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What’s in this issue: • Finding Substance Abuse Treatment

• Spring Allergy Tips

• Blue Cross of Idaho’s New Homepage

• Do You Need a Bone Density Test?

M E M B E R N E W S L E T T E RBlue Bulletin S P R I N G

EDITION

WelcomeSpring is the time of change. As winter fades, it’s the perfect time to make a healthy restart in our own lives. Whether that’s following through on your New Year’s resolution to get in shape, making plans to plant a healthy garden or just getting outside, there are plenty of ways to take a positive step on your personal health journey.

At Blue Cross of Idaho, we’re always dedicated to helping you and your family along that journey by making it as easy as possible to get the quality healthcare you need.

While most of us associate the idea of health with physical health, mental health can be just as important. In this issue of Blue Bulletin, our Chief Medical Offi cer Dr. Rhonda Robinson Beale discusses some of the options our members have when it comes to seeking help for substance abuse.

Spring is also the time of year when many of us have to deal with allergies. You can get some tips on how to deal with this unpleasant seasonal rite of passage on page 2.

A different rite of passage that many face as we get older is osteoporosis. Having weak or brittle bones is a serious condition, but thankfully, healthcare providers can not only address the issue,

sometimes they can prevent it altogether. Getting a bone density test can be an important fi rst step. Read the story on page 5 to get more insight into whether a bone density test is the right choice for you.

If you’ve visited our homepage bcidaho.com in recent months, you may have noticed a cleaner, more user-friendly look designed to make the online experience easier. You can get a tour on page 3.

We know understanding the world of health insurance can be tricky. That’s why in this issue we offer a primer on why you might receive multiple bills for the same claim.

Finally, this will be the last time I will have the chance to write this welcome message before I retire. Over my years here, I have always appreciated the opportunity to meet and talk to you, our members. I, along with everyone at Blue Cross of Idaho, am deeply honored by the trust you put in us. We are here to assist you as you travel on your healthcare journey. I have always taken this responsibility seriously and I know the many wonderful people at Blue Cross of Idaho will continue to do so in the future.

Zelda Geyer-Sylvia

President and CEO, Blue Cross of Idaho

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By Dr. Rhonda Robinson Beale

For substance-use disorders, finding the right type of care can be overwhelming and potentially costly.

Fortunately, as a Blue Cross of Idaho member, you have help through our Personal Care Support Service. Our staff of behavioral health specialists can help you make informed choices that both meet your treatment needs and are cost-effective.

Residential treatment centers (RTCs) are sometimes the correct option, but they are not emergency care. They must be recommended by a behavioral health professional who completes an evaluation to determine the best type of care in each case. At Blue Cross of Idaho, we can help you find a qualified provider to do an evaluation. If we find the evaluation meets our standards of medical necessity, we can then help find an in-network treatment service that best meets your needs.

RTCs are typically used in severe cases that require treatment in a monitored, live-in facility. Residential care is intensive treatment, and works best when the participant is truly committed to making the necessary changes and learning how to manage their symptoms. Active involvement by a patient’s support network is also key, so a program close to home is important. Additionally, residential care

requires continued outpatient treatment after a patient is discharged so connections between the RTC and outpatient providers is also important.

There are other levels of treatment, many of which do not require live-in care, including:

• Outpatient

• Intensive outpatient program

• Partial hospitalization program

Other services involve inpatient hospitalization, but this is only for treatment requiring intensive care for medical detox, or treatment of an active medical condition.

It is important to get guidance and help to find the most appropriate type and level of care covered by your insurance when seeking treatment for substance-use disorders. Many providers and facilities advertise programs and offer incentives, but you need to be informed before responding to these ads since some facilities may ask you to sign a financial promissory note, make a large deposit before admission, or bill you for charges higher than rates Blue Cross of Idaho has negotiated with in-network providers.

We can help you get the right level of care that is covered by your insurance, making sure you aren’t left with expensive out-of-pocket costs.

Selecting Treatment for Substance-Use Disorders Don’t forget these

important steps:Get a behavioral health evaluation and level of treatment recommendations from a trained behavioral health provider.

Have the provider submit clinical evaluation results to Blue Cross of Idaho if the recommendation is for residential treatment.

If there is a recommendation for residential treatment:

Contact Blue Cross of Idaho Customer Service to verify that your plan covers the service. A customer service representative will connect you with our Personal Health Support staff of behavioral health clinicians.

Our Personal Health Support staff will help you find in-network providers who offer the services with the lowest possible out-of-pocket cost.

Do not attempt to admit yourself to a RTC program without an evaluation and first contacting Blue Cross of Idaho.

Do not sign promissory notes with out-of-network providers. You are protected by the contracts that Blue Cross of Idaho sets up with providers to prevent you being billed for what isn’t covered by your plan.

H O U S E CALLS

Dr. Rhonda Robinson Beale is the chief medical officer at Blue Cross of Idaho. Our four medical directors maintain close ties with the healthcare provider community. These doctors and the more than 100 clinicians, nurses and medical professionals who work with them ensure we remain at the forefront of changes and innovations to the healthcare delivery system that will help improve health and lower costs.

Zelda Geyer-Sylvia

President and CEO, Blue Cross of Idaho

B L U E C R O S S O F I D A H O | M E M B E R N E W S L E T T E R2

Beating Seasonal AllergiesOn the pro and con list of springtime offerings, one thing falls squarely into the con category: allergies.

According to the American College of Allergy, Asthma and Immunology (ACAAI), an estimated 50 million Americans suffer from some kind of nasal allergy – that’s 30 percent of adults and 40 percent of children. But whether they are seasonal or year-round allergies, the stuffy, runny nose, watery eyes and sneezing (among other symptoms) can be miserable to deal with.

In fact, the ACAAI estimates that, annually, more than 13.4 million visits to doctors’ offi ces or other healthcare facilities are due to allergies.

Seasonal allergies tend to be triggered by pollens from trees, grasses or other plants, while year-round allergies are more typically caused by things like dust mites,

animal dander or mold spores. Sometimes, it can be hard to tell exactly what triggers your allergies. That’s why the Mayo Clinic suggests using a diary to track your symptoms and what’s going on when they occur to help you and your doctor identify patterns.

If you are diagnosed with allergies, you can work with your doctor to create an appropriate treatment plan. This can include helping you limit your exposure to things that worsen your allergies. Nasal sprays and other medications are available both with and without a prescription and can help relieve many of the symptoms. Some people only need to use these during certain times of the year, while others benefi t from using them year round. If you have suffered from seasonal allergies in the past, consider starting your medication two weeks before you expect symptoms to start.

In some cases, immunotherapy techniques may be helpful. Immunotherapy commonly involves allergy shots, which can help reduce symptoms in roughly 85 percent of people who suffer from allergies by exposing them to slowly increasing amounts of allergy triggers to build a resistance to them.

You can also reduce your symptoms with some simple avoidance techniques.

• Watch the weather reports to monitor the pollen counts and avoid spending too much time outdoors on high-pollen days.

• Keep your windows and doors of both your home and car shut when you’re suffering from allergies.

• Take a shower, wash your hair and change your clothes after working or playing outdoors.

Some simple steps could help you add a few items to your springtime pro list this year.

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If you’ve visited bcidaho.com recently, you probably noticed a whole new look on our homepage. It’s all part of our mission to make your healthcare coverage as simple as possible. The new homepage has a cleaner, more streamlined design to help you find exactly what you’re looking for as quickly as possible.

QUICK MEMBER LOGIN Jump straight to the member website where you can sign in to see your plan details, check on claims and more.

ACA UPDATES Learn about the latest changes related to the Affordable Healthcare Act.

CONTACT US Get your questions answered quickly by our Idaho-based staff.

SHOP MEDICARE ADVANTAGE PLANS Looking for a Medicare Advantage plan? Let us help you find a plan that works for you.

FIND A DOCTOR Need to find a doctor or healthcare provider? Select this link to see providers in your network.

FAQs Confused about a healthcare term? We can help clear things up.

New Look Online

Why Register Online?Registering online is fast and easy and gives you access to a wide range of features.

Need to see the details of what your plan covers or if you have to pay a copayment when you visit your doctor? Check out all your plan details online.

Want to check the status or see details of a claim? You can do that online, too.

Our online member portal can also help you find a doctor, healthcare provider or facility in your network, helping you save money.

You can even sign up to receive electronic copies of your explanation of benefits statements, as well as get our monthly member e-newsletter.

Don’t forget, you must have an online account to get the most out of our mobile app for smartphones, too.

All you need to register online is your member ID card. Just visit members.bcidaho.com and select Register at the top of the page.

B L U E C R O S S O F I D A H O | M E M B E R N E W S L E T T E R4

Your Care is Our First PriorityYou may have wondered about our policies regarding the way we pay our providers and claims processors. Well, it’s simple.

Blue Cross of Idaho:

• Makes decisions based on whether or not the healthcare service you need is appropriate and covered by your plan.

• Does not use incentives that make it harder for you to get healthcare and customer service.

• Does not pay practitioners or individuals for denying claims.

• Does not offer incentives to encourage denials.

• Does not encourage decisions that result in low use of covered benefits.

• Makes sure that referral decisions are independent and impartial and do not influence hiring, compensation, termination, promotion and any other similar matters.

Understanding the array of bills and statements you receive after using your health insurance can sometimes feel a little overwhelming. Sometimes you end up getting a bill from your doctor, then a statement from Blue Cross of Idaho and then something else from your doctor. Making sense of what you owe, or don’t, can be challenging.

Often, doctors and other healthcare providers will send you a bill at the same time they send a claim to Blue Cross of Idaho. Remember, you don’t necessarily owe this amount. Instead, wait until you receive an explanation of benefits (EOB) statement from us. This will outline the claim, charges, how much Blue Cross of Idaho paid, what network discounts were included and what, if anything, you still owe to the provider.

If you do owe your provider after Blue Cross of Idaho has processed your claim, your doctor will send you a bill for the remaining balance.

What you may owe your doctor depends on your specific benefits, whether you’ve reached your deductible for the year, and if the provider is in-network. You can save significant amounts of money by visiting in-network doctors and healthcare providers who contract with Blue Cross of Idaho since being part of our network guarantees certain discounts on services. Bottom line: you can save by staying in your network.

If you have questions about a claim or what your benefits cover, call the Blue Cross of Idaho Customer Service Department at the number on the back of your member ID card or log in to your online account at members.bcidaho.com.

Understanding Your Bills

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Common Risk Factorsfor Osteoporosis:• Age

• Being female

• Reached menopause

• Family history

• Being small and thin

Medical Conditions ThatMay Cause Bone Loss:• Autoimmune disorders (rheumatoid

arthritis, lupus and multiple sclerosis)

• Endocrine disorders (diabetes, thyroid disorders, low testosterone)

• Digestive disorders (celiac disease, infl ammatory bowel disease and weight loss surgery)

• Hematologic disorders (sickle cell disease)

• Neurologic disorders (stroke, multiple sclerosis, Parkinson’s disease)

• Other disorders including kidney disease, depression, certain cancers and HIV

Do You Need a Bone Density Test?Do you know your risk for osteoporosis? A bone density test can help tell you if you’re at risk for developing the disease which causes your bones to become weak. The best and only bone density test that can diagnose osteoporosis is an X-ray called a DEXA. The lower your bone density, or T-score, the greater your risk of breaking a bone.

The National Osteoporosis Foundation recommends bone density tests for:

• Women age 65 or older

• Men age 70 or older

• If you break a bone after age 50

• Women of menopausal age with risk factors

• Post-menopausal women younger than 65 with risk factors

• Men age 50-69 with risk factors

There are some steps you can take to help reduce your risk of developing osteoporosis, including:

• Getting enough calcium and vitamin D

• Doing weight-bearing and strengthening exercises

• Not smoking

• Not drinking too much alcohol

Identifying your risk through screening will help your healthcare provider develop a plan to reduce further bone loss. Talk to your healthcare provider about your bone health at your next visit.

Medication Update Spring 2016Brand Name Generic Name Drug UseZyvox Linezolid Bacterial infections

Viramune XR Nevirapine Antiretroviral agent for the treatment of HIV-1 infection

Avodart Dutasteride Symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate

Macrodantin Nitrofurantoin macrocrystals Urinary tract infectionsPrandimet repaglinide and metformin Antidiabetic

These brand-name drugs have recently been released in a generic form. Generics are a safe and effective way to lower the cost of your medications.

Ask your doctor or pharmacist if a generic medicine is right for you.

Contact UsMoved recently? Don’t forget to change your contact information with your human resources department or benefi ts administrator so you continue to receive important information regarding your health insurance coverage.

Website: members.bcidaho.comEmail: customerservice@bcidaho.com

Access the information on your mobile phone.

Call our Customer Service line at the numberlisted on the back of your member ID card.

Have a Question?

3000 E. Pine Ave.Meridian, ID 83642

Published by Blue Cross of Idaho. © 2016 by Blue Cross of Idaho, an independent licensee of the Blue Cross and Blue Shield Association. All rights reserved. No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement – not take the place of – the recommendations of your healthcare provider. Consult your physician before making major changes in your lifestyle or healthcare regimen. Blue Cross of Idaho makes no endorsements or warranties regarding any of the products and services included in this publication or its articles.

Healthy Recipe

Avocado Deviled EggsNutrition Facts: Servings: 6 Calories per serving: 112 Carbohydrates: 3 gFat: 9 g (0 g Trans Fat) Cholesterol: 215 mg Sodium: 73 mg Fiber: 2 g

• 6 eggs

• 1 large avocado

• 3 tsp. lime juice

• 2 Tbs. chopped red onion

• 1 tsp. cilantro

• Salt and pepper to taste

• A dash of paprika or chili to garnish

Boil eggs for 11 minutes, drain and place in refrigerator until eggs are cold. Remove the shell and halve the eggs, lengthwise. Remove the yolks and set aside in a bowl. Arrange the egg white halves on a platter and set aside.

In a bowl, mash the avocado and 3 whole egg yolks with a fork until desired consistency. Mix in lime juice, red onion, cilantro, salt and pepper adjust to taste and stir to combine. Spoon the mixture into the egg white halves and sprinkle with a little paprika or chili powder for color.