Keys To Using Your Coverage
Keys To Using Your Coverage
Check out these tips to help you make the most of your health care coverage:
- Select a primary care physician (if your plan requires it)
A primary care physician is a family practice physician or general internal medicine physician. For children, pediatricians may act as the primary care physician. The relationship between you and your primary care physician is very important and personal. That's why BlueChoice HealthPlan has developed a large list of doctors from which you may choose. If you have our Primary Choice plan or our BlueChoice Point of Service plan, your primary care physician will become your "health care manager" within our network, providing or arranging for all necessary care. We don't require our BlueChoiceAdvantage Plus members to select or get referrals from a primary care physician. But we strongly recommend all members maintain a strong and active relationship with a primary care physician.
- Maintain a relationship with a primary care physician and allow that physician to coordinate your medical care
Always seek care from your primary care physician first, unless it's an emergency. While we encourage you to maintain a long relationship with your doctor, we realize it sometimes may be necessary to make a change. Need to find an in-network doctor?
- Five Questions To Ask Your Doctor
5 Questions To Ask Your Doctor Before You Get Any Test, Treatment or Procedure
1. Do I really need this test or procedure? Medical tests help you and your doctor or other health provider decide how to treat a problem. And medical procedures help to actually treat it.
2. What are the risks? Will there be side effects? What are the chances of getting results that aren't accurate? Could that lead to more testing or another procedure?
3. Are there simpler, safer options? Sometimes all you need to do is make lifestyle changes, such as eating healthier food or exercising more.
4. What happens if I don't do anything? Ask if your condition might get worse or better if you don't have the test or procedure right away.
5. How much does it cost? Ask if there are less-expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs.
Use these five questions to talk to your doctor about which tests, treatments and procedures you need — and which you don't need.
Some medical tests, treatments and procedures provide little benefit. And in some cases, they may even cause harm.
Talk to your doctor to make sure you end up with the right amount of care — not too much and not too little.
www.ChoosingWisely.org/Patient-Resources*
*This link leads to a third-party website. That party is solely responsible for the contents and privacy policy of their site.
- Phone ahead for appointments and cancel at least 24 hours in advance
This helps you receive your medical care on a more timely basis. When you call first, your doctor's staff will arrange for the most appropriate care — either an appointment or advice for an ailment. If you must cancel any appointments, please let your doctor's office know as soon as possible. Some physicians may charge for missed appointments and BlueChoice HealthPlan does not cover those charges.
- Always bring your BlueChoice HealthPlan ID card with you
Whenever you seek medical care, be sure to identify yourself as a BlueChoice® member. When you arrive for your appointment, present your BlueChoice ID card to the office staff. You can access your digital ID card anytime, anywhere from your computer or mobile device. Your digital ID card is identical to your physical card. It contains your Member ID number and other coverage details that are unique to you. Unlike your physical card, you don’t have to worry about losing it or ordering duplicate copies for your family. To access your card, simply log into your My Health Toolkit® account. On your computer: Under the Insurance Card section on the left, select View Your Card. On your mobile device: Select Insurance Card from the main menu. Don’t discard your physical ID card. Some doctors may still want a copy of it for their records.
- Be familiar with what to do after hours if you need care
Your primary care physician has an agreement with us to provide 24-hour call coverage. This means no matter when you call your primary care physician, someone will answer the phone and advise you of the proper action to take based on your condition. If an emergency arises, try to phone your primary care physician first. If he or she is unavailable, you can go directly to the nearest Doctor's Care or other urgent care provider. But if your condition is life- or limb-threatening, you should go directly to the nearest emergency room. As soon as possible, let your primary care physician know about any emergency care you have received.
- Help yourself stay healthy
Take advantage of our Great Expectations® for Health health management programs. We can help you stop smoking, lose weight, control your diabetes or decrease your risk for heart disease. You'll learn to breathe easier with our asthma management program. Expectant moms count on our maternity program to provide information and support, which can help them deliver healthy babies. We even have a special program for women only. For more information, call our Health Management department at 800-327-3183, ext. 25541.
- Practice prevention
Nothing beats planning ahead when it comes to your health. Regular exams are one of our most attractive benefits, so make sure you practice preventive care. Here are guidelines for adults and children/adolescents seeking preventive services.
- Know how to get a referral (if your plan requires it)
Your primary care physician has access to the skills and support of specialists and other health professionals who are part of our network. Should you need the care of these professionals, your primary care physician will arrange for that care. A referral is a detailed record of the care your primary care physician orders on your behalf. It is very specific, stating the problem and number of visits or treatments. You must have an authorization before seeing any specialist (other than a gynecologist for routine care), even if you already had seen that specialist before joining BlueChoice HealthPlan.
Note: If you have our BlueChoice Advantage Plus coverage or if you have our BlueChoice Point of Service plan and wish to use non-network physicians, you do not need a referral from a primary care physician before seeking medical care. Please note that under our BlueChoice Point of Service program, visits to a network participating specialist without referral from a primary care physician is covered at the lower, out-of-network benefit level.
- Make the most of your appointment
Be prepared to ask your doctor questions and provide as much background about your health as you possibly can. On your first visit, bring all the medicines you currently take. Your doctor will need this information to assess your medical condition and monitor possible drug interactions. Here's a helpful checklist to make sure you're keeping up with you and your child's health.
- Help us keep your records up to date
If there are any changes in your family's status, address or phone number, please let us know through your employer's personnel office.
- Know the best ways to get information about your benefits
We are always happy to answer your questions about benefits or anything else. You have a lot of information at your fingertips.
Check out our Member Resources Flyer.
Send us an email through our secure My Health Toolkit®. If you are using it for the first time, you will need to create a profile – it just takes a few minutes.
Read your Schedule of Benefits. These are sent to you when you first become a member, and whenever your benefits change. You can also view your benefits in My Health Toolkit.
View your Member Guide. You can also call us at the number on the back of your ID card to request we mail you a copy of your Schedule of Benefits or Member Guide.
- Save money on lab tests
Depending upon your benefit plan, lab tests are usually covered in full as part of your coverage with BlueChoice. There are some guidelines to follow, however, and if you are being billed, it may be one of these situations:
The test is considered investigational:
There are more and more new tests being developed, but these are not all proven yet to be valid and medically necessary. If your doctor is recommending a test that is new or if there is any question, ask your doctor to check with us and make sure it is a covered test.
The test was processed by a lab that’s not in the BlueChoice HealthPlan network:
Lab tests, like many other services, have to be processed by a network laboratory to be covered. LabCorp is the biggest of these, but there are others, too. Ask your doctor to make sure the test is being performed at a lab that participates in the BlueChoice HealthPlan network. Laboratory tests performed in your doctor’s office or hospital are usually covered. There is more of a risk when your test is being sent out to another lab for processing.
- Where You Go Matters!
- Where Should I Go for My Health Care Needs?
Where you go matters! We care about you and want to help you take charge of your health. Avoid needless worry, out-of-pocket costs and hours sitting in the emergency room (ER) by knowing how to navigate through the health care system and being familiar with other options for your care.
Primary Care Physician
Your primary care physician (PCP) should be your first choice for health care. See your PCP for common medical issues:
- Illnesses such as colds, flu, earaches and sore throats
- Minor injuries such as sprains, strains and back pain
- Routine physical exams, vaccinations and screenings
- A health problem for which you need advice
Don't have a PCP? Find care.
Network Urgent Care Clinics
Urgent care centers provide another option when you need care and your regular doctor is not available. Urgent care centers provide attention for medical problems that need seeing to right away but are not life-threatening, or for problems that could get worse if you wait. An urgent care visit usually takes less time than a hospital emergency room and costs you much less.
Blue CareOnDemandSM
You can now visit with a doctor faster and more easily than ever. With Blue CareOnDemand, you can visit with a doctor via smartphone, tablet or computer, rather than visiting an office or urgent care facility. Doctors will diagnose and write prescriptions as appropriate.
What types of conditions can Blue CareOnDemand doctors treat?
- Colds
- Pink Eye
- Flu
- Ear Infection
- Fever
- Migraines
When should you use Blue CareOnDemand?
- The doctor's office is closed
- You are too sick to drive
- You are traveling
Download the app via the App Store or Google Play or visit www.BlueCareOnDemandSC.com and sign up for Blue CareOnDemand today!
When Should I go to the ER?
The emergency room is only for very serious or life-threatening problems.
- Sudden or unexplained loss of consciousness
- Signs of a stroke
- Poisoning
- Signs of heart attack
- Severe shortness of breath
- Medication/drug overdose, alcohol poisoning
The ER is not a substitute for a PCP visit. Going to the ER for something that is not a true emergency could result in long wait times and may result in your claim not being paid. The good news is that you have options! And if you're ever in doubt, err on the side of caution and seek immediate care.
For more information about making the most of your benefits and navigating the complex health care system, contact our teams:
Monday–Thursday, 8:30 a.m. – 8 p.m.
Friday 8:30 a.m. – 5 p.m. EST
Our team consists of licensed social workers and certified medical assistants that aim to address and modify the habits of high utilizers and reduce ER visits.
Patient Safety Tips
Our programs help improve the quality and safety of clinical care our members receive. Here are some helpful tips:
- Tips to Help Prevent Medical Errors
- Tips for a Safe Hospital Visit
- Four Ways to Play it Safe with Medicines
Other Helpful Links
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
This organization evaluates and accredits United States health care organizations and programs. You can search for JCAHO-accredited providers and review institution-specific quality reports in the Quality Check section.
The Leapfrog Group
The Leapfrog Group is made up of more than 150 private and public organizations that use their purchasing power to improve health care safety. It offers information to help people make informed choices about their health care. On this site, you can compare hospitals and providers based on quality and safety practices.
The Dartmouth Atlas of Health Care
This is a research effort of the Dartmouth Medical School. Its aim is to explain how medical resources are distributed and used in the United States. Site visitors can create a variety of reports using the project’s large health care claims database.
This article contains links lead to third party websites. Those parties are solely responsible for the contents and privacy policies of their sites.