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HealthChoice Select is a program designed to reduce the costs of
select services by contracting with select medical facilities to provide these
services and bill HealthChoice for a single amount for all costs associated with
the service on the date the surgery or procedure is performed.
The program is available to members and their covered dependents
enrolled in the HealthChoice High, High Alternative, Basic, Basic Alternative,
and FOCUS Plans and the High Deductible Health Plan (HDHP). You do not register
for the program, but you must use a HealthChoice Select facility.
Since HealthChoice Select was implemented Jan. 1, 2016,
HealthChoice has received numerous questions about the program. Following are a
few of the more frequently asked questions and the answers to those
questions:
Q. I am on the HealthChoice Basic Plan. Will services received
under the HealthChoice Select Program count against my first $500 of coverage?
A. No.
Surgeries and procedures received as part of the HealthChoice Select Program do
not count against your $500 first dollar coverage.
Q. Do Allowable Fees for a surgery or procedure received as part
of the HealthChoice Select Program apply to my out-of-pocket maximum?
A. The Allowable Fees for select surgeries
and procedures are covered by the Plan at 100 percent so you do not have any
out-of-pocket expenses that would apply to your out-of-pocket maximum. HDHP
members must first meet their deductible before any benefits, other than for
preventive services, are paid by the Plan.
It is possible that the facility may not include services
received in conjunction with the surgery or procedure performed on a different
date in the bundled service type. Charges for these services are covered
according to Plan provisions, including deductible, copay and coinsurance,
which apply to your out-of-pocket maximum.
Q. How do I schedule a surgery or procedure at a HealthChoice
Select facility?
A. The steps you need to follow to schedule a
surgery or procedure with a HealthChoice Select facility are:
1. Determine a procedure is needed
2. Access the HealthChoice Select Search on the HealthChoice website to locate a Select facility
3. Contact the Select facility directly and:
a. Identity yourself as a HealthChoice member
b. Identify what surgery or procedure is needed
c. Ask for a contracted provider within the Select facility to perform the surgery or procedure
4. Contact the provider to request an appointment/consultation (copay may apply)
5. The provider’s office then schedules the procedure at the Select facility
Visit the FAQ section of the HealthChoice website for
more questions and answers on the HealthChoice Select Program.
For a list of services covered under the program and a list of
participating facilities, visit the HealthChoice Select Search on the website. If
you have questions, contact HealthChoice Member Services at 1-405-717-8780 or
toll-free 1-800-752-9475. TDD users call 1-405-949-2281 or toll-free
1-866-447-0436.
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As HealthChoice members, you are probably familiar with the term
fraud, waste and abuse, or you may be familiar with the acronym FWA.
Fraud, waste and abuse can directly affect the security of your
personal information. It can also have harmful effects on any health insurance
plan, like HealthChoice. In the fight against fraud, waste and abuse,
HealthChoice wants to share the bad news and the good news.
First, some bad news regarding fraud, waste and abuse.
Fraud is the most harmful aspect of fraud, waste and abuse for
any health insurance plan. The primary difference between fraud and waste or
abuse is intention. Fraud exists when an individual or organization knowingly
and intentionally executes, or attempts to execute, a scheme or scam intended
to obtain money or resources for which no entitlement exists. When an
individual or organization intentionally commits fraud, law enforcement
agencies frequently become involved since fraud is a violation of federal and
state laws. Examples of fraud include a doctor billing for services or items
not provided, a physician providing a service not covered under the plan but
submitting the claim for a procedure that is covered, or an individual using
another person’s insurance identification card.
Although waste can be the result of errors or “honest” mistakes
made by an individual or organization, it can still be the cause of a
substantial financial loss for your health insurance plan if it goes
undiscovered for any length of time. The potential for law enforcement becoming
involved in cases of waste is extremely low. An example includes a physician,
unaware of the generic alternative, consistently prescribing a higher-priced
medication instead of a less expensive alternative covered under the plan’s
formulary.
Abuse may be present when an individual or organization performs
actions that directly or indirectly result in unnecessary costs to the health
insurance plan. These actions include the operation of any provider’s health
care practice that is not consistent with the goal of providing medically
necessary health care services and do not meet professionally recognized
standards of practice. Examples include a doctor charging excessively for
services or items and billing for services or items that are not medically
necessary.
It is not uncommon for allegations of waste or abuse to escalate
into a fraud investigation if a pattern of intent is uncovered.
Now, the good news.
HealthChoice understands the effects fraud,
waste and abuse can have on your health insurance plan and has taken
the steps necessary to prevent and detect fraud, waste and abuse. The Plan
works diligently at being good stewards of your premium dollars and continues
to develop and implement a variety of methods to protect you and your
HealthChoice coverage.
If you become aware of potential fraud, waste or abuse,
HealthChoice wants to hear from you. The best way to contact us if you suspect
fraud, waste or abuse is calling the EGID Fraud Hotline toll-free at
1-866-381-3815. The EGID Compliance Unit investigates all reported fraud, waste
and abuse claims and works to resolve each case. EGID Compliance also makes
every effort to inform you regarding the results of the investigation once
completed and advise you of any actions taken by HealthChoice.
For more information about HealthChoice policies on fraud, waste
and abuse, we encourage you to visit the “Fraud, Waste and Abuse Compliance” page on the
EGID website.
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Each time a claim is processed, the medical claims administrator
issues an “Explanation of Benefits” (EOB). HealthChoice currently sends EOBs to
the primary member’s address, including EOBs for covered dependents. This could
disclose confidential health information to someone other than the covered
dependent.
To prevent the possible disclosure of sensitive health
information and better maintain patient confidentiality for these covered
dependents, effective Jan. 1, 2016, HealthChoice removed procedure code
information, including code numbers and descriptions, from EOBs for all
claims processed on or after that date. The certification administrator also
removed all procedure code information from its communications.
If you have questions regarding this change to your EOBs,
contact the medical claims administrator at 1-405-416-1800 or toll-free
1-800-782-5218. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160.
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Although the Zika virus disease has been in national and global
news since it first spread to South America in 2015, you may not be aware of
some of the facts about Zika or have misconceptions about the disease.
- The
Zika virus is spread primarily through bites from infected mosquitos but
it can also be spread from mother to unborn child, through sexual contact,
and through blood transfusion.
- Common
symptoms include fever, rash, joint pain and conjunctivitis (pink eye),
which are mild and can last up to a week. Because these symptoms can be
associated with other conditions, many people do not even know they have
Zika.
- There
is no vaccine, but once you have Zika, you are likely to be immune to
future infection.
- Pregnant
women are most at risk because infection during pregnancy is linked to
severe birth defects and impairments, including microcephaly, an
abnormally small head due to improper brain growth, which leads to brain
damage.
- Zika
has also been linked to Guillain-Barré Syndrome, which can be fatal,
expanding the risk of complications well beyond women of childbearing age.
- Prior
to 2015, reported outbreaks of the Zika virus occurred only in tropical
Africa, Southeast Asia and the Pacific Islands. Since then, many other
countries have reported outbreaks.
- Currently,
there are nearly 400 U.S. mainland cases of Zika virus disease reported –
all associated with travel. The southern U.S. is at higher risk for local
transmission of the Zika virus than other parts of the country due to its
warm, humid climate and mosquito population.
In February 2016, the World Health Organization (WHO) declared Zika a Public Health Emergency of
International Concern. Since there is no preventive vaccine or
treatment for Zika, the key focus of the WHO and other scientific experts is
prevention.
Avoid areas of risk. Protect yourself from mosquitos if you do
travel to a high-risk area. Talk to your doctor if you are pregnant or could
become pregnant and plan to travel to an area where the Zika virus is
spreading.
The Centers for Disease Control and Prevention (CDC) website at www.cdc.gov
has more information about Zika. Visit their Zika Travel Information web page for more
information on areas to avoid.
Source: CDC.gov
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Did you name a beneficiary when you enrolled in the HealthChoice
Life Insurance Plan? Maybe you did but need to update your beneficiary
information.
Every spring, we check our files to ensure we have a
“Beneficiary Designation Form” for every member
enrolled in the Life Insurance Plan. As a courtesy, if it appears there is no
form on file or the form on file was completed many years ago and may need to be updated, HealthChoice mails a letter along with a blank form requesting
the member complete and return the form. This helps ensure your life insurance
benefits are paid as you intend them to be.
Please be aware, if there is no beneficiary on file with
HealthChoice at the time of your death, payment must be made to your estate.
Also, if your beneficiary information is not current, payment of life benefits
can be delayed. For example, when addresses or names are not current, it is
difficult for HealthChoice to locate your beneficiaries.
You can update your
beneficiary information at any time by sending a written request or completing
a new “Beneficiary Designation Form.” You can obtain
a form from the HealthChoice website, your employer, or by calling
HealthChoice Member Services at 1-405-717-8780 or toll-free 1-800-752-9475. TDD
users call 1-405-949-2281 or toll-free
1-866-447-0436.
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