a guide to a healthier youcms.ipressroom.com.s3.amazonaws.com/.../2010_guide_to_a_healt… · 2 a...

Your Blue Cross and Blue Shield

of North Carolina annual resource

One quick survey — many great prizesEnter to win grocery and sporting goods gift cards, a video fitness game system or a mini music player — just answer some quick questions at www.tinyurl.com/bcbsnc-hlth10.

A Guide to a Healthier YouSM1

Customer Resource 2010

2 A Guide to a Healthier You Customer Resource 2010

Table of contentsHealth 4 Focus on prevention Follow these simple

screening schedules for better health.

6 Nutritionists can help We can make losing

weight easier. Read one member’s story.

8 Brighter smiles mean better health

Make sure regular dental care is on your calendar.

9 Your rights and responsibilities

Here’s how to get more information about your rights as a BCBSNC customer.

10 Call us with your health questions

A health coach can keep you motivated to reach your goals.

11 Quality is the heart of care

We work with your doctor to ensure quality care.

Service12 Health information

technology makes a difference

We’re a leader in promoting high-tech health care solutions.

13 We’re listeningWe’ve listened and are focused on providing you with quality and personal service.

14 Online resources put health in one place

Member Services gives you control of your health plan in one place.

16 Submitting and tracking claims

Faster and more accurate claims: always our goal.

17 How to appeal payment decisions

Disagree with a payment decision? You have the right to appeal.

Value18 Our provider network

has you covered Our network of

doctors, hospitals and other providers make quality, affordable health care available to customers.

19 Your ID card opens up a world of care

Extensive coverage starts with the ID card that’s just for you.

20 Tips for managing your health care costs

These 10 tips can help you save money starting now.

21 Where your premium dollar goes

Understand how your premiums work to cover the cost of your care.

22 We protect your privacy

Your health information privacy is a top priority.

All you have to do is log on to www.tinyurl.com/bcbsnc-hlth10 by May 22 and take our short survey — just five quick questions about A Guide to a Healthier You. Give us your opinion, and you’ll be entered into a drawing for grocery and sporting goods gift cards, a

video fitness game or a pocket-size music player. You can enter without taking the survey by sending a postcard by May 22 to “BCBSNC Guide Drawing” in care of the address on the back cover. Be sure to include your name and mailing address.

You could win! It’s as easy as counting to five!

Our Customer Commitment

Prevenir es mejor que curar.

Se recomienda ir al médico perió dicamente, al menos una vez al año para examinaciones generales, así como para recibir atención de salud para la prevención y el control de enfermedades. De esta forma es posible detectar problemas de salud antes que éstos empeoren.

Estos son algunos consejos que puede tener en cuenta para llevar un estilo de

vida más saludable: + Aliméntese bien y cuide su peso + Manténgase activo + No fume + Conduzca seguro

Por favor llame al número que aparece al respaldo de su tarjeta de identificación de afiliado para comunicarse con un profesional de servicio al cliente bilingüe. Nuestros representantes están disponibles de lunes a viernes de 8:00 a.m. a 6:00 p.m. para contestar sus preguntas.

La atención preventiva es el primer paso hacia una mejor salud

The BCBSNC AdvantageWhether you’re facing a health emergency or having a routine checkup, your Blue Cross and Blue Shield of North Carolina (BCBSNC) ID card helps you get the attention you need when you need it. That’s peace of mind in your hip pocket.

As a BCBSNC member you have: Unmatched Access — to extensive local and nationwide networks of leading health care providers, to a comprehensive range of health services, and to online wellness informationResponsive Service — from a knowledgeable and caring team of customer service professionalsPractical Support — through online resources to help you succeed in your own plan for better health

Look for examples of each of these throughout this Guide.

HeALtH — We are dedicated to improving quality and helping people improve their health.

SeRvICe — We set the standard for great service that is easy to use and puts the customer first.

vALUe — We deliver value through unrivaled physician and hospital networks, competitive rates and products that meet our customers’ needs.

+ Access. + Service + Support

Advantages you can count on.

WHAT We GIVe

YOU

3A Guide to a Healthier You

Review these screening schedules to make sure your family is up to date on preventive care. To get the full list of recommended screenings and learn how you can take advantage of BCBSNC’s preventive health benefits, including recommended immunizations, visit bcbsnc.com/memberservices and click on “Health Resources”1 or call 1-800-218-5295 for a printed copy.

Men should visit their doctor every one to three years for these routine screenings and procedures:

+ Physical exam + Height and weight + Immunizations2

+ Colon cancer screening (starting at age 50)3

+ Cholesterol screening + tobacco use screening

and counseling

Women should visit their doctor every one to three years for these routine screenings and procedures:

+ Physical exam + Bone density test4

+ Chlamydia screening (until age 24)

+ Colon cancer screening (starting at age 50)3

+ Height and weight + Immunizations2

+ Mammogram — consult with your doctor on when to begin.

+ Pap test (starting at age 21)5

+ tobacco use screening and counseling

Children should visit their doctor for routine screenings and procedures:

+ Physical exam + Developmental and

behavioral assessment + Height/weight/length + Immunizations2

+ Chlamydia (for sexually active girls)5

+ Hemoglobin

Discuss the timing and appropriateness of all screenings with your doctor.

Focus on prevention

4 A Guide to a Healthier You

1 Don’t use tobacco and avoid secondhand smoke.

2 Be active at least 30 minutes a day, five days a week.

3 Eat well but with restraint.

4 Get sleep — aim for seven hours a night.

5 Limit alcohol intake.

6 Don’t use illicit drugs/substances.

7 Learn to deal with/reduce stress.

8 Take your medications as prescribed.

9 Know and get recommended preventive services (see p. 4).

10 Talk with your doctor about all the medications you take (over-the-counter/prescription/herbal).

11 Wear seat belts in the car and helmets during appropriate activities.

12 Stay connected with your family, your friends and your own interests.

Twelve positive steps to better health

visit BetterHealthNC.com to find fun ways to get healthy in North Carolina.


Nutritionists can help

Whether you want to lose weight, eat healthier or manage your health, a registered dietitian can help — all at no cost to you.

BCBSNC covers up to six nutritional counseling visits6 — with no copayment — for members enrolled in Member Health Partnerships.SM1,7 During office visits, members learn how to make healthy choices when eating out, pick the best portion sizes, read food labels, choose healthy recipes and build a well-balanced meal plan.

Dr. Joye Willcox is the registered dietitian who helped BCBSNC member Susan Meyer (read her story on page 7). “Susan had many bad experiences, but it was different for her this time. We didn’t work on a quick fix but on a concrete guide for a lifestyle she can follow for the rest of her life,” says Dr. Willcox.

Do most people make progress toward a healthier weight by working with a dietitian? “It’s rare not to make progress,” says

Dr. Willcox. “It takes determination, but more important is having a plan for success. It’s the patient who must make a journey to healthy weight. I’m just the travel agent providing the roadmap.”

You can take advantage of nutritional counseling yourself by enrolling in Member Health Partnerships. Just call 1-800-218-5295 weekdays between 8 a.m. and 5 p.m. EST.


One member finds her way to healthy weight loss

A growing number of Americans battle weight problems. In fact, a new study estimates that if current trends continue, 43 percent of U.S. adults will be obese by 2018, and health care costs due to obesity will hit $344 billion — more than one in every five dollars spent on care.8 BCBSNC members have a partner in bucking that trend. Member Health Partnerships has a proven track record of helping members change their lives for the better through nutritional counseling.

BCBSNC member Susan Meyer is a good example:

“I’m 47 years old and have struggled with weight since 4th grade, losing and gaining a total of 800 pounds. I have now lost 142 pounds and maintained my healthy weight for almost two years, because I finally did it the right way. I keep quality in mind in my food choices, use portion control and get daily exercise. It’s all about lifestyle change, and that’s where the one-to-one attention from Blue Cross and Blue Shield of North Carolina came in.

“Through Member Health Partnerships, I began seeing my dietitian, Dr. Willcox. She was caring and supportive and with me every pound of the way. I wish I could say it’s been easy, but that isn’t true — old habits die hard! I now make food choices that are healthy and delicious, and I love my daily walks. My new life feels great and is a perfect fit.”

BCBSNC member Susan Meyer


Daily brushing and regular checkups help keep your mouth in great shape, protecting you from tooth decay and gum infections. But did you know your dental health may also affect other health conditions such as diabetes, heart disease and respiratory disease?9 So be sure to brush and floss daily, maintain a healthy diet and avoid tobacco, which can discolor and damage teeth and lead to oral cancer. And remember to see your dentist regularly for an exam and a cleaning. Put Dental Blue to work for youBecause we know preventive services are important to keeping you in good oral health, Dental Blue® covers preventive visits at little or no cost to you. Have a question?To speak with a BCBSNC representative, call us at the toll-free number on your member ID card.

Brighter smiles mean better health

Save time, go onlineTo locate a Dental Blue network provider, visit bcbsnc.com/dentist.

If you need claim forms, benefit information, ID cards and more, visit bcbsnc.com/memberservices. To view dental claims status, visit bcbsnc-dental.com.

FINd A PROVIdeR

Approaching Medicare age? Review plan options for Medicare beneficiaries at bcbsnc.com/medicare.


As a BCBSNC member, you have certain rights and responsibilities. These guidelines are included in your BCBSNC Member Guide, or you can view them online at bcbsnc.com.

To access Member Rights and Responsibilities, visit bcbsnc.com/memberservices/public/forms. On the page that appears, you’ll find the “Member Rights and Responsibilities” link at the bottom, where you can download a PDF of your Member Rights and Responsibilities.

If you’d like us to mail you a printed copy of your Member Guide, which contains your Member Rights and Responsibilities, just call the toll-free number on your BCBSNC ID card to request a copy.

Your rights and responsibilities as a BCBSNC member

Official notice of mastectomy benefitsAs required by the Women’s Health and Cancer Rights Act of 1998, your health insurance policy provides benefits for mastectomy-related services, including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses and complications resulting from a mastectomy, including lymphedema. This coverage is subject to the same deductibles, copayments, coinsurance or limitations as applied to other medical and surgical benefits provided under your policy. If you have questions, please check your Member Guide or call the Customer Service number on your ID card for more information.


Start at our FAQ pageGet answers to your questions at bcbsnc.com/assets/help/faq, our handy Frequently Asked Questions (FAQ) page. You’ll find many helpful answers organized by subject and health plan type.

Need AN

ANSWeR?

What would you say if you found out you could call a health care professional — such as a nurse, dietitian or respiratory therapist — anytime of the day or night, with any health care question? Well, you can. Better yet, it won’t cost you anything.

Health Line BlueSM nurses can help you understand your health condition, discuss medical procedures and treatment options, and help you think through health care decisions.11 Health Line Blue nurses do not take the place of your doctor, but they can help you have more productive discussions with him or her.

Health Line Blue nurses will provide you with up-to-date information from respected medical experts and can even send you free, informative videos, when appropriate. To talk to a Health Line Blue nurse, call 1-877-477-2424.


We can make it easierManaging a chronic condition such as heart disease, diabetes, or asthma can be tough to do on your own. Even if you just need some motivation to get more exercise or eat a more balanced diet, call a Health Line Blue nurse today at 1-877-477-2424.

GIVe US A RING

Call us with your questions

Get healthy discounts10

Your Blue Cross and Blue Shield of North Carolina membership gets you more than just health insurance. Our family of discount programs is available to members at no additional cost, and includes:

+ Chiropractic services + Hearing aids + Vision care + Laser eye surgery + Vitamins and supplements

+ And more!

All you need to start enjoying these discounts is your BCBSNC ID card at the time of service. To learn more, visit bcbsnc.com/content/health-wellness/ blue-extras/index.htm, search for Blue ExtrasSM on bcbsnc.com, or login to Member Services and visit the Rewards and Discounts section. Save money and take charge of your health!

We believe that a close, ongoing relationship with one doctor who coordinates your care is important to staying healthy. That’s why we highlight those doctors who meet certain quality standards for open scheduling, expanded hours and communication among patients, physicians and staff.

On our Web site, you can find doctors who have earned recognition as Physician Practice Connections and Patient-Centered Medical Homes from the National Committee for Quality Assurance (NCQA), a private not-for-profit organization dedicated to improving health care quality.

Recognized doctors have shown that they and their teams focus on you and your good health, not just treating your illnesses. Each doctor must pass strict requirements to be recognized, with recognition as a Patient-Centered Medical Home the highest recognition.

To locate a doctor meeting these standards, visit bcbsnc.com and search for “Find a Doctor.” Pick your plan and then, in the pulldown menu beside “Specialty,” choose “NCQA-Physician Practice Connections” or “NCQA- Patient-Centered Medical Homes” as a search option.

In the search results, NCQA-recognized doctors are listed with one or more NCQA seals.

BCBSNC is also leading an effort to promote health care quality with its Blue Quality Physician ProgramSM, which provides doctors with incentives for the quality of their care. In addition, our Blue Distinction programs recognize high standards of care in knee and hip surgery, back surgery, weight-loss surgery, heart care, certain cancers and transplants.

Quality is the heart of care


Recent survey results show that BCBSNC customers’ satisfaction with their doctor and health plan is higher than the regional average. If you would like a copy of our Quality Improvement program description, please e-mail us at partnerships@ bcbsnc.com or send a written request to us at: BCBSNC Member Health Partnerships P.O. Box 2291 Durham, NC 27702.

See how we’re improving

The business of health care relies increasingly on the electronic movement of information — your medical records, your prescriptions, your claim forms, etc. But too often, senders and receivers of this information aren’t able to “talk” to each other because of incompatible systems and processes. That’s all changing, and quickly, thanks to nationwide standardization in health information technology (IT).

New standards put patients at the center by allowing all providers involved in a patient’s treatment to share information and coordinate care, whether they’re colleagues across town or specialists across the continent. No more need to duplicate expensive tests, repeat lengthy medical histories or worry about interactions from unknown drugs.

At BCBSNC, we’ve seen health IT at work in our ePrescribeSM1 capability, which allows doctors to submit prescriptions online while patients are still in the office.

Since 2006, more than 7.8 million electronic prescriptions have been written, each saving about $250 per doctor per month because of increased use of generics and avoidance of unnecessary or inappropriate prescriptions.12

The HITECH Act of 2009 is investing more than $31 billion nationwide in comprehensive health IT infrastructure and provider incentives. BCBSNC is part of North Carolina’s efforts to help doctors and hospitals get electronic health technology installed statewide with the goal of improving the health information flow supporting all patients seeking care.

Health information technology makes a difference


We’re listeningFor the past two years, we’ve called several hundred members each month to find out how we’re doing and how we can do better. You’ve been talking, and we’ve been listening. Here’s what you told us in 2009:13

+ Almost nine out of 10 said you’d recommend BCBSNC to a friend.

+ More than eight out of 10 said you were satisfied with your overall experience with BCBSNC.

+ Eighty-two percent said you were highly satisfied with the customer service professional who handled your call.

Our goal is to help you make the best use of your plan’s benefits, understand your personal costs and be aware of the comprehensive value your plan offers.

You’ve said that efficiency is important, especially in handling claims, but a personal touch matters, too. That’s why we answer calls quickly but take whatever time is needed to help you with your questions. While some issues take research and follow up, more than two-thirds are resolved during the first call.

For our individual members at risk of losing their coverage due to financial difficulties, we’ve worked out alternative payment arrangements and devised some lower-cost plan options. To help members coping with serious illness we’re piloting a one-to-one approach providing ongoing help in understanding coverage options, claims status and out-of-pocket health care costs.

“I didn’t know insurance companies did that,” one member said. Most companies don’t. We do.

Protecting your well-beingDid you know that there are standards in place to protect you, the health care consumer? The National Committee for Quality Assurance developed the following national standards that BCBSNC follows:

+ All decisions made about coverage for care or services are based on your benefit plan. BCBSNC medical policy and information from your doctor about your medical condition.

+ The BCBSNC doctors and nurses who review your requests for service or coverage are not given bonuses or other financial incentives to influence their decision.

At BCBSNC we are committed to making appropriate coverage decisions which are based on the terms of your health benefit plan and address your medical needs.


You have an online friend in Member Services, the Web site that puts you in charge of your health plan.

Take a quick tour by going to bcbsnc.com/memberservices and logging in. If you’re a new user, click “Register Now.” Here’s what you can do in Your Plan:

+ In “My Account,” review your plan’s member guide, get a status report on your usage, request an ID card or verification of coverage if you are waiting for your ID card.

+ In “My Benefits & Claims,” get details about your plan’s benefits and view your claims status.14

+ In “Doctors, Rx & Hospitals,” use our provider directory to find a doctor or hospital, estimate costs, and access comprehensive drug information, including generics.

And take a peek inside Better Health: + In “Health Programs,” find ways you and your family can build a healthy lifestyle and manage chronic diseases.11

+ In “Health Resources,” locate and compare hospitals and access expert advice. + In “Rewards & Discounts,” take advantage of discounts on specialty services and health needs such as vision care, hearing aids, vitamins and supplements.10

Looking for a needed form? On Member Services, you can access:

+ Claimformsfor medical and dental procedures. + Memberauthorizations formslet you designate another person to receive information and/or call us on your behalf.

+ Studentleaveofabsenceapplicationsto continue coverage for a dependent on a medical leave of absence.

+ Appealsforms for use in filing an appeal if you disagree with a decision made by BCBSNC related to claims payment.

Online resources put health in one place


Online resources put health in one place Q&AMember Services has the answers you need.

Where can I find a description of what my plan covers?You’ll find it online at bcbsnc.com/memberservices under ”My Benefits & Claims” or in your BCBSNC Member Guide or you can call BCBSNC Customer Service at the toll-free number listed on your ID card.

How can I check the status of my claims online?Just access ”My Benefits & Claims” on bcbsnc.com/memberservices.

How can I get a new BCBSNC ID card? Order a new ID card through “My Account” or by calling BCBSNC Customer Service. Until you receive the card, you can print out and use the Verification of Coverage form found on the “Request ID” page.

Does BCBSNC help members with chronic conditions such as diabetes or asthma?Yes. Our Member Health Partnerships program offers one-to-one phone support with a registered nurse, discounts on medication and supplies, online and print information, and access to valuable resources.11 Find out more under the ”Health Programs” section of Member Services.

How do I know if a doctor or hospital is in the BCBSNC network?Check out the ”Find a Doctor” search tool to locate in-network doctors and hospitals in North Carolina, throughout the U.S. and even outside the U.S.

Is there a way to find out what other members think about specific doctors and hospitals? Yes. Go to the Zagat®1 Health Survey on Member Services to read members’ feedback and learn whether a doctor has met national quality standards for patient care, clinical outcomes and operating efficiency.15 You can also find out which facilities and doctors are recognized for excellence in bariatric surgery, cardiac and cancer care. There’s even a Hospital Comparison ToolSM1,16 to help you compare hospitals based on what matter most to you.

Is there a way I can estimate how much my health care services might cost?You can estimate the costs of certain services, including medications, with our Health Cost estimator toolSM1,17 located in the ”Health Resources” section. Please note that your provider’s charges and the benefit allowed under your specific plan for the service in question may vary.


Handling your claims accurately and quickly is one of the most important things we do. Even with a huge volume, we treat each claim individually and aim to do things right the first time.

On average we process four out of five claims automatically, moving them from start to finish in less than 24 hours.18

Number of claims paid in 2009 Nearly 47.2 million

Value of claims paid in 2009 More than $11.3 billion

Number of customer calls answered in 2009 More than 4.3 million

Submitting and tracking claims

Find your claims information onlineInformation about your claims is available to you online at bcbsnc.com/memberservices. Just log in and go to “Benefits & Claims.”

There you can view your claims history and see if your current claims have been processed.14 Just click on the specific claim you want to know more about, and you’ll see details such as the billed amount, when it was paid, how much was paid and if any copayments or coinsurance were applied.

Get needed formsIf you’ve been to an out-of-network provider and need to file a claim yourself, you can download medical and dental claim forms, or fill out them out online, print them and mail them to us.

With the Member Authorization form, you can authorize someone else to receive information about your account or call us on your behalf. If you disagree with a claims payment decision, you can appeal using the online Appeals form.


According to the BCBSNC Appeals Department, there are three common reasons that payment for services is denied or benefits are reduced:

+ The service is not considered medically necessary.

+ The service is not covered under your health plan.

+ The service was provided by a nonparticipating doctor (not in the BCBSNC network).

Your first stepTo find out whether something is covered by your health plan, first carefully review the benefits in your Member Guide or visit bcbsnc.com/content/services/medical-policy to see our medical policies. If you need more help, a BCBSNC Customer Service professional can help your review your benefits. If you disagree with the denial of payment or authorization of a service, you have the right to appeal by following the process below.

Level One: At this level, you can appeal a decision by submitting a written request that includes a description of the situation and a full explanation of why you disagree with BCBSNC’s initial decision. Be sure to supply any documentation that supports your position, and BCBSNC will review this information. If you disagree with the outcome, then, in most instances, you can proceed to the next level of the appeals process.

Level two: Please refer to your Member Guide for specific details regarding the Level Two appeals process.

Level three: External Review*: This level is handled through the North Carolina Department of Insurance (NCDOI). You may request a review through the NCDOI for all medical necessity denials. Generally, you must complete the Level One and Level Two appeals before you can appeal to the NCDOI. If your request is accepted by the NCDOI for review, it will be sent to an Independent Review Organization (IRO). BCBSNC must follow the decision of the IRO. Please note that members of self-insured groups do not utilize this third level of appeal

The appeals process

* The option of an external review is limited to members insured by BCBSNC and is subject to North Carolina law. Check your Member Guide to confirm the appeal levels available to you.

How to appeal payment decisions

For more information about the appeals process, please refer to your Member Guide.


When you need medical care, you can turn to our large statewide network of doctors, hospitals and other providers. These “in-network providers” have contracted with BCBSNC to make quality care available to BCBSNC members, often at substantially lower rates.* These member-only discounts help lower your out-of-pocket expenses and help keep health care costs down for everyone.

We work very closely with our network of doctors and hospitals to ensure that you receive quality care and have a good health care experience. A good

example is the Blue Quality Physician Program launched in 2009, which rewards physicians based on clinical outcomes, patient care experience and administrative efficiency. In a recent provider satisfaction survey, BCBSNC out-scored all local competitors on the measures providers consider most important.

Because the BCBSNC provider network provides all kinds of services all across the state, members seeking care will find it within a short drive. The Blue Medicare HMOSM and Blue Medicare PPOSM network reaches 80 percent of Medicare-eligible citizens.19 The entire BCBSNC network of providers continues to add new doctors and hospitals.

Our provider network has you covered


We’Ve GOT N.C. COVeRed

* Members can still go to out-of network providers, but out-of-pocket costs will be higher.


On the front of your BCBSNC ID card is a small suitcase packed with a world of reassurance. The suitcase symbolizes the Blue Cross and Blue Shield BlueCard Program, which provides in-network coverage for BCBSNC members who travel or live in another Blue Plan’s service area.

With 39 Blue Cross and Blue Shield Plans providing coverage in all 50 states and with more than 90 percent of the nation’s hospitals and 80 percent of physicians contracting with BCBS Plans, your access to health care is more extensive than it would be through any other insurer.20

Through the BlueCard® Program you are also part of BlueCard Wordwide,® which provides access to a network of traditional inpatient, outpatient and professional health care providers in more than 200 countries and territories around the world.20

* If you go to a provider in any BlueCross and Blue Shield Plan’s network, you should not have to fill out claim forms or pay up front for covered medical services other than the usual out-of-pocket expenses for co-payments, deductibles or co-insurance. Outside the U.S, advance payment for medical services may be required by some providers but not by hospitals in the BlueCard Worldwide program. Paperwork is handled internally, and BCBSNC will send you an Explanation of Benefits after the claim is received and processed.

Here are five easy ways to ensure your health coverage away from home*:

+ Always carry your BCBSNC ID card. + In an emergency, go to the nearest hospital.

+ To find a doctor or hospital, call BlueCard Access at 1-800-810-BLUe (2583), or, from outside the U.S., call collect to 1-804-673-1177 or visit BlueCard® Health Coverage information on bcbs.com.

+ Call the BCBSNC toll-free number on the back of your ID card to find out if pre-authorization is needed and inform your doctor.

+ When you arrive at the doctor’s office or hospital, simply present your BCBSNC ID card.

Your ID card opens up a world of care

1 take care of yourself. Focus on building wellness rather than curing illness. Take advantage of your preventive care benefits, such as check-ups and immunizations (see page 4), which your plan provides at little to no out-of-pocket cost to you.

2 Build your relationship with your primary care provider. Talking about health concerns when they’re small may spare you an expensive visit later. Share your medical history and records to save time and eliminate duplicate tests.

Tips for managing your health care costs3 Stay in network when choosing a

provider. Check our online provider directory for nearby doctors and hospitals at bcbsnc.com.

4 Ask your doctor about more affordable generic drug alternatives for your prescriptions.

5 Do your homework by using the online Health Care Costs Estimator,17 or call your doctor’s office to learn the cost of a service before you receive it.

6 Be a smart shopper. Check our online provider directory to see if deductible/coinsurance charges will apply for services at specific provider locations.21


Where your premium dollar goes*

About 85 cents of every premium dollar goes toward health care services for members, primarily in payments to providers.

What members pay out of pocket is a small percentage of the overall cost of health care. BCBSNC continues to look for ways to make health care more affordable, through lower in-network provider charges and lower-cost generic drug options, for example. Also, by supporting preventive care and providing Member Health Partnership programs targeting specific health needs, BCBSNC helps members improve their own health and get the most out of their benefit plan.

Tips for managing your health care costs7 Read your member guide to

understand how your benefits work and avoid unexpected costs.

8 Better manage chronic conditions such as diabetes, asthma or heart disease by enrolling in a Member Health Partnerships program.7

9 Keep track of your claims and other expenses via the online convenience Member Services.

10 take advantage of member discounts on vision care, hearing aids, vitamins and more.

As a member, you’ll find the information you need at bcbsnc.com/memberservices, your secure online resource.

* BCBSNC 2009 data, excluding self-funded business.

** BCBSNC earnings add to reserves, strengthening the company’s financial stability.

Physician $0.34

Outpatient facility services $0.19

Prescription drugs $0.17

Hospital inpatient services $0.15 Operating expenses/ Administrative $0.12

earnings** $0.02

Income taxes $0.01


The protection of our members’ medical and personal information is a top priority for BCBSNC. We take our commitment seriously and have strict privacy policies addressing our customers’ protected health information (PHI). All employees must complete training on the policies and sign a privacy acknowledgment form binding them to follow those privacy policies and procedures. You will find more specific information in our Notice of Privacy Practices, which describes our responsibility to safeguard your PHI and your rights regarding the information we maintain about you.

You have the right to: + See and get a copy of certain records containing your PHI.

+ Ask us to make corrections to the records if you think they contain errors. There may be times when we cannot change records, especially if someone else, such as your doctor, created the record.

+ Ask for an accounting of certain disclosures of your PHI that we have made to others. We are not required to record every disclosure that we make, however.

+ Ask us to restrict the use or disclosure of your PHI and to communicate with you in a confidential way or at an alternate address.

+ File a privacy complaint with BCBSNC or the Secretary of the Department of Health and Human Services.

+ Receive a copy of the privacy notice.

We protect your privacy

to obtain a copy of our Notice of Privacy Practices, call the Customer Service number on your BCBSNC ID card or download a copy from bcbsnc.com. Just click on “Privacy and Usage” at the very bottom of the homepage screen to view the entire notice.

WANT MORe INFO?



Endnotes1 Recommendations compiled from 2009 U.S. Preventive

Services Taskforce. Recommendations are guidelines and for specific preventive care benefits offered; refer to your benefit booklet. These guidelines are subject to your preventive health benefits.

2 Recommended childhood, adolescent and adult immunization schedules can be accessed at www.cdc.gov/vaccines/rec/schedules/default.htm. Source: Centers for Disease Control and Prevention 2009 Childhood, Adolescent and Adult Immunization Schedules. Additional vaccines may be ordered, subject to clinician discretion (e.g., meningococcal vaccine). Sequence and timing of vaccines may also vary.

3 One of the following colon cancer screening tests is recommended:

+ Annual fecal occult blood test (FOBT) or stool sample + Flexible sigmoidoscopy, every five years + Annual FOBT and flexible sigmoidoscopy,

every five years + Total colon exam by double-contrast barium enema

(DCBE), every five years + Total colon exam by colonoscopy, every 10 years

4 This screening is indicated for women at risk for osteoporosis. Go to the National Osteoporosis Web site at www.nof.org for more information.

5 Pap test screening should begin three years after beginning sexual activity or until age 21, whichever comes first.

6 The nutrition counseling benefit is only available to members who are participating in the Blue Cross and Blue Shield of North Carolina (BCBSNC) Member Health Partnerships program who have Blue Care®, Blue OptionsSM, or Blue Advantage® plans. Some self-insured employer groups may choose not to offer this benefit. Deductible and coinsurance apply if you are enrolled in a high-deductible health plan or if you receive nutrition counseling services in a hospital-based setting.

7 BCBSNC provides the Member Health Partnerships (MHP) program for your convenience and is not liable in any way for the services received. BCBSNC reserves the right to discontinue or change the program at any time. Benefits available through the MHP program are subject to your current benefit plan and pre-existing waiting periods. Not all employer groups participate in the MHP program. Additionally, some MHP benefits may be different for members of BCBSNC’s high-deductible health plans. If you are a member of a group plan, please consult your employee benefits consultant for more information about your specific benefit plan.

8 “The Future Costs of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses.” A collaborative report from United Health Foundation, the American Public Health Association and Partnership for Prevention. www.americashealthrankings.org/2009/report/Cost%20Obesity%20Report-final.pdf. Retrieved on 2/8/2010 from www.americashealthrankings.org/requestreport.aspx.

9 “The Health Perils of Gum Disease.” Dulce Zamora. Reviewed by Brunilda Nazario, M.D. www.webmd.com/content/article/104/107269.htm. April 2005, Reviewed May 2009. Accessed March 2010.

10 Blue Extras and Blue PointsSM may not apply to all health plans. Discounts on certain goods and services may not be provided directly by BCBSNC, but may instead be arranged by BCBSNC for member convenience. Any discounts are outside your health plan benefits. BCBSNC is not liable for problems resulting from goods and services it does not provide directly, such as goods and services not being provided or being provided negligently. BCBSNC may change or discontinue these programs at any time.

Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. ®, SM and TM are Marks of the Blue Cross and Blue Shield Association. ®1 is a registered trademark of Zagat Survey, LLC. Dialog Center®2 is a registered trademark of Health Dialog Services Corporation. SM1 is a Mark of Blue Cross and Blue Shield of North Carolina.

11 BCBSNC has contracted with Health Dialog Services to bring you Health Line Blue, the Dialog Center®2, Health Crossroads®2, the Healthwise®3 Knowledgebase (online health encyclopedia) and Online Healthy LivingSM1 programs. BCBSNC provides these programs for your convenience and is not liable in any way for the information, goods or services received. These programs provide tools to aid you in improving your health; results are not guaranteed. They are meant to be reference tools only and not intended to provide legal, medical or tax advice. BCBSNC reserves the right to discontinue or change the programs at any time. Decisions regarding your care should be made with the advice of your doctor. Due to specific contracts, selected employer groups will not be participating in these programs at this time. Contact your benefits administrator or BCBSNC Customer Service to determine your eligibility.

12 BCBSNC internal Pharmacy data, 2009.

13 BCBSNC internal Customer Service Member Survey, 2009.

14 Excludes claims for prescription drugs, dental and mental health.

15 BCBSNC has contracted with WellPoint, Inc., to bring you the Zagat Health Survey. The information contained within is intended as a resource and is not intended to provide medical advice. BCBSNC does not exercise editorial control over the pages outside of bcbsnc.com. BCBSNC reserves the right to discontinue access to this program at any time.

16 BCBSNC has contracted with WebMD to bring you the Hospital Comparison Tool. The information contained within is intended as a resource and is not intended to provide medical advice. BCBSNC does not exercise editorial control over the pages to which you are linking, except for the network participation status of North Carolina hospitals. BCBSNC reserves the right to discontinue access to this program at any time.

17 The cost ranges described in the Health Care Cost Estimator tool are based on average costs as collected by BCBSNC and are provided for informational purposes only. It is not intended to report the member, provider or payer actual cost for any specific service or episode of care. The costs reported represent the billed charge, or retail price, for services, and do not reflect member benefits or negotiated provider discounts through your health insurance policy. While the price ranges should give you a good idea of the relative costs of certain services, your actual costs may exceed this range depending on your chosen provider and the particular services rendered.

18 BCBSNC internal Claims data, 2009.

19 BCBSNC Network Management data, 2009.

20 Blue Cross and Blue Shield Association Internal Data, 2010: www.bcbs.com/about/ and www.bcbs.com/coverage/bluecard/ (Accessed 2010).

21 Some services and supplies received in an office setting or in connection with an office visit are in fact provided by hospital-owned or -operated practices. The online directory will display a yellow symbol next to a provider’s name to alert you that the provider is affiliated with a hospital and that additional deductible or coinsurance charges will apply.

5006

M

You

coul

d w

in!

All

you

have

to

do

is lo

g o

n to

w

ww

.tiny

url.c

om/b

cbsn

c-hl

th10

by

May

22,

201

0 an

d t

ake

our

sho

rt s

urve

y —

just

five

qui

ck q

uest

ions

ab

out

“A

Gui

de

to a

Hea

lthi

er Y

ou.

” Yo

u’ll

be

ente

red

into

a d

raw

ing

to

win

gro

cery

and

sp

ort

ing

go

od

s g

ift c

ard

s, a

vid

eo fi

tnes

s g

ame

or

a p

ock

et-s

ize

mus

ic p

laye

r.

You

can

ente

r w

itho

ut t

akin

g t

he s

urve

y

by

send

ing

a p

ost

card

by

May

22

to

“BC

BSN

C G

uid

e D

raw

ing

” in

car

e o

f th

e ad

dre

ss a

t th

e to

p o

f th

is p

age.

Be

sure

to

in

clud

e yo

ur n

ame

and

mai

ling

ad

dre

ss.

eNTe

R TO

dAY

!

PRSR

T ST

DU

.S. P

osta

gePA

IDBl

ue C

ross

and

Blue

Shi

eld

of

Nor

th C

arol

ina

Pase

a la

pág

ina

3 pa

ra o

bten

er

info

rmac

ión

en e

spañ

ol.

tam

bién

pue

de v

isita

r nue

stro

sitio

Web

en bcbsnc.com

/azul.

U45

62

a guide to a healthier youcms.ipressroom.com.s3.amazonaws.com/.../2010_guide_to_a_healt… · 2 a...

Documents