Most health insurance plans offer you resources, tools and even savings on retail items. For example, you may get perks to help you save time and money, lose weight, quit smoking and even get discounts at retail stores. Here you'll find some helpful tips for making your health insurance plan work for you.
Making the Most of Your Medical Benefits
Medical benefits are probably the number 1 reason you chose to get health insurance. Here are a few simple things you can do to get the most out of your benefits.
- Stay in the network. Most health plans have worked with doctors, hospitals and other health care experts to get discounts for in-network care. That often means lower out-of-pocket costs to you.
- Use the ER for emergencies only. Real emergencies call for a trip to the closest emergency room (ER). But you can usually save money on your copay by going to your primary care provider (PCP) for colds, minor sprains and other less serious health issues.
- Follow your doctor's orders. Be sure to take any medicines, treatments or therapies your doctor suggests. That way you can get better quickly and avoid extra costs.
- Use generic drugs. Generic drugs cost less than brand name drugs and offer you the lowest available copay. Generic drugs often have the same ingredients and work the same as the brand-name option.
- Use freestanding medical service facilities. You can usually lower medical costs by scheduling lab work, imaging and other outpatient services at freestanding medical service facilities instead of a full-service or general acute care hospital.
- Know your coverage. Make sure services or treatments are covered before you plan your next doctor's visit. Knowing this ahead of time can save you money.
- Do an "annual check-up" of your health plan. Make sure your plan still meets your needs. This is even more important if you had any major, life-changing events in the past year, such as getting married, having or adopting a child or having a dependent turn 26 and leave your plan.
Use Your Member Perks
Most health plans offer useful tools to their members. To get the most from your plan, take full advantage of these perks:
- Get online. We offer a secure member website, Blue Access for MembersSM, where you can check the status of claims, review benefits information, find a doctor and much more.
- Take advantage of programs. If your plan has free health screenings or wellness programs, use them to better your health. For example, some have programs to help you lose weight and quit smoking with no extra cost to members.
- Learn how to be healthy. We have information to help keep you and your family healthy. Sign up for newsletters, read articles online or find health and wellness tips.
Use Blue Access for Members
Blue Access for Members is the best way to get the most from your plan. With this secure members-only website, you can:
- Manage your account online
- Take a health assessment to get personalized wellness tips
- Check the status of claims and set-up email alerts
- Order a new member ID card and print a temporary card
- Look into our special, members-only discounts and offers from health and wellness companies
Understanding Provider Quality
We offer performance data and quality feedback for doctors, hospitals and more to help you make health care choices for you and your family. Be sure to follow your doctor's advice for getting care and check whether your plan covers those services and treatments.
If there is no performance data for a doctor or provider, that doesn’t mean that they’re not following the standards of care. There might not be a way to measure their performance yet, or maybe there isn't enough data to review.
Hospital Quality Measures – Process of Care Measures and Outcome of Care Measures
The Centers for Medicare and Medicaid Services (CMS) follows a standard set of performance measures for recommended hospital care for these 5 conditions:
- Heart attack
- Heart failure
- Surgical care improvement and infection prevention
- Pediatric asthma
Hospitals are encouraged to report their quality of care information for these 5 medical conditions. Reporting is voluntary, but it’s linked to the payments hospitals get for treating Medicare patients.
Each hospital is given an overall score and detailed benchmark scores for each of the quality measures. The detailed benchmark scores include the national average hospital compliance and the top hospitals' compliance for each of the measures. (The top hospitals are the top 10% of hospitals nationwide.)
Process of care measures include quality measure sets for each of the conditions listed above.
Outcome of care measures are the 30-day rates for death and readmission to the hospital. They’re tracked for these categories:
- Heart attack
- Heart failure
Blue Distinction Centers
Blue Distinction is a title given by the Blue Cross and Blue Shield companies to medical facilities that have shown expertise in delivering quality health care. The awarded title is based on strict, evidence-based selection guidelines chosen by leading medical specialists and professional organizations.
To earn this title, a facility's overall experience and total data must meet the criteria formed by expert clinicians and leading professional organizations.
Blue Distinction Centers+SM are hospitals recognized for their expertise and efficiency in providing specialty care. Quality is key: to become a Blue Distinction Center+, a facility must first meet all the quality requirements for a Blue Distinction Center before cost will be decided.
Health Care Centers of Excellence
Health Care Center of Excellence is a designation awarded to HMO and HealthSelect facilities that have shown expertise in delivering quality health care. The designation is based on rigorous, evidence-based selection criteria formed by leading medical specialists and professional organizations.
To earn this designation, a facility's overall experience and total data must meet criteria formed by expert clinicians and leading professional organizations.
Health Care Centers of Excellence are hospitals recognized for their expertise and efficiency in delivering specialty care. Quality remains key: to qualify as a Health Care Center of Excellence, a facility must first meet all of the quality requirements for a Blue Distinction Center before cost will be evaluated.
BlueCompare for Hospitals
To learn about the care a hospital provides, BlueCompare gets information from the claims hospitals send to external reporting agencies, such as CMS. This data is used to measure and compare hospitals' performance and affordability in providing care.
We measure performance and affordability only for general acute care hospitals--not for specialty hospitals like children's, mental health, or rehabilitation facilities. Hospitals that are given the BlueCompare symbol(s) have met or went beyond expected performance and/or affordability measures when compared to other hospitals.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national, standardized survey. It’s sent to a random sample of hospital patients 18 years and older within 48 hours to 6 weeks after being released from the hospital. The survey includes 10 questions about a patients' view on important measures of care. The HCAHPS results can help you compare patients' experiences at different hospitals and against state and national benchmarks.
The survey includes information about these hospital patient experiences:
- Communications with nurses and doctors
- Responsiveness of hospital staff
- Pain management
- Communication about medicines
- Discharge information
The survey also includes questions about:
- Cleanliness of the hospital environment
- Quietness of the hospital environment
- Overall rating of the hospital
- Their willingness to recommend the hospital