HealthChoice is excited to continue (Help Check) in 2013 and has streamlined the program to assist you with completing its requirements. The program places attention on face-to-face interaction between you and your primary care physician by using preventive medicine to address health concerns. The newly revised steps for completion are as follows:
Step 1. Register online for at www.healthchoiceok.com (you will receive an e-mail confirmation along with the proper billing codes for your free comprehensive preventive services visit).
Step 2. Complete your free comprehensive preventive services visit.
Following the successful completion of these steps, you will receive your incentive payment of $200.
Certain comprehensive metabolic and lipid tests are still covered at 100% of Allowed Charges once per calendar year. There is no copay or out-of-pocket cost to you when services are provided by a HealthChoice Network Provider. Also, while no longer required to complete the program, you are still encouraged to complete or update the free online health risk assessment (HRA) that is available by registering through our website at www.healthchoiceok.com.
All HealthChoice members age 20 and older who are not enrolled in a HealthChoice Medicare supplement or the HealthChoice USA Plan are eligible to participate. Program requirements must be met by December 31, 2013. It is our goal to have every primary HealthChoice member participating in , so spread the word!
Detailed information is provided once you’ve registered online to participate.
TAKE CONTROL OF YOUR HEALTH!!! Register today at www.healthchoiceok.com.
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Medical identity theft occurs when someone steals your personal information (like your name, Social Security number, HealthChoice number, or Medicare number) to obtain medical care, buy drugs, or submit fake billings to an insurance company in your name. Medical identity theft can disrupt your life, damage your credit rating, and waste health care or taxpayer dollars. The damage can be life-threatening to you if the wrong information ends up in your personal medical records.
Protect Your Personal Information
Guard your HealthChoice, Medicare, and Social Security numbers. Treat them like you would treat your credit cards.
If it’s free, they don’t need your number! Be suspicious of anyone who offers you free medical equipment or services and then requests your HealthChoice or Medicare number.
It’s illegal, and it’s not worth it! Do not let anyone borrow or pay to use your HealthChoice or Medicare ID cards or your identity.
Who to Contact
If you suspect that HealthChoice and/or Medicare have been defrauded or are being defrauded or that resources have been wasted or abused, report the matter to the OMES EGID Compliance Officer immediately. You can report suspicious acts or claims by:
- Visiting the OMES EGID Compliance Officer in person
- Sending a report in writing to:
OMES EGID Compliance Office
3545 NW 58 Street, Ste 110
Oklahoma City, OK 73112
- Emailing a message to firstname.lastname@example.org
- Calling the OMES EGID toll-free hotline at 1-866-381-3815
To report suspected Medicare fraud, contact the Department of Health and Human Services Office of Inspector General Hotline at 1-800-447-8477 or via email to HHSTips@oig.hhs.gov.
Additional information on how to prevent Medicare fraud is available at www.StopMedicareFraud.gov.
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In January 2011, Surgeon General Regina Benjamin issued a call to action to support breastfeeding. The program provides guidance on how families, communities, and medical professionals can encourage breastfeeding by providing education and support to mothers who choose to breastfeed.
The surgeon general also emphasized the health benefits of breastfeeding. Research has shown that breast milk is healthier for babies than formula. Breast milk contains cells, hormones, and antibodies that help protect babies from illness. These cells, hormones, and antibodies help guard against diarrhea, ear infections, upper respiratory infections, and pneumonia. In fact, babies who are breastfed are less likely to develop asthma or become obese.
Breastfeeding is also healthy for moms. Women who breastfeed are less likely to develop breast and ovarian cancers, Type 2 diabetes, and postpartum depression.
In an effort to help encourage breastfeeding and provide support for our members, HealthChoice has new benefits available for women who are pregnant or breastfeeding. The new benefits provide coverage for the following:
- Breast pumps purchased through a recognized health care provider.* Coverage is limited to one breast pump per lifetime and includes the following types of pumps:
- Rental or purchase of a manual pump – (rental: EO602RR) (purchase: EO602NU)
- Purchase of an electric pump of any type (EO603)
- Purchase of an electric, hospital-grade pump (E0604)
- Replacement supplies for breast pumps when they are purchased through a recognized health care provider.* Supplies are limited to one each per pregnancy.
- Tubing (A4281)
- Adapter (A4282)
- Cap (A4283)
- Shield (A4284)
- Bottle (A4285)
- Locking ring (A4286)
- Comprehensive breastfeeding support and counseling for pregnant and postpartum women when services are obtained through a recognized health care provider.* Services are limited to two sessions per calendar year for pregnant and postpartum women. (99241, 99242, 99243, 99244, 99245, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99351, S9443)
Be aware that HealthChoice does not provide coverage for over-the-counter supplies such as creams, slings, covers, pads, shields, latch assist products, nursing bras, or ice packs.
Breastfeeding is a healthy alternative to formula. It’s also easier and less costly than formula. So, if you are planning a pregnancy or are currently expecting, consider the health benefits of breastfeeding and talk to your doctor about what is best for you and your infant.
*HealthChoice does not provide coverage for pumps and supplies purchased from non-recognized providers (i.e., BabiesRUS, Walmart, Walgreens, etc.)
Resources: Centers for Disease Control and Prevention and the Department of Health and Human Services, Office on Women’s Health
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HealthChoice provides our female members coverage for certain contraceptive products and procedures. Additionally, contraceptive counseling services provided by recognized health care providers are also covered. All products are subject to Plan provisions. Following is a list of covered products and services:
- The following products are covered under the pharmacy benefits of the HealthChoice health plans. All products require a physician’s prescription:
- Cervical Cap
- Oral Contraceptives
- Vaginal contraceptive rings
- Transdermal patches
- An independent tubal ligation is covered once per lifetime for women ages 18 and older and includes*:
- Facility fees
- Anesthesia fees
- Radiology fees
- Physician fees*
IUD Insertions and Removals
- Covered for ages 18 and older and includes:
- IUD or implantable rod – 1 every 5 years
- IUD Insertion – 1 every 5 years
- IUD Removal – 1 every 5 years
- Prescription required
- Covered under health benefit
*When a tubal ligation is performed in conjunction with a different surgical procedure, HealthChoice will cover only the surgeon’s fee for the tubal ligation.
Speech therapy guidelines currently require certification through the HealthChoice Health Care Management Unit for ages 17 and younger.
Effective July 1, 2013, for ages 18 and older, visits exceeding 20 per calendar year will also require certification through the HealthChoice Health Care Management Unit.
For additional information please contact the HealthChoice Health Care Management Unit at 1-405-717-8879 or toll-free 1-800-543-6044, ext. 8879. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.
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HP Administrative Services, LLC (HP), the health administrator for the Employees Group Insurance Division (EGID), will complete end-to-end impact analysis of ICD-10 readiness from February 1, 2013 to July 31, 2013. This analysis will review impact to all entities, codes, system scripts, interfaces, and import/export files.
HP will schedule testing with third parties, providers, and EGID from February 2, 2014, to August 31, 2014, and be prepared for ICD-10 implementation on October 1, 2014.
More information will be forthcoming as progress is made.
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EGID has clarified the member responsibility after the out-of-pocket maximum is reached. This means that you will still have to pay for some services once you have reached your out-of-pocket maximum. The following is the clarification:
“The out-of-pocket maximum does not include charges for non-covered services, balance billed charges from non-Network providers, and copays.”
If you have questions or need further information, please contact HP Administrative Services, LLC at 1-405-416-1800 or toll-free 1-800-782-5218. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160.
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The Office of Management and Enterprise Services (OMES) Employees Group Insurance Division (EGID) has adopted the following criteria for coverage of skin tag removal, CPT codes 11200 and 11201. For all charges incurred on or after July 1, 2013:
- Skin tag removal for infected, inflamed, or abscessed skin lesion as documented in the medical record.
- Removal for skin tags suspected to be pre-malignant or malignant and referred to a pathologist as documented in the medical record certification is required.
To request certification, contact the Health Care Management Unit at 1-405-717-8879 or toll-free 1-800-543-6044, ext 8879. If you have questions or need further information, please contact HP Administrative Services, LLC at 1-405-416-1800 or toll-free 1-800-782-5218. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160.
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HealthConnect is an online benefit application designed to give you quick and easy access to your benefit information.
You can access HealthConnect from our website at www.sib.ok.gov or www.healthchoiceok.com.
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HealthChoice provides a benefit for wigs or other scalp prostheses to members who lost their hair due to radiation or chemotherapy treatment for a covered medical condition. The maximum annual benefit is $150, and coverage is subject to annual deductibles and coinsurance. Wigs and prostheses must be purchased through a licensed cosmetologist or durable medical equipment provider.
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