On the Mend with Outpatient Rehab

Premera’s Outpatient Rehabilitation Management program makes sure you get the best care—and the right kind of care—after an illness or injury.

Outpatient rehabilitation, or rehab, benefits are part of every Premera plan. They include therapy you get outside of a hospital admission:

  • Massage therapy
  • Physical therapy
  • Occupational therapy

Ensuring your best care
Premera reviews treatment plans for outpatient rehab that are developed by therapists to make sure you’re getting care that’s both effective and medically necessary. We want you to:

  • Get the right care for your condition
  • Avoid paying for services that don’t help you recover
  • Have benefits available when you need them

What to expect
When your doctor refers you for outpatient rehab:
1. Your therapist assesses your condition and treats you at your first visit. The first 6 visits you need to treat your condition must be medically necessary, but do not need review by eviCore – Premera’s medical review partner.

2. If additional visits are needed beyond the initial 6 to treat the same condition, your therapist tells eviCore about your condition, gets authorization for additional visits, and creates a treatment plan.

3. eviCore’s medical professionals review the plan using medical best practices and clinical
guidelines to determine the medical necessity, and best duration of care.

4. Once your treatment plan is approved, you can proceed with your next visit.

Most plans are reviewed within 24 hours.

Denied? Don’t despair.
If your treatment plan is denied:

  • Your therapist can revise and resubmit the plan
  • Your therapist can review the plan with an eviCore therapist or medical director
  • You may appeal the decision

5 Questions to Ask When Your Doctor Suggests a Treatment

When your doctor suggests a treatment, it’s important for you to be an active participant in the final decision. After all, it’s your health. Here are some questions to ask to help you make the decision that is best for you.

1. Do I really need this test or procedure?
Ask your doctor to tell you if you really need the treatment, test or procedure and how it will make a difference.

2. What are the downsides?
Your doctor should clearly outline the risks of the treatment, test or procedure, so you can balance them with the potential benefits.

3. Are there simpler, safer options?
You should know all your choices to determine the right one for you.

4. What happens if I do nothing?
Sometimes, doing nothing can be an option to consider seriously.

5. How much does it cost?
Consider your out-of-pocket costs. A simpler treatment may cost less money and be just as effective.

Keep this handy guide in your wallet: Five Questions to Ask Your Doctor.

You can also use the Community Checkup website to see how medical groups and clinics rank in potentially avoidable care.

To learn more visit Own Your Health.

Eat well. Sleep well. Live well.

Lifestyle diseases are preventable illnesses linked to a person’s habits. They include serious conditions such as:

  • Heart disease
  • Type 2 diabetes
  • Obesity
  • High blood pressure
  • Many cancers

Practice these habits to help you enjoy a healthy life:

  • Eat a healthy diet: Put colorful fruits and veggies on the menu. Nutritional counseling is part of every Premera health plan. For information, call the customer service number on the back of your card.
  • Stay active: Choose an activity you enjoy and you’ll be more likely to stick with it.
  • Get enough sleep: Over time, good sleep can benefit your weight, heart, and mood. It may even help you live longer.

Personalized help
Premera has Personal Health Support clinicians who can help you get on track. For information, call 888-742-1479, 6 a.m. to 8 p.m. Monday through Friday; 10 a.m. to 4 p.m. Saturday.

Online resources
Sign in at premera.com for additional health information, support, and educational resources.

Tip: Another important habit of healthy living is to see your doctor annually. A preventive visit is included in your Premera health plan.

Communicating About Health Care Benefits With Your Employees Has Never Been Easier!

Premera’s communication center, B’link, provides information that supports your employees in getting the most out of their healthcare benefits. This convenient employer resource features ready-to-use, downloadable content that helps your employees better understand their health plan and costs.
How to get the most out of B’link
B’link offers on-demand content that best suits you and your employees’ needs throughout the year.

For each topic, we provide:

  • Flyers/poster that you can customize with your logo and plan details
  • Email templates – simply open and send
  • Content 3 ways: messages you can copy, paste, and share — long, medium, and, short versions are available 

Ready to get started?
Visit B’link today to find the right communications for your employees’ seasonal needs. Download your preferred materials (email, flyer, and/or messaging), and you are all set!

Feeling low? You’re Not Alone.

Nearly 1 in 5 people are dealing with mental health conditions, such as depression and anxiety. In fact, depression is the leading cause of disability worldwide.

Common symptoms of depression include:
• Fatigue
• Feelings of hopelessness
• Trouble concentrating
• Loss of interest in hobbies
• Change in appetite
• Trouble sleeping or sleeping too much

If something feels off, be sure to talk to your doctor. Depression is highly treatable.

Personalized help
Premera has Personal Health Support clinicians who can help you get on track. For information, call 888-742-1479, 6 a.m. to 8 p.m. Pacific Time, Monday through Friday, or 10 a.m. to 4 p.m. Pacific Time on Saturday.

Online resources
Sign in at premera.com for additional health information, support, and educational resources.

Tip: Mental healthcare is part of every Premera health plan. Go to premera.com or call the customer service number on the back of your Premera ID card.


Photo by Tim Gouw on Unsplash

Becoming a Savvy Health Care Shopper

There is enormous variation when it comes to the quality of health care. Not all care is equally good. Check out this helpful infographic from Own Your Health to learn more about how to choose quality care.

Quality is one aspect of high quality care – along with patient experience and cost. See this video about how to make sure you are getting the quality, patient experience and cost you deserve when it comes to your healthcare.

Telebehavioral Health is Finding Its Niche

Health systems are embracing telehealth and digital apps to improve workflow and reduce costs around behavioral health.

Behavioral healthcare has long lived adjacent to the traditional delivery system of U.S. hospitals, but that’s changing as providers and payers begin to view patients more holistically.

In turn, a number of companies are betting on behavioral health, with a new twist using telehealth principles. Vendors Teladoc and American Well for example are stepping into a vacuum created by a psychiatrist shortage, providing complementary services to primary care settings.

Providers are exploring these offerings, and some are seeing a return on investment. But there’s still work to be done to integrate mental health into the larger healthcare delivery system. It’s helping that payers are getting on board, with a push to to combine behavioral health and primary care.

Read the full article at HealthCareDive.com.