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.

Helpful Hints for HSA's

Due to an increase in our calls lately on this subject, our team felt like it might be helpful to provide an explanation for HSA's (Health Savings Accounts). Understandably, this is a confusing topic and knowing how to navigate your benefits is important so the maxiumum outcome can be achieved.

A HSA is a tax exempt savings account whose funds:

1.  Are not subject to federal income tax at the time of deposit.
2.  Roll over and accumulate year to year if it is not spent and is yours to keep if you leave employment.
3.  The money can only be used to pay for qualified medical and prescription expenses at any any time without federal tax liablility or penalty.

It is important to remember that the HSA:
1.  Is a bank account.
2.  It cannot have funds withdrawn without your permission from the carrier; however, if you leave your card information on file with a provider, they may automatically run it.
3.  It can be subject to overdraft fees.
4.  They do not communiate with the carrier or vice versa.
5.  It is not the same as your deductible.

If you have any questions, please contact Member Services on the back of your ID card or you can call the MB Customer Care team for assistance.

Can my doctor ask for money before services?

With the popularity of high deductible health plans, it is becoming a common practice among many facilities and doctors to ask for money upfront before surgery and other higher cost procedures.  Many doctors have had problems of never receiving payment by members and this has led them to take payment in advance.  Unfortunately, our customer care team and your insurance carrier cannot stop this from happening.  The biggest issue with this is that you may have multiple claims pending and you can end up paying the provider too much once the claims have processed.  If you paid your provider in advance and met your deductible before that specific claim processed, the provider should owe you a refund.  If you have already met your deductible or out of pocket max or are very close to meeting it and your provider is trying to collect a larger amount than what is left, let your provider know and try to have the amount adjusted. If the provider does not budge our customer care team can try to verify with your carrier where you are on your deductible and out of pocket max and try to confirm with the provider what is left and the amount they can collect. If you do pay in advance, be sure to know what you pay in advance and make sure you do not pay the amount again when you receive a bill. 

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)