Past Issues

Since 2003, there have been 206 human cases of avian flu, including 114 fatalities, according to the World Health Organization (WHO).* Birds migrating from infected nations are expected to reach the continental United States later this year. U.S. public health officials are concerned that a mutation in the H5N1 strain could occur, making transmission to humans easier.

Our members look to you, their physicians, for help weighing health care decisions and receiving effective care. But you don’t have to go it alone. Through our arrangement with SubimoTM 1, a leader in providing decision-support tools, we continue to broaden access to tools and resources to help members, as well as physicians, make more informed health care decisions.

Ninety percent of adults with Internet access want to communicate with their physicians via email.* At University of Florida Physicians they found the answer: e-Medicine offered through RelayHealth.**

n Florida, 19 percent of the population has no health insurance. And the number continues to grow, leaving physicians and providers, particularly hospitals, rendering health care services to more patients who find it difficult to pay or don’t pay at all.

BlueOptions members can choose to receive services out of network. Traditional network physicians and providers (not participating in NetworkBlue) should collect the applicable copay or coinsurance (or deductible and coinsurance) from the member. Out-of-network benefits apply.

The English and Spanish versions of the NetworkBlue Fast Tracker for BlueOptions has been revised to reflect after-hours code updates, information on inpatient admissions notification and an additional laboratory service code eligible for payment when performed in the physician’s office.

Effective May 1, hospitals following the process below regarding newborn services will help reduce denials and appeals related to authorizations and certifications.

Four common noninvasive tests for breast cancer are not accurate enough to routinely replace biopsies for women who receive abnormal findings from a mammogram or physical examination, according to a study, Effectiveness of Noninvasive Diagnostic Tests on Breast Abnormalities, released Feb. 9, 2006, by the Agency for Healthcare Research and Quality (AHRQ).

Medicare beneficiaries who are enrolled in Medicare Part D have two ID cards – one for their health plan and one for the prescription drug program. Many members are providing the wrong card when receiving medical services.

The deadline for initial enrollment in the Medicare prescription drug plan is May 15. Penalties in the form of increased premiums will apply to eligible Medicare beneficiaries who don’t enroll before the deadline.

Blue Cross and Blue Shield of Florida’s revised Insurance Manual for Physicians and Manual for Ancillary Facilities are now available on our website. These comprehensive reference manuals are designed to assist office staff in understanding our networks, products, utilization management programs, and claims filing and reimbursement guidelines.

Blue Cross and Blue Shield of Florida (BCBSF) has purchased an equity interest in Prime Therapeutics LLC, a company owned exclusively by 10 Blue Cross and Blue Shield plans and serves approximately 8 million people nationwide. The company will serve as the pharmacy benefit manager for all BCBSF and Health Options members beginning Jan. 1, 2007.

On April 1, Blue Cross and Blue Shield of Florida expanded its Generic Copay Waiver Program to include high blood pressure, allergy and antidepressant medications in addition to heartburn medications.