HEALTH INSURANCE EMPLOYEE EDUCATION: PREVENTIVE CARE

Transcription

1 HEALTH INSURANCE EMPLOYEE EDUCATION: PREVENTIVE CARE Mott Community College Health Benefits Task Force

2 DISCLAIMER The content in this presentation is informational. Each employee should review the benefit summary and network information specific to their plan and discuss specific circumstances and questions with their carrier.

3 OVERVIEW Your insurance plan offers many preventive services at no cost to you as mandated by the ACA. Types of preventive care available Primary care physicians Chronic conditions Tips for accessing preventive care Overcoming obstacles Additional resources

4 PREVENTIVE CARE A pattern of nursing and medical care that focuses on disease prevention and health maintenance. It includes early diagnosis of disease, discovery and identification of people at risk of development of specific problems, counseling, and other necessary intervention to avert a health problem. Screening tests, health education, and immunization programs are common examples of preventive care. preventive care. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved January from

5 PREVENTIVE CARE Approved services are covered at 100% for plan enrollees with no deductible or copay liability (no enrollee out of pocket cost) Services must be received in network Ex: annual physicals, well baby check ups, some immunizations, etc. Confirm with carrier that scheduled services are preventive Refer to the Federal Patient Protection and Affordable Care Act list of mandated preventive services at and to the benefit summary for your medical plan You may see multiple providers depending on which preventive services are recommended

6 PRIMARY CARE PHYSICIAN Establish a relationship with a primary care physician Make a list of attributes you are seeking in a doctor Find a doctor who you trust will listen and treat you with respect Determine if they are in network Ask questions (check online for other good questions): owhat should I expect as a patient of yours? owhat steps does your office take to help patients maintain their health? odo they refer to in network specialists?

7 PRIMARY CARE PHYSICIAN Once you have established a doctor relationship, keep a consistent dialogue Am I up to date on my immunizations? What recommendations do you have based on my family history? What recommendations do you have based on my current lifestyle and health condition?

8 PRIMARY CARE PHYSICIAN Maintain an ongoing relationship Annual visit Notify if: o Admitted to the hospital o Visited the urgent care or ER o Visited a specialist o Changed medicines o Notice a change in a condition Visit as recommended if managing a chronic condition

9 PRIMARY CARE PHYSICIAN Make a list prior to each visit What would you like to discuss with your physician? List medications you are currently taking List any info that would be helpful to your physician (see list of suggested notifications from previous slide) Ask if there is anything you can be doing to maintain/improve your health Don t be afraid to refer to your list during your visit!

10 CHRONIC CONDITIONS What if my preventive appointment uncovers health concerns? Tests/appointments associated with a noted concern are not considered preventive services Follow up appointments/tests/prescriptions associated with management or monitoring of a past or ongoing condition are not considered preventive services The examples above are subject to deductible and/or copays in accordance with your plan summary Although it s not considered preventive, it is often less costly to manage a condition rather than to treat an unmanaged condition

11 CHRONIC CONDITIONS Affect about half of all adults in the U.S. (as of 2012) 86% of health care dollars are spent on chronic conditions Examples include: Heart disease, Stroke, Cancer, Diabetes, Obesity, Arthritis

12 Heart disease CHRONIC CONDITIONS Cause of 1 in 4 deaths in the U.S. annually Leading cause of death for both men and women Stroke Fourth leading cause of death in the U.S. Cancer With heart disease, accounts for about 1/2 of all deaths in the U.S

13 CHRONIC CONDITIONS Diabetes Increases risk for heart disease, stroke, kidney failure, blindness and premature death High blood pressure 1 in 3 Americans have high blood pressure Increases risk for heart attack, stroke, heart failure and other cardiovascular problems High cholesterol About 1 in 3 Americans have high LDL or bad cholesterol Increases risk of heart disease

14 CHRONIC CONDITIONS Learning to control your condition can help you: o Improve your quality of life o Save money o Avoid disability o Prevent untimely death

15 TIPS FOR ACCESSING PREVENTIVE CARE Preventive services are the primary reason for your visit Confirm you are visiting an in network doctor and are referred to innetwork facilities for any tests Call before an appt. to understand what services and tests will be performed Ask for a list of diagnosis codes associated with the planned services/tests Call Blue Cross customer service to determine how each service and test will be covered under your plan (have the list of codes available) at

16 OVERCOMING OBSTACLES Who do I contact if my preventive services are not covered at 100%? Call Blue Cross customer service at Who do I contact for my medical records or to appeal a denied claim? Call Blue Cross at Who do I contact with questions about getting approval for a procedure? Call Blue Cross at

17 BLUE CROSS BLUE SHIELD RESOURCES Create a Blue Cross account online at o Online health assessment o Informational resource library, calculators and quizzes o Smoking cessation tools

18 How to register at the new bcbsm.com Go to bcbsm.com Click LOGIN in upper right corner Click on Register now Verify Eligibility Create Your Account If unable to register with this process, a letter will be sent with a personal PIN to complete the process Demo

19 Blue Health Connection Healthy Basics offers health care support and innovative online resources Engagement Center Engage online health management solution Health Assessment Complex Chronic Condition Management Case Management 24-hour nurse line

20 Engagement Center Monday through Saturday 8am to 8pm EST BLUE (2583) Conduct doctor and hospital searches Answer questions regarding wellness and care management Provide information on program discounts Guide you through online Health Assessment Assist you with navigating digital health coaching programs

21 Engage Online Health Management Solution Make an online health connection at bcbsm.com Digital health coaching access to 11 digital health coaching programs Health Assessment Offers more than 90,000 medically-reviewed resources Libraries, encyclopedias and dictionaries News on recent developments in clinical research, treatment options and medical advances Videos, calculators, podcasts and animations Decision-making guides and interactive quizzes

22 BHC Health Assessment Take the Succeed Health Assessment Go to bcbsm.com Log in as a member Click the Health & Wellness tab, then click Take Assessment Now Results include Picture of your current health and health risks and tips on reducing the risks Lifestyle score Tailored action plan Recommended digital health coaching programs

23 Digital Health Coaching Provide a personalized plan and supportive tips on how to live a healthier lifestyle. Care for Pain Care for your Back Relax Overcoming Binge Eating Balance Breathe Overcoming Depression Care for Diabetes Overcoming Insomnia Nourish

24 BHC Complex Chronic Condition Management Get personal health to better manage conditions such as: Diabetes Heart Failure Chronic obstructive pulmonary disease Coronary artery disease Asthma

25 BHC Complex Chronic Condition Management A team of registered nurses, social workers and registered dietitians work with you to manage your condition Coordinated care Education Support with treatment plans

26 BHC Case Management Complex medical conditions, multiple chronic conditions, or injuries and illnesses with serious, long-term effects. A dedicated nurse case manager will work with you, your family and your treating physician to Coordinate care Inform you about your disease and treatment options Provide information on Blues doctors and hospitals Refer you to community resources Find specialty medical devices and equipment

27 BHC 24-hour Nurse Line BLUE (2583) Access to registered nurse health coaches, 24 hours a day, seven days a week. Symptom Management Health Information Audio Health Library

28 Discounts Save money and live healthier with Healthy Blue Xtras and Blue365 Show your Blues ID card at participating retailers or type in the online code. Visit bcbsm.com/xtras to access over $7,000 in savings offers Blue365 offers health and wellness discounts across the nation. Weekly deals on products and services Discounts on fitness centers Discounts on LASIK and eye health services Healthy Blue Xtras offers discounts on Michigan-based products and services Food and nutrition, Health and Fitness, Recreation

29 ADDITIONAL RESOURCES Resources for establishing a healthy diet and lifestyle: CDC Healthy Eating: USDA Food Tracker: supertracker.usda.gov/foodtracker.aspx Utilize available smart phone apps (e.g. MyFitnessPal)

30 ADDITIONAL RESOURCES Purchasing healthy foods: Can t afford healthy food alternatives? o Smoking cessation resources: CDC: o o Or call QUIT NOW ( ) Blue Cross Blue Shield of Michigan o Access resources through Blue Health Connection

31 ADDITIONAL RESOURCES Preventive Medications: Can t afford your prescriptions? o Rx Assist: o Drug discount cards through Rx Assist: cards o Patient Access Network Foundation: o Rx Hope: o Benefits Check Up: o Cancer Care Co Payment Assistance Foundation: o Needy Meds: o Visit for additional resources

32 Questions?