PUBLIC EMPLOYEES BENEFIT TRUST (PEBT) BENEFITS REPORT
VOLUME 5, ISSUE 2

Pay Attention to the Details of Your Health Care Plan

It's a good idea to stay informed of the details of your health care plan. The following tips will help save money, time and stress.

Emergency Rooms Only for Emergencies
Too often, participants visit the emergency room for non-emergencies. If a health problem is life-threatening, call 9-1-1. If it isn't, call the physician's office phone number on the back of the card, even if it is after hours. Someone is usually available to answer the phone, or an alternative telephone number may be found on the office's answering machine.

While some think that a hospital is the place to go for quick treatment, ERs admit patients based on the actual need of treatment. Therefore, if someone visits the emergency room for something as minor as a headache or the flu, he or she could wait hours to see a doctor. Participants also could end up paying the entire bill if the health plan does not consider the visit a true life-threatening emergency.

Generic Drugs Cost Less Than Brand Name Drugs
Brand-name medications require a higher co-payment than their generic equivalents. For many participants used to paying a lower co-payment for a generic drug, this often comes as an unpleasant surprise.

To guard against a larger-than-expected co-payment, ask the doctor if the prescribed medication has a generic counterpart. If it does, ask if that medication is appropriate.

Pre-authorize Non-Emergency Surgeries
Many participants assume that if they need surgery, their health care plan will cover the expense. The only way to know if the procedure is covered is to get it preauthorized.

Emergency surgeries do not need pre-authorization, but it is required for any type of reconstructive surgery. If pre-authorization is not requested and it is later determined that the surgery is not a covered benefit, the burden of payment is on the participant. so, obtain pre-authorization before a date is scheduled for surgery to confirm that the procedure is, in fact, medically necessary rather than cosmetic.

Notify PacFed of Changes in Status
PacFed must be notified when there are any changes in a participant's life. That means that if one gets married, divorced, has a baby, adopts a child or moves to a new location. PacFed must be notified immediately. Waiting too long could result in medical expenses not being covered or the participant getting a bill for a claim that was incorrectly processed.

Call PacFed About any Unusual Bills
Hospitals and doctors working in medical plans care for thousands of patients who produce millions of dollars in claims annually. It is, therefore, not surprising that occasionally a bill is sent out in error.

Participants should never get a bill for authorized services. If a bill is received, then it's probably a mistake and PacFed can fix it.

Participants' reactions to these occasional mistakes range from panic to apathy. The most appropriate reaction is somewhere in between. Although it is not usually recommended to pay the bill, don't ignore it, either.

After all, if the mistake isn't brought to the attention of the proper authorities, it could be turned over to a collection agency and your credit may be adversely affects.

You can save yourself time, irritation and unnecessary expense by understanding the details of your health plan.

A complete description of your rights under HIPAA can be found in the Fund's Notice of Privacy Practices. In accordance with HIPAA, you as a participant are entitled to a copy of the Fund's Notice of Privacy Practices.

The Fund's Notice of Privacy Practices is available for your review upon request at the office of PacFed Benefit Administrators. Please submit your request in writing to the following address:

1000 N. Central Ave., Suite 400
Glendale, CA 91202

Please remember to include your name and Social Security number in your inquiry; this will help us direct your request to the proper department for processing.

If you have any questions, please do not hesitate to contact us.

When ordering prescription drugs, be sure to bring your new HealthNet card with you and make sure your pharmacist understands that you are no longer with Blue Shield and are now covered by HealthNet.