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Blue Cross Blue Shield Federal Diabetic Supplies

Blood Glucose Meter Program

Blood Glucose Meter Program

Preferred Test Strips Ascensia and Abbott products are the preferred brands of test strips for all of our prescription drug programs. Both of these brands offer your patients simple and accurate test strips and monitoring systems. For Abbott monitors, the preferred test strips include FreeStyle®, FreeStyle Lite®, and Precision Xtra®. For Ascensia monitors, the preferred test strips include Contour®, Contour®NEXT, Breeze®2, Elite®, and Autodisc®. Prior Authorization Required If your patient chooses to use a test strip that is not FreeStyle, FreeStyle Lite, Precision Xtra, Contour, Contour®NEXT, Breeze 2, Elite, or Autodisc, you will need to complete a prior authorization form on your patient’s behalf. If the prior authorization is not approved, the non-preferred test strips will not be a covered pharmacy benefit for your patient, and he or she will be responsible for the entire cost of the test strips. If the request for the non-preferred test strips is approved, your patient will be charged the highest level of cost-sharing. Free Blood Glucose Meters Both Abbott and Ascensia blood glucose meters are available at no cost to our members. Below is a comparison chart of important features of the blood glucose meters and corresponding test strips. The preferred brands rank high in patient satisfaction and can be used in several test sites, as listed below. Abbott Diabetes Care Ascensia Diabetes Care Blood Glucose Meter FreeStyle FreeStyle Freedom Lite Precision Xtra Contour Breeze 2 Contour® Next One Contour® Next EZ Contour® Next Sample size (uL) 0.3 0.3 0.6 0.6 1.0 0.6 0.6 0.6 Test time 5 seconds 5 seconds 5 seconds 5 seconds 5 seconds 5 seconds 5 seconds 5 seconds Approved test sites Fingertip, hand, forearm, upper arm, thigh, calf Fingertip, hand, forearm, Continue reading >>

1 Y0114_17_29079_i_002 09/22/2016 55325mupenmub_002

1 Y0114_17_29079_i_002 09/22/2016 55325mupenmub_002

IMPORTANT 2017 COVERAGE CHANGES FOR DIABETIC SUPPLIES For this plan year, all of our individual Medicare Advantage plans will continue to cover only specific brands of lancets. Covered lancets: • Roche Diagnostics • Prodigy Diabetes Care • Owen Mumford US • Perrigo Diabetes Care • LifeScan, Inc. • Good Neighbor • Kroger/Perrigo A limit of 100 lancets per month. As a reminder, continuing in 2017, all of our individual Medicare Advantage plans will only cover specific brands of glucometers and test strips. Our plans will not cover them when purchased from In-network Durable Medical Equipment (DME) providers. Covered glucometers and test strips: • LifeScan, Inc., OneTouch® • Roche Diagnostics, ACCU-CHEK® A limit of 100 blood test strips per month. New for 2017, a limit of one glucometer every 180 days. To be covered for a $0 copay, the members must purchase these supplies at an in-network retail or mail- order pharmacy supplier. HCPC codes not covered when purchased through an In-network DME provider: • A4253 blood glucose test strips • E0607 home blood glucose monitor • E2100 blood glucose monitor with integrated voice synthesizer • E2101 blood glucose monitor with integrated lancing/blood sample Members impacted by this change have been notified through their Annual Notice of Change and Evidence of Coverage plan benefit materials. Other blood glucometer, blood glucose test strip or lancet brands or quantities of more than 100 test strips or lancets per month are not covered unless you, as the doctor or provider, tell us another brand or a larger quantity is medically necessary for the member’s treatment. • If our member is currently getting their covered glucometer and test s Continue reading >>

Diabetes Management Incentive Program

Diabetes Management Incentive Program

Our Diabetes Management Incentive Program is designed to help educate and support you as you take an active role in managing your diabetes. The contract holder and spouse, age 18 and over, can participate in the program and earn up to $100 on their MyBlue Wellness Card.* If eligible, you can use these rewards to pay for qualified medical expenses, such as copayments and prescriptions. Complete the Blue Health Assessment and indicate that you have Type 1 or Type 2 diabetes. Youll automatically be placed in to the Diabetes Management Incentive Program. Participating is easy and well guide you through the program. Your next step is to submit your A1c test results between January 1 and June 30, 2018 to earn $25. Lower your A1c or attend nutritional counseling Submit a second A1c test result between July 1 and December 31, 2018. If your A1c is lower than 8%, youll get an additional $75 on your MyBlue Wellness Card. If your second A1c test result is 8% or above, you can still earn $75 when we receive claims showing that you attended 3 nutritional counseling sessions during the calendar year, which are covered in full for both Standard and Basic Option members when you visit a Preferred provider . Log in to MyBlue to submit your results via upload, mail or fax. Simply follow the instructions after you hit Submit Your A1c Results. You can also ask your provider to mail or fax the results. You can find complete details about this benefit on page 121 of the English 2018 Blue Cross and Blue Shield Service Benefit Plan brochure and page 139 of the Spanish version of the brochure. Youll find more information on nutritional counseling benefits on pages 39 and 42 of the English brochure and on pages 46 and 50 of the Spanish brochure. *You must be the contract holder or spouse, 18 or Continue reading >>

Consumable Medical Supplies

Consumable Medical Supplies

Provide clarification of the standard Horizon benefit contract exclusions relative to consumable medical supplies using specific codes and examples. All plans/products that include the following standard Horizon benefit contract exclusions are considered in scope. Non-HMO Individual Consumer and Small Group Employer (2-49 employees) plans: Non-prescription drugs or supplies, except insulin needles and syringes and glucose test strips and lancets; colostomy bags, belts and irrigators; and as stated in this Policy for food and food products for inherited metabolic diseases. Personal convenience or comfort items including, but not limited to, such items as TV's, telephones, first aid kits, exercise equipment, air conditioners, humidifiers, saunas, hot tubs. Self-administered services such as: biofeedback, patient-controlled analgesia on an Outpatient basis, related diagnostic testing, self-care and self-help training. Services or supplies that are not furnished by an eligible Provider. HMO Individual Consumer and Small Group Employer (2-49 employees) plans: Non-prescription drugs or supplies, except insulin needles and syringes and glucose test strips and lancets; colostomy bags, belts and irrigators; and as stated in this Policy for food and food products for inherited metabolic diseases. Personal convenience or comfort items including, but not limited to, such items as TV's, telephones, first aid kits, exercise equipment, air conditioners, humidifiers, saunas, hot tubs. Self-administered services such as: biofeedback, patient-controlled analgesia on an Outpatient basis, related diagnostic testing, self-care and self-help training. Non-HMO Large Group Employer (51+ employees) plans: Ancillary charges connected with self-administered services such as: patient-controlled a Continue reading >>

Diabetes Education Program - Arkansas Blue Cross And Blue Shield

Diabetes Education Program - Arkansas Blue Cross And Blue Shield

You are now leaving the ArkansasBlueCross.com website and entering the BluesEnroll website operated by Benefitfocus.com. BluesEnroll is an online benefit enrollment program administered by Benefitfocus.com on behalf of Arkansas Blue Cross and Blue Shield. Benefitfocus.com is solely responsible for the content and operation of its website, including the privacy laws that govern the site. Linking Disclaimer Linking Disclaimer By selecting "Continue," you will be exiting the Arkansas Blue Cross and Blue Shield (ABCBS) website. If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that ABCBS is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites. You further agree that ABCBS and its affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible under any circumstances for the activities, omissions or conduct of any owner or operator of any other website. Once you choose to link to another website, you understand and agree that you have exited this website and are no longer accessing or using any ABCBS Data. You understand and agree that by making any third-party website link available as an option to you, ABCBS does not in any way endorse any such website, nor state or imply that you should access such website or any services, products or information which may be offered to you through such other websites or by the owner or operator of such other websites. The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation of all such websites. Continue reading >>

Blue Cross Newsletter - November 13, 2013 - 2014 Federal Employee Program (fep) Group Health Plan

Blue Cross Newsletter - November 13, 2013 - 2014 Federal Employee Program (fep) Group Health Plan

Blue Cross and Blue Shield of Kansas, Inc. An Independent Licensee of the Blue Cross and Blue Shield Association 2014 Federal Employee Program (FEP) Group Health Plan The Federal Employee Program (FEP) group health plan will renew with BCBSKS effective January 1, 2014. The 2014 Blue Cross and Blue Shield Service Benefit Plan information can be located on the Blue Cross and Blue Shield Federal Employee Program Website: www.fepblue.org . The Blue Cross and Blue Shield Service Benefit Plan continues to offer two plan options: Standard Option and Basic Option. Standard Option members receive services by choosing a Preferred provider from a network of hospitals, physicians, dentists, pharmacies and other healthcare providers. When the member uses a Preferred provider, the provider files the claim, payment is made to the provider and both Preferred and Participating providers must accept the Plan's payment as payment in full, except for any applicable deductibles, co-pays or co-insurance. Members can choose to use Non-participating providers, but the out-of-pocket expenses may be higher than if the member uses Preferred or Participating providers. Some of the 2014 changes to the Standard Option include: The calendar year deductible is now included in the out-of-pocket catastrophic protection maximum, in addition to coinsurance and copayments. Previously, the out-of-pocket maximum did not include the member's calendar year deductible. For Self and Family contracts, the catastrophic out-of-pocket maximum is now $6,000 per year when a member uses Preferred providers and $8,000 per year when a member use a combination of Preferred and Non-preferred providers. Previously, the out-of-pocket maximum was $5,000 for Preferred provider services and $7,000 for both Preferred and Non-pr Continue reading >>

Diabetes | Bcbsne

Diabetes | Bcbsne

More than 29 million adults in the United States have diabetes and 25% of them do not know it. People with diabetes either do not make enough insulin (type 1 diabetes) or their bodies cannot use insulin properly (type 2 diabetes). Several factors can increase your risk for type 2 diabetes, such as being overweight, having a parent or sibling with diabetes, having high blood pressure and being physically inactive. The A1C test is a blood test that provides information about a persons average levels of blood glucose, also called blood sugar. The A1C test is sometimes called the hemoglobin A1C or glycohemoglobin test. The A1C is the primary test for diabetes management. If your health care provider determines that your blood glucose level is very high, or if you have some of the classic symptoms of diabetes, he or she may choose to check your blood glucose levels. Fit4D is Blue Cross and Blue Shield of Nebraskas diabetic education program. Your voluntary participation in the free Fit4D program gives you access to a wide variety of support and educational materials, including how to remove any barriers to control your hemoglobin A1C and how diet and exercise can affect your blood sugars. You can participate in Fit4D from the comfort of your own home at times convenient for you. Fit4D materials and support are available in both English and Spanish. You may contact Fit4D directly if you would like to learn more now. Please call (402) 205-3245 (extension 0017) and mention that you are a Blue Cross and Blue Shield of Nebraska member who is interested in the diabetic education program. To learn more about the risk factors for diabetes, how to get checked for the disease and how to treat it and information on the Fit4D diabetes education program, utilize the following resources: Continue reading >>

Blue Cross Cover Strips??

Blue Cross Cover Strips??

Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. I have a prescription for test strips (Freestlye) These are not on BCs formulary list, and I haven't met my precription deducible, so I get only $5 off for having insurance. I'm wondering if anyone is doing better with Blue Cross and they are covering the strips? Try a different type of strips. On my insurance Lifescan (and some others) are a tier 2 item and Freestyle strips are a tier 3 item. It has to do with Freestyle not wanting to budge on test strip pricing as much as other companies. Also, BCs are not one entity; they differ from state to state, and requirements/mandates for coverage differ from state to state. There are BC associations, but that's not the same thing. And even within BCs (as with other insurance companies) there are different plans--different deductibles, inclusions, etc. Pegasus is correct, plus it depends on your particular plan as far as your co-pay or deductible. My plan, BCBS of Alabama only covers OneTouch and Accu-Chek strips. Accu-chek and Lifescan will likely be your best bets for coverage. on my plan mail order is always cheaper or try Walmart. I'm getting ready to do an intense battle with BCBSNC over the next couple of days. One battle has to do with denial of 72 hr CGMS. The other battle is over strips. Unless I'm misreading something, it says in my book that strips are covered under prescription copay but the other day, I ended up paying 20% on them. Phone calls galore over the next couple of days. There are so many different BC's. I have Anthem (Federal) BC/BS--for civilian workers and DOD workers and others working or retired from the government. We hav Continue reading >>

Formulary-blue Cross And Blue Shield's Federal Employee Program

Formulary-blue Cross And Blue Shield's Federal Employee Program

Preferred Specialty Drugs. Proven to be safe, effective, and favorably priced compared to Non-preferred specialty drugs. Non-preferred Specialty Drugs. These drugs typically have a Preferred brand available, therefore your cost share will be higher. Certain drugs are no longer covered under Basic Option. These drugs, known as Managed Not Covered drugs, have available covered options in the same therapeutic class. Click here for a full listing of Managed Not Covered drugs and available covered options. Basic Option members taking a Managed Not Covered drug should expect to pay the full cost of the prescription. A few drugs are no longer covered on the Standard Option formulary. These excluded drugs have other drugs available that treat the same condition - either generic drugs, brand name drugs or both. These options are effective and safe, and they may help you save money on your prescriptions. Click here for a full listing of excluded drugs and available covered options. Standard Option members taking an excluded drug should expect to pay the full cost of the prescription. Certain drugs on the formulary have quantity limits, which means your pharmacy benefit will only cover up to a specified, limited amount of the drug each time you fill a prescription or a limited amount per year. Quantity limits are often applied to ensure drugs are safely and appropriately used. Your prescribing doctor can request quantities greater than the allowed amount by submitting for Prior Approval through: Some prescription drugs and supplies need approval in advance, or prior approval before we provide coverage for them. We need to find out if: The drug is related to a service or condition that is covered under the Service Benefit Plan The drug is prescribed in a way that matches generally Continue reading >>

Bcbs Federal Employees Plan

Bcbs Federal Employees Plan

This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More. Is anyone else here on BCBS FEP and get Dexcom supplies. Who do you use? I'm about to lose it on Diabetes Management and Supply. I tried to call to see who else might be in network, but the office in our area is closed for Good Friday. Is anyone else here on BCBS FEP and get Dexcom supplies. Who do you use? I'm about to lose it on Diabetes Management and Supply. I tried to call to see who else might be in network, but the office in our area is closed for Good Friday. Not FEp but now on a BCBS and was having issues with finding someone that I could get Dexcom from, ended up with Liberty Medical. I have not placed our order yet but all I have to do is say yes. They have been very attentive and not bothersome at all to work with. Derek is the guy we have as a contact (877) 922-7867 Ext 50988 I am about to jump through the phone and strangle someone at the company I'm with. Admitedly this is partially my fault, but they called me about reordering my testing supplies in January. The contract changed where you now have to get those through Caremark. Of course Diabetes Management and Supply didn't tell me that. They just said they verified my insurance and gave me an amount to pay. Now I realize I shoudl have known, but anyhow. Now they are saying they will settle with me for the contracted amount they would have gotten from insurance which I am perfectly willing to pay. They think I'm stupid and dont' know how things work. They gave me the contracted price on my test strips and lancets which matched the last EOB. They know that I have no way of knowing what the contracted price on the needles was because I hadn't gotten them before. So....they are telling me that they Continue reading >>

Appendix F: General Exclusions | Essential Health Benefits: Balancing Coverage And Cost | The National Academies Press

Appendix F: General Exclusions | Essential Health Benefits: Balancing Coverage And Cost | The National Academies Press

This table presents a sampling of general exclusions, beginning with a set of what was presented as typical of industry-wide practices, 1 followed by a Federal Employees Health Benefits (FEHB) program fee-for-service product, 2 and then exclusions among CIGNA typical small group employer plan, 3 UnitedHealthcare small group plans, 4 Wellpoint Anthem Blue Standard small business plan 5 (see Appendix E for more detail on the latter), and the Medicare program. 6 , 7 The FEHB program develops a short list of general exclusions for both its fee-for-service and managed care plans (see, for example, Chapter 5 , Box 5-2 ), which individual insurers can expand upon. 1 Personal communication, Charles Bevilacqua, Kaiser Permanente; the list of industry-wide practices are not necessarily specific to Kaiser but identified across many insurers as typical. 2 These are specific to Blue Cross and Blue Shield (BCBS) fee-for-service benefit plan under the FEHBP program ( ). 3 Personal communication, Rosemary Lester, CIGNA Product, September 9, 2011. 4 Personal communication, Sam Ho, UnitedHealthcare, September 13, 2011. 5 Personal communication, Ruth Raskas, WellPoint, September 9, 2011. 6 CMS (Centers for Medicare and Medicaid Services) Medicare benefit policy manual: Chapter 16general exclusions from coverage ( ). 7 Responses were compiled exactly as submitted, explaining any variance in style (e.g., X = excluded; X for Cigna = explicitly excluded or otherwise not a covered benefit; Y = excluded; N = not excluded). Suggested Citation:"Appendix F: General Exclusions." Institute of Medicine. 2012. Essential Health Benefits: Balancing Coverage and Cost. Washington, DC: The National Academies Press. doi: 10.17226/13234. a Approximately 25 percent of customers will accept these exclusions a Continue reading >>

Pharmacy-blue Cross And Blue Shield's Federal Employee Program

Pharmacy-blue Cross And Blue Shield's Federal Employee Program

The Specialty Pharmacy Program provides personalized pharmacy care and close monitoring of your specialty drugs to ensure you receive the support you need. The Discount Drug Program is available to members for specific drugs that are not covered under the regular prescription drug benefit. The formulary list is a list of drugs that are considered the preferred treatment for a patient's condition and that can be used as a guide for a doctor when prescribing drugs. For certain prescription drugs, the Service Benefit Plan Pharmacy Program must determine whether the drug is related to a service or condition that is covered under the Service Benefit Plan before benefits can be approved. Switching your prescriptions to generic drugs can be a great a way to save money. Standard Option members may also be eligible to get the first four prescription fills or refills at no charge when you switch from qualified brand name drugs to generics at a Preferred retail pharmacy or the Mail Service Pharmacy within the same benefit year. The Mail Service Pharmacy Program (available to Basic Option members with Medicare Part B primary coverage and all Standard Option members) is a convenient way to get drugs you take regularly delivered to your home. Standard Option Generic Incentive Program Under Standard Option, your cost share may be waived for up to four generic prescription fills if you switch to a generic drug replacement from a brand name prescription. Patient-Centered Care is a complimentary medication-therapy management program available exclusively to Blue Cross and Blue Shield Service Benefit Plan members in which a clinical pharmacist works individually with members over the telephone. The Blue Cross and Blue Shield Service Benefit Plan has a special program to promote patient s Continue reading >>

Insurance Information | Edgepark Medical Supplies

Insurance Information | Edgepark Medical Supplies

With Edgepark, youll have no insurance paperwork when you order. Once we have your signed authorization, well handle all of your billing paperwork. If you have Medicare, Edgepark honors Medicare assignment on most items. This means that Edgepark accepts Medicares allowed price for your supplies instead of our retail price. Medicares allowable for each item is much lower than the retail price listed in the Edgepark catalog/Web site. This means that you may have no upfront costs and you will not have to wait for reimbursement. You only would be responsible for your copayments and deductibles, if applicable. If you have a supplemental policy, your out-of-pocket expense may be nothing! With private insurance, your out-of-pocket costs will vary based on your coverage. The prices for items paid by insurance companies vary, but are much lower than the retail prices listed in our catalog/Web site. And again, if you have secondary insurance, or your primary insurance covers 100% of your costs, your out-of-pocket costs may be nothing! In addition, we offer a 20% discount on most supplies not covered by your health insurance or Medicare. Your copay depends on your insurance coverage. The following are examples of how a copay is calculated. Please note that deductibles may apply. An item has a retail price of $151.32, but the Medicare allowable price is $82.50 (allowable prices vary by state). Medicare will pay 80% of the $82.50 allowable price, which is $66. That means that your copay will be 20% of $82.50, of $16.50. If you have a supplemental policy, you may have no out-of-pocket costs. If you are insured through a private insurance plan on our list, your insurance plan may cover the entire cost of your medical supply order, and you will not have a copay. Because Edgepark is an Continue reading >>

Glucose Monitoring Devices

Glucose Monitoring Devices

Blood glucose levels (also called blood sugar levels) reflect how well diabetes is being controlled and how well the plan of care (diet, exercise, and medicine) is working. If the blood sugar levels are consistently under control (with levels near normal), diabetes complications may be reduced or even prevented. Checking blood glucose levels regularly is very important in proper diabetes management. Current methods of blood sugar monitoring require a blood sample. Blood sugar monitoring can be done at home with a variety of invasive devices to obtain the blood sample (invasive means the penetration of body tissue with a medical instrument). Usually a drop of blood obtained through a finger prick is enough to use on a test strip that is then measured in a monitor. A finger prick can be done with a small lancet (special needle) or with a spring-loaded lancet device that punctures the fingertip quickly. The strip goes into the meter first, then a drop of blood is placed on the tip of the strip(also called a glucose meter or glucometer)that reads the blood sugar level. Checking your blood glucose regularly can help you keep it under control. There are many types of monitors on the market today. They range in price, ease of use, size, portability, and length of testing time. Each monitor needs its own type of testing strip. Most blood glucose monitors have been found to be accurate and reliable if correctly used, and most monitors give results within seconds. Some glucose monitors can also give verbal testing instructions and verbal test results for people who are visually or physically impaired. There are also glucose monitors available that provide verbal instructions in Spanish and other languages. New monitoring systems are becoming available that can monitor blood suga Continue reading >>

Stop Applying The Cost Of Diabetic Pump Supplies To Insurance Deductible

Stop Applying The Cost Of Diabetic Pump Supplies To Insurance Deductible

My son Ryan is an 18 year old college student with Type 1 diabetes. He currently uses an OmniPod insulin pump to manage his diabetes and has used a pump since he was diagnosed at age 13. Well validated medical studies have proven the benefit of insulin pumps vs. multiple daily injections in blood sugar control. Without the pump, our son would have to take up to 10 injections of insulin a day--a shot every single time he eats anything--even a few bites of popcorn. With the pump, he only has to attach one pod per three days and does not have to take a single injection. His blood sugar stays stable and he is proof that pumps work far better than injections. Furthermore, he can feel more like a normal teenager and not have to pull out a syringe and needle to take a shot when he is eating in a restaurant with his friends. Our insurance company, Blue Cross and Blue Shield of SC considers the OmniPod insulin pump durable medical equipment which is the same category as wheelchairs, hospital beds, etc. and applies the cost of the pods to our annual deductible. This forces us to pay $300.00 out of pocket each month just to keep our son alive, as well as several hundred dollars a month for our insurance premiums and the $45.00 co-pay per month for his insulin. Other diabetic supplies, such as blood glucose sensors, are also subject to the deductible. The most well-known medical fact about diabetes is that better blood sugar control leads to less complications of the disease including blindness, kidney failure, heart disease, stroke and loss of limbs. Yet, our insurance company essentially forces us to choose between paying our bills and giving our son the medical supplies necessary for his best chance to have a long, healthy life. While we would love to get him a started with a co Continue reading >>

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