New Blue Cross partnership with U-M, Michigan hospitals aims to clear risk of blood clots in patients

Colloquially speaking, venous thromboembolism may not be much of a conversation starter. But the medical condition more commonly known as the blood clot plays a key role in driving up medical costs and preventable deaths in the U.S.

That’s why the Blues are partnering with the University of Michigan Medical Center and 16 other hospitals to reduce the risk of blood clots in hospitalized patients. It’s the latest of our ongoing efforts to improve patient care across the state.

Hospitalized patients have a higher risk of developing blood clots due to surgery, prolonged periods of immobility, use of certain medications and the presence of other conditions like obesity or congestive heart failure. Patients who develop VTE while hospitalized tend to experience longer hospital stays, poorer clinical outcomes and various ongoing complications.

Biggest Loser: Detroit Edition II contestants to be revealed Monday, Aug. 30

Blue Cross Blue Shield of Michigan is teaming up with WDIV-TV and The Parade Company to announce participants in The Biggest Loser: Detroit Edition II.

The six Biggest Loser: Detroit Edition II finalists will be revealed during the WDIV newscast on Monday, Aug. 30, beginning at 4 p.m. During the announcement, BCBSM President and CEO Daniel J. Loepp will be interviewed by Chuck Gaidica during the 5 p.m. newscast.

This year, 310 people entered the contest. That’s 100 more applicants than last year. The applicants were narrowed down to 60 who were called back for audition interviews. From there, the final six were chosen.

Health insurance 101: Explaining hospital charges and patient costs

[Eighth in a series of posts to help you better understand health insurance and how recent changes affect you.]

If you’ve ever glanced at an Explanation of Benefits form, you know that it contains a confusing array of dollar figures, all for the same medical procedure.

The often wildly divergent figures illustrate how the modern health care system works.

For the sake of illustration, let’s say you go to the hospital, where you receive an outpatient colonoscopy procedure. And let’s say the hospital charges $2,000 (not necessarily a true average charge, but let’s use it for our purposes here.)

But “charges are not the same as cost,” as Ellen Ward, a project manager in Hospital Contracting and Policy for Blue Cross Blue Shield of Michigan, points out. “Charges are typically much higher than the total cost of providing a service.”

Health insurance 101 – How to read your Explanation of Benefits ( EOB)

[Seventh in a series of posts to help you better understand health insurance and how recent changes affect you.]

Many people find their Explanation of Benefits statements difficult to understand or confuse them with a bill.

Different insurers use different terms and formats, so you should direct specific questions to your insurance company. But here’s a general guide for how to make sense of your EOB:

Health insurance 101 – A glossary of common insurance terms

 [Sixth in a series of posts to help you better understand health insurance and how recent changes affect you.]

 

Confused about health insurance? You’re not alone.

 

The health care industry is a highly regulated, complex delivery system with multiple stakeholders, including you as a consumer and the insurance plan that helps you pay for care. And in an era when costs are rising, insurance plan benefit designs are changing and health care reform heralds big changes, it’s not easy staying informed.

 

To help you make better sense of the intricacies of your insurance plan, we’ve put together a reference glossary and explanation of health insurance basics. You can also check out our companion posts exploring emerging trends and products in health insurance.

 

What is a health insurance premium?

 

A premium is the amount that an individual policy-holder or, if you have coverage through your job, your employer pays to a health plan each month to purchase health coverage.

 

What’s a deductible?

 

A deductible is a fixed amount that a subscriber (the person who is covered by the insurance plan) is required to pay each year toward his or her medical services before the insurance company will begin to pay for services.

 

For example, if the insurance company specifies a $250 annual deductible, the subscriber must pay for medical services until that amount reaches $250 for the year. Then, the insurance company will begin to pay a portion of the costs.

 

The use of deductibles reduces the cost of premiums by sharing some of the risk with subscribers. It also helps predict the overall expected costs for a group.

 

What is a copayment?

 

A copayment is either a fixed dollar amount or a percentage paid by the subscriber for medical services. Once a subscriber pays an agreed-upon copayment, the insurance carrier pays the balance.

 

For example, the subscriber pays 25 percent of the total cost for services, and the insurance carrier pays the remaining 75 percent.

 

The use of copayments reduces overall expenses for insured groups because the subscriber is sharing costs. It also gives the subscriber an incentive to use fewer services, one factor contributing to health care cost inflation.

 

What is coinsurance?

 

Coinsurance is a provision by which an insured individual shares in the cost of certain expenses; sometimes the term is used interchangeably with copayment.

 

At Blue Cross Blue Shield of Michigan, we use the term copayment to designate flat dollar amounts, while coinsurance refers to percentage amounts. For example, if a person is responsible for a percentage of a particular charge, it is considered coinsurance.

 

What is an Explanation of Benefits, or EOB?

 

An EOB is a statement mailed to a subscriber or insured individual explaining how and why a health insurance claim was or was not paid. There are various types of EOBs, but all have the same general format and contain the same claim information. An EOB is not a bill. Your care provider (doctor, hospital, clinic, etc.) will send you a bill.

You can also find a comprehensive glossary of health care terms on our corporate website.

 

Next week: How to read your EOB.

 

See also:

• Health insurance 101: Rising health care costs
• Health insurance 101: Costs influence plan designs
• Health insurance 101: Consumer-directed plans
• Health insurance 101: Rewarding wellness
• Health insurance 101: Health savings accounts

Blue Cross proposal protects Michigan’s most vulnerable seniors, while giving all seniors deep discounts on Medigap coverage

Blue Cross Blue Shield of Michigan filed a proposal with our regulators today that would provide Michigan seniors with monthly discounts of $48, $64, $75 or $96 off the full price of our most popular Medicare Supplemental insurance plan, also known as Medigap.

Medigap is optional insurance that pays for many of the out-of-pocket costs that are charged when seniors visit the doctor or hospital.

The annual dollar value of the BCBSM Medigap discounts would be $576, $768, $900 or $1,152. The variations are based on seniors’ income – with those who have the lowest income getting the biggest discount on their health care.

BCBSM is the only insurer in Michigan that provides a discounted Medigap product. BCBSM is assessed 1% of our total revenue by the state every year to fund the discounts. This assessment totaled more than $180 million in 2009.

Providing discounts based on income is a change from how discounts are applied today. Currently, discounts offered by BCBSM are applied evenly across our Medigap subscriber base. Seniors who earn six-figure incomes receive the same break on their Medigap policies as do low-income seniors who depend on Meals on Wheels for the nutrition they need to remain independent.

With the cost of health care rising, BCBSM is concerned about some low-income seniors not being able to afford Medigap – even with the hefty discount we provide.

In fact, under this new approach, low-income seniors would receive a $16 monthly reduction in their Medigap premium. Almost nowhere in the nation are health insurance premiums going down. We can make it possible by realigning our discounts to give a greater share to the lowest-income.

When you squeeze the balloon like that, you reduce the discounts provided to the middle- and upper-income seniors. This has the affect of increasing their monthly premiums.

But we believe that Michigan will support providing a little extra help to poor seniors – and we ask our Medigap members for their support as well. If you are enrolled in our Medigap Plan C and earn between $32,000 and $85,000 a year, your premium will be about $15 a month higher. That’s about 50 cents a day that you are investing in keeping health care within reach for someone your age that is getting by on less than $16,245 a year.  And your overall discount will still be significant – $64 every month, or $768 a year.

BCBSM will continue to provide deep discounts to all Michigan seniors who independently enroll in our Medigap plans. We are asking for your support to provide a little extra help to those seniors who need it most.

Andrew Hetzel

BCBSM Vice President, Corporate Communications

2nd Annual Buy Michigan Now Health Festival

Blue Cross Blue Shield of Michigan presents the 2^nd Annual Buy Michigan Now Festival in downtown Northville Friday, August 6.  The event supports health and wellness and the growth of Michigan business.

The 3-day festival features sidewalk sales, children’s activities, and Michigan-based businesses and Michigan-made products. Dieticians will be on site to answer questions and offer free blood pressure screenings, nutritional consultation, and fitness demonstrations.

Paul W. Smith from WJR is broadcasting live at the event discussing the importance of a healthier Michigan and growing Michigan based companies. The broadcast event will encourage people to ask questions and share stories about Michigan business and the local community.

To join the conversation on creating a healthier Michigan, visit ahealthiermichigan.org.

Health insurance 101: Health savings accounts help consumers fill gaps in coverage

[Fifth in a series of blog posts to help you better understand health insurance and how recent changes affect you]

As we’ve noted throughout this series, consumers are shouldering more responsibility for their own health care spending. New consumer-directed health plans incorporate tools to ease the burden and help individuals make smarter decisions regarding their care. One way is through health savings accounts.

An HSA allows you to pay for current health care expenses not covered by your high-deductible health plan and save for future ones, all on a tax-free basis. The account is funded by the employee, the employer, or both, but the account is owned by the employee. Leftover balances can be rolled over from year to year.

Pairing an HSA with a high-deductible health plan, which generally doesn’t cover the first several thousand dollars of your health care expenses, can be a smart way to go for some. Withdrawals are tax-exempt when used to pay for qualifying medical expenses, and contributions to an HSA reduce your taxable income.

Money used to pay for nonqualified expenses, however, is subject to a 10 percent tax penalty, an amount that rises to 20 percent after Dec. 31, 2010. A partial list of qualified medical expenses is available on Publication 502 at irs.gov.

When you set up an HSA, you determine your annual contribution. You can estimate these needs by:

• Reviewing your eligible expenses from the previous year
• Determining how your upcoming expenses may differ from the previous year

For 2010, your contribution cannot exceed the maximum of $3,050 for individual coverage or $6,150 for family coverage. A variety of other rules apply, but money not used during the year rolls over to the next year and can earn interest tax-free. You can also place your unused funds in a longer-term investment through the bank that administers your HSA.

You can contribute money directly, through deductions from your tax return, or via withdrawals from your 401(k) or other retirement plan. Employer contributions are not subjected to payroll taxes.

The use of health savings accounts has risen dramatically since being introduced in 2004. The ranks of Americans who supplement their health plans with HSAs was expected to rise as high as 45 million by 2010, from 438,000 in late 2004.

Next week: A glossary of health insurance terms

WalkyTalk.com is full of inspiration, motivation and conversation

Blue Cross Blue Shield of Michigan’s walking and healthy habits advocate Jodi Davis wants you to start living a healthier life. Why? Because she did and you can, too. Jodi lost over 160 pounds and has kept it off for nearly 8 years. Her secret? Walking and eating right.  

Jodi has been BCBSM’s walking advocate since 2007 – and she is still just as passionate about helping others start a walking regimen and stay away from unhealthy foods.  Take a look at this excerpt from Jodi’s recent blog :

“I’m here to help you “step-by-step” along your weight-loss journey.  I am that person who believes you can do this… that you WILL do this!”

You can read Jodi’s blog on WalkyTalk , where Jodi shares thoughts, stories, articles, photos and more. Check out the blog and leave Jodi a comment – she would love to hear from you!

Search for WalkyTalk.com on Facebook and look for Jodi on twitter at twitter.com/WalkyTalkJODI.