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Find where to get FLU SHOTS.
IMPT: You have to tell BCBS EACH YEAR!!
Recent changes in BCBS procedures for EOBs
Medicare Prescription Drug Coverage Option
BCBS Web site for Members
WSRC Contacts for Medical Coverage Questions (also, Safety Glasses)
BCBS Contacts for Medical Coverage Questions
Annual Physical Examinations
Helpful Hints for Getting Your Health Care Expenses Reimbursed by Insurance
Are you considering surgery?
Hospital and doctor ratings
Find BCBS Coverage while traveling anywhere
Where you can get your FLU SHOTS.
The Carolinas Center for Medical Excellence (CCME), is providing a web-based list of flu clinics in the Carolinas. To find a clinic near you, visit
Flu Clinic Finder.
Also, check with your county health department to see when they will be giving flu shots.
Note: Flu shots are 100% covered by Medicare.
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IMPT: You have to tell BCBS EACH YEAR!!
Every year, the BCBS asks for information about other health
insurance information you may have. However, they don't really "ask" you: instead, they wait until you or your doctor submits a bill (usually large) and then they deny the claim with a footnote that says,
"We need current information regarding any other health/dental insurance you may have before we can process your claim. You may either complete and return the other health/dental insurance questionaire provided
[SRSRA NOTE: many members never actually receive such a quesitonaire]
or contact us at the customer service phone number or web site on the back of your ID card. We cannot determine benefits on this claim until we receive the requested information from you."
What this means is that, at the beginning of every year, you MUST contact BCBS by phone, email, letter, or their online web site, and tell them that you have not made any changes in your insurance coverage and that you have no other insurance (other than Medicare if you are over 65 years of age).
Of course, if you have made changes in your insurance coverage then tell them that. But the majority of our members will simply have their claims rejected for no valid reason other than the BCBS requirement that, each and every year, they tell BCBS, "No change".
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Recent Changes in BCBS procedures for EOBs
Customer Service has advised that Blue Cross will only send an Explanation Of
Benefits (EOB) to participants when Blue Cross has made a payment on a claim to
either a medical provider or the participant.
If you have not received an EOB for a specific medical procedure, Blue Cross will provide an EOB upon request.
As a result of these cost saving administrative changes, retirees may find it more difficult to track their medical expenses. If a retiree needs information about a medical claim they should not hesitate to contact Customer Service at Blue Cross. The phone numbers are listed below on this page.
Please note that you can also view the EOB online at the "BCBS Web Site for Members" listed below on this page.
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MEDICARE PRESCRIPTION DRUG COVERAGE OPTION
If you are over 65 and on Medicare, you certainly have been receiving solicitations to sign up for Medicare prescription drug coverage. The following information is taken directly from the August, 2005, SRSRA Newsletter, and describes our best advice on what to do about this new option.
"SRSRA recommends keeping your current WSRC/BSRI prescription drug coverage coverage. Do not elect the Medicare Prescription Drug Program."
"But before you act either way, please read further in this article."
"The SRSRA is monitoring developments related to the new Part D, Medicare Prescription Drug Coverage, option. We are recommending the nominal best choice when comparing the current Retiree WSRC/BSRI Health Choice Medical Plan to the new Medicare Part D Prescription Drug Coverage. The SRSRA thinks that it is very important to reach all retirees faced with this important choice, both SRSRA members and non-members alike. We encourage SRSRA members to become well informed about Medicare Part D as compared to the WSRC/BSRI Health Choice Medical Plan and to share that information with all retirees."
That assessment is still valid today (as of Dec. 2007).
Facts:
• You decide if you want to join a Medicare prescription drug plan
• The original signup was from November 15, 2005, through May 15, 2006. A subsequent signup began in Nov. 2007.
• Medicare will help pay for employer retiree drug coverage that meets Medicare's standards for their retirees with Medicare
• Medicare will charge you a premium for Part D coverage if you elect Part D coverage
• The Site BCBS prescription drug plan is better than any of the Medicare prescription drug plans for all but exceptional cases. The figure below shows the out-of-pocket cost for prescription drugs for three options:
(1) No insurance
(2) SRS-BCBS plan
(3) Medicare Part D coverage
The figure below clearly shows that the out-of-pocket cost for prescription drugs is lowest for the SRS-BCBS plan.
Choose to either:
• keep your current drug plan. If you choose to join a Medicare prescription drug plan later (after May 15, 2006) your monthly Part D premium won’t be higher (no surcharge), or
• drop your current drug plan and join a Medicare prescription drug plan, but you may not be able to get your WSRC/BSRI drug plan back.
You may want to begin looking at your current retiree health insurance coverage and see what prescription drugs aren't covered or what part of the costs you pay yourself. Medicare is working with employers to help you keep your current drug coverage. Medicare has a handy downloadable chart (PDF) to record ongoing prescription medications that you currently use.
(Click here for chart.)
Medicare will help pay for employer retiree drug coverage that meets Medicare's standards for their retirees who are on Medicare by giving the employer incentives to retain their program.
WSRC Benefits personnel told your SRSRA Benefits Committee members that the Site planned to mail all retirees information they need concerning prescription drug benefits under the current WSRC/BSRI Health Benefit and how it may relate to the new Medicare Part D.
Additionally, WSRC/BSRI has already sent you a notice stating that our Prescription Drug coverage under the WSRC Team Health Choice Plan already meets Medicare’s standards for retirees on Medicare. YOU SHOULD KEEP THAT LETTER FOREVER!
[IMPT. NOTE:You can download a copy of that vital letter
here.]
On-line tools that you may want to use are at:
Your Medicare Prescription Drug Coverage Options
Prescription Drug Coverage Frequently Asked Questions
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Blue Cross/Blue Shield of SC web site for members
BC/BS of SC Members web page
(Use this link to access all your questions about your BCBS coverage and/or your Explanation of Benefits statements; to find providers in SC, Nationwide, or worldwide; or to file a claim.
The procedure is a little convoluted, and the following explanation may help:
1. When you go to the BCBS member web page (link in the above paragraph), you will need to click on the "My Insurance Manager" tab on the left-hand side column of links.
2. Fill in your user name and password (first time users will have to register, and the link is over on the right-hand side at the top of the page) and select either the "Health" or "Dental" button, depending upon what coverage you are asking about.
3. On the page that then appears, at the upper left-hand side click the "Claims Status/Explanation of Benefits" link.
4. Select the time period for the claim you wish to examine (e.g., last 3 months, or last 6 months). When the claim list appears, select one to examine.
5. When the claim finally appears (unfortunately, the BCBS web site is quite slow), near the bottom of the page there is a line that says, "Check your Explanation of Benefits (EOB)." CLICK THIS LINK. That finally takes you to the EOB statement which has the information you are looking for. Note that you will have to scroll the EOB page to see all the information on it.
Please note that the BCBS web site will automatically log you off if you have on activity on a page for several minutes.
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WSRC Contacts for Medical Coverage, Safety Glasses
Here are some contacts at SRS for help with Medical Coverage questions. They are listed in the order that SRS-HR prefers you to use: that is, start with the Service Center and, if you need further help, go to the next contact on the list.
Life, Health, Dental
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People Support Service Center (intended to be the first contact for most HR questions):
803-725-7772 (local area SC, GA),
or
800‑368‑7333 (toll-free long distance)
or send an email to
Service Center
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Wanda McGee: 803-725-0531,
or email Wanda McGee
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Cindy McClintock: 803-725-7004,
or email Cindy McClintock
Safety Eyeglass Office
Tom Cuny: 803-208-8515 (Note: Friday is the only day he is "up front" and accessible without badging.)
Another helpful source for all onsite contacts, for Life Insurance, Health Insurance, Pension, Value Options, etc., including handbooks, is the
Retiree Benefits web page.
The specific web page for contacts such as telephone numbers of People Support Service Center, SIP, Value Options (mental health and substance abuse assistance), BAC (Westinghouse Corporate Pension), etc., is here.
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Blue Cross/Blue Shield Contacts for Medical Coverage
There is a prescribed heirarchy you need to follow to resolve issues with BCBS. There are 3 steps.
Step 1 - Contact Customer Service Representatives.
Toll-free telephone: (800) 325-6596.
Option 1 for Medical
Option 2 for Dental
Option 3 for Pre-Cert/Med Authorization
Option 0 for Customer Service Representative
BlueCross/BlueShield has 6 customer service reps dedicated to WSRC. The recorded message on this toll free line is rather long, but it has an opt out option and you can press "0" at any time to talk to a customer service rep. If you stay on the line and don't press anything, it will automatically route to a customer service rep.
The mailing address is:
BlueCross BlueShield of SC
PO Box 100300 AX-D30
Columbia, SC 29202-3300
Step 2 - (NOTE: BCBS asks that you please complete step 1 first, and only go to step 2 if your issues have not been resolved to your satisfaction.)
Contact Tawanda Knapper, who is the BCBS dedicated customer service representative for WSRC.
Tawonda Knapper's contact information is as follows:
Tollfree Telephone: (800) 868-2500, ext 43112
FAX: (803) 870-8029.
Email: tawonda.knapper@bcbssc.com
Step 3 - If, after exhausting the above channels, you still have not received satisfactory service,
Contact the WSRC/BCBS liaison:
Kaye Bozeman
Marketing Service Representative
I-20 at Alpine Rd AV-100
Columbia, SC 29219
Telephone: (803) 264-4452, or
Toll-free: (800) 288-2227, Ext. 44452
FAX: (803) 264-9353
Email: kaye.bozeman@bcbssc.com
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Annual Physical Examinations
When retirees were no longer able to obtain annual physicals at the Savannah River Site, the SRS Retiree Association negotiated with SRS and Internal Medicine Partners of Augusta, GA, to receive an annual physical for only the co-pay expense. The remaining cost is covered by the SRS BCBS medical plan. Please contact:
Internal Medicine Partners
3121 Peach Orchard Rd
Augusta, GA 30906
Telephone: (706) 792-5075
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Helpful Hints for Getting Your Health Care Expenses Reimbursed by Insurance
In the complex world of getting reimbursement for your Health Care expenses, the following Helpful Hints will help you get the correct insurance reimbursements due you under the WSRC Health Benefit Plans.
In general, Blue Cross/Blue Shield (BC/BS) won’t consider your claim for payment until they have the related Medicare Summary Notice (MSN). Most providers will file Medicare for you. In case they don’t or won’t, it is up to you to file for Medicare payment, even if the amount to be paid by Medicare is zero or small, because BC/BS won’t consider your claim unless they have the MSN from Medicare.
If you have a provider who lives in your state of residence, the provider will in most cases file Medicare for you in the state of residence, and Medicare will send the MSN to BC/BS in your state of residence, thus enabling BC/BS to provide you with payments under the contract.
If the provider is outside your state of residence, the provider will in most cases file Medicare for you in the provider’s state, not your state of residence, and in general neither Medicare nor the provider will file the MSN with your state of residence BC/BS. It is therefore generally up to you to forward the MSN to BC/BS in your state of residence in order to receive appropriate payment.
However, as of January 1,2006, if the provider is outside your state of residence, your Medicare claim information will be automatically crossed over electronically to your WSRC Health Benefit Plan for secondary payment consideration. This process eliminates the need to have your medical summary notice sent to the BCBS in your state of residence. Upon completion of processing under your WSRC Plan, you will receive an Explanation of Benefits.
If a provider does not accept assignment under Medicare Part B for a Medicare covered procedure, then provider charges are capped by law at 15 % above Medicare Part B payments.
For claims to BC/BS where there is a dispute whether services rendered are under medical or mental health coverage, BC/BS generally won’t consider your claim for payment until they have the related Medicare Summary Notice and a Statement of Denial from Value Options (VO), the mental health coverage carrier. This latter Statement of Denial is a formal letter stating VO's refusal to pay.
Finally, do not sign any waivers and do not pay anything until you receive an Explanation of Benefits (EOB) from Blue Cross Blue Shield.
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If you are considering surgery
Elective surgery can be accompanied by special problems, both with regard to patient care and insurance reimbursement. One source of information that may be helpful in this regard is a recently published book, "When Less is More", by Bethanne Snodgrass, M.D., FACS, and published by HarperCollinsPublishers, 2005.
Even though the author specializes in plastic and reconstructive surgery and wrote for a specific audience (women considering breast reduction surgery), the book thoroughly covers topics related to elective surgery of any kind. The author discusses, for example,
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exercises or other actions the patient can do to help a situation before considering surgery
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patient self-care before and after surgery
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specific steps to take before surgery to comply with insurance company's requirements
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the type of questions you should ask your doctor before surgery
While the book focuses on one specific type of surgery, the overall discussion is clearly useful to anyone considering any type of surgery.
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Hospital and Doctor Rating services
HospitalCompare.gov
[This site was created by the U.S. Dept. of Helth and Human Services, together with the nation's major hospital groups, and has performance ratings of hospitals nationwide. It focuses on the quality of care for patients with heart attacks, heart failure, and pneumonia.]
HealthGrades.com
[This site has performance ratings of hospitals (FREE), physicians (by specialty), and health plans.]
LeapFrogGroup.org
[Another hospital rating service. This site looks at safety measures such as computerized prescription ordering, which eliminates miscommunications caused by messy handwriting and helps staff check for harmful drug interactions.]
AARP State-by-State Guide to Health Care Provider Performance
[This site lists links, including some of the ones above, that provide information on hospitals and doctors performance (as of Dec. 2006).]
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BCBS Coverage while traveling anywhere
Blue Cross Blue Shield medical coverage is available across the country and around the world.
Download a brochure that tells you how to find medical treatment wherever your travels take you. The file is a pdf file that you can print out and take with you.
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Send e-mail to:
Board of Directors
US Mail: SRS Retiree Association
P.O. Box 5686
Aiken, S.C. 29804
©1998-2008
SRS Retiree Association, Inc.
Aiken SC
Revised: Mar. 12, 2008.
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