Anthem & UC Health reach deal on new contract

Just before the contract was set to expire, Anthem and UC Health (University of Cincinnati Medical Center, UC Health Surgical Hospital, West Chester Hospital, the Drake Center, Lindner Center of Hope and all UC Health-affiliated physicians) have reached a new contract agreement.

This will allow all Anthem members to continue to seek care from their UC Health providers without paying higher amounts for a non-contracted (or Out-of-Network) provider.

Cincinnati.com article, Anthem & UC Health

Avoid Pre-Ex, Provide Prior Health Coverage

In order to prevent the hassle of an unnecessary pre-existing condition exclusion from your insurance plan, it is important complete the prior health coverage section of any insurance application. This applies to you if you are a new hire, joining the company plan for the first time, or if you are an existing employee because the company is considering a change to their policy carrier.  It is critical that you list correct information that documents ONE full year of previous insurance coverage. If you’ve had more than one coverage in the last 12 months, make sure you list that information as well.   This information includes, your prior insurance company’s name, the type of coverage you had, your prior policy number, your prior effective date, and the end date of that policy.  There will be times when the carrier will ask for a certificate of credible coverage that verifies the accuracy of the information. Most carriers will send these out after a termination is completed, but if you need one and don’t have it, you can contact the prior carrier to request it.

Anthem’s policy on Shingles Vaccine **NEW UPDATE**

As of 12/7/2012, Anthem has removed the age restriction from the Shingles vaccine. Previously only adults age 50 and up were eligible to receive coverage for this, but now, it is covered for all adults.

Hospital fees? I didn't go to a hospital...

In the recent months, we have noticed that members are receiving bills for higher amounts, following routine check-ups or laboratory services with their physicians in private practices. After taking a closer look, we can see that these patients are being billed for hospital fees due to the fact that many private practices have been bought out by larger groups that are owned by local hospitals. Examples of some of these services include x-rays, laboratory services, and scopes (endoscopy, colonoscopy). This is happening because many private practices are now billing under a facility tax id number that links to the hospital they are owned by. If this is something you are experiencing and you have questions, please feel free to contact our customer care team at 937-260-4300 or by e-mail at customerservice@mcgohanbrabender.com.

Anthem's Shingle Vaccine Update!

For the last several months, Anthem's shingle vaccine age minimum has been 50.  However, that is all about to change once again.  Effective 11/16/2012, Anthem will be changing the age back to 60.  For anyone interested in the vaccine who may be between the ages of 50 and 60 and have Anthem insurance may want to get the vaccine while it will be covered for them.  Otherwise, you will have to pay full out of pocket expense or wait until you are at the minimum age.  If you have any questions about this update, please feel free to contact the Customer Care Team!

Customer Care Is Your Advocate

Here at McGohan Brabender, the Customer Care Team's role is the advocate for our client- facilitators between customers, providers, and their insurance companies.  All of our reps are trained in cross-functional roles and empowered to provide customers with assistance in most insurance related issues.

The first point of contact for our clients is Member Services (located on the back of your ID card).  Most issues can be resolved with the carrier; however, if assistance is still needed our team is here to help!

The role of the customer advocate is three-fold:

• To be the point of contact for the customer in handling a question or problem and keeping the customer updated with timely and frequent updates to inform the progress being made towards a resolution.
• To facilitate a resolution by bringing together the approrpriate department heads to escalate issues if they are urgent.
• To implement procedures that ensures the problem does not occur again and educate members about their plan.

Please feel free to reach out to our Customer Care Team.  Our business hours are 8 to 5 Monday through Friday.  You can reach us locally at 937-260-4300 or toll-free at 877-635-5372.

HOT OFF THE PRESS...Anthem And Walgreens Reach Multi-Year Deal

Anthem has announced that Express Scripts, Inc. (ESI) and Walgreens have reached an agreement for Walgreens to participate in Anthems retail pharmacy network and members will be able to use their pharmacy benefit at Walgreens stores beginning September 15, 2012.  This will impact members in commercial, Medicare and Medicaid.

Also, Walgreens-owned pharmacies including BioScrip, Duane Reade, and Happy Harry's will be part of the pharmacy network.  Express Scripts members can log in to www.express-scripts.com to search in network pharmacies and starting September 15th, this will include Walgreens pharmacies.

Anthem is currently working with Express Scripts to ensure there are no problems for members who may want to transfer prescriptions to Walgreens.  Usually, members an take their medicine bottle to the new drug store.  However, some state regulations as well as certain medications will require members to contact their doctor to have them call the new store with prescription details.  To make sure there is no delay in receiving medications, you may want to contact your local Walgreens prior to needing your prescription filled to clarify the best way for the prescription to be transferred.