Frequently Asked Questions
Mahoning County School Employees Insurance Consortium
To read the FAQs about the new Anthem Network Changes with UPMC, download the BlueCard Network FAQs.
Where is the best place to find information about my Anthem Medical, Dental or Vision plan?
Register on www.anthem.com or on the Anthem mobile app (for iPhone and Android) to manage your health care and your benefits simply and conveniently. The online site allows you to check on claims, find a doctor, track your health care spending and compare the quality and cost of hospitals, providers and other facilities. If you need help navigating the website, visit www.anthem.com/guidedtour to watch a video explaining how the website can help you.
What if my current provider is not in Anthem’s network?
If your current provider is not in Anthem’s network, you may reach out to your district benefit contact with the name, address and telephone number of your provider so that this information can be relayed to Anthem’s Contracting Department. While Anthem can contact the provider, there is no guarantee that the provider will agree to join and accept Anthem’s contract terms.
Is preventive care covered at 100%?
Yes, a key provision of the Affordable Care Act (ACA) is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. The Anthem plan covers the same preventive care services as Medical Mutual covered. Remember that all tests and procedures must be coded as preventive by your provider or facility in order to be covered at no cost to you.
Recent news articles state that Anthem will no longer cover non-emergency use of the emergency room effective January 1, 2018 – Does this affect me?
This change does apply to some Anthem plans in the state of Ohio, the Mahoning County School Employees Insurance Consortium (MCSEIC) is NOT one of them. Please remember to continue to use the emergency room wisely. There are less expensive alternatives, urgent care and minute clinics. Always feel comfortable contacting your physician if you ever have a question as to where to seek care.
Do we have a service similar to Teladoc?
Yes, Anthem’s telemedicine program is called LiveHealth Online and gives you access to a doctor 24 hours a day, 7 days a week, 365 days a year. Typically members use this service for flu symptoms, colds, sinus infections, pink eye, rashes, fever and other acute conditions. In addition, Anthem includes a behavioral health line as well. Members can use the service to talk to a counselor, psychologist or psychiatrist from the comfort of their home. Visit www.livehealthonline.com to create your account or call 1-844-784-8409. The Explanation of Benefits (EOBS) are difficult to read. A communication was recently emailed out to members of each school district explaining how to read your Anthem Explanation of Benefits. This was part of our Consortium “Hot Tip” communication campaign and was Hot Tip #15. Is there a way to find out how much a procedure will cost prior to having it performed so that I can be financially prepared? Yes, on www.Anthem.com there is a tool to compare how much the same medical procedures will cost at various providers in your area.
- 1. Go to www.anthem.com
- 2. Log in with your member user ID and password
- 3. Click on “Estimate Your Cost”, located under the green “Useful Tools” tab at the top
- 4. Search by procedure type, zip code or provider
I would like to know why out-of-network doctors that members have requested to be added to the Anthem network have not been added. During the transition to Anthem, it was communicated to members to share the names and contact information for any non-network providers to their treasurers or benefits department. All providers were shared with Anthem and Anthem’s Physician Contracting Unit reached out to these providers. If the provider continues to a non-network provider, it is likely – either they were not agreeable to Anthem’s contractual provider terms or there were enough providers within the network for that particular zip code area. For example, chiropractors in the Youngstown/Canton area were not approached due to an over saturation of the number of this type of provider.
The deductibles and out-of-pockets on our plan are considered “embedded.” What does this mean?
In a health plan with an embedded deductible and out-of-pocket, no single individual on a family plan will have to pay a deductible or out-of-pocket higher than the single (individual) deductible or out-of-pocket amount. This means that a member covered by a family plan will only need to meet the single network deductible of $300 before the 10% coinsurance applies. Once this member meets the $500 coinsurance limit, benefits will pay at 100%. Medical and prescription drug co-pays will continue to apply until you meet your individual out-of-pocket maximum of $7,150. The rest of the family will be responsible for the remainder of the family deductible, coinsurance limit and out- of-pocket maximum.
Why is there a $25 copay for every specialist visit?
On average, specialist office visits are three times as costly when compared to a visit to a primary care physician. The higher office visit copay is designed to educate people to develop a relationship with a primary care physician (PCP) and to use a specialist only when necessary. Example: A patient has a minor rash and opts to visit a dermatologist when a primary care provider is equipped to assess the condition and recommend an appropriate treatment method. The PCP will charge approximately half the cost to provide the same level of care.
Should a doctor or hospital request payment upfront for services that have not yet been rendered or processed by insurance?
Typically an Anthem participating network provider will not ask for payment up front before services have been rendered. However, it does not violate their contract with Anthem to do so. Most often this happens prior to more serious inpatient or outpatient procedures like surgery. If this happens to you, make sure to keep all receipts showing payment to a provider or facility. Once all of the claims for the services have been processed by insurance, reach out to your district benefits contact to ensure that you have paid appropriately towards your deductible and coinsurance limits.
Where can I find the details about the wellness screenings, Health Risk Assessment and Incentives for Wellness?
Bravo Wellness, the Consortium’s wellness vendor, created a program booklet that is available on the Consortium’s new website – address coming soon. By participating in a biometric screening, completing your Health Risk Assessment on Bravo’s website and completing a Bravo University well-being course or attending a Gallagher Education Presentation employees can earn a $100 gift card while covered spouses can earn a $50 gift card. Please note, spouse requirements differ. Please review the program booklet for more details.
What is the difference between generic equivalent versus a generic substitution?
A generic equivalent has the same active ingredient in the exact same strength and releases into the body in the exact same way as its brand name counterpart.
A generic substitution or alternative does NOT have the same active ingredient as the brand name drug. This type of generic is simply in the same drug classification. It can be used for the same symptoms and diagnosis and can effectively treat the same condition as the brand name drug. But it is NOT the same exact drug.
For example, for the treatment of acid reflux a patient may take Pepcid which is famotidine or Zantac which is ranitidine. These drugs are in the same classification (H2 Blockers) and used for the same condition and symptoms but they are two different drugs.
Talk to your doctor or pharmacist about changing to a generic medication. It’s a good idea to ask about generic options every time your doctor prescribes a new medication, and talk to your pharmacist about generics each time you fill a prescription.
Why do generic medications cost less?
Generic medications are less expensive because generic manufacturers don’t have the large investment costs of the original developer. New drugs have a patent that allows the drug to only be sold by that one company. That company controls the price. Once the patent expires, other manufacturers can apply to the U.S. Food and Drug Administration (FDA) to sell the generic equivalent. With little investment costs and more competition among the generic manufacturers, the price of generics is substantially less. The quality is NOT less. Why?
The FDA requires generic equivalents to have the same active ingredients, and work in the body the same way as the brand-name drug. The FDA requires generic equivalents to have the same quality, strength, purity and stability as brand drugs.
The FDA says that all drugs (generic and brand) must work well and be safe. Generic medicines may look different in size or color, and their names are different (they are referred to by their chemical names instead of brand names), but the FDA has the same standards for quality and effectiveness as their brand-name counterparts. Generic drug manufacturers have facilities that are FDA-inspected, just like brand-name facilities. The FDA conducts about 3,500 inspections a year to ensure standards are being met.