How do I find out what insurance covers and how much I owe?

 

 

 

 

 

 

 

 

 

We send Blue Cross Blue Shield of North Dakota (BCBSND) members an Explanation of Benefits form (also known as an EOB), in the mail after they receive medical care. EOBs, which you can also sign up to receive electronically, include important information about how your medical claims were processed.

EOBs explain where and when you received medical care with your insurance coverage, how much of the original claim your insurance will take care of, and the remaining out-of-pocket amount that you owe the health care facility. We recommend that members compare their EOBs and medical bills to make sure they match. If there are discrepancies or you have questions, you can always call the phone number on the back of your BCBSND ID card or your medical provider.


This short video explains what an EOB is and how you can track your health expenses.

Your paper EOB will show the amount your insurance coverage reduced your out-of-pocket total. EOBs will also show how your deductibles, coinsurance and copayment levels may impact your medical bill.

Here’s a complete breakdown of how to read your EOB. Here’s an explanation of what common insurance terms like coinsurance and copayment mean.

Let us know if you have any questions. We’re here to help.

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

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BCBSND honored for improved communication, collaboration with North Dakotans

We are constantly looking for ways to improve communication with our members, provide better customer service and help explain the complexities of health care and health insurance. As a nonprofit that is governed by a member-elected board of directors, serving our members is at the heart of everything we do every day.

That’s why we are so excited by the news that we have been awarded with a prestigious Silver Anvil award for improving reputation and brand management by the Public Relations Society of America. The award demonstrates our commitment to respond to member concerns and better educate and inform North Dakotans about health care, health care costs and health care reform.

“We are humbled to win such a prestigious national award,” said Tim Huckle, Blue Cross Blue Shield of North Dakota’s interim president and CEO and chief operating officer. “This award is a testament to all the great work our employees do every day to provide North Dakotans with high-quality, affordable health insurance and first-class customer service.”

What we’re doing to serve members better
During the last five years we have taken steps to be more approachable and address member concerns. We are listening to our members more and trying to be more responsive. We have made our website easier to use and have become more active in social media, engaging with North Dakotans and answering questions.

We have also played a major role explaining health care changes. We have distributed health reform surveys to members and held forums across the state to help explain how health reform will impact their health insurance and coverage.

While we are honored to receive such a coveted national award, we understand that our most important goal remains continuing to serve our members. Let us know 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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Our customer service scores lead nation’s Blue Cross/Blue Shield plans

As a member-owned, nonprofit company, our focus revolves around serving our members and providing the best possible customer service to members, employers and health care facilities in North Dakota.

So it was no surprise that Blue Cross Blue Shield of North Dakota ranked first among all of the nation’s Blue Cross and Blue Shield insurance plans during the second half of 2013 in a set of customer service rankings.

  • We ranked No. 1 among Blue Cross and Blue Shield plans with a 99.9 score out of 100 possible points in industry Member Touchpoint Measures (MTM) rankings.
  • The rankings track accuracy and how fast enrollment, claims and member questions and concerns are resolved, as well as how many member inquiries are resolved during the first phone call to us.

“Our members are at the center of everything we do,” said Tim Huckle, our interim president and CEO and chief operating officer. “These outstanding scores underscore our focus on putting members first and providing best-in-class customer service.”

Health reform changes
While we have long been known for the great customer service we provide our members, changes in the health insurance industry brought on by health care reform have highlighted the importance of customer service. In addition to continuing to provide traditional customer service to members by explaining their coverage and working to resolve any issues, we have also taken a leadership role in the state, using forums, meetings and other communications tools to explain health reform impacts and insurance changes to our members, employers, doctors, hospitals and clinics in the state.

Give us a call
Let us know if you need anything. You can call the phone number listed on the back of your Blue Cross Blue Shield of North Dakota ID card to talk to one of our employees. We’d love to talk to you and see how we can help you.

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

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Accreditation shows devotion to members

Blue Cross Blue Shield of North Dakota is dedicated to delivering affordable solutions to improve the care and health of its members and all North Dakotans. As a nonprofit directed by a board of directors that is elected by members, our main focus has always been on how best to serve our members.

We take that responsibility seriously, which is why we continually push ourselves to search for ways to better serve our members and become more efficient.

URAC accreditation
One measure of that devotion is the full accreditation we recently received for Health Plan and Health Plan for Health Insurance Exchange from the nationally respected URAC health care accrediting organization.

“By applying for and receiving URAC accreditation, Blue Cross Blue Shield of North Dakota has demonstrated a commitment to quality healthcare,” said URAC President and CEO Kylanne Green. “Quality healthcare is crucial to our nation’s welfare and it is important to have organizations that are willing to measure themselves against national standards and undergo rigorous evaluation by an independent accrediting body.”

URAC, formerly known as the Utilization Review Accreditation Commission, is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, education and measurement.

Accreditation reinforces commitment to members
URAC’s accreditation process involves a rigorous four-phase review, which can take as long as six months to complete.

“Achieving this accreditation is validation of the quality services that we provide to our customers,” said Jacquelyn Walsh, vice president of Clinical Excellence and Quality at BCBSND.

BCBSND has held URAC accreditation for Health Utilization Management (HUM) standards since 1993 and in 2013 received provisional accreditation for Health Plan for Health Insurance Exchange, which is required for all insurers to participate on state health insurance exchanges or marketplaces.

The URAC accreditation process demonstrates a commitment to quality services and serves as a framework to improve business processes through benchmarking organizations against nationally recognized standards.

This is just another example of how we are working for and constantly searching for ways to improve and to serve you better.

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

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Shoes for Kids program breaks fundraising record

The Shoes for Kids program, which donates free running shoes to kids in the Fargo-Moorhead community, raised a record total of more than $35,000 this year.

This year $1 was donated from each Fargo Marathon Friday Night 5K registration. Friday Night 5K co-sponsors Blue Cross Blue Shield of North Dakota and Discovery Benefits and the Dakota Medical Foundation matched donations to help provide shoes to local kids. Additional funds raised from the Run a Mile with Mark event and online donations helped push the total past $35,000.

The Shoes for Kids program donated 1,000 shoes to Fargo-Moorhead area elementary schools in both 2012 and 2013.

Like in years past, Fargo Marathon officials will deliver new Nike Pegasus running shoes to Fargo-Moorhead area elementary schools in late August.

As The Official Sponsor of Recess, we are proud to participate in the Shoes for Kids program. We believe that all children, regardless of their economic background, should have access to resources to help them get active. We support programs like this that help to remove barriers to help North Dakotans live healthier lifestyles.

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

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A look at how your premium dollars are spent

We often receive questions from members about how their insurance premiums are used. Here is an explanation.

Members pay us premiums in exchange for receiving health insurance coverage. If you receive insurance through your employer, your premium may be deducted from your paycheck or direct deposit.

Breakdown
In 2013, 92.7 percent of member premiums (or roughly 93 cents out of each premium dollar we collect) was used to pay for medical care and services used by our members. The rest went to pay for the cost of running the business, such as processing claims, taxes and regulatory fees (see breakdown below). Our administrative costs of 8.2 percent were among the lowest in the nation. If anything is left over at the end of the year, it is kept in reserves to pay for higher than anticipated medical claims. In 2013 we posted an operating loss, so we dipped into our reserves to make up the difference. But rest assured that our reserves remain adequate.

Calculating premiums
Financial losses from 2013 not associated with providing health insurance to members will not impact future member premiums. Premiums are set based on past and predicted future member medical claims and must be approved by the North Dakota Insurance Department. If premiums rise for some of our members in 2015, it will be because of increasing medical claims for those groups and individuals and anticipated higher claims for those people in the future. The primary driver of health insurance premiums is health care costs.

Pooling risk
Health insurance works by pooling risk to make coverage affordable to all those in the group. When you buy insurance from an employer or directly from an insurance company, you become part of a group depending on your plan and coverage selections. The premiums paid by all in the group are pooled together to cover the health care costs of everyone in the group. Some people in the pool may use more health care services than others, but by pooling resources together, it helps to keep insurance more affordable for all and increases purchasing power through discounts we negotiate with doctors and hospitals.

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

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Healthy lessons learned from Fargo Marathon 5K

A throng of participants of all ages and ability levels streamed through downtown Fargo on May 9 during the Fargo Marathon Friday Night 5K.

The 10th anniversary running of the 3.1-mile race returned the event to its downtown Fargo roots. Some of the 8,000 participants ran, while others walked the course that traversed two bridges spanning downtown Fargo and downtown Moorhead, Minn.

After a spirited event, the runners finished at Island Park. Those who stayed were treated to a free concert featuring the Johnny Holm Band.

We had a blast co-sponsoring the Friday Night 5K along with Discovery Benefits this year. It was great to see everyone getting outside and taking steps to improve their health.

Each year the Friday Night 5K provides an excellent example of how easy it can be to start your journey to better health. Every year there are some serious runners who train for months and then sprint the entire 3.1-mile course. But there are also numerous examples of kids running along with their parents, mothers pushing babies in strollers and friends and family members walking together. One West Fargo mom even walked the 5K while 9 months pregnant.

The Friday Night 5K shows us that you don’t have to be in top physical shape to go for a run or walk with several thousand of your closest friends. In fact, it shows that no matter your health or fitness level, you can start taking small, but important steps to improve your health and fitness today. No matter how slowly you walk, you’re already lapping the people sitting on the couch.

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

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How to choose running shoes

 

 

 

 

 

 

 

 

Runners have a number of things to consider when preparing for a run. Proper preparation, diet and an effective training plan are all essential. But it is also important for expert runners and novices alike to select running shoes that fit their running style and regimen.

Choosing the right shoes that fit your feet and provide the right amount of cushioning and support can help improve your performance and prevent injury. If you’re training or planning to compete in a running event, make sure to check your shoes for signs of wear and tear, inside and out. Don’t forget to select running shoes, not cross trainers or basketball shoes that are designed for running.


Watch a video with some tips for selecting running shoes that work for you and your workout routine.

Here are some more tips to help you select your next pair of running shoes:

  1. Make sure they fit
    Make sure the shoes provide enough cushioning, support and fit properly.
  1. Try on a few pairs of shoes before buying
    Don’t buy the first pair of shoes you try on. You should try on several different pairs of shoes before deciding. Be careful not to make your decision solely based on how the shoes look or if they are a particular brand.
  1. Seek out a knowledgeable salesperson
    Some stores employ running experts as salespeople. Ask the salesperson some questions to help find the right shoes for your running plan and situation.

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

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April is Alcohol Awareness Month

Many people are surprised to learn just how little alcohol is safe to consume daily without overindulging.

Alcohol Awareness Month

According to the National Centers for Disease Control and Prevention (CDC) guidelines, a safe amount of alcohol consumption for the average adult is one drink a day for women and two drinks a day for men.

 

 

 

Just what is a drink? One drink is:

  • 12-ounce bottle of beer
  • 5-ounce glass of wine
  • 1.5-ounce shot of liquor

The key to safely enjoying alcohol is moderation. Here are five tips to help you avoid becoming tipsy.

  1. Limit time with friends or at social events that trigger you to drink more than you should. If your one Friday post-work happy hour drink is turning into three, try signing up for a healthier way to unwind, like joining a running club or other fitness group, starting a book club or setting up a happy hour at a coffee shop that does not serve alcohol
  2. Sip, don’t swig. Alcoholic beverages are meant to be enjoyed for their taste, not their buzz factor. If it’s hard for you to take it slowly, try alternating sips of your drink with sips of water or opting for a non-alcoholic beverage altogether.
  3. Save your shots for the doctor’s office. Shots of alcohol are dangerous for many reasons, especially because their effects tend to sneak up on you.
  4. Eat. Fill your stomach with healthy proteins and carbohydrates that will keep you feeling full so that you don’t drink more than you need to.
  5. Reward yourself for limiting or eliminating your booze intake. Take pride in becoming the designated driver. You could just save a life or two! Spend the extra money you saved opting out of alcohol to buy a massage or new outfit. 

Drinking too much alcohol can increase your risk of health-related injuries, violence, drowning, liver disease, and some types of cancer.  

If you suspect you or someone you care about has a drinking problem, remember alcohol dependency is common, and it’s treatable. There are many resources available to you if you are concerned about your own or a loved one’s drinking habits.  

You can find an extensive list of licensed care throughout North Dakota at https://www.nd.gov/dhs/services/mentalhealth/. 

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

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Automated phone system helping doctors

We recently launched a new automated phone system to support doctor’s offices, clinics and hospitals communicate with us in a more efficiently. Our new Provider Self Service automated phone system allows health care providers 24-7 access to member eligibility, cost sharing and claim status information without having to wait on hold for an operator. The new service helps us and doctors conserve resources and save time.

Testimony
“It’s by far the best system that I’ve used and I use them a lot daily verifying insurance,” said Stephanie Beaty of Coram Healthcare, who has used the new automated phone system. “It was super quick and easy. I was able to get my information in just a few minutes, just going through the menu.”

Health care providers also like being able to get 24-7 access to patient info and claims data.

“It was easy to use. I like having after-hours access,” said Teresa Davidson of Rapid City Regional Rehabilitation. “I like that you can type in the numbers on the phone. Sometimes there is so much background noise in the office that the computer has a hard time understanding what you’re saying.”

Reduced wait times
By offering health care professionals access to an automated phone system for these functions, we are able to reduce the wait times for those calling in to talk with operators and conserve employee resources to better use our members’ premium dollars.

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

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