in your diet,  lose weight, exercise more, and don’t smoke. There are medications to help with this if necessary.

Member Health Partnerships has changed to better accommodate members with chronic conditions

Published on July 27, 2010 in BCBSNC and Health and Wellness. 2 Comments

Since July 1, BCBSNC has made some changes so that it is easier for members to enroll and participate in the Member Health Partnerships (MHP) program. Earlier, sign up was done by completing a mail-in survey only. Now, there are new options such as enrolling by phone and beginning in September, members will have the ease of being able to join online. They are no longer using the paper surveys. Members can easily join by calling 1-800-218-5295 and press 1.

Also the educational materials have been updated. Numerous books are no longer accessible, but have been replaced with exceptional substitutes. Members can sign up using email or phone to get great tips concerning weight management or smoking cessation. The pregnancy program even has an optional text-messaging feature. All members signed up for the program will acquire a Chronic Care Guide.

The outreach efforts are now concentrated on members at the highest risk level. Members who are considered “most impacted” will be called by specially trained nurses who will invite them to engage in health coaching and to join the MHP program. The hope is to reach more of the members who will benefit the most from the program.

The Pregnancy program has been changed to self-refer only, because it is sometimes very hard to identify members early in their pregnancy. Claims will be monitored for high-risk pregnancies and these members will be referred to a case manager.

All members’ claims will be constantly monitored for status changes, and the outreach will be adjusted accordingly. The “most impacted” members will receive a phone call from  a health coach, who will work with them whether or not they choose to enroll in the MHP program.

The members who are identified for the program but not considered “most impacted” will get a mailed invitation. The members who do enroll in the Member Health Partnerships program will receive  an annual mailing.

Some things will remain the same. Members who join our programs will still continue to receive targeted information and services, which will help them take care of their particular health care needs. Customized benefits, like nutritional counseling and discounts are also available to members. Members currently in the MHP program will not have to do anything to remain in the updated program; they will automatically be enrolled.

BCBSNC CEO is now in favor of health reform bill

Published on April 6, 2010 in BCBSNC and Health Insurance. 0 Comments

The CEO of Blue Cross and Blue Shield of North Carolina, Brad Wilson, has recently revealed that he stands behind the health-care reform bill that passed in the evening of March 21. He says “It’s a step in the right direction, however, there is still a lot of work to do to give Americans a health-care system that they can both depend on and afford.”

He also appealed to Congress for them to try and tackle the rising health-care costs that have caused major surges in the cost of insurance in the past few years.

This surprising show of support from the CEO of BCBSNC is in sharp contrast for the insurance company that was formerly opposed to the bill and even organized a campaign that debated against health-care reform legislation passed by the House of Representatives.

Wilson announced that his company, the state’s largest health insurer, is getting ready for the changes that the new law will bring. Just days before taking over from Greczyn on February 1 from COO to CEO, Wilson announced to TBJ that his reservation over the health-care reform was his utmost concern about BCBSNC. The company controls almost 97 percent of individual of the health insurance market in North Carolina.

Ways to decrease your individual health insurance premiums

Published on February 18, 2010 in Health Insurance. 0 Comments Tags: , , , , , , .

There are three key elements that can substantially affect the cost of individual health insurance. These are the deductible, the coinsurance percentage and the co-pay benefit.

The deductible is the amount that the insured pays before they can receive the policy benefits. Of course higher deductibles will mean lower premiums’ but it will usually take longer to reach your deductible if you choose this type of plan.

Coinsurance is a percentage that you may be required to pay once you have paid the deductible. It can range anywhere from 50% to 0%. You will need to pay this percentage until you get to your annual “out of pocket limit”. Higher coinsurance percentages normally mean you will pay lower premiums.

Co-payments are what many are asked to pay at a doctor’s visit or when a prescription is filled. It is a flat amount that you pay at the time of service or when the medication is received.

Once you have paid your annual deductible and out-of-pocket limit, the co-pay is waived for the rest of the year. Usually the co-pay benefits are an optional feature since they have a big influence on the premium.

Each individual or family should consider their current health situation, need for prescription medication and frequency of doctor visits so they can get the plan that best fits their needs. An agent from http://nchealthcarecoverage.com will be glad to take the time to help you find the policy that best fits you and your family’s needs. Or if you prefer, you can call (800) 797-0327 to talk to a friendly agent 24/7.

If you or your family hardly ever has to see the doctor other than for an annual check up, a plan that has a higher deductible and coinsurance percentage without a co-pay benefit may substantially reduce your overall health care costs.