Each year,  BCBSNC  rates are adjusted based on what is believed what medical trends will be overall, as well as how it will be distributed within the portfolio. Example, rating for male customers between the ages of 35-39 who live in the Triangle area of our state are currently less than females aged 50-54 that live in the eastern part of our state. In general, females submit more claims, and generally so do people as they get older, and the cost of care in the east is generally more than in the Triangle. As any of those factors shift relative to one another for those groupings of customers they will be adjusted, so that the low-cost customers are not unfairly burdened by the purchases and practices of the higher cost customers.

While high rate increases garner all the headlines, consumer -driven health plans continue to see lower medical trend. The good news is that in January, 3O% of new Individual customers chose HSA products.  We need to continue to tell the utilization story, something that the current debate on reform continues to ignore. To personalize this, just this week a family was at the doctor, and they asked whether the next wellness visit for their very healthy 12 year-old should be every two years or every year, and the physician replied, “Every two years is fine, unless it is covered by your insurance, in which case you may as well take advantage of it.”

Consumerism and personal accountability are the most powerful tools we have in the fight against higher medical costs. Consumer driven health plans incent both. It requires effort and understanding by the customer, the doctors and those who market the products, but it is the opinion, they will certainly be worth that effort. The more customers buy these products, and feel good about exercising their right to understanding what procedures cost, the more it will become a normal part of how care is delivered.

For more information on health insurance coverage in North Carolina, 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.

As stated in the 2009 financial summary, BLUE CROSS BLUE SHIELD OF NORTH CAROLINA’S profit margin was 2.1% with 87% of premiums collected going towards medical expenses. As is statutorily required, rates are reviewed and approved by the North Carolina Department of Insurance. It is hard to measure market share in the individual market accurately because the people in the market move in and out regularly. However, member population helps BLUE CROSS BLUE SHILD OF NORTH CAROLINA negotiate lower rates with hospitals and other providers.

When shopping for your health coverage, rates do not vary between agents or the company. Rates are established and set each year, regardless who you purchase your coverage through.

Trust the agent you are working with – what makes the difference in who you purchase your coverage through – CUSTOMER SERVICE is the ONLY difference, don’t let any agent tell you their premiums are cheaper or their products are better. If you are told that, you need to find someone else to work with.

For more information on health insurance coverage in North Carolina, 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.

Ruptured Cranial Cruciate Ligament (CCL), Ruptured Cruciate, Ruptured Ligament

 Ruptured Anterior Cruciate Ligament (ACL), Torn ACL, Torn ligament.

Affected Animals: Commonly, dogs and humans; less commonly, cats. Obese animals are at greater risk for suffering this injury. In addition, certain breeds of dogs are more susceptible than others to developing a ruptured cruciate ligament. Most commonly, these breeds include the rottweiler and cocker spaniel. The Labrador retriever, German shepherd, mastiff, golden retriever, miniature and toy poodle, Lhasa apso, and bichon frise are likely to suffer from the problem as well.

Overview:
A normal dog’s knee joint works like a hinge, keeping the animal’s leg stable as it bends. When the knee has a ruptured cruciate ligament, the “hinge” becomes loose and no longer functions as effectively. This looseness prevents the knee from maintaining stability of motion. As a result, the dog suffers pain, inflammation, and eventually develops arthritis. This is a very common orthopedic disease in dogs.
When a knee injury occurs suddenly — as it usually does among humans who suffer from injuries to the cruciate ligament due to a skiing, football, or other sports-related accident — the ligament will tear rapidly. But usually with dogs, the tearing is partial and occurs gradually, resulting in low-level lameness that may improve initially over time. However, progressive injuries can be quite damaging; because of the trauma to the ligament, the knee joint becomes inflamed, leading to arthritis, which only grows worse with continued weight bearing.

Trochlea of Femur – Tibia; Fibula – Cranial Cruciate Ligament – Caudal Cruciate Ligament- Lateral Meniscus – Medial Meniscus

In more severe chronic cases, the “shock absorbers” of the knee — quarter-moon shaped sections of cartilage called the medial and lateral menisci — tear or become crushed because of exposure to abnormal stress that occurs when the knee is loose. Animals with this condition often are severely lame and may not be able to put any weight on the affected leg.

Both surgical and non-surgical methods for treatment are available. Generally, dogs have a good chance of recovering normal, or almost normal, movement after surgery, but the arthritis that has occurred already will not be reversible. Additionally, dogs that have ruptured the cruciate ligament on one side are more likely to tear the ligament in the other knee.

Obesity is a major risk factor for this injury and certain breeds of dogs are more likely than others to rupture their ligaments. (more…)

When it comes to torture, we could all learn a thing or two from kids. Who knows better than they how to extract most anything they want within minutes of applying the technique? I’m talking about whining, of course — that grating mewling that causes us to do anything (anything!) just to make it go away. But you can break the habit. And the rewards of victory can be rich for both of you.
Toddlers
Why they do it: Early talkers whine like babies cry. Some experts say that whining tends to peak in a child’s development when she’s feeling out of control and overwhelmed — emotions that pretty much sum up toddlerhood. She lacks the vocabulary to articulate her frustrations, and that whimpering is the natural default noise.
Certain triggers, such as hunger and fatigue, can also cause breakdowns (true for kids of all ages), so keep that in mind the next time you take your toddler grocery shopping close to naptime.
How to stop it: Patience becomes the first rule when confronted with these early bouts of whining. When her son, Matthew, who’s almost 3, melts down because he can’t wait ten more minutes for dinner, Rae Sullivan of Durham, North Carolina, gives him a little extra attention, like five minutes of lap or snuggle (more…)

CAN YOU PURCHASE A “CHILD ONLY” POLICY?

  As an agency, we receive many calls each day from parents who are looking to purchase private health insurance for their child and/or children.  Circumstances could vary from removing a dependent off an employee group health insurance policy to saving money in premium, a child reaching maturity, a new birth, marriage and an array of different circumstances.  The answer is YES… Blue Cross Blue Shield of North Carolina (BCBSNC) provides health insurance beginning at birth.  To apply for private insurance for your child click here and complete the form with all information and we will immediately send you an email with the quote and on-line application for Blue Advantage.    The good news, child only policies are affordable and provide excellent insurance coverage. You can select from a variety of coverage that works in your budget, 100%, 80% or 70% plans.  With Blue Advantage, Plan A, you pay just a $15.00 co-payment to visit your primary care physician and only $30.00 to see a specialist, neither are subject to the deductible or co-insurance.   Prescription drug benefits are available under these Blue Advantage plans with only a $10.00 co-payment for generic drugs, $35.00 for preferred and $50.00 for non-preferred and 25% co-insurance for specialty drugs.  Plan B and C require a deductible before prescription co-payments begin, Plan A does not. (more…)

Provide incentives for employees to get active and eat right

Incentives can both support and motivate participation among employees. Consider both formal or company incentives and informal or program rewards and prizes from local resources to reinforce participation in workplace wellness programs. Either way, it is important to provide incentives that are attractive and meaningful to your employees.

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Cold Versus the Swine Flu

Fever: Fever is rare with a cold. Fever is usually present with the flu in up to 80% of all flu cases. A temperature of 100°F or higher for 3 to 4 days is associated with the flu.
Coughing: A hacking, productive (mucus- producing) cough is often present with a cold.
A nonproductive (non-mucus producing) cough is usually present with the flu (sometimes referred to as dry cough).
Aches:Slight body a chest and pains can be part of a cold. Severe aches and pains are common with the flu.
Stuffy Nose Stuffy nose is commonly present with a cold and typically resolves spontaneously within a week. Stuffy nose is not commonly present with the flu.

Chills: Chills are uncommon with a cold. 60% of people who have the flu experience chills.

Tiredness: Tiredness is fairly mild with a cold. Tiredness is moderate to severe with the flu.

Sneezing: Sneezing is commonly present with a cold. Sneezing is not common with the flu.

Sudden Symptoms: Cold symptoms tend to develop over a few days. The flu has a rapid onset within 3-6 hours. The flu hits hard and includes sudden symptoms like high fever, aches and pains.

Headache: A headache is fairly uncommon with a cold. A headache is very common with the flu, present in 80% of flu cases.

Sore Throat:  Sore throat is commonly present with a cold. Sore throat is not commonly present with the flu..

Chest Discomfort: Chest discomfort is mild to moderate with a cold. Chest discomfort is often severe with the flu.

The above information is for general information only.  Always consult a doctor and seek medical attention if you are ill.

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.

Chapel Hill (September 22, 2009) – Defying expectations in this time of economic stress, Blue Cross and Blue Shield of North Carolina (BCBSNC) has been named among the 2009 Working Mother 100 Best Companies for its unwavering dedication to family-friendly benefits.

BCBSNC and the other winning companies lead the way in pioneering programs that support families with 100 percent offering flextime, on-site lactation and telecommuting; and 98 percent offering job-sharing and wellness programs-numbers that dwarf those seen nationwide. In addition, financial programs available to the 100 Best employees are on the rise, a much needed boost for families in today’s economy. These include tuition reimbursement, retirement planning and pre-tax FSAs for childcare.

Bob Greczyn, BCBSNC president and CEO said, “This is a great honor for our company to be recognized for third year in a row as one of the 100 best companies in the nation for working mothers. This ranking recognizes our strong commitment to attract and retain high quality employees by offering benefits that count. It shows that we’re listening to and responding to the needs of North Carolina’s working mothers and working families.”

By contrast, national numbers are significantly lower with just 25 percent of companies offering on-site lactation (vs. 100 percent of the 100 Best), 11 percent with stress reduction programs (vs. 96 percent of the 100 Best), 35 percent offering health insurance for part-timers (vs. 99 percent of the 100 Best) and 16 percent offering job-sharing (vs. 98 percent of the 100 Best).

“The Working Mother 100 Best Companies stand head and shoulders above the rest,” said Carol Evans, CEO, Working Mother Media. “For example, in the last year, we saw the number of companies nationwide offering flexible work arrangements diminish five percentage points, while the 100 Best Companies stayed steady at 100 percent. The 100 Best provide leadership where and when we need it most, furnishing a framework of support for working families during good times and bad. If all companies adopted these best practices, more families could weather the economic storm.”

Profiles of the 100 Best Companies, as well as national comparisons, are in the October issue of Working Mother and at workingmother.com ( http://www.workingmother.com/ ).

“Moms are increasingly becoming the sole breadwinners in many households as men lose their jobs at a higher rate than women,” said Suzanne Riss, Editor in Chief, Working Mother magazine. “Now more than ever, our readers and all working mothers need the support of their employers. By offering benefits like paid maternity leave, the ability to work from home and wellness programs, as well as programs that enhance financial well-being, our 100 Best are helping to reduce stress in the busy lives of working moms. These companies epitomize family-friendly support at its best.”

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BCBSNC Launches New Online Application

On September 28th, Blue Cross Blue Shield of North Carolina launched its new user-friendly Online Application.  The Online Application is now compatible with popular internet browsers such as Safari, Mozilla and Firefox.  In addition, the new application provides BCBS applicants navigation panel links, radio buttons for health questions, red text showing where an error occurred, the ability to change effective dates before accepting a final rate and plan, and the ability to view 2010 rates.  Dental effective dates will now coincide with health effective dates for applicants as well. 

Click here to request a Personalize Quote and Online Application for Blue Cross Blue Shield of North Carolina!  It will be our pleasure to assist you with your health insurance needs!

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.

Blue Advantage health insurance through Blue Cross Blue Shield of North Carolina is our most popular individual health plan in NC.  This is a traditional PPO plan with doctor office co-payments as low as $15 for your primary care physician and as low as $30 for a specialist.  BCBSNC allows you to build your own plan, selecting deductibles ranging from $250.00 up to $5000.00 with co-insurance starting at 50% up to 100%.  Blue Advantage Plans also allow an add on option of Dental Blue and/or maternity coverage as well.   (more…)

To encourage members to get the H1N1 vaccine, BCBSNC will waive deductible and coinsurance payments for its fully-insured customers that do not have immunization/preventive benefits and will pay 100 percent of eligible charges for the administration of the H1N1 vaccine.

As with the seasonal flu vaccine, ASO groups are responsible for the claims costs associated with the H1N1 vaccines. ASO groups that don’t have immunization/preventive benefits can choose to cover the cost of the H1N1 vaccine administration at 100 percent of eligible charges for employees and their dependents. If you have an ASO group that may want to do this, please contact your BCBSNC representative.

Communication Plan
BCBSNC issued the attached press release Monday (10/5), and we expect to receive media coverage. We will also be mailing the attached letter to group administrators of fully-insured groups this week.

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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.