Citi Benefits Handbook
Anthem BlueCross BlueShield
LiveHealth Online — Doctors On Demand
LiveHealth Online provides access to a national network of U.S. board-certified doctors and pediatricians who are available on-demand 24 hours a day, 7 days a week, 365 days a year to diagnose, treat and prescribe medication (when necessary) for many medical issues via phone or online video consultations. LiveHealth Online does not replace the existing primary care physician relationship, but enhances it as a convenient, affordable alternative for medical care.
For 2017, you pay $49 per LiveHealth Online phone or video consultation with a physician until the deductible is met. After that, you pay $9.80 per consultation. Once you meet the annual out-of-pocket maximum, consultations are covered in full for the remainder of the year. Charges for phone or video consultations with a physician and/or other provider who is not contracted with Anthem's LiveHealth Online service are excluded. In most states, the physician can e-prescribe medications for you after a LiveHealth Online consultation if needed. For more information, visit www.livehealthonline.com. Behavioral health counseling is also available. You can receive a 45-minute consultation with a psychologist or social worker. These services are subject to deductible and coinsurance.
Complex Case Management
The Anthem BlueCross BlueShield Complex Case Management program helps you control your health care expenses through proactive outreach. If you are managing a condition such as cancer, multiple congenital anomalies, or significant orthopedic, cardiology, or neurological-related conditions, the Complex Case Management team will contact you to assist with your care and managing your treatment.
Future Moms helps routine to high-risk expectant mothers focus on early prenatal interventions, risk assessments and education, leading to overall healthier outcomes for mothers and newborns. The program includes:
- 24 / 7 phone access to a nurse coach who can talk with you about your pregnancy and answer your questions
- Your Pregnancy Week by Week, a book to show you what changes you can expect for you and your baby over the next nine months
- Useful tools to help you, your doctor and your Future Moms nurse coach track your pregnancy and spot possible risks.
Future Moms with Breastfeeding Support on LiveHealth Online will be available starting January 1, 2017. You can have secure and private video chats with a certified lactation consultant, counselor or registered dietitian at no cost when using Future Moms with Breastfeeding Support on LiveHealth Online. These professionals will be able to provide personalized support to help you with breastfeeding techniques, including consultations about milk production, baby hunger cues, foods to avoid, postpartum nutrition and more. Sign up for free at www.livehealthonline.com or on the mobile app. You do not have to be enrolled in the Future Moms program to utilize this service.
If you or one of your dependents is pregnant, the Maternity Management program can help you develop a guided course of care and treatment.
Neonatal Intensive Care Unit (NICU)
The program consists of inpatient, post-discharge and extended outpatient management by a NICU case manager with neonatal and/or pediatric nursing experience.
If you're identified as a potential (or actual) transplant candidate, you will be referred to the transplant team. The transplant nurse will manage all of your care (inpatient, outpatient, home care, discharge planning, etc.) from the day of approval through six months post-transplant.
Behavioral Health Resource
Behavioral Health Resource includes a 24/7 Resource Center for you to call for assistance at any time, with care management programs for behavioral health and depression.
If you or a covered family member have a long-term (chronic) health problem, ConditionCare can help with,
- 24-hour, toll-free access to a nurse
- A health assessment by phone
- Support from Nurse Coaches, pharmacists, dietitians, doctors and other health care professionals, and
- Educational guides, newsletters, and tools to help you learn more about your condition.
ConditionCare nurses work with members of all ages who have asthma or diabetes. They also work with adults who have chronic obstructive pulmonary disease (COPD), heart failure or coronary artery disease.
The Anthem BlueCross BlueShield MyHealth Coach program offers you and any covered family members one-on-one support by phone from a health coach. MyHealth Coach has strategies to help with:
Health coaches set individualized health and wellness goals, develop treatment plans, and can provide guidance on what programs are covered under your benefits. This program is different than the Health Coaching program offered through the Live Well at Citi Program.
AIM Imaging Cost & Quality Program
Anthem Blue Cross Blue Shield has partnered with AIM Specialty Health offering access to important information about imaging services you might need.
If you need an MRI or a CT scan, it's important to know that costs can vary quite a bit depending on where you go to receive the service. Sometimes the differences are significant—anywhere from $300 to $3,000 — but a higher price doesn't guarantee higher quality. If your benefit plan requires you to pay a portion of this cost (like a deductible or coinsurance) where you go can make a very big difference to your wallet. AIM does the research and makes it available to help you find the right location for your MRI or CT scan. Here's how the Program works:
- Your doctor refers you to a radiology provider for an MRI or CT scan.
- AIM works with your doctor to help make sure that you are receiving the right test — using evidence-based guidelines.
- AIM also reviews the referral to see if there are other providers in your area that are high quality but have a lower price than the referred one.
- If AIM finds another provider that meets the quality and price criteria, AIM will give you a call to let you know.
- You can choose which radiology provider you wish to perform the service. AIM will even help you schedule an appointment with the new provider.
Sleep Study Program
The Plan includes benefits for a Sleep Management Program, administered by AIM Specialty Health, which is a program that helps your doctor make better informed decisions about your treatment for sleep related issues. The Sleep Management Program includes outpatient and home sleep testing and therapy. If you require sleep testing, depending on your medical condition, you may be asked to complete the sleep study in your home. Home sleep studies provide the added benefit of reflecting your normal sleep pattern while sleeping in the comfort of your own bed versus going to an outpatient facility for the test.
As part of this program, you are required to get precertification for:
- Home sleep tests (HST)
- In-lab sleep studies (polysomnography or PSG, a recording of behavior during sleep)
- Titration studies (to determine the exact pressure needed for treatment)
- Treatment orders for equipment, including positive airway pressure devices (APAP, CPAP, BPAP, ASV), oral devices and related supplies.
If you need ongoing treatment, AIM will review your care quarterly to assure that medical criteria are met for coverage. Your equipment supplier or your doctor will be required to provide periodic updates to ensure clinical appropriateness. Ongoing claim approval will depend partly on how you comply with the treatment your doctor has ordered.
Please talk to your doctor about getting approval for any sleep testing and therapy equipment and supplies.
Autism Spectrum Disorders (ASD) Program
The ASD Program is comprised of a specialized, dedicated team of clinicians within Anthem who have been trained on the unique challenges and needs of families with a member who has a diagnosis of ASD. Anthem provides specialized case management services for members with autism spectrum disorders and their families. The Program also includes precertification and medical necessity reviews for Applied Behavior Analysis, a treatment modality targeting the symptoms of autism spectrum disorders.
For families touched by ASD, Anthem's Autism Spectrum Disorders Program provides support for the entire family, giving assistance wherever possible and making it easier for them to understand and utilize care — resulting in access to better outcomes and more effective use of benefits. The ASD Program has three main components:
- Educates and engages the family on available community resources, helping to create a system of care around the member
- Increase knowledge of disorder, resources, and appropriate usage of benefits
- Applied Behavior Analysis management, including clinical reviews by experienced licensed clinicians. Precertification delivers value, ensuring that the member receives the right care, from the right provider, at the right intensity. ABA Therapy is covered, subject to deductible and coinsurance, in accordance with Anthem's clinical policy.
- Increased follow-up care encouraged by appointment setting, reminders, attendance confirmation, proactive discharge planning, and referrals.
- Assure that parents and siblings have the best support to manage their own needs.
- Enhanced member experience and coordination of care.
- Assistance in exploration of medical services that may help the member, including referrals to medical case management.
- Licensed behavior analysts and program managers provide support and act as a resource to the interdisciplinary team, helping them navigate and address the unique challenges facing families with an autistic child.
Primary Nurse serves as a personal health guide for individuals and their families. Each personal nurse provides education, counseling, tools and support to help you navigate the health care system and make wise decisions. Primary Nurse is available if you are experiencing health issues or need assistance managing lifestyle issues. Primary Nurse primarily uses the following:
- Coaching for education and self-care via web-based, self-help tools and the program's 24/7 NurseLine.
- Collaborative goal planning and intervention strategies with you.
- Facilitation, coordination and referral to necessary services.
- Incorporating clinical resources such as pharmacists, social workers and dietitians.
- Mailed and telephonic education, including healthy living support through the Healthwise Knowledgebase®.
The coach works with you and your family to create an individualized program care plan that features personalized goals to ensure you are following your provider's plan of care.
You may have emergencies or questions for nurses around-the-clock. 24/7 NurseLine provides you with accurate health information any time of the day or night. Through one-on-one counseling with experienced nurses available 24 hours a day via a convenient toll-free number, you can make more informed decisions about the most appropriate and cost-effective use of health care services. A staff of experienced nurses is trained to address common health care concerns such as medical triage, education, access to health care, diet, social/family dynamics and mental health issues. Specifically, the 24/7 NurseLine features:
- A skilled clinical team — RN license (BSN preferred) that helps you assess symptoms, understand medical conditions, ensure you receive the right care in the right setting and refer you to programs and tools appropriate to your condition
- Bilingual RNs, language line and hearing impaired services
- Access to the Audio Health Library, containing hundreds of audiotapes on a wide variety of health topics
- Proactive callbacks within 24 to 48 hours if you are referred to 911 emergency services, poison control and pediatric members with needs identified as either emergent or urgent
- Referrals to relevant community resources
Anthem's Specialty Drug Management Programs
Anthem will provide the following specialty medication programs to plan members:
Site of Care Redirection Program
If you are receiving infusion therapy, Anthem has partnered with a specialty pharmacy provider, Coram CVS/specialty infusion services, to give you additional options for where to receive therapy. Through the Site of Care Redirection Program, you may choose to receive infusion therapy in your home or at an infusion suite, instead of a hospital outpatient setting. Receiving your treatments at home or at an infusion suite may be more comfortable and convenient for you. It may also save you money.
A Coram CVS/specialty infusion services representative can work with you and your doctor to set up home or infusion suite treatment. Coram CVS/specialty infusion services nurses are experts in infusion therapy, and its network of locations means you can get support wherever you are. To find an infusion suite, go to www.coramhc.com/locations. You can also call Coram CVS/specialty infusion services at 1 (844) 242-0677, 5:30 a.m. to 7 p.m. ET, Monday through Friday.
Right Drug Channel Program
The Right Drug Right Channel program targets self-administered specialty drugs which can be best managed through the pharmacy benefit rather than through the Anthem medical plan. If you are currently receiving a specialty drug through your doctor, you will need to get the drug from the Accredo Pharmacy instead.
Accredo will contact your doctor and start the arrangements for your specialty prescription. Or your doctor can fax your prescription and a copy of your member ID card to Accredo at 1 (855) 778-1460
If the drug you take is given as an injection, you will need to give the drug(s) to yourself rather than going to your doctor's office. Your doctor or nurse can teach you or a caregiver how to give the injection. You can also ask your doctor to call the Provider Services number on your member ID card and find out if a nurse can train you at home.
You can call Accredo at 1 (855) 778-1460, Monday through Friday, 8 a.m. to 11 p.m. Eastern time and Saturday, 8 a.m. to 5 p.m. Eastern time