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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