Quarterly News for Individuals Under 65

Fall 2005

(Continued on page 2)

801 Pine StreetChattanooga, Tennessee 37402

Presorted StandardU.S. Postage

PAIDBlueCross BlueShield

of Tennessee

iBlueBe en sf Yout

www.bcbst.com

Hospital Quality Reports for Consumers InformPatients, Improve Delivery SystemMaking health care decisions for youand your family can be complicatedand confusing. But now that choicehas been made easier with theintroduction of consumer hospitalquality reporting, jointly developedby BlueCross BlueShield of Tennesseeand the Tennessee HospitalAssociation (THA).

Consumers can go online and researchquality data on 60 of the most

common and frequent procedures andconditions for inpatient services. Thecomparative data are posted on theBlueCross BlueShield of TennesseeWeb site at bcbst.com. To access thequality reports, consumers can clickon the “consumer health tools“ linkunder the health resources section onthe homepage.

“Whether you’re purchasing a car or a

New State LawRequires GenericDrug Dispensing

A new Tennessee law requirespharmacists to automaticallysubstitute the generic equivalentof a prescribed drug or a genericcovered under the patient’shealth plan.

The Tennessee Affordable Drug Actof 2005 allows pharmacists tooverride a physician’s prescriptionorder and offer the patient the lessexpensive option.

If the name brand drug ismedically necessary, doctors mustwrite “Dispense As Written (orD.A.W.),” “Brand Name MedicallyNecessary,” “Medically Necessary,”or “Brand Name, No Generic”on the prescription. Doctors canalso call the pharmacist to have abrand name drug supplied insteadof a generic.

The Tennessee Affordable DrugAct of 2005 was signed into lawin June, and pharmacies across thestate are already abiding by thisnew policy. ■

Select Middle Tennessee YMCAsJoin BluePerks®

2 Blue Benefits You • Fall 2005

VA/DOD/IHSPrescription ClaimsTreated as PharmacyClaims Oct. 1If you are eligible for benefits throughthe Veterans Health Administration,Department of Defense or Indian HealthServices, you have the option of obtainingprescription drugs from these agencies’health care facilities on an outpatient basis.

Starting October 1, 2005, VeteransHealth Administration, Departmentof Defense and Indian Health Servicesfacilities will begin submitting claims forprescription drugs as pharmacy claims.In the past, these health care facilitiessubmitted prescription drug claims toBlueCross BlueShield of Tennessee ashospital claims.

What does this mean for you?If your individual policy includesprescription drug coverage, you’ll beresponsible for the appropriate copayor coinsurance for medications coveredunder your plan.

If your policy does not includeprescription drug coverage and you obtainprescription drugs from these facilities,you will receive a notice stating that yourprescription drug claim was denied.

If you have questions about this change,please call member service at1-800-294-3845. ■

home or seeking health care, knowledge is key in making a gooddecision. Without the necessary information, we’re all operating in thedark,” said Dr. Ken Patric, chief medical officer for BlueCross BlueShieldof Tennessee. “The hospital quality comparison tool helps shed light onthe information Tennesseans need to better understand and control theirhealth care.” ■

Hospital Quality Reports(continused from page 1)

Some Insulin Products Discontinued,Voluntary Withdrawal of Palladone™

BlueCross BlueShield of Tennessee wants to make its members aware ofthe following issues with some insulin products and the prescription drugPalladone. Members who are taking any of the drugs mentioned belowshould contact their doctor for more information.

Manufacturing of some insulin products to be discontinuedOn July 6, 2005 Eli Lilly and Company announced it is no longermaking some of its insulin products. These insulin products areRegular IIetin® II and NPH IIetin® II Pork Insulins; Humulin® LLente® and Humulin® U Ultralente®. Eli Lilly has stated theseproducts should be available in pharmacies through the end of 2005.

This not a recall. Eli Lilly has announced it is no longer making theseproducts because newer insulin products are available. As a result, some ofthe insulin products made by Eli Lilly are being used less.

Please consult with your health care provider on this issue. If youwould like further information, please call Eli Lilly’s customer serviceline at 1-800-LillyRx (1-800-545-5979). You may also access EliLilly’s web site for information at www.LillyDiabetes.com/ and thenclick on PRODUCTS.

Voluntary withdrawal of palladone™Purdue Pharma L.P. has agreed to withdraw Palladone,hydromorphone hydrochloride, from the market. Palladone is anextended release capsule and a potent narcotic painkiller.

On July 13, 2005 the U.S. Food and Drug Administration issued apublic health advisory to inform patients and health care providersthat Purdue Pharma L.P. had voluntarily withdrawn this medicationbecause of the potential for severe side effects if Palladone is taken withalcohol.

Please consult with your doctor. For more information, call theFDA Information Office at 1-301-827-4573 or toll-free at1-888-INFO-FDA or by accessing their Web site at www.fda.gov. ■

3Blue Benefits You • Fall 2005

BlueCross BlueShield of Tennessee is pleasedto announce that 22 YMCA locations in theNashville area have joined the BluePerks discountprogram. Through BluePerks, members can showtheir member ID card and receive discounts onnon-covered health and wellness services.

In addition to discounted fees for membershipsto fitness clubs, members can enjoy discounts onJenny Craig® weight loss programs, cosmeticservices, massage therapy, acupuncture, spa services,LASIK vision surgery and other vision services.

For more details or to find a participatingpractitioner, please visit: http://www.bcbst.com/members/blueperks. ■

BluePerks YMCA Locations

Brentwood YMCA BrentwoodClarksville YMCA ClarksvilleCool Springs YMCA FranklinDonelson-Hermitage YMCA NashvilleDowntown YMCA NashvilleFranklin YMCA FranklinGreen Hills YMCA NashvilleHarding YMCA NashvilleJoe C Davis YMCA AntiochMargaret Maddox YMCA NashvilleMaryland Farms YMCA BrentwoodMaury Co YMCA ColumbiaNorhtwest YMCA NashvilleRobertson Co YMCA SpringfieldRutherford YMCA MurfreesboroScottsville YMCA ScottsvilleSumner YMCA HendersonvilleUptown YMCA NashvilleY-CAP NashvilleYDC NashvilleOakwood CommonCookeville YMCA Cookeville

Select Middle Tennessee YMCA LocationsJoin BluePerks® Discount Program

Blue Benefits You • Fall 20054

BlueCross BlueShield of Tennessee, Inc., an IndependentLicensee of the BlueCross BlueShield Association

® Registered marks of the BlueCross BlueShield Association,an Association of Independent BlueCross BlueShield Plans

This document has been classified as public information.

801 Pine StreetChattanooga, TN 37402

www.bcbst.com

Protect Your HearingWal-Mart JoinsPreferred PharmacyPricing NetworkMembers without prescription drugcoverage can now receive BlueCrossBlueShield of Tennessee preferredpricing at Wal-Mart pharmacies. To getthis preferred pricing, just show yourmember ID card when you drop offyour prescription. A complete list ofparticipating pharmacies can be foundonline at www.bcbst.com under thepharmacy section. ■

The most common causes of hearing lossin adults are age and noise. As you getolder, changes in the nerve tissue and cellsof your inner ear cause a gradual butsteady hearing loss. It’s a simple fact oflife. Hearing loss due to noise can bemuch more gradual. That’s why you needto be aware and do what you can to lessenthe level of noise in your life before it’s toolate.

Sudden loud noises such as an explosion,a gunshot or a firecracker close to the earcan produce immediate hearing loss. Thistype of injure often requires medicaltreatment.

Temporary exposure to loud noise, such as attending a rock concert, canresult in a temporary threshold shift. You may notice that sounds aremuffled or you may experience a ringing in your ears. This type of hearingloss may only last for a few hours. However, frequent exposure to sounds thatcause a temporary threshold shift can result in permanent hearing loss.

Noise-induced hearing loss can be the result of repeated exposure to moderatelyloud noise over and extend period of time. Situations include:

• Exposure to loud noise from machinery or other types of sounds at work.• Recreational activities such as riding motorcycles or other vehicles that

have loud engines.• Listening to loud music, especially from a personal CD player or MP3

player with headphones.

“The good news about noise-induced hearing loss is that it is almostcompletely preventable,” said Dr. Ken Patric, chief medical officer forBlueCross BlueShield of Tennessee. “All that’s required is some simpleadjustments in your normal routine.”

Here are some steps you can take to prevent noise-induced hearing loss:

• Avoid exposure to loud noises and loud equipment if possible.• If you can’t avoid the exposure, wear protective devices such as earplugs

or earmuffs.• Minimize the time you are exposed to loud noises. If you are exposed

at work, try to avoid noisy situations in your leisure time.• Control the volume whenever you can. Resist the temptation to crank

up the volume of your radio to hear your favorite song.• Limit the time spent listening to music through headphones. Even

lower volumes through headphones can damage your ears because thenoise is pumped directly into your ears.

Take care now. Don’t wait until you begin to notice the symptoms ofhearing loss. Once noise-related damage is done, it cannot be reversed. ■

Benefit Exclusion RidersApply for the Life ofYour PolicySometimes it is necessary for BlueCrossBlueShield of Tennessee to place a benefitexclusion rider on individual healthinsurance policies in order to be able tooffer you coverage. Benefit exclusion ridersare not related to your policy’s 12-monthpre-existing condition waiting period.Benefit exclusion riders remain in effect forthe life of the policy, meaning that nobenefits will be paid on the conditions listedin the rider for as long as you hold the policy.

However, you can request that a benefitexclusion rider be reconsidered. Requestsmust be submitted in writing along withthe appropriate medical records no earlierthan 12 months from the originaleffective date of your policy. Upon review,if it is determined that your benefitexclusion rider can be removed, you willbe notified in writing.

For more information on the recon-sideration process, please call customerservice at 1-800-294-3845. ■