spring 2010 Free Yourself Tips for living without back pain - Log on to live healthier - Diabetes do s and don ts - How to appeal a claim best friends enjoying Idaho's city of rocks one TO one newsletter for members
ONE TO ONE Welcome to Our Commitment At Blue Cross of Idaho, we take a special interest in all our members. That s why we ve been providing health insurance for more than six decades. During this time, we ve demonstrated a long-standing commitment to serving our clients one that is supported with a comprehensive range of plans and valuable resources that help simplify the more complex aspects of health insurance. This very publication is presented to you as a tool to help you manage your health and control your spending on healthcare services. We hope you find this issue to be informative and useful, and that you see this publication as a tangible reminder that we re committed to providing smart, cost-conscious coverage. Good To Know: If you re looking for a provider, start with our online directory. You can search by specialty, location and insurance type. Go to and click Find a Provider from the Resource Center. = term to learn Out-of-Pocket Maximum A fixed dollar amount that is the most you will pay for deductibles and coinsurance for most covered services in the course of a benefit period (typically a year). Once the out-of-pocket maximum is met, most covered services are paid at 100 percent of the allowed amount. blue cross of idaho 2
Do You Have Diabetes? Our disease management program helps you control the condition successfully. If you ve been diagnosed with diabetes, you re not alone. Roughly 76,000 adults in Idaho and 23.6 million across the U.S. report having the condition. Among these people, about 20,000 are Blue Cross of Idaho members who have benefited from our diabetes disease management program. How It Works When you re enrolled in the program, you ll get reminders about screening and tests. We ll help you understand and follow your physician s recommended treatment plan. You ll also get information and encouragement to help you manage your blood glucose levels, weight, cholesterol and blood pressure. We ll help you learn how to make positive health changes. Items such as blood glucose monitors and test strips, lancets and glucose control solutions are usually covered for members with diabetes. (Please check your benefits for specific coverage.) And members at risk for diabetes may find that fasting plasma glucose tests are covered, too. How to Learn More For more information about the diabetes management program or our disease management programs for low back pain, heart disease and asthma, call Blue Cross of Idaho at 208-387-6924 or 800-627-1187, extension 6924. Or visit and select Disease Management under the Health & Wellness tab. = consumer tip Save Your Money These days, we re all looking for ways to save money. There are many ways you can save money on medical costs without compromising quality of care. Here are two to get you started: Visit your doctor and follow any instructions you receive. You ll get the most out of healthcare services if you follow through on prescribed treatments and medical advice. Carefully review forms and documents. Check the explanation of benefits (EOB) forms you get to make sure they include procedures, services and equipment that you received. Call Blue Cross of Idaho if you find a mistake. medication update Blue Cross of Idaho encourages the use of generic drugs as a safe and often less costly alternative to brand-name drugs. The brand-name drugs below have recently been released in a generic form. For a complete listing of medications on our formulary, visit /Prescription Drugs. Brand Name Generic Name Medication Use Mirapex Pramipexole Parkinson s Disease Flomax Tamsulosin Men s Health blue cross of idaho 3
The Secret to Back Pain Relief Here s a hint: You won t find it in bed. Most people don t realize that lying down for too long can make back pain worse. Sitting can make it worse, too. Doctors used to prescribe rest, but it turns out bed rest really isn t best. So, if you ve hurt your back, be as active as you can. Staying in bed for more than one or two days can weaken your muscles and make the pain worse. Being active helps you stay flexible and strengthens your back. That helps you heal. Keep Moving Walking may be the best exercise for your back. If you can, walk for 10 to 20 minutes at a time every two to three hours. Walk on level surfaces, not on hills or stairs. Walk quickly, and swing your arms as you move. blue cross of idaho 4
Take Care While You Heal Here are four tips that can help: - Use your bed only for lying down. Don t sit up to read or watch TV in bed. - Sit on firm seating. Look for chairs with armrests for getting up and down. - Keep your back straight when moving into a lying-down position. - Take breaks when sitting for a long time. Get up and walk around, or lie flat to gently stretch your back. Back FAQs Find answers at the online Back Pain Center! Q Will exercise help you heal? A Some simple moves can help. You ll find illustrated examples of exercises that can help relieve pain and strengthen your core. Help Is Here: The Back Pain Center Most back pain heals on its own with time, medicine and activity. But you don t have to do it alone. Visit our online Back Pain Center, where you can find interactive tools and information like quizzes, videos and case studies. Q How do you prevent pain in the morning? A Learn tips for sleeping and how to protect your back. Q Do heat, ice and medicines help? A Depending on your individual symptoms, effective remedies do exist. Visit the Back Pain Center at /BackPainCenter to find the support you need. blue cross of idaho 5
Appeals and Complaints It s in your rights to appeal a claim. Here s how. There may be a time when you disagree with a claim decision Blue Cross of Idaho made. If so, you have the right to appeal that claim decision. Just follow the steps outlined on the back of every explanation of benefits (EOB) you receive. The information on the EOB tells you to write a letter stating the reasons you believe our claim decision was incorrect. Include comments, documents, medical records or other relevant information with your letter. You should also request copies of any guidelines or documents Blue Cross of Idaho used to make our decision. Send your letter and all documentation to the Appeals and Grievance Coordinator no later than 180 days after you received your EOB, using the following address: We will mail you a decision within 30 days from the day we receive your appeal. You or your authorized representative may request copies of all documents related to this appeal at no charge. In Idaho, after exhausting the Blue Cross of Idaho appeals process, you may contact the Idaho Department of Insurance and request an external review of health claims denied for medical necessity or as an investigational service or supply. This option applies to covered plans issued or renewed on or after Jan. 1, 2010. * * Check with your plan administrator to make sure your coverage qualifies for external review. Appeals and Grievance Coordinator Blue Cross of Idaho PO Box 7408 Boise, ID 83707 We can help you: If you have questions or concerns about a claim or information about your EOB, please call the telephone number listed on your Blue Cross of Idaho ID card. blue cross of idaho 6
Assess Yourself Four ways to improve your health while sitting at your computer. Visiting your doctor regularly is the best way to keep tabs on your total health. But Blue Cross of Idaho also offers online, interactive questionnaires that help you assess and manage your health on your own time, too. First, there s the Health and Well-being Assessment. It s free and you can take it in about 10 minutes. After you answer some simple questions about your health, nutrition, physical activity and other aspects of your lifestyle, you ll receive a detailed report. The report provides feedback about all the ways you re doing a good job taking care of yourself. It also highlights areas that need some improvement, along with recommendations tailored to your needs. Once you ve taken the assessment and reviewed your report, talk with your doctor. Plan on retaking the assessment on a regular basis to track your progress and stay motivated. You ll also find other assessment tools on, including these: - Sleep: Are you getting enough rest? Learn how to improve the quality of your sleep, such as adjusting when you eat dinner or making your bedroom more calming. - Stress management: Identify sources of your stress and learn practical strategies for reducing anxiety. - Nutrition: Answer a few questions about your diet and you ll receive tips for improving your eating habits. Go Online to Get Started Today You ll need to register to take advantage of the interactive tools offered on. All it takes is four easy steps: 1. Go to and select Register Now! on the left side of the screen. 2. On the landing page, select Member. 3. This takes you to the registration page. Enter information from your ID card and create your username and password. 4. Once you ve registered successfully, Blue Cross of Idaho will send you a confirmation email. Log in and access all the tools, information and health assessments available to registered members. blue cross of idaho 7
A Lifetime of Healthy BONES Bone loss can cause pain and contribute to loss of independence. To keep your bones healthy, it s important to understand two conditions: osteopenia and osteoporosis. Osteopenia is defined as having lower than normal peak bone mineral density (BMD). This pre-osteoporosis condition affects 34 million Americans, and is more common in people over age 50 who have below average BMD. There s good news about an osteopenia diagnosis: It means bone loss has been caught before progressing to osteoporosis, a more serious condition. Osteoporosis is characterized by low bone mass, which leaves bones susceptible to fractures. It affects more than 10 million Americans and has no symptoms in its early stages. Most people don t even know they have osteoporosis until a bone breaks. You can t feel your bones getting weaker, but you can prevent bone loss and talk to your doctor about getting screened. These four tips from the National Osteoporosis Foundation can help: - Get the recommended amount of calcium and vitamin D. - Stay physically active and include weightbearing exercise in your daily routine. - Avoid smoking and drinking alcohol. - Have a bone density test and take medication, if it s appropriate for you. 3000 E. Pine Ave. Meridian, ID 83642 PRSRT STD U.S. POSTAGE PAID One to One ID Published by McMurry. 2010. 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. McMurry makes no endorsements or warranties regarding any of the products and services included in this publication or its articles.