MEDICAL INFORMATION
Updated February 25, 2010SPECIAL NOTICE
There has been a problem with the transition from Anthem BCBS of California to BCBS of New Mexico and the subsequent notification to Medicare that the secondary insurance carrier has been changed. For some of the retirees, Medicare knew about the new insurance carrier, for others they did not. If Medicare does not know about your new secondary insurance carrier they will continue to forward your medical bills to Anthem BCBS of California who will bounce them because you are no longer covered. You will then receive the bill for whatever Medicare didn't cover.
As an individual, you cannot fix this. The insurance carrier must fix the problem. As of February 19, BCBSNM said that they had sent "Medicare Cross-over" information to Medicare on February 11, which should have fixed the problem. The individual at Medicare did say that posting such information on the your Medicare record could take up to 30 days from receipt of the information from BCBSNM.
It is strongly suggested that you contact Medicare(1-800-633-4227) and find out if your records have been updated to show the new secondary insurance carrier. Be sure and have your Medicare card available when you call. If they do not show BCBSNM as your secondary carrier by March 11, then call BCBSNM (1-877-878-5265) and make sure they know what your specific problem is and ask them to set up a Medicare Crossover for you. Again, be sure and have your new insurance card available when you call. If you get a bill from the doctor, or hospital, or whomever, that has been sent to Medicare for payment and not forwarded to BCBSNM, take it to your doctor's office (or business office) and tell them to send it to BCBSNM with a "Medicare Summary Notice" for payment. However, this action on your part will only handle payment for this particular claim.
The following is special update of medical information as of February 25, 2010.
The best site with by far the most information is the Blue Cross Blue Shield of NM site at www.bcbsnm.com/lanl. You can also contact them by telephone at 1-877-878-LANL (5265). Other sources of information are listed at the bottom of this web page.
It is recommended that you visit the BCBSNM site and register for access to their membership site which they call "Blue Access." You will need a new user id and password. While you are there explore the site so you will know how to use it to collect the information you might need in the future.
Prime Theraputics is the company that provides mail order drug service for BCBSNM. You can access their web site by going to the BCBSNM web site and clicking on "Prescription Drugs" in the menu bar on the right hand side of the weg page. To get into the Prime Theraputics web site you will need to register with another id and password. The ones you choose for the BCBSNM site will not work.
The medical insurance card that was issued by BCBSNM is to be used for BOTH doctor visits and prescription drugs. If you have trouble when entering the id numbers from your card into an on-line form try leaving off the letters and only use the numbers. For some mysterious reason, the card has preceeding letters in the id but they are seldom used.
Mail order forms for drugs are available on the BCBSNM web site. You must have Adobe Acrobat reader installed on your computer because the form is in PDF format.
The information on this web page is an attempt to answer some of the questions concerning your medical insurance for 2010. Remember, the 2009 health care plans were carried by United Health Care and Anthem Blue Cross. The health care plans for 2010 will be carried by Blue Cross Blue Shield of New Mexico. Your new plan became effective on January 1, 2010. If you have questions about any aspect of your new plan you can get information from the sources listed under "Questions" at the bottom of this web page.
Here are two common questions about the new medical insurance plans
- I have signed up for either EPO or PPO. How do I find out if the doctor that I have been seeing is part of my provider network?
- You will have to call your doctor directly to determine if they or their practice has signed on with Blue Blue Cross/Blue Shield of New Mexico. Please refer to about page 8 of the Guidebook under "Will My Doctor(s) Participate?" You can also contact Member Services at 1-877-878-5265 or go to the available providers web page page at http://www.bluecares.com/healthtravel/finder.html.
- I order my prescriptions from MedCo and they will not be providing the mail order service under my new health plans. When will I receive information about the new mail order company?
- Please refer to "Prescription Coverage At-a-Glance" on about page 6 of the Open Enrollment booklet. All prescription coverage will be through Prime Therapeutics. The new formulary, instructions on how to order prescription drugs by mail and other drug information is now available on the Blue Cross Blue Shield of New Mexico web site at www.bcbsnm.com/lanl. Please see the additional information under Special Update, above.
Prescription Drug Coverage
You should have received a notice from Anthem Blue Cross notifying you that your MedicareRX Part D prescription drug coverage would expire on December 31, 2009 because LANL was not renewing the contract for health care. By federal law Anthem is required to notify you that your drug coverage under them will be cancelled as of December 31. However, your drug coverage is not being cancelled. It is being picked up by Blue Cross Blue Shield of New Mexico through their prescription drug provider, Prime Therapeutics. This new plan is at least as good as the minimum Medicare Part D plan which means that you could switch to the federal government Medicare Part D prescription drug plan without penalty if you chose to do so. It is not recommended that you make this switch.
Please refer to the section in the 2010 Open Enrollment booklet titled "Prescription Coverage AT-a-Glance" on page 6. (Unfortunately they didn't number the pages. You can number the pages starting with the inside cover page as page 1). The first sentence clearly states: "All prescription coverage for 2010 will be through Blue Cross Blue Shield of New Mexico (Prime Theraputics)". This subheading also gives you co-pay information. Even though the Confirmation of Coverage letter you received from LANS dated 11/09/2009 does not specifically say so YOU ARE COVERED if you are enrolled in any of the four medical plans available for 2010. For complete information about the drug plan and other information about the new health care plan go to Blue Cross Blue Shield of New Mexico www.bcbsnm.com/lanl. This web site contains information about the drug formulary and about setting up a mail order account. It is recommended that you visit this site which contains far more information about the entire health care plan than can be included on this site.
Questions?
There are several places where you can get some answers about your medical insurance for 2010.
Access the Blue Cross Blue Shield of New Mexico web site, www.bcbsnm.com/lanl or call them at 1-877-878-5265.
Access the Your Benefits Resources web site at www.ybr.com/benefits/lanl. You can also call the Customer Service Center toll-free at 1-866-934-1200 between 8 AM and 9 PM Eastern Time, Monday thru Friday.
Blue Cross Blue Shield has appointed Syd Peavey to be a dedicated claims advocate with Blue Cross Blue Shield of New Mexico and they say "she will be happy to assist you directly with any claims or medical benefit coverage issues". You can contact her by email at Syd Peavey or by telephone at 1-505-962-7277.
For questions concerning the Medicare portion of your health insurance, call Medicare at 1-800-633-4227.
Go to OE FAQ page.
Glen Lockhart has graciously ageed to answer your questions. You can call him at 505-672-3784 or you can email your question to mandmlockhart@cs.com.
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