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- What are the benefits of this plan for an employer?
- How will members know they are not sacrificing quality for cost (lower copayment)?
- What happens when a member chooses an Enhanced Benefits Tier primary care provider (PCP) but that doctor refers them to a specialist who admits at a Basic Benefits Tier hospital for inpatient care?
- Will a member need to look up information every time they want to receive care?
- How easy is it for members to move between providers in different tiers for different services?
- This sounds complicated. How does it work?
- How will a doctor's office know which copayment to charge my employees and their family members when they visit a PCP for care?
- Why is site of service important?
- Can a provider opt out of the Blue Options network?
- Why shouldn't I link a PSA with this product?
What are the benefits of this plan for an employer?
Blue Options can be part of a strategy to control costs today and over the long term because it delivers high-value benefits with premiums that are lower than many other managed care plans. In addition, it can help transform the way members use their care by giving them tangible reasons to select lower cost, higher quality providers.
For larger employers, this purchasing shift can help lower their claims costs and ultimately their premium rates. The Blue Options plan gives members access to benefits with no deductible—similar to those in a much more expensive plan—when members choose Enhanced Benefits Tier providers. Costs on the other tiers are greater, but the three-tier approach offers the choice of three plans in one easy-to-use plan design.
And the Blue Options plan can fit into an overall strategy of moving employees toward consumer-directed health care with a plan design that is easy to understand and use, and gives members transparent access to cost and quality benchmark scores.
Members are fully supported with a specially trained Member Service department and a plan-specific website that helps them effectively get started and use their plan.
How will members know they are not sacrificing quality for cost (lower copayments)?
The Blue Options benefit tiers are based on both quality and cost ratings. To be in the Enhanced Benefits Tier, a provider must meet our highest standards for both quality and cost. In fact, the vast majority of our providers did meet the quality benchmarks set by Blue Options, regardless of their final tier.
It's easy for members to check the scores of their providers on the cost and quality benchmarks. Just visit employer.bluecrossma.com/medical-insurance/blue-options and use the Find a Doctor & Estimate Costs tool to research their providers.
It's also important to remember that all network providers must also meet our credentialing standards just to be part of our network, so members can feel good about choosing any of our providers for their care.
What happens when a member chooses an Enhanced Benefits Tier primary care provider (PCP) but that doctor refers them to a specialist who admits at a Basic Benefits Tier hospital for inpatient care?
The out-of-pocket costs for members of Blue Options plans are based on where they choose to get care.
For that reason, a member getting inpatient care at a Basic Benefits Tier hospital will pay the Basic Benefits Tier out-of-pocket costs, regardless of the tier of the provider who made the referral.
This is why we recommend checking the tier of any new provider online at employer.bluecrossma.com/medical-insurance/blue-options before getting care with a new provider. This not only lets a member know what they will pay, but also gives them a chance to work with their doctor to find another facility, as some specialists have affiliations at more than one hospital.
Will a member need to look up information every time they want to receive care?
No, members do not need to check their provider's tier every time they get care. We do, however, recommend that members check any new providers they may be seeing before they get care to help proactively manage costs.
We also recommend that members who are joining the Blue Options plan for the first time review the tiers of all of the providers their family uses and make decisions about whether they want to choose a new provider.
To make this easy, we created employer.bluecrossma.com/medical-insurance/blue-options, a special online destination for members of the Blue Options plans to check their providers and help them pick a new provider. Members can also call Member Service at the number on the front of their ID card for help finding a provider.
How easy is it for members to move between providers in different tiers for different services?
Members can choose providers on any tier whenever they get care. There are no restrictions on picking network providers from any tier. They may, if their plan requires it, need to get referrals for care. In those cases, they will need to work with their doctor to select a provider for care.
This sounds complicated. How does it work?
The Blue Options plans are a little different than other plans—but they are no more complicated than plans that engage members in their care. Blue Options plans are based on a simple truth that everyone can understand: some doctors, hospitals, and specialists provide higher quality or more efficient care than others.
The idea of tiered costs for health care may seem like a novel concept, but it is similar to decisions people make every day, like when they choose gasoline at the pump or pick which gym to join. Members are given information on providers' cost and quality, and in the case of Blue Options, higher quality and lower medical care costs actually translates to lower out-of-pocket costs for the member.
The main responsibility for members is to manage their providers and choose those that deliver the highest value. This requires some initial investigation by members to check the tier of their current providers. They will also need to check any new providers during the plan year.
We make it easy for members to check a provider's tier by visiting our specially designed website at employer.bluecrossma.com/medical-insurance/blue-options, or by calling Member Service at the phone number on the front of their ID card.
Once a member has selected their provider, using the plan couldn't be easier. Members just show their ID card and pay their out-of-pocket costs.
How will a doctor's office know which copayment to charge my employees and their family members when they visit a PCP for care?
Communicating with providers is a critical part of how we support the Blue Options plan and make it easier for members and employers to use. Blue Options has been part of the Massachusetts health care landscape for three years, with more than 17,000 members using the plan.
Today, providers are already accustomed to Blue Options and the concept of tiers, and we continue to educate and engage providers each year as we update the tiers to reflect new data. We have added an identifier to our member ID card to indicate the version of the Blue Options plan a member has. If a provider or their office staff is unsure what tier they are in, they can call our special provider support line and get that information quickly and easily so that the member is charged the appropriate copayment at the point of care.
Why is site of service important?
While Massachusetts residents enjoy some of the best care in the nation, the cost and quality of that care is not the same at every location. As with most consumer services, the value a member gets from their care can vary widely from one provider or facility to the next.
The Blue Options plan can help members choose providers who provide the best value by balancing the provider cost and quality and providing incentives to choose providers who scored well on both benchmarks.
At Blue Cross Blue Shield of Massachusetts, we believe that improving the quality of the health care our members receive is the most promising way to slow rising health care costs. From changing the way we pay providers to working with community leaders and organizations, we strive to connect members to the right care at the right time.
Can a provider opt out of the Blue Options network?
No. Under the current arrangements with provider groups, network hospitals may not drop out of the Blue Options network alone. From time to time, providers do leave the Blue Cross Blue Shield of Massachusetts network, and those providers are no longer part of the Blue Options network.
Why shouldn't I link a PSA with this product?
Blue Options plans are designed to encourage members to choose providers who deliver the highest value by offering different benefit tiers. Combining this structure with a spending account, especially an employer-funded account, would limit the impact of the provider choice incentives on member out-of-pocket options and keep the plan from functioning as intended. Blue Cross Blue Shield of Massachusetts will not provide claims feeds in connection with the Blue Options product to support HRAs.
A Flexible Spending Account is, however, appropriate to combine with the Blue Options product, as FSAs are employee funded.