Hospitals Accepting Blue Cross Blue Focus Care Gold 211
Why is FocusCare right for you?
High
Quality
High Quality
- Improved diabetes education
- Avoid unnecessary hospital admissions
- Better after hours care
- More efficient Rx prescribing
Member
Rewards
Member Rewards
Lower:
- Deductible than HDHP
- Office copays than POS
Low
Cost
Low Cost
Annual Savings
| HDHP | POS | |
|---|---|---|
| Employee | $111.84 | $279.38 |
| Family | $633.36 | $1757.28 |
| Plans | Employee | Employee + Spouse | Employee + Child(ren) | Family |
|---|---|---|---|---|
| POS | $51.24 | $187.02 | $159.54 | $304.80 |
| High Deductible | $37.28 | $128.58 | $109.40 | $211.14 |
| FocusCare | $27.96 | $96.44 | $82.04 | $158.36 |
How does FocusCare work?
Learn more in this video
FocusCare is everywhere you are.
More than 3,000 providers in network.
Through our extensive vetting process, we've identified doctors and service providers in communities across the state who are committed to your well-being.
Find your
FocusCare Doctor.
Find your doctor First things first.
Find a primary care physician (PCP) who will serve as your care coordinator. Your PCP will ensure you get all the special care you may need going forward. If you currently are seeing a specialist, check to see if he/she is in the network. If not, don't worry. Your PCP will work with you to find a specialist in network. And be sure you know what to do if you have dependents living outside the FocusCare Service area (see FAQs).
FocusCare is
customized for you.
Is health insurance a "one-size-fits-all" thing? No, not exactly. But you can't pick and choose the specific body part you want to insure or the specific disease you want to cover. With FocusCare, it does mean that if you have specific health issues, you can get help to manage or, hopefully, fix them. FocusCare provides access to and coverage for health services and programs that will benefit you. That's part of creating a customized health plan. Some benefits you will see because they affect you now. Some benefits you won't see right away or ever because you don't need them. Regardless, we keep these three commitments in mind for everyone…
Cost
Affordability is kind of relative, isn't it? We get it. Health insurance isn't free but we've worked hard to make sure that with FocusCare you have lower monthly premiums and less out-of-pocket costs. Lower costs happen when everyone plays an active role in keeping you healthy – including you, your doctor and your insurance.
Network
With more than 3,000 healthcare providers in the FocusCare network, you have a large network of doctors, hospitals and others to choose from to get care and services when you need them. And for your peace of mind, we've pulled together those caregivers who are like-minded in providing care that puts you at the center.
Your voice
Every person is unique. Not everyone wants to pursue health in the same way, so you can rest assured that your FocusCare doctors and healthcare providers will listen to you when it comes to getting and staying healthy. Your voice is essential as a part of your healthcare team.
A collaborative conversation
about your health.
FocusCare brings you the healthcare providers, guides and services you need to have complete confidence in your insurance coverage and wellness plan. This plan is built upon an open, ongoing, two-way conversation – a conversation in which your voice, decisions and needs play the most important role.
- Pick your physician health home. A close relationship with your doctor's the core of your FocusCare plan. You'll need to pick a primary care physician from our exclusive network of trusted doctors to serve as your health coordinator and advocate.
- Make important connections to trusted specialists and treatments. Armed with complete knowledge of your health, history and preferences, your doctor will carefully select the specialists you need to see, and only refer you to ones who are proven to be as committed to your care as your primary doctor.
- Participate in a care plan designed around your needs. Your healthcare needs are unique, and FocusCare doctors address your health treatment and management to allow you to take an active role in health and well-being.
Open Enrollment ForArkansas Blue Cross and Blue ShieldOctober 9-27
FocusCare is a health maintenance organization (HMO), which means there are no out-of-network benefits. The members on the plan will be assigned a primary care physician (PCP) that they must use, and that PCP will have to give them a referral to see a specialist. An Open Access/POS plan has out-of-network benefits where the member is not required to see an assigned PCP and does not need a referral.
On InsideBlue, click the HR tab and select FocusCare Plan. The information on that page will offer a simple, yet detailed breakdown of each plan. Under the same HR tab on InsideBlue, you can also select links for the POS and HDHP plans to compare and contrast the schedule of benefits for each. FocusCare uses the same drug lists as the POS and HDHP plans.
The answers to this question may vary. Contact an HR representative directly or email the $HR Benefits mailbox for the most accurate information.
Yes. If the FocusCare plan no longer meets your needs, you may return to the HDHP plan during next year's open enrollment. You may also return to the POS plan, if eligible.
No. Bariatric surgery is a specific exclusion on the FocusCare policy. It is also a specific exclusion on the POS and HDHP plans.
You can connect with one of the over 3,000 FocusCare participating providers using the Find Care tool. This tool gives you all the information you need to pick a healthcare provider for your specific needs, including information such as gender, language, location and hospital affiliation. It even includes reviews from other Health Advantage members that have used the provider. If you need assistance beyond the Find Care tool, simply contact customer service at 800-843-1329.
You can call Health Advantage customer service 800-843-1329 or make the change online with Blueprint Portal.
If you are currently under the care of a physician for more serious treatment or care, you may be able to remain with your current physician to maintain continuity of care. In this instance, you would have to request your assigned PCP to submit an out-of-network referral exception to be approved based on the continuity of care information, which should be presented in the request. Once approved, members will have coverage until the treatment ends or 90 days, whichever comes first. The Out-of-Network Referral Request [pdf] is available when seeking an approval for out-of-network referrals.
The simple answer is yes; all eligible services provided within a FocusCare hospital will be considered in-network.
Occasionally, a provider who is not in-network might practice in a FocusCare facility. We don't want this to be a concern for our members. We would treat this provider's service as in-network. Your follow-up care with this provider would also be considered in-network under the continuity of care provision – meaning you would remain with your current physician to finish treatment for a specific condition. In this instance, you would have to obtain, complete and submit an out-of-network referral exception to be approved based on the continuity of care information, which should be presented in the request. Once approved, members will have coverage until the treatment ends or 90 days, whichever comes first. The Out-of-Network Referral Request [pdf] is available when seeking an approval for out-of-network referrals.
If another primary care physician in the same clinic is also participating with the FocusCare network, then the claim can be processed in-network.
Yes, FocusCare is a reasonable choice for you. If you are willing to partner and travel to a FocusCare provider and receive your care within the plan's service area then the program benefits can be yours. Please understand all services must be provided within the FocusCare network of providers to be considered in network.
If the dependent resides outside of Arkansas, regardless of student status, a Dependent Application for Out-of Area Classification form must be completed and submitted to Health Advantage by the subscriber. As long as they live outside of Arkansas for at least 90 consecutive days, the dependent will receive in-network benefits from any Blue Card participating provider. Renewal is required annually. We want our members covered even when they aren't near FocusCare providers. The completed application may be attached to the employee application upon enrollment, faxed to 501-301-6869 or mailed to Health Advantage Membership, P.O. Box 8069 Little Rock, AR 72203.
However, if the dependent resides within Arkansas but outside of Pulaski, Lonoke, Faulkner or Saline counties, he or she will need to travel to see an in-network provider.
Using urgent care facilities or after-hours clinics depends on how the provider bills your visit. To be considered in-network, an urgent care facility or after-hours clinic has to perform emergency care and bill it as urgent care.
If you use an after-hours clinic for convenient service but non-emergency care, it will likely be considered out-of-network unless the dependent is seeing his or her primary care physician (PCP) or a specialist who their PCP referred them to.
In general, members with HMO policies are encouraged to reconsider using urgent care facilities and after-hours clinics except for true instances of emergency or urgent matters.
This part is easy for you because you are guided to a specialist through a referral from your primary care physician. The primary care physician refers you to a like-minded specialist who partners with them to transition your care so that you are comfortable with the process and know that you are in capable hands. It is always a good idea for the member to make sure the specialist is a part of the FocusCare network by using the Find Care tool for the FocusCare network.
Emergency services are processed at the in-network benefit regardless of the provider's participation status. The member may be balance billed the difference between the allowance and total billed amount if the provider is out-of-network though.
If it is not an emergency, you will have to file an Out-of-Network Referral Request [pdf] form to Health Advantage for review and approval before the services are performed. This is true even if the provider is participating with the local Blue Plan (and is also true for all three policies).
For urgent/emergency situations that are tied to sudden onset of injury or illness, we encourage you to see the nearest provider.
For urgent/emergency situations outside of Arkansas, please keep in mind that if the provider used is not participating with their local Blue plan you may be liable for the difference between the charges the non-participating healthcare provider bills and the payment we will make for the covered services. You can find a participating provider by visiting the National Doctor and Hospital Finder and entering the three-digit prefix of your member ID number. You can narrow down your search by specialty and/or location.
The network might expand in the future but not at a rate that would justify enrolling in FocusCare on the chance that your current providers will be added later in the year.
There is no exception allowing employees who reside and work outside of the four counties to utilize out-of-network providers. These members are encouraged to find providers who are in-network (which may require travel) or to choose the other Open Access plans.
For more information, employees can visit our website healthadvantage-hmo.com, where the enterprise has worked very hard on its literacy campaign to make health insurance understandable. Our customer service line 800-843-1329 is also a valuable resource for information related to insurance, claims, and benefits.
Looking for additional
information?
Partners in Care
Arkansas Children's Hospital
Arkansas Children's Hospital brings extraordinary, specialized healthcare to FocusCare as the only pediatric medical center in Arkansas. Known for being one of the largest pediatric medical providers in the United States, Arkansas Children's Hospital proudly provides world-class medical care to children and families throughout Arkansas and surrounding areas.
Baptist Health
Baptist Health provides a wealth of resources to FocusCare as the state's most comprehensive healthcare system. Its mission includes providing patient-centered services and providing high-quality healthcare and health education. With more than 175 points of access, including eight hospitals, Baptist Health is committed to delivering the best to the people of Arkansas.
Health Advantage
FocusCare is an exclusive product of Health Advantage – the state's largest and oldest health maintenance organization, serving more than 225,000 members in every county of Arkansas. With Health Advantage, employers enjoy all the advantages and support of the national Blue Cross Blue Shield Association, including the population health management and cost control expertise.
University of Arkansas for Medical Sciences
Leading FocusCare's commitment to innovation and research is the University of Arkansas for Medical Sciences – the state's only comprehensive academic health center, with colleges of medicine, nursing, pharmacy, health professions and public health; a graduate school; a hospital; a northwest Arkansas regional campus; a statewide network of regional centers; and seven institutes. It also is the only adult Level 1 trauma center in the state.
Source: https://focuscarear.com/arkbluecross/
0 Response to "Hospitals Accepting Blue Cross Blue Focus Care Gold 211"
Post a Comment