Health reform basics

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Health care reform can be confusing. We’re here to help.

The landmark Affordable Care Act (ACA) federal health reform law was passed by Congress in 2010. Some of the major provisions of ACA that are in place now include:


Here’s a brief video explanation of health reform.

Here is a look at some resources that help explain the basics of health care reform:

How to Purchase Insurance
A look at how you can enroll in insurance coverage, including how to navigate the online marketplace.

Health Insurance Requirement
Most Americans are now required to have a basic level of health insurance coverage or face a tax penalty from the IRS.

Health Insurance Marketplace
A brief overview of health insurance marketplaces.

New Health Plans
A look at the four basic levels of coverage available on online marketplaces and some other insurance plans.

Essential Health Benefits
Brief overview of the types of health care services that health insurance plans are required to provide a basic level of coverage to members on insurance plans.

Tax Credits on the Marketplace
Those who qualify based on income requirements can receive help paying their premiums if they purchase coverage online on a health insurance marketplace.

More information about health reform is available on our website and on Tips & Insights blogs.

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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Mother and daughter undeterred by Type 1 diabetes

Julie Kinneberg’s gut was telling her something was terribly wrong with her    10-year-old daughter.

It all started days earlier with Hannah drinking a lot of water and losing weight because her stomach hurt too much to eat. Doctors first diagnosed a viral bug and when she didn’t improve, she was diagnosed with strep throat, although a throat culture was not performed.

Hannah continued to lose weight. At 11 p.m. on Sept. 5, 2012, Hannah started vomiting. A few hours later, Julie and Aaron rushed their daughter to the ER in Grand Forks. Aaron carried Hannah who was now too weak to walk. In all, Hannah had lost 12 pounds since “coming down with the flu.”

Unbeknownst to Julie and Aaron, their daughter’s blood sugar level had soared to 800—nearly eight times the normal range.  Hannah was dangerously close to slipping into a coma.

Julie and Aaron felt “blown away” when the doctor informed them that Hannah had Type 1 diabetes, a condition in which the body no longer produces insulin. While the cause of the disease remains a mystery, insulin injections are needed for survival.

Let’s learn this
From day 1, the Kinnenbergs adopted the attitude of “it is what it is” and “let’s learn this!” During the three-day hospital stay in Grand Forks, Julie and Hannah learned about the disease and how to do insulin injections. “She was a trooper, she really was,” Julie says.

“It was like coming home with a new baby,” Julie says. “It was a whole new world. They send you home with a book as thick as a Bible.” 

Hannah begins doing injections as soon as she is released from the hospital.


In addition to working with a diabetes educator, Julie and Aaron did their own research online. Julie connected with a 21-year-old Grand Forks woman who was diagnosed with Type 1 when she was about Hannah’s age.

The world of type 1 diabetes (formerly known as juvenile diabetes or insulin-dependent diabetes) can turn school lunches, birthday parties and sports into challenges to monitor and master. Even a slight change in the school menu could affect Hannah’s blood sugar.

“I am her biggest advocate,” Julie says. “I made it known that she has Type 1. If she needs candy or a juice box, give it to her.” If Hannah’s blood sugar drops too low, she needs to quickly consume carbohydrates.

The whole family, including Isaac, 9, and Abbey, 7, practiced their math skills to figure out the insulin-to-carbohydrate ratio required to determine how much insulin Hannah needed.

Meal preparation took on a new level of importance as Julie wanted Hannah’s blood sugar to be perfect. Through trial and error, they learned which food would cause a spike. “Nothing is off limits. If you want a caramel roll, it’s OK. You can cover it with insulin. I want her to be a child,” Julie says.

Role model
Hannah has not let Type 1 slow her down. Active in student council, Hannah also plays soccer and swims like a fish. Hannah’s artistic side shines through in playing guitar and creating art. She sews clothing and perhaps someday will design fashion-savvy cases for diabetes supplies, unlike the camouflage one she received in the hospital. “I would rather have diabetes than a nut allergy,” Hannah says. 

Hannah became a role model for her classmates, teaching them about her disease and creating games with friends on how to count carbs. Hannah attends birthday parties and drinks pop just like any other kid—only her choice is now Diet Sprite. 

Since her hospital discharge, Hannah has handled her own injections. However, they became increasingly painful due to scar tissue. Her doctors recommended an insulin pump to address that and other concerns. 

Hannah proudly wears her insulin pump, which she describes as “uber fantastic.”

The Kinnebergs live in Grand Forks and have Blue Cross Blue Shield of North Dakota (BCBSND) health coverage. “Insulin pumps require lots of education and responsibility for the patient. That’s why we worked with Hannah and Julie to make sure the pump was the right fit through the prior approval process,” says Kirsten, who works as BCBSND’s medical management review coordinator.

 

 

 

“The pump is just a helper,” Kirsten explains, “Hannah still needs to be in control of her health—what she eats and drinks and her activity level.”

In April 2014, Hannah received an insulin pump, which she proudly wears. In fact, you could easily mistake it for a cell phone.

“The pump is uber fantastic,” Hannah says. The pump releases a steady flow of insulin throughout the day. At mealtime, Hannah tells the pump her blood sugar and how many carbs she will eat. The pump calculates the amount of insulin she needs. When she plays sports, the pump will also adjust the flow based on her activity level.

Camp Sioux is a highlight of the summer for the Kinnebergs. The camp gives children with diabetes an opportunity to have fun. The staff is well trained with diabetes. “We all get a week off from thinking about diabetes,” Julie says.

The Kinnebergs participated in the Step Out: Walk to Stop Diabetes event in Grand Forks as Team Hannah in October 2013 and ranked in the top five for fundraising.

Know the warning signs
Julie wants everyone to know the symptoms of Type 1 diabetes in children because they can develop quickly over a period of weeks. 

  • Increased thirst and frequent urination
  • Extreme hunger
  • Weight loss
  • Fatigue
  • Irritability or unusual behavior
  • Blurred vision
  • Yeast infection 

And if you’re a parent who has just learned your child has Type 1 diabetes, Julie offers this encouragement: “It gets easier. Anything gets easier with time, it’s not the end of the world that at first it seems like,” Julie says.

The Kinnebergs are now living their new normal. “Don’t be afraid to ask questions and get help,” Julie says.

“Diabetes is a piece of me, but not the whole picture,” Hannah says. 

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

 

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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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