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Blue Cross Blue Shield Program Great Risk Management

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Blue Cross Blue Shield Program Cuts Healthcare Costs

A Blue Cross Blue Shield program email appeared in my email inbox last week.   The email pointed out that I could have a well-being appointment and pay no co-pays or deductibles.   The program even covered the labs at 100%.

Blue Cross Blue Shiled Program Severe Ankle Fracture Xray
Wikimedia Commons -Chaim Mintz

The Affordable Care Act contained the same type of language.   The health insurance carriers covered any yearly check-up at 100%.   The concept likely originated with well-baby care appointments.   I just had my yearly physical,  so the appointment seemed unnecessary for me.

The Blue Cross Blue Shield program does not represent

I do realize many companies practice pre-employment job physicals.   Those physicals address the employee at the beginning.  What happens after they have been working for five years?

The Blue Cross Blue Shield program starts with a 15-minute assessment where they will provide a $25 gift card.  Do you think that the health insurance carrier would offer to pay $25 per person  if it was not an important assessment of a policyholder’s health condition?

Would Workers’ Compensation carriers and self-insureds benefit from a well-being appointment?  The worst claims I have ever handled started as

  • Medical only claims ignored by the employer and claims staff – leaving the closure to an algorithm -see claims festering
  • Work-related medical conditions where the employee worked with the condition to keep their job.
  • Serious unknown preexisting condition at the time of hire.  I will leave this one alone due to ADA/HIPPA other than to say an aggravation of a preexisting condition counts just like an on the job injury.  I have one on my screen out of WV where a bad knee at the time of hire is a worse knee now that the condition has been aggravated by another accident.
  • Loss of medical control at the beginning – where the $400 claim turns into the $750,000 claim over two years.  I used to have the claim on a  flowchart for presentations to governmental organizations.

A recent WCRI study proposed that a person with health insurance has better workers’ compensation outcomes. The study points out the need for well-being appointments with the employees’ healthcare provider.   We have come full circle back to the reason for my email from the Blue Cross Blue Shield program.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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