Medical Benefits and Contacts

Blue Cross/Blue Shield of SC website for members

BC/BS of SC Members web page (Use this link to access all your questions about your BCBS coverage and/or your Explanation of Benefits statements; to find providers in SC, Nationwide, or worldwide; or to file a claim.

The procedure is a little convoluted, and the following explanation may help:

1. When you go to the BCBS member web page (link in the above paragraph), you will need to click on the "My Insurance Manager" tab on the left-hand side column of links.

2. Fill in your user name and password (first time users will have to register, and the link is over on the right-hand side at the top of the page) and select either the "Health" or "Dental" button, depending upon what coverage you are asking about.

3. On the page that then appears, at the upper left-hand side click the "Claims Status/Explanation of Benefits" link.

4. Select the time period for the claim you wish to examine (e.g., last 3 months, or last 6 months).  When the claim list appears, select one to examine.

5. When the claim finally appears (unfortunately, the BCBS website is quite slow), near the bottom of the page there is a line that says, "Check your Explanation of Benefits (EOB)." CLICK THIS LINK.  That finally takes you to the EOB statement which has the information that you are looking for.  Note that you will have to scroll the EOB page to see all the information on it.  If the link to the EOB is not there, either contact Customer Service at Blue cross or retry the website in a few days.  It takes several business days after a claim is processed for the EOB to be added.

Please note that the BCBS website will automatically log you off if there has been no activity on a page for several minutes.

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• Sign on to " southcarolinablues.com"
• Select the blue colored category identified as Member
• Login to My Health Toolkit
• Provide your individual user name and password and select enter
• On next page, under Quick Links select Health Eligibility and Benefits
• On upper right side of the health eligibility & benefits page select: View your benefits and coverage information

A table of contents is provided which houses the coverage provided by the SRS Health Care Plan

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How to Use the Caremark Website for Prescriptions

In January, 2010, a new method of obtaining our prescription drugs was initiated.  Our Health Care Provider (Blue Cross Blue Shield) introduced a mail service pharmacy (Caremark).  Below is a procedure outlining the steps to help simplify your efforts in using this option.

1) Go to : https://www.caremark.com/wps/portal

2) Along the left side, click on the link to “Register Now”.

3) Fill in your personal information and click “Continue”.

4) Choose a Login Name and password. Click “Continue”.

5) Once you are “logged in”, you should be on a page where the left hand column under LOGOUT lists: Refill by Mail, Check Order Status, etc.

6) Refill by Mail should be used when you or your doctor have submitted a prescription that has refills. You can also sign up to have your prescriptions refilled automatically.

7) For New Prescriptions click on the link and follow the instructions depending on the option you choose, CALL US, and ASK YOUR DOCTOR TO CALL US (800-370-5697), or MAIL IN PRESCRIPTION. You can also ask your doctor to FAX a prescription into Caremark (1-877-278-0328).

8) The Check Drug Cost  option allows you to compare prices between Caremark and your local pharmacy. Enter your drug, the drug strength; select a local pharmacy, and click, “Continue”. It will display the Caremark cost and your local pharmacy’s cost.

9) My Prescription Plan defines our plans benefits and where you stand on the deductibles.

10) The Savings Center  lets you compare drug purchase options and the resulting costs.

11) FastStart>  is the best way to order a new prescription.

12) Contact information (supply email address, phone numbers) allows Caremark to contact you if necessary.

13) Set My Alerts>  lets you choose what you want to be notified about and how Caremark should notify you.

You can also contact Caremark for help at (800-552-8159), or email customer service at: https://www.caremark.com. For questions about the website or your account (800-378-9442), or to discuss specialty drugs (866-814-5506).

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Here are some contacts at SRS for help with Medical Coverage questions. They are listed in the order that SRS-HR prefers you to use: that is, start with the Service Center and, if you need further help, go to the next contact on the list.

Life, Health, Dental

• SRNS Service Center (intended to be the first contact for most HR questions):
  
               803-725-7772 (Local Area SC, GA),
          or  800‑368‑7333 (Toll-Free long distance)
  
          or send an email to Service Center
  
          or send a letter to the following mailing address:

  SRS SRNS Support Service Center
  Savannah River Nuclear Solutions L.L.C.
  SRS Building 703-47A
  Aiken, SC 29808

• Susan P. Danne: 803-725-8596, or email Susan Danne
  
• Cindy McClintock: 803-725-7004, or email Cindy McClintock

Currently, a Benefits Overview and General Information Summary Plan Description is located at Site Contractor Retiree Benefits page, (click on the "Medical Tab").  Unfortunately, the Plan is dated 2007.  An updated Plan was anticipated to be available in Dec. 2010, but . . .???

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We have been informed by SRNS that, "The Prescription Safety Glass program has been discontinued for retirees. In addition to this change, employees are no longer able to purchase items for personal use from Medical Services. Prescription safety eyeglasses and eyewear are provided to actively working employees who are routinely exposed to hazards requiring eye protection."

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Toll-free telephone: (800) 325-6596.

Option 1 for Medical
Option 2 for Dental
Option 3 for Pre-Cert/Med Authorization
Option 0 for Customer Service Representative

BlueCross/BlueShield has 6 customer service reps dedicated to SRS. The recorded message on this toll free line is rather long, but it has an opt out option and you can press "0" at any time to talk to a customer service rep. If you stay on the line and don't press anything, it will automatically route to a customer service rep.

The mailing address is:

BlueCross BlueShield of SC
PO Box 100300 AX-D30
Columbia, SC 29202-3300

Contact Gari Howard, who is the BCBS dedicated customer service representative for SRS.

Gari Howard's contact information is as follows:
Toll-free Telephone: (800) 868-2500, ext. 45805
FAX: (803) 870-8492.
Email: Gari.Howard@bcbssc.com

or go to

BCBS My Insurance Manager for Members   and log in there.

Contact the SRS/BCBS liaison:

Kaye Bozeman
Marketing Service Representative
I-20 at Alpine Rd AV-100
Columbia, SC 29219
Telephone: (803) 264-4452, or
Toll-free: (800) 288-2227, Ext. 44452
FAX: (803) 264-9353
Email: kaye.bozeman@bcbssc.com

or the SRS Supervisor:

Clarissa Dickerson
Supervisor, Major Group Customer Service
Telephone: (803) 264-5199, or
Toll-free: (800) 288-2227, Ext. 45199
FAX: (803) 870-8029
Email: Clarissa.Dickerson@bcbssc.com

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When retirees were no longer able to obtain annual physicals at the Savannah River Site, the SRS Retiree Association negotiated with SRS and Internal Medicine Partners of Augusta, GA, to receive an annual physical for only the co-pay expense. The remaining cost is covered by the SRS BCBS medical plan.

Please be advised that our current Site health plan only pays up to $250 for these physicals. Internal Medicine Partners has not been able to keep the physical costs at $250. Any expenses incurred which exceed the $250 are currently the responsibility of the retiree to pay. If you continue to use Internal Medicine Partners, it would be advisable to inquire what the cost of the physical will be depending on the procedures your having done, i.e. X-rays, blood work, etc….

As of 3/15/10 Internal Medicine Partners is no longer affiliated with University Hospital. As a result they are no longer in-network providers within BCBSSC. However, Internal Medicine Partners is an in-network provider with BCBS of Georgia and can submit their bills through BCBS of Georgia who will in turn transmit the bills to BCBSSC so that correct in-network payments can be applied.

Members who have had problems with correct payment of their annual physicals and other services provided during their annual physical since 3/15/10 should contact Internal Medicine Partners to have their bills resubmitted for corrected payment.

Please contact:

Internal Medicine Partners
3121 Peach Orchard Rd
Augusta, GA 30906

Telephone: (706) 792-5075

As of January 1, 2011, individuals who have been on Medicare Part B longer than 12 months, can get a yearly wellness exam from a physician who will accept Medicare payment. Detailed information related to this can be found on page 39 of the 2011 Medicare and You.

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In the complex world of getting reimbursement for your Health Care expenses, the following Helpful Hints will help you get the correct insurance reimbursements due you under the SRS Health Benefit Plans.

In general, Blue Cross/Blue Shield (BC/BS) won’t consider your claim for payment until they have the related Medicare Summary Notice (MSN). Most providers will file Medicare for you. In case they don’t or won’t, it is up to you to file for Medicare payment, even if the amount to be paid by Medicare is zero or small, because BC/BS won’t consider your claim unless they have the MSN from Medicare.

If you have a provider who lives in your state of residence, the provider will in most cases file Medicare for you in the state of residence, and Medicare will send the MSN to BC/BS in your state of residence, thus enabling BC/BS to provide you with payments under the contract.

If the provider is outside your state of residence, the provider will in most cases file Medicare for you in the provider’s state, not your state of residence, and in general neither Medicare nor the provider will file the MSN with your state of residence BC/BS. It is therefore generally up to you to forward the MSN to BC/BS in your state of residence in order to receive appropriate payment.

However, as of January 1,2006, if the provider is outside your state of residence, your Medicare claim information will be automatically crossed over electronically to your SRS Health Benefit Plan for secondary payment consideration.  This process eliminates the need to have your medical summary notice sent to the BCBS in your state of residence.  Upon completion of processing under your SRS Plan, you will receive an Explanation of Benefits.

If a provider does not accept assignment under Medicare Part B for a Medicare covered procedure, then provider charges are capped by law at 15 % above Medicare Part B payments.

For claims to BC/BS where there is a dispute whether services rendered are under medical or mental health coverage, BC/BS generally won’t consider your claim for payment until they have the related Medicare Summary Notice and a Statement of Denial from Value Options (VO), the mental health coverage carrier. This latter Statement of Denial is a formal letter stating VO's refusal to pay.

Finally, do not sign any waivers and do not pay anything until you receive an Explanation of Benefits (EOB) from Blue Cross Blue Shield.

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Elective surgery can be accompanied by special problems, both with regard to patient care and insurance reimbursement. One source of information that may be helpful in this regard is a recently published book, "When Less is More", by Bethanne Snodgrass, M.D., FACS, and published by HarperCollinsPublishers, 2005.

Even though the author specializes in plastic and reconstructive surgery and wrote for a specific audience (women considering breast reduction surgery), the book thoroughly covers topics related to elective surgery of any kind. The author discusses, for example,

• exercises or other actions the patient can do to help a situation before considering surgery
• patient self-care before and after surgery
• specific steps to take before surgery to comply with insurance company's requirements
• the type of questions you should ask your doctor before surgery

While the book focuses on one specific type of surgery, the overall discussion is clearly useful to anyone considering any type of surgery.

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HospitalCompare.gov   [This site was created by the U.S. Dept. of Health and Human Services, together with the nation's major hospital groups, and has performance ratings of hospitals nationwide. It focuses on the quality of care for patients with heart attacks, heart failure, and pneumonia.]

HealthGrades.com   [This site has performance ratings of hospitals (FREE), physicians (by specialty), and health plans.]

StopHospitalInfections.org   [This shows a map of the United States and you can select the state or hospital for more information.]

LeapFrogGroup.org   [Another hospital rating service. This site looks at safety measures such as computerized prescription ordering, which eliminates miscommunications caused by messy handwriting and helps staff check for harmful drug interactions.]

AARP State-by-State Guide to Health Care Provider Performance   [This site lists links, including some of the ones above, that provide information on hospitals and doctors performance (as of Dec. 2006).]

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Blue Cross Blue Shield medical coverage is available across the country and around the world.

Download a brochure that tells you how to find medical treatment wherever your travels take you. The file is a pdf file that you can print out and take with you.

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Send e-mail to: Board of Directors

US Mail: SRS Retiree Association
P.O. Box 5686
Aiken, S.C. 29804

©1998-2011
SRS Retiree Association, Inc.
Aiken SC

Revised: November 14, 2011.

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