Tag Archive for 'BCBSNC'

BCBSNC Updates Growth Hormone Therapy Program with Omnitrope as Preferred Drug

 A new update has been made to the growth hormone therapy program.  Omnitrope, the preferred somatropin brand, is now the medication of preferred over others.  This drug was selected based on safety, efficacy, delivery device, and cost.

Key Points:

  • On November 18, 2011, Omnitrope moved from Tier 4 to Tier 3.
  • On January 1, 2012, all other growth hormones were moved to Tier 4.
  • By March 1, 2012, any BCBSNC member who is not on Omnitrope will be required to have their physician submit documentation demonstrating a medical explanation on why they should be prescribed a different drug.

 

BCBSNC No Longer Requires Interviews with all Parents of Newborns

Since April 8, 2011, BCBSNC is no longer requiring telephone interviews with parents of newborns for every application. This change applies to all under-65 individual products. The requirement for telephone interviews with parents of newborns is now being determined on a case-by-case basis during the underwriting process.

New Treatment Cost Estimator initiated by BCBSNC

On August 1, Blue Cross and Blue Shield of North Carolina began a new Treatment Cost Estimator that was created to assist members in their health care decisions by providing them with data on the costs of elective procedures. It will give consumers an estimated range of what a procedure might cost and provide them with information on how the cost will differ based on the physician or hospital they select. The new tool takes the place of the other cost estimation tool and provides cost information to the provider search tool. Blue Cross and Blue Shield of North Carolina joined other Blue plans throughout the U.S. to provide new cost range information for different types of treatments and procedures based on network claims data. The tool can be found on mybcbsnc.com.

This new cost estimator provides average costs for 59 common elective procedures. This information will help members get more informed and be more in control when they make choices about their health care. More information and medical procedures will be added to the tool later in the year. Unfortunately, the tool is not available to members on Medicare Advantage (Blue Medicare), Medicare Supplement, FEP and Dental-only.

BCBSNC decided to introduce the tool because health plans are progressively asking consumers to  make informed decisions about their health care, and consumers often don’t have the information they need to find out how much they will have to pay for a procedure and why. The goal of this new cost estimator tool is to help members as they work with their doctor to make decisions about where to select their health services.

BCBSNC members can use the tool after they log into Member Services online at www.mybcbsnc.com to find information about the cost of the treatment they need. Once they log in using their Member ID and secure password, members can use the doctor or facility search to see the cost ranges of specific practices or facilities.

The Treatment Cost Estimator in Member Services can also be used by members to find out the estimated cost range for many elective procedures, without even choosing a certain physician or hospital.

The tool will be updated every six months in April and October.

Locate an authorized agent in your area

Blue Cross and Blue Shield of North Carolina offers affordable health insurance for individuals and families in North Carolina. Their health plans include Blue Options HSA, Blue Advantage PPO, and Medicare.

Whether you just have some questions or are ready to purchase a plan, click on www.bcbsnc.com/apps/AgentGuidedSelling/ to locate an authorized agent in your area.

BCBSNC to change their prior requirements for specific prescriptions

BCBSNC has made changes to their prior review/certification requirements for certain prescription drugs. The change will take effect on April 1, 2011.

Members who have filled prescriptions for oxymetholone (Anadrol-50), oxandrolone (Oxandrin) or doxepin (Silenor) within the past three months will be receiving letters from BCBSNC this week beginning March 14, 2011.

BCBSNC Bariatric surgery policy for morbid obesity

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

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

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.

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

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.

BCBSNC launches new program to fight the rise of childhood obesity and diabetes

Blue Cross and Blue Shield of North Carolina (BCBSNC) and the Blue Cross and Blue Shield Association (BCBSA) have recently introduced the national commencement of the Good Health Club Physician Toolkit to fight obesity and diabetes. This toolkit, which was initially created and tested in five states including North Carolina, will become accessible to pediatricians in North Carolina and communities throughout the U.S. The toolkit was designed with materials that were used with great results by BCBSNC and augmented in consultation with the American Diabetes Association (ADA) and the American Academy of Pediatrics (AAP). The toolkit is obtainable in both English and Spanish and is composed of tip sheets, physician reference materials, wall posters, tracking sheets and brochures with educational information.

The Good Health Club Physician Toolkit presents messages from the “Good Health Club, ” which is a group of friendly animal characters that motivates children to:

* Eat 5 servings of fruits and vegetables each day

* Curb screen time to 2 hours or less each day

* Exercise at least 1 hour each day

* Eliminate sweetened drinks

Dr. Don Bradley, senior vice president and chief medical officer at BCBSNC, and Dr. Edie Bernosky, Chapel Hill pediatrician, are both pleased and optimistic about the new program.

In the last 20 years, type 2 diabetes (formerly called adult-onset diabetes) has been reported among U.S. children and adolescents with increasing incidence, according to the Centers for Disease Control and Prevention (CDC). One in three U.S. children born in 2000 could get diabetes during their lifetime and the pervasiveness of obesity in children aged 6 to 11 has more than doubled in the past 20 years, rising from 6.5 percent in 1980 to an astounding 17 percent in 2006.

Since 1999, Blue Cross and Blue Shield of North Carolina has developed an assortment of programs in our community that focus on healthy lifestyles. The lifestyle modification program, called Health Lifestyle Choices, gave customers the support and instruments they needed to reach and maintain a healthy weight. In 2005, BCBSNC converted into one of the very first insurers to label obesity as a medical condition and cover nutritionist visits. Since 2007, they have augmented model tool-kits to assist families in getting routine exercise and taking control of managing their health and well-being.

To take a look at the Good Health Club Physician Toolkit and to get more information about what the Blue Cross and Blue Shield companies are accomplishing in their communities to fight childhood obesity and diabetes, please visit www.bcbs.com/goodhealthclub.