Health Messenger Summer 2007

Understanding Your Benefits Can Save You Money

Precertification Can be a Valuable Tool to Help Manage Health Care Costs

Every day, we hear or read about the ever-increasing cost of health care in America. This undesirable trend has led insurers, like FirstCarolinaCare Insurance Company (FCC), to find ways to slow the growth in the cost of health care and thus help slow the growth of premiums.

While many factors are involved in rising health care costs, the increasing use of costly technologies and procedures plays a significant role. Sometimes, more costly technologies and procedures may not be any more effective than less costly alternatives.

Precertification is the process FCC uses to determine whether there is a valid medical reason for using certain technologies and procedures. Precertification can be a valuable tool to help manage health care costs.

While FirstCarolinaCare has required precertification for a number of years, larger insurers are now implementing the precertification process as well to help manage health care costs.

FCC's precertification guidelines are based on widely accepted standards for deciding whether a treatment, test or other medical service is medically necessary. The goal is to try to make sure that the most appropriate care is provided, based on the specific patient's needs.

Members are responsible for completing precertification before a service is provided. A list of services that require precertification can be found in the Certificate of Coverage booklet that you received at enrollment as well as on the FCC Web site. Members should call 1-800-574-8556 to verify precertification information for these services. Most precertification requests are handled with one phone call or fax, as long as the necessary medical information is provided.

Providers will usually help with getting a precertification, but it is ultimately the member's responsibility to be sure that the precertification is requested. FCC nurses will follow up with the provider's office to obtain the necessary information to complete the process.

Precertification must be completed before any treatment is started so that FCC will have time to make a decision or, if needed, to get more information.

If precertification is not obtained before the treatment is received, a financial penalty will be applied when the claim is received and processed. Therefore, it is very important to make sure precertification is completed when required.

Using Generic Medications Can Save You Money

One of the best ways to save money is to use generic medications whenever possible. Generic medications are the same as brand-name medications and will cost you only a $10 copayment each month.

Generic medications must meet the same Federal Drug Administration (FDA) standards as brand-name medications. Generic medications must contain the same active ingredients, in the same strength and dosage form, and meet the same high quality standards as their brand-name counterparts. The difference in cost comes not from cutting corners on the quality of generic medications but from the fact that generic companies are not paying for the development or marketing associated with brand-name medications. About 50 percent of generic medications are manufactured by the same company as the brand-name medications and the only difference is the logo on the tablet or capsule.

Split the Pill, Split Your Bill

FCC offers a tablet-splitting program, "Split the Pill, Split Your Bill," that can save you 50 percent on your copayment. Effective September 1, 2007, the program is expanding to include Lexapro, Lamictal, Amlodipine, Benicar, Benicar HCT and Pravastatin 80mg tablets in addition to the current medications Crestor, Lipitor, simvastatin and pravastatin. If you take one of these medications and would like to save 50 percent on your monthly copayment, talk with your physician or pharmacist to see if tablet splitting is an option for you. For more information, call (800) 574-8556 or visit www.firstcarolinacare.com.

Chronic Condition Management Program for Diabetic Members

New Providers

According to the American Diabetes Association, 20.8 million children and adults in the United States (7 percent of the population) have diabetes.
While an estimated 14.6 million have been diagnosed, 6.2 million people (or nearly one-third) are unfortunately unaware that they have the disease. In an effort to identify members with chronic conditions, such as diabetes, FCC provides worksite health screenings at no charge to members. If an at-risk member is identified, he or she is then invited to participate in FCC's Chronic Condition Management Program. This free program provides regular follow-up visits by FCC nurses to the worksite to provide education related to diet, medications and disease process, to assist with obtaining diabetic supplies and to perform HgbA1C testing (a finger stick blood test that evaluates how well blood sugar is controlled over a period of time).The nurses are also available by phone between visits for questions or concerns. By participating in this valuable program, members can increase their knowledge about their condition and often slow the progression of their disease and avoid more serious complications. Recently, an employee named “Jane” attended a health fair at her worksite. When her health screening results revealed elevated cholesterol and blood sugar levels, the FCC nurse referred her to her primary care physician. Jane then was diagnosed with diabetes as well as high cholesterol. As a participant in the Chronic Care Management program, Jane has made progress in maintaining stable blood sugar and cholesterol levels. The goal of this free program is to encourage members to become actively involved in their own care while providing a support system that will help to reinforce lifestyle and behavior changes that improve their health status. For more information, call (910) 715-8100 or (800) 574-8556 toll-free. Annual Eye Exams for Diabetic Members Managing diabetes usually means making changes to your lifestyle, and necessary changes include healthier eating, increased physical activity and stopping smoking.You also need regular check-ups with your physician. One important check-up is a yearly eye examination. People with diabetes are more likely to have eye problems that can lead to blindness. According to the American Diabetes Association, diabetes is the leading cause of adult blindness in the United States. Many of the eye conditions found in people with diabetes can be prevented or delayed with prescribed eye examinations. Sadly, patients with diabetes lose their vision because they did not seek eye evaluation early enough. FirstCarolinaCare provides coverage for a yearly routine eye examination for our diabetic members. So, if you have diabetes, please take advantage of this benefit.The best treatment is prevention! back to top
Diabetes Prevention
Make Healthy Food Choices Knowing the right foods to eat can be very confusing. The American Diabetes Association provides the following guidelines for making healthy food choices:
-	Eat lots of fruits and vegetables. The more variety in the color of fruits and vegetables you choose, the better.
-	Choose whole grain foods over processed grain products.
-	Include dried beans (like kidney or pinto beans) and lentils into your meals.
-	Include fish in your meals two to three times a week.
-	Choose lean meats like cuts of beef and pork that end in "loin" such as pork loin and sirloin. Remove the skin from chicken and turkey.
-	Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese.
-	Choose water and calorie-free diet drinks instead of regular soda, fruit punch, sweet tea and other sugarsweetened drinks.
-	Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats.
-	Cut back on high-calorie snack foods and desserts like chips, cookies, cakes and full-fat ice cream.
-	Eating too much of even healthful foods can lead to weight gain.Watch your portion sizes.
Increase Your Physical Activity Physical inactivity is a major risk factor for many conditions, including diabetes.That is why regular physical activity is critical to a healthy lifestyle. The many types of physical activities include walking, dancing, sports activities and working in the yard. It may be easier than you think to increase your physical activity. Try the following tips:
-	Park the car farther away from your destination.
-	Take the stairs instead of the elevator or escalator.
-	Join a walking group.
-	Get the whole family involved; enjoy an afternoon bike ride or walk with your kids.
-	Take your dog for a walk.
-	Clean the house or wash the car.
-	Plant and care for a vegetable or flower garden.
-	Take a class in martial arts, dance or yoga.
Most importantly, find something that you enjoy and have fun while being active. back to top

Andrew Knecht, D.C.

Behavioral Health Care of the Carolinas
- NC Mentor
Theodore, C Mataxis, LPA

Brown Orthopedic Surgery & Sports
Medicine Center
Stephanie L. Bonham, P.A.
Andrew P. Bush, M.D.

Cabarrus Family Medicine
Ricardo Vargas, M.D.

Carolina Behavioral Care, P.A.
Charlie L. Swanson, M.D.

Deborah M. Nodrick, D.C.

Fellowship Hall

Lymflo Therapies, Inc.
Carol L. Johnson,O.T.

M. Frances Purcell-Abbott, LPC

Moncure Community Health Center
Cynthia B.Weeks, M.D.

Pediatric Neurology of N.C., P.A.
David J. Jaffee, M.D.

Pembroke Family Practice
Michael L. Brooks, M.D.

Pinehurst Medical Clinic, Inc.
Mark D. Kochenderfer, M.D.
Michol Stanzione, D.O.

Pinehurst Surgical Clinic, P.A.
John A. Lovier, M.D.
Toni Anne T.Washington, M.D.

Quality Care Pharmacy

Ramesh V. Patel, M.D.

Sandhills Emergency Physicians, Inc.
William F. Shilkitus, P.A.
Matthew J.Vreeland, M.D.

Stanly Medical Services
Thomas F. Garland III, M.D.

Electronic Version of Health Messenger
Now Available
Would you rather receive your copy of Health Messenger in an e-mail rather than in the regular mail? If so, simply send your request with your e-mail address to essloan@firsthealth.org

Important Benefit Change
FirstCarolinaCare Insurance Company will include “ectopic pregnancy that is terminated” within the definition of “Complication of Pregnancy.” Therefore, ectopic pregnancy will be covered as a complication of pregnancy for non-spouse dependents.

Publishing Info
Health Messenger is published quarterly by the Corporate Communications Department of FirstHealth of the Carolinas.

For more information, call (910) 715-1478 or write to:

Health Messenger
Post Office Box 3000
Pinehurst NC 28374

We welcome your comments and suggestions. Please send them to Emily Sloan, Editor, at essloan@firsthealth.org or call (910) 715-1478.

FirstCarolinaCare Insurance Company, Inc. is a wholly-owned subsidiary of FirstHealth of the Carolinas.