To encourage members to get the H1N1 vaccine, BCBSNC will waive deductible and coinsurance payments for its fully-insured customers that do not have immunization/preventive benefits and will pay 100 percent of eligible charges for the administration of the H1N1 vaccine.

As with the seasonal flu vaccine, ASO groups are responsible for the claims costs associated with the H1N1 vaccines. ASO groups that don’t have immunization/preventive benefits can choose to cover the cost of the H1N1 vaccine administration at 100 percent of eligible charges for employees and their dependents. If you have an ASO group that may want to do this, please contact your BCBSNC representative.

Communication Plan
BCBSNC issued the attached press release Monday (10/5), and we expect to receive media coverage. We will also be mailing the attached letter to group administrators of fully-insured groups this week.

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How generic versions of drugs are developed
When new drugs are developed, manufacturers obtain a patent,
which prevents other pharmaceutical companies from producing
the same drug for a certain period of time. When the patent
expires, drug manufacturers can apply to the U.S. Food and Drug
Administration (FDA) for permission to make a generic version of
the drug, without having to repeat the clinical trials and research
performed by the drug’s original manufacturer.

Why generic drugs are cheaper
Generic drugs are less expensive than brand-name drugs
because manufacturers don’t have to pay the research,
development, marketing and promotion costs that the original
manufacturer did in bringing the new drug to the market place.
The average price for a generic drug is 30 to 80 percent less
than its brand-name equivalent. That means savings for you.

Generic drugs are regulated by the FDA, just like brand-name
drugs. And the FDA requires that the generic version have the
same active ingredients, strength and dosage form (pill, injection
or liquid). Every generic drug must undergo a scientific review of
its ingredients and performance. The FDA also inspects generic
drug manufacturing plants and monitors drug quality.

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It’s important to think about who you go to and where you go for services when you’re trying to manage your health care costs.

1. If you choose an in-network doctor in North Carolina, you’ll be working with a physician who has a contract with BCBSNC and knows what services are covered.  Plus, the provider can perform any prior review and certification for services you need.
2. Location matters.  For example, if you choose to get a colonoscopy in a hospital setting rather than an office setting, this affects what you pay out-of-pocket.  Make sure that your are informed and aware of the costs associated with the locations you plan to go to for certain services.

Important: When seeking care you should always first verify that your health plan covers the services you seek prior to receiving care (except in the case of an emergency).

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It’s more important than ever to be a savvy health care consumer.  You can take charge of your health by knowing where your money goes and committing to live a healthier lifestyle. 

What we all pay out-of-pocket is a small percentage of the overall cost of health care.  BCBSNC continues to look for more ways to make health care less of a burden and more of an advantage. 

You can take your dollar further by enrolling in free and discounted programs:

• Improve your health and save money by joining Member Health Partnerships.  These programs offer special tools and savings to help you lose weight, manage stress, quit tobacco and manage a host of other conditions.
• You might be eligible for discount programs including chiropractic care, vitamins and supplements, vision and Lasik, hearing aids, and weight management.
• Enjoy Blue365 Discounts with savings from selected companies on healthy lifestyle products and services.

Stay in-network:  Visiting in-network health care providers save you out-of-pocket costs.  You can check out the online provider directory to see what doctors participate in our network and what deductible and coinsurance amounts may apply to your visit.

Save money with generic drugs:  Did you know that some drugs can cost 80 percent less than their brand-name counterpart?  Make a habit of asking your physician or pharmacist if a generic option is available.

The information above is brought to you from BCBSNC, A Guide to a Healthier You, 2009.

For more information on health insurance coverage in North Carolina and how to utilize My Member Services, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

Have you ever been denied payment for a claim and didn’t agree with the decision?  Has your doctor ever recommended services for you that BCBSNC did not authorize and you didn’t know why?  According to the BCBSNC Appeals Department, there are three common reasons that payment for services is denied or benefits are reduced:

• The service may not be medically necessary.
• The service is not covered under your health plan
• The service was provided by a nonparticipating doctor (not in the BCBSNC network).

To determine whether the services you required are  covered by your health plan, carefully review your benefits in your Member Guide.  If you still can’t determine whether the services are covered, a BCBSNC Customer Service representative can help you review your benefits.  If you still disagree with the denial of payment or service, you have the right to appeal by following the process outlined below.

The Appeals Process

Level One:  At this level, you can appeal the decision by submitting a written request that includes a description of the situation and a full explanation of why you disagree with the outcome.  Be sure to supply any documentation that supports your position.  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 process.

Level Three:  This level is handled through the North Carolina Department of Insurance (NCDOI).  You may request a review through the NCDOA for all medical denials.

The information above is brought to you from BCBSNC, A Guide to a Healthier You, 2009.

For more information on health insurance coverage in North Carolina and how to utilize My Member Services, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

The following information is from a recent publication on Mastectomy Benefits from Blue Cross and Blue Shield of North Carolina.

As required by the Womens’ Health and Cancer Rights Act of 1998, your health insurance policy provides beneftis for mastectomy-related services, including all stages of reconstruction and surgery to achieve symmetry between the bresats, prostheses and complication 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.

The information above is brought to you from BCBSNC, A Guide to a Healthier You, 2009.

For more information on health insurance coverage in North Carolina and how to utilize My Member Services, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

“When you go to the doctor, make sure you talk about your prescription options and how they affect your wallet.  Generic drugs are safe, affordable options should be at the top of your list when you and your doctor discuss a new prescription.

All you have to do is ask… Before your doctor writes you a prescription or prescribes a medication for you electronically, you can say, “I’m interested in generic medications if they’re available.”

If your doctor says generic is not available, ask, “Is there a generic drug in the same therapeutic class that could work for me?”

Other ways to manage prescription costs….. The BCBSNC Web site can help you find out how much a brand-name prescription drug will cost and let you know if there are less expensive alternatives.  Go online to the BCBSNC website and click on “Find a Drug” then click on “Prescription drug search”.  In the search box, type in the name of the drug you’re looking up and click “Find drug”.  The tool will then show you which tier the drug falls under so that you know your cost up front.  It will also tell you whether there is a generic alternative and will list other treatment options.”

The information above is brought to you from BCBSNC, A Guide to a Healthier You, 2009.

For more information on health insurance coverage in North Carolina and how to utilize My Member Services, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

The Blue Cross and Blue Shield Health Insurance ID Card has undergone a facelift!  The new card, according to BCBSNC is more durable and provides a better explanation of benefits.

“The main change is that the new two-sided ID card is now more wallet-friendly and durable.  It’s just a new look with added convenience.  As always, please refer to your BCBSNC Member Guide for complete benefit information.

Be sure to show your new ID card to your doctor or pharmacist at your next visit.

Important updates to your card:

• Copayment and benefit information most commonly used at the time of service is displayed.
• Benefits listed reflected your responsibility (example: $0 or 20 percent coinsurance) rather than BCBSNC’s responsibility.
• Helpful phone numbers and Web site addresses are grouped together on the back of the ID card
• Routine vision, chiropractic care and mental health/substance abuse benefits no longer appear on the ID card.

The information from this post is from BCBNC,  A Guide to a Healthier You, “Your ID card has a new look”.

For more information on health insurance coverage in North Carolina and how to utilize My Member Services, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

A recent publication from Blue Cross and Blue Shield of North Carolina titled, A Guide to a Healthier You outlines all of the benefits and features of My Member Services.  This online tool allows members to manage their health insurance policy and opens the door to valuable resources provided by BCBSNC.

“With Member Services, the Web site exclusively for Blue Cross and Blue Shield of North Carolina members, taking charge of your health plan is easy.  It’s all designed with you in mind. Online. Secure. In real time.  The site is organized into two sections, Your Plan and Better Health. 

Your Plan is designed to give you secure online access to the basics of our health plan.  Click on these links: My Account, My Benefits & Claims, or Doctors, Rx & Hospitals

You Can: View Claims in real time, Get up-to-date information on your benefits, Find a doctor with our comprehensive in-network provider search, Access comprehensive drug information that compare drug costs, outlines tier structures and provides information on generic drugs.

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BCBSNC Constructing 100,000-Square-Foot ‘Green’ Building

Chapel Hill, N.C. (April 16, 2008) – Blue Cross and Blue Shield of North Carolina (BCBSNC) on 4-16-08 broke ground on an environmentally friendly building that will use 65 percent less energy and half the water per square foot of the company’s traditional office space. The five-story building, which will include a six-level parking deck, is being built across the street from the company’s Customer Service Center on Ivy Creek Blvd in Durham. The energy savings will be enough to power about 100 typical households(1). The amount of water saved will be enough to supply more than 10 local homes(2).
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 March 19, 2009

NEW YORK (Reuters Health) – An important cause of neurological impairment in infants — infection with cytomegalovirus while they are in the womb — may be curbed with the use of a new vaccine.

Most adults have been infected with cytomegalovirus or CMV, usually with negligible consequences. However, when women become infected with CMV for the first time while they are pregnant, there is a danger that their baby will also be infected. In some cases, this “congenital” CMV infection can lead to permanent defects such as hearing loss, vision loss, mental disability, lack of coordination, or seizures.

Now, a study in this week’s New England Journal of Medicine reports that a newly developed CMV vaccine reduces cases of CMV infection in women and has the potential to decrease congenital CMV infection.

“The development of a vaccine for the prevention of congenital CMV infection was listed as a top priority for the US by a committee of the Institute of Medicine in 2001,” Dr. Robert F. Pass, from the University of Alabama, Birmingham, and colleagues point out in the report.

Finding an effective CMV vaccine, however, has been a challenge. The first trials of a CMV vaccine began over three decades ago. In the present trial, the researchers tested a vaccine containing a protein found on the envelope of cytomegalovirus and an adjuvant to increase the immune response.

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Study: Cancer patients of faith more likely to get intensive treatments 

March 17, 2009

By Liz Szabo, USA TODAY

Strong religious faith can comfort people who are dying of cancer, allowing patients to find meaning in their suffering and easing their passage out of life, experts say. But faith can be a “double-edged sword,” says nurse Carol Taylor, director of the Center for Clinical Bioethics at Georgetown University. Some terminally ill patients latch on to stories of biblical miracles, hoping against hope to be cured, instead of using their little remaining time to make peace with God and loved ones.

Yet even Taylor, who has counseled many dying patients, says she was surprised by the findings of a study in today’s Journal of the American Medical Association, which examined the choices of dying cancer patients who rely strongly on their religious faith to cope with their illness. These patients were three times more likely than others to receive intensive, invasive medical procedures — such as being hooked up to a ventilator or getting cardiopulmonary resuscitation when their hearts stop — even in their last week of life, the study shows. (more…)