A Good Plan How a checkup can save you money

WINTER 2010 A Good Plan How a checkup can save you money - Cost Compare Online - Pay Less for Your Care - Heart Health one TO one NEWSLETTER FOR MEMBERS SNOWSHOeiNG in THe SAWTOOTH NATiONAL recreation AreA

ONE TO ONE It Begins With You and Your Doctor Money doesn t grow on trees and lately every dollar feels more precious. At Blue Cross of Idaho, we understand this and want to provide tools to help you manage your healthcare costs. It s why we pack every issue of One to One with information about your coverage options and tips to control spending. One of the best ways to take care of both your health and your wallet is to visit your doctor for regular preventive care. Checkups let your doctor monitor important health indicators like blood pressure and give you an opportunity to learn more. When you visit the doctor, bring a list of medications and supplements you take and compile any questions you have as well as information about changes you ve noticed in your body. If you don t understand anything the physician says, speak up. Feel free to take notes and ask questions. It s your health, and your doctor s there to help. Read more about the benefi ts of checkups on page 4. And be sure to visit us online at bcidaho.com for more helpful resources. = KNOW MORE Term to Learn: DEDUCTIBLE A deductible is the amount of money you have to pay for medical expenses before Blue Cross of Idaho begins paying benefits for covered services. When you pay for services, the amount you pay accumulates until you reach your total deductible for the year. The amount of your deductible varies based on the type of coverage you have. To discuss your plan or review your benefits, call the customer service number on the back of your ID card. blue cross of idaho 2 bcidaho.com

= WELLNESS LOWER YOUR RISK Medications, supplements and smart lifestyle choices improve your cholesterol levels. Approximately one in every six adults 16.3 percent of the U.S. adult population has high cholesterol. People with high cholesterol are twice as likely to develop heart disease. Lowering your cholesterol can reduce your risk for having a heart attack. The first line of treatment for high cholesterol is regular physical activity and a healthy diet. Quitting smoking also helps. In addition to lifestyle changes, your doctor may prescribe medications or supplements to help your cholesterol numbers. Statins help lower LDL, the bad cholesterol, by blocking the production of cholesterol. Statins may also prevent further blockage in your blood vessels by removing plaque on your artery walls. Some well-known brand medications include Lipitor, Zocor and Crestor. Less expensive generic drugs include lovastatin, simvastatin and pravastatin. Ask your doctor if these may be right for you. Studies show that supplements like niacin, fl axseed and fi sh oil can help improve cholesterol levels when used in combination with a healthy diet and exercise. These are available over the counter. As with all supplements or vitamins, consult your doctor fi rst to ensure they won t interact with your existing medication or health conditions. BOTTOM LiNe: Taking medication doesn t give you a free pass to misbehave! A healthy lifestyle is critical to reduce your risk for heart disease, even if you re taking a prescription. medication update Blue Cross of Idaho encourages the use of generic drugs as a safe and often less costly alternative to brand-name drugs. The brand-name drugs below have recently been released in a generic form. For a complete listing of medications on our formulary, visit bcidaho.com/prescription drugs. Brand Name Generic Name Medication Use Alphagan P brimonidine glaucoma Aceon perindopril high blood pressure Allegra-D fexofenidine allergies Acular ketorolac eye allergy symptoms/eye inflammation Prevacid lansoprazole stomach Prevacid OTC (15 mg only) lansoprazole stomach blue cross of idaho 3 bcidaho.com

Save Money, See Your Doctor How checkups deliver cost savings in the long run. Ignorance is bliss. It s a familiar saying, and one that we ve all uttered at least once. But here s something to consider: When it comes to your health, ignorance is dangerous. Quite a few medical problems don t show symptoms until they are very serious and costly to treat. The best way to catch these conditions early, when treatment can be more successful, is to see your doctor for a checkup regularly. Look at the schedule of recommended exams for your gender and age and see your physician for a checkup on that schedule. Also, talk with the physician about the following medical issues. The Big Three As more Americans have become overweight or obese, type 2 diabetes has become increasingly common. Yet the symptoms of elevated blood sugar can be subtle, so a blood test is the only way to diagnose the condition. If your doctor catches your type 2 diabetes early enough, you will have the chance to improve your diet and make more time for exercise to reverse the condition. High blood pressure develops silently, too Blood pressure should be less than 120 systolic (the top number) over 80 diastolic (the bottom number), according to the American Heart Association. Anything above this may eventually increase your risk for a stroke or heart attack. As long as your numbers aren t too high, you can often reduce blood pressure with exercise, stress reduction and better nutrition. Only a blood test can detect high cholesterol. But it s a major risk factor for heart disease. And just like diabetes and high blood pressure, when it s in the early stages, you can control it, sometimes without medications. Don t Forget Many cancers sometimes develop so slowly that you don t know anything s wrong. Women should get clinical breast exams yearly to check for signs of breast cancer. And ask your doctor to take a look at any moles or skin discolorations, as these might indicate skin cancer. Depending on your age and your family medical history, you may also be a candidate for screenings that check for colon cancer. Most sexually transmitted diseases start without symptoms, too. An annual pelvic exam and Pap test can help to identify these conditions before they endanger your life or fertility. When you think of all that you could prevent and protect yourself from, consider a visit to your doctor an investment in your future. BLUE CROSS OF IDAHO 4 BCIDAHO.COM

You Have The Option to PAY LESS There are instances when going to the hospital isn t necessary. Q A My doctor found a lump on my back. She doesn t think it s serious, but she wants me to have an Mri to be safe. do i have to go to the hospital for this test? Not necessarily. It s true that hospitals can perform imaging tests such as MRIs, CT scans, X-rays, mammograms, ultrasounds and bone density scans. But independent imaging centers and many urgent care clinics or outpatient facilities can, too. If your doctor has prescribed imaging, start by asking, How soon should I have this test? That s because hospitals often provide 24-hour access to their imaging labs, so they are the best choice if you require urgent attention. If your doctor says you can wait a few days or longer, make a few calls to independent facilities to fi nd the best price and most convenient time for your scan. When the service costs less, you save out-of-pocket expenses, which is always a good thing. Just as vital is knowing when you should go to the hospital. Proceed quickly to the emergency room if you have any of these conditions: - Chest pain with shortness of breath and/or sweating - Severe injuries such as burns, electrical shock or amputation - Vaginal bleeding during pregnancy - Seizure or unconsciousness - Poison ingestion = WHERE TO GO But Wait! There s More Think you understand when a visit to the hospital is the best place to get care? Read on to test your knowledge. It s 8 p.m. and your 3-year-old is wide awake with an ear infection and a fever. Where do you go? Your husband just called from his Sunday afternoon soccer game. He needs you to pick him up because he sprained his ankle. Where do you go? If you said the emergency room for either or both examples, then pay attention. The correct answer to both questions is an urgent care clinic, also known as walk-in clinics. Ear infections, sore throats and sprains are worrisome and painful, but can be treated at an urgent care facility more quickly and at lower cost. The rule of thumb is, if your doctor isn t available, you should go to an urgent care center (if available in your community) for help with any illness or injury that you would normally take to your doctor s offi ce. These include minor cuts and burns, and small infections. blue cross of idaho 5 bcidaho.com

Let Us Introduce Your Explanation of Benefits How to read and what to do with your EOB. An explanation of benefi ts (EOB) is just what it sounds like: It s a description of the benefi ts that relate to a medical service you ve received. It is not a bill and, typically, it requires no action on your part. When you get an EOB, review it closely to ensure all the information appears accurate. If you have any questions or concerns, call the customer service phone number on the back of your ID card. For example, if you did not receive the service described on the form, you should speak up as soon as possible. It s a good idea to save EOBs in your healthcare fi les. This way, you can keep track of the medical care you ve received as well as the cost of your care. EOB 05/03 XMH530842151 02 03/17/2003 March 17, 2003 SUMMARY EXPLANATION OF BENEFITS THIS IS NOT A BILL If you have a question about your claim, please call Customer Service at 208-331-7319 or 1-800-627-6654 www.bcidaho.com Patient Jacob Lastname Identification No. XMH000000000 Group 00000000 Name of Group SERVICES BILLED BY CHARGES NETWORK OTHER AMOUNT WHAT YOU OWE SAVINGS INSURANCE WE PAID PROVIDER Amount saved by using Amount your Payment made a Blue Cross of Idaho other insurance to provider. contracting provider. paid. Health Care Clinic 344.00 46.00 0.00 238.20 59.80 TOTAL 344.00 46.00 0.00 238.20 59.80 DEDUCTIBLE STATUS For claims processed through 05/05/03 For benefit period 01/01/03-12/31/03, the following has been satisfied: 250.00 of the 250.00 out-of-network deductible Health Care Clinic Provider Bill Cureall Patient Account 0000000 DETAIL Insurance Claim 000000000000 Service Date Service Description Charges Network Savings Other Insurance Non Covered Deductible Copayment/ Coinsurance Amount We Paid Notes 02/21/03 Physician Care 329.00 46.00 4.00 55.80 223.20 1 02/21/03 Laboratory 15.00 0.00 15.00 CLAIM TOTAL 344.00 46.00 4.00 55.80 238.20 Notes 1 Amounts listed in the Network Savings column exceed the allowable amount for this service. You are not responsible for for this amount. Amounts listed in the Noncovered column exceed the allowable amount for this service. You are responsible for this amount. Suspect fraud? Please help by calling our hotline at 1-800-682-9095. THANK YOU FOR ALLOWING US TO SERVE YOU APPEAL PROCEDURES: If you would like to appeal a claim decision, you may do so through the following: A written appeal stating the reasons why you believ our claim decision was incorrect must be sent to the Appeals and Grievance Coordinator within 180 days after receipt of this Explanation of Benefits. Any written comments, documents, or other relevant information may be included. We will mail a written decision within 30 days after we receive the appeal. You or your authorized representative may request copies of all documents that are relevant to this appeal. If the original claim decision is upheld upon appeal, you may send a second written appeal to our Appeals and Grievance Coordinator stating the reasons for requesting further review. Your request must be sent within 60 days of our mailing of the initial appeal decision. A final decision on the appeal will be made within 30 days after our receipt of the second appeal. Under section 502(a) of the Employment Retirement Income Security Act, you may have the right to file a civil action following the exhaustion of the complete appeals process if you are not satisfied with the outcome. If this EOB indicates that we relied on an internal guideline in determining your claim, a copy of that guideline may be obtained upon request. Explanations of determinations based on medical necessity or experimental and/or investigational treatment exclusions may also be obtained upon request. Key Characteristics Here, you ll fi nd the patient s name, ID number and Group name. Check that all of this information is correct. Under Services Billed By, you ll fi nd who submitted the claim. It may be a doctor, a hospital, a clinic, a lab or a third-party billing service. The Charges are what the provider charged for the service. If you used a network provider, you ll see how much money you helped save under Network Savings. The Amount We Paid is how much Blue Cross of Idaho has paid. Under What You Owe Provider, you ll see the dollar amount you are responsible for. Remember, though, this isn t your bill. The EOB just explains what you owe. If you have a deductible, Deductible Status tells you how much you have met to date. BLUE CROSS OF IDAHO 6 BCIDAHO.COM

It s OK to Compare Costs Get empowered with this online tool. The last time you shopped for a new TV or camera, you probably compared brands and prices online before you ever set foot in a store. Did you know that you can do something similar with some medical treatments? At bcidaho.com, you ll find price ranges for treatments, based on location. Here s how: - Go to bcidaho.com. - Click Members. - Enter your username and password. - On the next screen, click Decision Support Tools. - Then click Treatment Cost Advisor. - Select a category, such as Skin, or a procedure, such as Burns, and click Next Step. Enter the age range, gender and ZIP code of the patient and click Next Step. The next screen will present a range of in-network and out-of-network costs for the treatment and patient description you selected, along with the average cost of the service. The result does not include your out-ofpocket cost. For that, check which services your health plan covers. Knowing how much a procedure may cost can help you plan for the expense. It s also very useful information to have when you re talking to your doctor. Ask if he or she would recommend any alternative treatments for your condition, so you can check the costs on those, too. While you re in the Decision Support Tools section of the Web site, you can also compare the costs for prescriptions, compare hospital quality and estimate how much you ll pay for health coverage. How to GeT STArTed Have you registered on our Web site yet? All it takes is four easy steps: 1. Go to bcidaho.com and select Register Now! on the left side of the screen. 2. On the landing page, select Member. 3. This takes you to the registration page. Enter information from your ID card and create your username and password. 4. Once you ve registered successfully, Blue Cross of Idaho will send you a confirmation email. Log in and access all the tools, information and health assessments available to registered members. blue cross of idaho 7 bcidaho.com

State of HealtH: Time to QuiT The facts are undeniable: Smoking is bad for your health. If you ve chosen to quit, don t go it alone. - Blue Cross of idaho s Quit for Good program guides you through the process of becoming a non-smoker with step-by-step support. Sign up at bcidaho.com/ medicare for this free six-week online program. From the member home page after you log in, click the Start now! icon under WellConnected, then choose Click here to log in! under the Personal Health Assessment header on the left side of the page. Look under the Stress tab on the WellConnected page, where you ll find Behavioral Change Programs including Quit for Good. - idaho QuitLine (cdhd.idaho.gov/chec/ services/cessation.htm), provides information and telephone counseling sessions. You may also have coverage for smoking cessation medications. To find out, check your Evidence of Coverage or call customer service. 3000 E. Pine Ave. Meridian, ID 83642 PRSRT STD U.S. POSTAGE PAID One to One IN Published by McMurry. 2010. All rights reserved. No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement not take the place of the recommendations of your healthcare provider. Consult your physician before making major changes in your lifestyle or healthcare regimen. McMurry makes no endorsements or warranties regarding any of the products and services included in this publication or its articles. 2010 William mullins / idaho stock images (cover)