Talk with your primary care provider about preventive screenings

talk to doc

Colonoscopy?  Tetanus shot? Mammogram?

With changes to health guidelines, it can be difficult to know if and when you need a preventive screening or vaccine. That’s where having a relationship with a primary care doctor can help.

“The health care system is pretty complex and if you have a relationship with a primary care doctor it enhances your care and helps to give you access to the care treatment you need,” says Dr. Julie Blehm, a primary care physician.

Your primary health care provider stays abreast of current guidelines. They can recommend and order appropriate screening or vaccine, as well as decide when you need additional testing. What’s more, they can treat most chronic disease and decide when you need see a specialist.

Having someone to coordinate your care is important. For example, if you have chronic diseases such as diabetes and coronary heart disease, your primary health care provider can manage your care and if necessary coordinate care with other specialists. They will make sure you— as a patient—understand what is being done and recommended.

Your annual exam is a good time to discuss your health care needs, concerns, goals and fears with your primary care provider. Based on your age, family history and risk factors, they may recommend the following preventive screenings:

  • Mammogram
  • Pap smear
  • Colonoscopy
  • Hepatitis C
  • HIV
  • Lung cancer
  • Blood glucose

If you have questions about which screenings are covered, please contact Blue Cross Blue Shield of North Dakota at 1-800-342-4718.

Denise Pinkney is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.

 

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Insurance networks explained

Network Hospital graphicHealth insurance can be confusing. We’re here to help.

What is a network?

A NETWORK  is a group of doctors or medical facilities that provide services to a health insurance company’s members at a discounted rate.

As the largest health insurance company in the state, Blue Cross Blue Shield of North Dakota is able to negotiate favorable rates for its members with participating health care facilities.

HOW NETWORKS WORK
If you see a doctor who is in your plan’s network, you will save money. You may pay higher out of pocket costs if you see a doctor who is not in your network, or who is not a participating provider.

Networks vary depending upon your insurance plan. Some networks require members to select a group of health care facilities to seek care.

Here is a description of how health insurance works.

Visit www.BCBSND.com/find-a-doctor to find which doctors in your area are part of your network. Here are some tips to help you select a doctor for you and your family.

Please call the phone number on the back of your ID card if you have any questions.

Ryan Schuster is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.

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Take time to enjoy being physically active

Be physically activeIt’s easy to be so busy with work and family responsibilities that you forget what it was like to enjoy the simple pleasure of playing like a 10-year-old at recess.

Regardless of your age, physical activity is important to your health. Exercise benefits kick in the moment you begin moving — and the benefits continue as long as you do. Experts recommend doing cardio exercise at least three times a week and resistance or weight training two times each week.

You can feel the benefits of exercise right away as you breathe faster and deeper, delivering extra oxygen to your muscles. Endorphins trigger a higher level of alertness. Within one hour, proteins bolster your immune system while you keep burning calories. Over time, you’ll reduce your risk of diabetes, high blood pressure and several cancers, plus you’ll increase your potential to reach and maintain a healthy weight.

What’s more, regular exercise slows the aging process.

Exercise and periodic “brain breaks” give adults physical and mental benefits that are similar to what they gained from recess as kids. “Brain breaks” can help lower the risk of Alzheimer’s disease. Exercise fights obesity, which is common, serious and costly:

  • More than one-third of U.S. adults are categorized as obese according to their Body Mass Index, according to the Centers for Disease Control and Prevention.
  • Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer.
  • Medical costs for people who are obese tend to be higher than those of normal weight.

Denise Pinkney is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.

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Learn about health reform at August employer workshops

8-6-2015 ACA workshops graphic

The Affordable Care Act (ACA) is complex, affecting employers and the benefits they offer to their employees. Blue Cross Blue Shield of North Dakota (BCBSND) wants to provide information to employers to help them better understand how the ACA affects them and to plan their 2016 strategy.

BCBSND will host a series of public forums for employer groups in August throughout the state. Information presented will be geared more for employers with 50 or more FTE employees, and information may not be as relevant for groups of all sizes.

You can register today at HealthReformWorkshopsND.com.

The workshops will cover a variety of topics, including:

  • ACA 101: The ACA’s complexities affect insurance, and ultimately, employee compensation. Understanding individual and employer incentives created by the ACA allows employers to more fully understand market dynamics.
  • Definition of a small group and timing: Certain employer groups currently considered “large” for rating purposes will soon be re-defined as small. The timing varies based on insurance anniversaries, when the group’s size was last evaluated and how companies are structured. Understanding how this change affects group renewals and quotes will help the employer prepare and avoid significant disruption.
  • Large Employer reporting requirements: This will be a fairly thorough treatment of the data elements required, how BCBSND will partner with both fully insured and self-funded groups and takeaway tasks for employers to complete.
  • Minimum Essential Coverage (MEC): Self-funded groups have a reporting responsibility to report coverage information for those covered under your health plan.

We encourage you to attend a workshop near you.

  • Monday, Aug. 24, 8:30-11:30 a.m., Alerus Center, Grand Forks
  • Monday, Aug. 24, 2:30-5:30 p.m., Lake Region State College, Devils Lake
  • Tuesday, Aug. 25, 8:30-11:30 a.m., Holiday Inn Riverside, Minot
  • Wednesday, Aug. 26, 8:30-11:30 a.m.,  Grand Williston Hotel and Conference Center,  Williston
  • Thursday Aug. 27, 8:30-11:30 a.m., Ramada Inn, Dickinson
  • Thursday, Aug 27, 2:30-5:30 p.m. Ramkota Inn, Bismarck
  • Friday, Aug 28, 8:30-11:30 a.m., Quality Inn, Jamestown
  • Monday, Aug. 31, 1-4 p.m., Holiday Inn, Fargo

Denise Pinkney is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.

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When to go to the ER or doctor’s office

You’re not feeling well and have decided to seek medical attention. But where you should go? Should you go to the local hospital’s emergency room, visit your personal doctor, or go to an urgent care center?

The answer depends on your specific situation. It’s important to go to the right medical setting so you can get the best type of care for your medical needs.

Here are some tips to help you decide where to go when you require medical care.

EMERGENCY ROOM
If you think it is a life-threatening emergency, immediately go to the ER or call 911. Do not delay.

Emergency rooms are designed to handle these urgent medical situations.

4-9-15 KnowWhereToGo-ER TWITTER

Some examples of emergency situations include:

  • Heart attack
  • Difficulty breathing
  • Severe burns
  • Head injury
  • Major injuries or severe bleeding

If it is not an emergency, try visiting your doctor or an urgent care center. That way you will avoid a long wait, and will likely avoid more expensive medical bills. It’s important to save the hospital emergency room for true emergencies. Visiting the emergency room for a common illness or minor injury delays care for someone who is experiencing a true emergency and drives up the cost of health care.

DOCTOR’S OFFICE
If you are feeling sick, but it’s not an emergency, you should visit your primary care doctor first. Your doctor is familiar with you and your medical history. Your doctor will be able to help diagnose your condition, and will let you know if you need to seek additional care.

4-9-15 KnowWhereToGo-PCP TWITTER

Some examples of generally non-emergency situations:

  • Sore throat
  • Ankle sprain
  • Rash
  • Immunization
  • Sports physical
  • Chronic conditions, such as asthma or diabetes

URGENT CARE
If you feel sick or have an injury that doesn’t require immediate emergency treatment, but you can’t wait to visit your doctor, you may want to consider visit an urgent care center or walk-in clinic. Many cities have urgent care centers that help patients in these types of situations.

KnowWhereToGo-UrgentCare TWITTER

Urgent care centers are often open later at night than general doctor’s office hours, and visiting an urgent care center often leads to shorter waits and less expensive out-of-pocket medical expenses than visiting the ER. You should check to make sure the urgent care center is part of your plan’s insurance network, however.

Some examples of potential reasons to visit urgent care include:

  • Spiking high fever
  • Painful possible ear infection
  • Broken wrist
  • Injury requiring stitches
  • Painful urination

These are just some general suggestions. Please consult a medical professional to help diagnose your condition and the necessary medical care you should seek.

Please call the phone number listed on the back of your Blue Cross Blue Shield of North Dakota ID card for questions about your insurance coverage.

Ryan Schuster is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.

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Medicare celebrates 50th anniversary of bill signing

Fifty years ago, Americans were sharply divided on the bill that would provide health insurance to the elderly. Some groups thought it would cost too much. While others thought it didn’t do enough. And some groups feared the possibility of socialized medicine.  This bill was as hotly debated in its day as the Affordable Care Act was in 2010.

On July 30, 1965, President Lyndon B. Johnson signed Medicare into law.
On July 30, 1965, President Lyndon B. Johnson signed Medicare into law.

At that time, most in Congress believed the need was real. The number of Americans older than age 65 had increased from 3 million in 1900 to 15 million in 1950, according to the U.S. Census Bureau. Sadly, this group was the nation’s poorest, with two-thirds having an income of less than $1,000 a year

Only one in eight of America’s elderly could afford health insurance.

This generation had started working during the Great Depression, when 70 percent of North Dakotans received some form of public assistance. They endured the hardships of World War II. Many of them had no big nest eggs.  A hospital stay could wipe out their financial savings.

Many physicians weren’t paid for services to the elderly because the elderly didn’t have the money. Even so, the American Medical Association fiercely fought the legislation, fearing socialized medicine.

On July 30, 1965, President Lyndon B. Johnson signed Medicare into law. As a result, elderly Americans, including many North Dakotans, were now able to receive health insurance that they previously could not afford.

Uncertainty prevailed. Physicians and hospitals in North Dakota and nationwide wondered how the new law would affect them, how they would be paid and how long it would take to receive payment. With Medicare, they were now expected to submit insurance claims and needed to add staff to handle the paperwork. They, in turn, passed that cost to their patients through higher charges.

BCBSND was selected to administer Medicare in North Dakota and proudly processed North Dakota’s first Medicare claim in 1966. The work was labor and paper intensive. Staff processed claims once a week by key-punching them. Notes were painstakingly copied from one piece of paper to the next. A total of 14,568 claims were processed in fiscal year 1966. Thanks to advances in technology, the process improved throughout the years. In 2001, BCBSND formed a subsidiary, now known as Noridian Healthcare Solutions, to handle the Medicare workload.

No doubt, Medicare has helped people 65 and older to get the health care they need throughout the years. Today, more than 110,000 North Dakotans receive health care services through Medicare.

You can learn more about the Medicare controversy in the 2004 article titled “Medicare: A look back to 1965” published in BCBSND’s Healthcare Discussions magazine.  

Denise Pinkney is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.

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Upper body stretches you can do at your desk

Sitting too much can be hazardous to your health. Some have even compared the health impacts of sitting for long periods of time to smoking.

Unless you have a newfangled treadmill desk or have converted your workspace into a standing desk, you likely are required to sit at a desk for hours a day.

But just because you work at a desk, doesn’t mean you can’t move around during the day, or get up and stretch a little.

Here are some quick microburst videos showing how you can stretch different parts of your body during short breaks at your desk. Most of these videos are between 30 and 45 seconds long. The complete 10-video playlist is available on our YouTube channel.

Here are some upper body stretches you can do at your desk:

Neck stretches

Upper back stretch

Chest stretch

Wrist stretches

You can also stretch out your legs and do some upper body exercises while seated.

Here are some more deskercises, or exercises you can do at your desk.

Ryan Schuster is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.

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How health insurance works

Health insurance can be confusing. We’re here to help.

People often ask us how health insurance works. We’ll try to explain.

HOW HEALTH INSURANCE WORKS
Here’s an example. Say you cut your hand and needed stitches. You went to the hospital and showed them your health insurance card.

First you were asked to pay a COPAYMENT, or copay, at the time of service. Copay amounts vary depending upon your specific plan. Some plans have different copay amounts for doctor’s visits and ER visits. You then got stitched up and left the hospital.


Watch the video to find out more.

When you received the bill from the hospital and your insurance company’s Explanation of Benefits in the mail, this is what you found:

TOTAL HOSPITAL BILL $1,000
Copay (you pay) -$10
Deductible (you pay) -$500
Coinsurance (you pay) -$98
Coinsurance (insurer pays) -$392

In this example, your plan had a $10 copay, a $500 deductible and 80/20 coinsurance (insurance pays 80 percent after deductible, you pay the other 20 percent).

After paying a copay, if applicable, you must pay the amount of your DEDUCTIBLE during your plan year before your insurance company will begin sharing costs with you. In this example, your deductible is $500.

After your copay and deductible have been paid, the remaining balance is $490 in the example. Of this amount, you are responsible for your COINSURANCE percentage. In this example, your insurance company pays 80 percent ($392), and you pay the other 20 percent of what’s left ($98 in this example). Keep in mind this is only an example. Cost sharing amounts vary depending upon your specific plan.

After reaching your full deductible for the year, you will not have to pay this the next time to seek care, you will only have to worry about your copay and paying your coinsurance amount.

Please call the phone number on the back of your ID card if you have any questions.

Ryan Schuster is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.

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How health insurance premiums are used

People often ask us what happens to the health insurance premiums our members pay. Here is an explanation.

Blue Cross Blue Shield of North Dakota charges premiums in exchange for providing our members with health insurance coverage. If you get insurance through your job, your premiums may be deducted from your paycheck or direct deposit.

Here is a look at how BCBSND premium dollars were used in 2014.

2014 BCBSND Dollar Breakdown UPDATED (reserves)

For every premium dollar BCBSND members paid:

  • 87.2 cents went to cover the costs of medical care members received.
  • 7.2 cents were used for operating expenses, including processing member claims, technology, and wellness programs to benefit members.
  • 2.3 cents were paid to the federal government in taxes and fees mandated by the Affordable Care Act.
  • 1.2 cents were paid in premium taxes.
  • 2.1 cents, the remaining balance, went into reserves to provide a necessary safety net in case member medical claims outpace premiums collected from members.

We have been asked if premium increases help us post hefty profits and where that money goes. As a nonprofit member-owned company, when there is anything left over after paying for members’ medical claims and our bills, it is kept in reserves — not distributed as profits to benefit shareholders.

Premiums don’t cover the full cost of members’ health care costs, but help to keep costs down, and give members discounts for covered services. Health insurance provides a safety net by capping the amount of out-of-pocket expenses members are billed by hospitals and clinics for expensive medical procedures. Those without insurance are billed directly by medical facilities and are not eligible for the discounts that our members receive. Health care costs are the primary driver of health insurance premiums.

Ryan Schuster is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.

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Practice food safety during the summer

The aroma of burgers on the grill. The delight of a red slice of watermelon dripping with juice. There’s nothing like eating outdoors in the summer. 

Practice food safety at your picnic.When you cook outdoors, you’re often away from your kitchen sink, refrigerator and kitchen thermometer. Even so, cooking outdoors is no pass to forgo food safety. After all, no one wants to get sick from foodborne illnesses.

 

You can make your gathering safe by following these tips when packing your cooler:

  • Keep cold food cold by using ice or frozen gel packs. Aim to keep coolers at 40°F or colder to prevent bacterial growth, and consider packing meats, poultry and seafood into coolers while still frozen.
  • Organize, putting beverages in one cooler and perishables in another, so as guests reopen the beverage cooler to replenish drinks, perishable foods aren’t exposed to warm air.
  • Limit the number of times perishable food coolers are opened. Replenish ice as needed.

All year, food safety starts with clean hands, utensils and platters. For summer picnics and other outdoor meals, follow these steps:

  • Always wash your hands with warm water and soap for at least 20 seconds before and after handling food. No access to running water at a park? Use a water jug, soap and towel. Or use moist disposable wipes.
  • Clean all picnic tables and other setting surfaces before you set out foods and utensils.

Remember foodborne illness is no laughing matter. Each year, roughly one of every six Americans gets sick from foodborne illnesses. That’s 48 million cases that are completely preventable.

Denise Pinkney is an editor in the Communications department at Blue Cross Blue Shield of North Dakota.

 

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