2815 Coburg Road Eugene OR 97401 ph: 345-0338

4J Benefits and Wellness Newsletter

Prepared by Mike Caley 687-3244 December 4, 2006 Issue No. 215

MODERATELY OVERWEIGHT AT SIGNIFICANT RISK (back to top)
Last year, a hotly disputed study by the CDC, suggested that being only slightly or moderately overweight does not result in a higher risk of death than those in the normal weight range.

A recently released study, published in the New England Journal of Medicine, tells a different story. In this study of over 500,000 AARP members, it was reported that the risk of premature death for those in the “overweight” group, as measured by Body Mass Index (BMI) increased 20 to 40% among healthy people who had never smoked. For those individuals whose weight placed them in the category of “obese,” the risk is increased by 100 to 200%. These findings were backed up by a large Korean study reported in the same journal.

As an example, a person 5’8” would be overweight if they weighed between 165 & 196 pounds. 197 pounds or more would put that person in the obese category.

NEW DEDUCTIBLE YEAR (back to top)
On January 1, the new deductible year begins. The first number of dollars specified by your plan as the annual deductible is your responsibility before Regence begins to pay its coinsurance percentage. This is no longer true for your prescription drug coverage. Your prescription drug plan provides “First Dollar” coverage unlike past years in which there was a $50 or $100 annual deductible. The $25 annual deductible on the ODS dental plan remains in effect and begins anew on January 1.

The medical plan has a deductible carryover provision. If you do not meet your entire deductible for the calendar year, any amount of deductible that is applied during the months of October, November, or December will be carried over into the new plan year. But, this provision only applies if the entire deductible is not met.

COFFEE & HEART DISEASE (back to top)
Can’t get your mind and body working in the morning without your cup of coffee? According to an article in the September edition of HealthNews, “Drinking coffee might do more than awaken your brain: It might also reduce your risk of heart disease.”

A 15-year study cited in the American Journal of Clinical Nutrition found that in a group of over 27,000 women between 55-69 years of age, with no history or evidence of inflammatory-based disease, the death rate due to heart disease was lowest among those who drank between 1 and 3 cups of coffee per day. And, whether the coffee was caffeinated or decaffeinated did not matter. In contrast to its positive effect on heart health, coffee consumption did not show itself to be protective against infectious diseases or cancer.

HEALTH INSURANCE AND THIRD-PARTY LIABILITY (back to top)
I have had some complaints recently from members regarding requests by Regence BCBSO for documentation of the circumstances leading to specific claims. They generally have been for orthopedic conditions (spine, hips, knees, shoulders, etc.). These requests have been in the form of a letter indicating that the processing of a particular claim is delayed as Regence gathers more information. The letter generally is accompanied by a form that asks if the injury/condition is the result of an accident (specifically a motor vehicle accident or an on-the-job accident). This is an attempt by the insurance company to determine whether the claims might be the responsibility of another party such as auto insurance or worker’s compensation insurance coverage. Here is the language from our Regence BCBSO plan book on this.

Third Party Liability
This provision applies when you or an enrolled dependent incurs health care expenses in connection with an illness or injury for which one or more third parties may be responsible. In that situation, benefits for otherwise covered expenses are excluded under this contract to the extent you or your enrolled dependent receives a recovery from or on behalf of the responsible third party.

Please understand that the carrier is, in asking you to document that the claims in question are/are not subject to third-party liability, simply administering the plan according to contract language. It is ensuring that costs are properly assigned and that they do not result in plan costs higher than necessary.

Simply fill out the form, and if the claim is not the result of an on-the-job or auto accident, state that fact clearly and respectfully request that the claim(s) be processed and that your providers receive payment as soon as possible.

It has been my personal experience that this is the best strategy for moving the claim along to the quickest resolution. I think you will find this to be the case also. I also call the provider’s office just to let them know that I have provided the requested information to the insurance company and that payment should be coming soon. This lets them know that you are not being neglectful of your bill. Please call me if you have questions.

Michael Caley
Licensed-Staff Benefits Coordinator
Eugene School District 4J
200 North Monroe
Eugene, OR 97402-4295
Phone: W: 541-687-3244 H: 541-485-1493
fax: 541-687-3687 e-mail: caley@4j.lane.edu