Certificate of Creditable Coverage- WHAT IS IT AND WHY DO I NEED IT?

"Certificate of Creditable Coverage" or commonly referred to as a "COCC" is a written document provided to you by an insurance company after you terminate their coverage.  Most healthcare programs impose a waiting period for a pre-existing condition for all new or reinstated members who have had a break of coverage for 63 days or more.  The certificate of creditable coverage indicates the length of time you have been continuously covered under the plan and allows waiver of any waiting period related to a pre-existing condition.  This is part of the Federal Health Insurance Portability and Accountability Act of 1996 (often referred to as HIPAA) and this provision provides that once you have been continuously insured for at least 18 months there is no need to satisfy another waiting period when you change health insurance.
Certificates are generated automatically within a few weeks of a member's termination.  If you do not receive a Certificate by mail within 30 days of termination, contact the carrier by calling Member Services on the back of your ID card to verify your mailing address and request another Certificate to be sent.

HSA Limits for 2013

The Internal Revenue Service has released the 2013 inflation adjustments for HSAs:

2013 Annual Contribution Limit:
 Single coverage: $3,250 (up from $3,100 in 2012)
Family coverage: $6,450 (up from $6,250 in 2012)

2013 Minimum Deductible for HDHP:
 Single coverage: $1,250 (up from $1,200 in 2012)
Family coverage: $2,500 (up from $2,400 in 2012)

2013 Maximum Out-of-pocket:
 Single coverage: $6,250 (up from $6,050 in 2012)
Family coverage: $12,500 (up from $12,100 in 2012)

I Need A Precertification. What Is That?

A precertification is a process of confirming medical necessity and collecting information prior to inpatient services and other specialty types of services.  Without a precertification for these services, your health plan may not provide coverage and may deny any claims related to these services.  Some providers may list a precertification procedures list online.  If you are going through a network facility, the facility should automatically do a precertification.  However, that is not always the case.  If a precertification was not done and your claim is denied, often a retro precertification can be submitted.  When these types of services are done, it is up to the doctor to prove that the procedure was medically necessary.  Each carrier has a specific list of criteria that must be met in order to deem a procedure medically necessary.  If you have any questions about a precertification that is needed or your services are being denied, you can always call the number on the back of your ID card to seek help.  As always, our Customer Care Team is here to help as your advocate.

Prescription Prior Authorization- It's Easier Than You Think!

Prior authorization is a requirement for your physician to obtain approval from your health plan to prescribe a specific medication for you. Without this prior approval or authorization, your health plan may not provide coverage, or pay for your medication.  The authorization requirements may vary depending on the carrier. Online drug lists often indicate which medications require prior authorization.  There are some medications that authorizations can be required for due to quantity limitations. If your doctor feels that it is appropriate for you to receive more or less of a medication, they will need to provide the insurance company with documentation. Some insurance plans also have a generic preferred requirement and if your doctor prescribes the brand name only, it may require a prior authorization. Certain medications may require prior authorization depending on the condition that it is being prescribed for. Medications are often approved for treatment of certain conditions; however, if your physician feels that another condition can be treated with a specific drug, they will need to provide the insurance company with that information. There is no guarantee that submitting the information for a prior authorization is going to ensure your insurance company will approve it. If a medication is denied, the insurance company may give suggested preferred alternatives or you, or your doctor can appeal their decision. Again, even with an appeal, there is no guarantee the decision will be overturned. Calling Member Services, the number on the back of your ID card, is the best place to start.  Also our Customer Care Team is available to help as your advocate, if needed.

Be sure to follow us for future post on medical pre-cert!

Anthem Care Comparison

How do you know what the costs of procedures are at different facilities within a certain area?  Anthem has a convenient and easy to use tool to compare facilities for your health care.  You can see a variety of sources about inpatient and outpatient services as well as cost and quality.  Please note, you must be an Anthem member to utilize this tool.

To use this tool, login to Anthem.com

Click on the Estimate Your Cost link on the bottom right side of the page.

Click on the Start Cost Search button.





If you have any questions, you can contact Anthem Member Services or you can contact the Customer Care Team for assistance.





Joint Township District Memorial Hospital and Hospital-Based Physicians Termed 4-13-12

This is to make Anthem members that utilize Joint Township District Memorial Hospital aware that as of 4/13/2012 this provider will no longer be in-network.  This is due to contract negotiations where a new contract could not be reached.  In addition to JTDMH, all hospital-based physicians have been terminated as of 4/13/2012 as well.  Attached is a list of these affected providers.  Since Anthem's website takes time to update, it may still show this hospital and these physicians as in-network.  Please contact Anthem member services at the number on the back of your ID card for help locating a network facility or physician for services.

JTDMH Physicicans Termed

Healthcare Reform and Anthem's Preventive Care for Women

As most of us know, there is change on the horizon.  Keeping you informed is one way to empower healthier living for you and your family.  Attached is a FAQ sheet from Anthem detailing how they will be covering preventive care for women after certain healthcare reform changes take place.  This particular article will be valid for palns starting on 8/1/2012 or later.


Women's Preventive Care