Health Care Quality Concerns Form
Complete and submit this online fillable form. Your concerns and comments are important to us. If you have concerns about a clinic, doctor or other health care professional, we’d like to hear from you.
Fraud Alert: caller targets Regence members
Regence offers advice for protecting yourself
October 22, 2007, updated November 2, 2007
We recently learned that several of our members have received suspicious phone calls from a caller claiming to be from Regence. Members were asked for either their bank account or credit card information.
Regence is committed to protecting our members’ privacy. As such, we never call members to request this type of financial information over the phone in a “cold call” style.
However, members would receive this type of call from Regence if they have elected to deduct their premium from their bank account and we require information to complete their application. In this case, the interaction would have been initiated by the member. In addition, members are also offered the opportunity to send in a new form, should they not wish to provide financial information over the phone.
Members should contact Regence or their benefits administrator if they suspect they have received a questionable phone call. In the meantime, there are things you can do to protect yourself if you receive these types of calls:
- Do not provide credit card or bank account information to the caller.
- If you have received a call and provided financial information, we recommend that you cancel the credit card(s) immediately or contact your bank to flag your bank accounts to monitor suspicious activity. You can also request free credit reports online to monitor your credit for possible identity theft. Be sure to use the official, centralized web site: www.annualcreditreport.com.
- You can also contact your local police department. Regence will fully cooperate with any law enforcement agency to assist in their investigation.
Questions?
If you have any questions or concerns, please contact us.
Discontinuation of Oregon CHEC, Consumer Advantage and Oregon YouthCare Plans
March 31, 2006
Please note that all benefits and rates are pending regulatory review, and we will notify you of any changes to the information provided below.
As part of our ongoing efforts to meet the needs of our members with Individual & Family coverage, Regence is discontinuing the CHEC and Consumer Advantage (CAP)/Oregon Youth Care (OYC) plans, effective July 1, 2006. In their place, we offer four different options that will provide you with the same great coverage at affordable rates:
- Blue Selections Basic – a basic plan that offers preventive and catastrophic coverage at an affordable rate
- Blue Selections Plus – offering preventive benefits, convenient office visit copays, and vision coverage
- Blue Selections Premier – full coverage with all of the extras that is convenient for the family
- Regence HSA Qualified Plan – designed for those interested in health savings accounts
Plan Choices
You have the opportunity to choose any Blue Selections or Regence HSA Qualified plan with the same or higher deductible as your current plan. For example, if you have a CHEC $1,000 deductible plan, you can move to any plan with a deductible of $1,000 or higher. To discuss your options, call customer service at 1-800-777-3168 or mail in the Individual Plan Change Form included in your discontinuation notice mailing with the postage-paid return envelope provided. If we do not hear form you by May 15, 2006, you will automatically be enrolled in our Blue Selections Premier plan with the same deductible that you currently have. All requested changes will take place the member’s premium due date, July 1, 2006 or after.
Deductibles
Any amount that you have accrued so far in 2006 towards your deductible, stop-loss or any benefit maximums will continue to accrue on their new plan. Any pre-existing limitation and exclusion periods on your new plan will be reduced by the number of months that you have had continuous coverage.
Questions?
If you have any additional questions or concerns, please contact Customer Service at 1 (800) 777-3168. Service hours are Monday through Friday, 6:00 a.m. to 6:00 p.m.
Explanation of Agent and Broker Commissions
November 21, 2005
The Regence Group and affiliate companies offer benefit plans and services through independent life and health insurance agents and/or brokers. Agents and/or brokers are independent contractors – they are not employees of Regence. Agents and/or brokers must be licensed in the state(s) in which they do business. As a health carrier, we pay agents and brokers commissions for selling our plans and services.
Independent health insurance agents with whom we do business enter into a contract with us, agreeing to fairly represent our plans and services, abide by our privacy policy and requirements, and adhere to our expectations of performance and professionalism in dealing with members who chose us as their health carrier. An independent life and health insurance agent who is paid a commission by the insurance carrier is representing the carrier and the products and services that carrier offers. Most independent health insurance agents represent a variety of insurance companies, which allows them to provide their clients with comparison information to aid in benefit purchase decisions. Most agents and/or brokers are also an excellent resource for questions regarding coverage, and may act as an advocate for their client when questions arise.
It’s important to us that you understand the role that your agent or broker plays in the health care and the health benefits industry. In Oregon and Southwest Washington where we offer our plans and services, independent life and health insurance agents, agencies and brokers perform important services for you as their client. While they are not employees of our company, they are an important part of our sales and service team.
Agents, agencies and brokers with whom we do business are paid commission for selling and renewing the plans we offer. Our agent commission is part of administrative expenses, which factor into the premium rates we charge for individual policyholders, small group policyholders, and most large employer group policyholders. Large employers and their agents or brokers may negotiate direct compensation fees, in lieu of commissions. You are not required to include an ‘agent of record’ on coverage you purchase with us. We charge the same premium rates for members who elect not to use an agent as we charge for those who do.
In addition to commissions, agents and/or brokers may receive bonus, administrative service fees or other compensation from us. The compensation we pay may include non-cash compensation, such as incentives based on the amount of business they place with us, the products they sell, their overall volume of clients that they maintain with our company, and/or the services they provide to our insured members. Like all costs included in our administrative expenses, the cost of these incentives may have a direct or indirect impact on premium rates.
Individual and Small Group Agent Commission
We pay a percentage of the overall premium as commission compensation to our agents. Our premium rates for these plans include administrative expenses that include agent/broker commissions. Regulation requires us to ‘pool’ our plan pricing by the type of plan. Individual plans are a ‘pool’, small employers with 2-25 employees are another ‘pool’ and employers with 26-50 employees are another ‘pool.’
Large Group Agent Commission
Large employer group health plans may choose to negotiate the commission rate or agent/broker fees as they negotiate coverage, benefits and pricing. These negotiated amounts are disclosed in our proposals of coverage, to assure the employer is aware of all charges and fees associated with the purchase of our plans and services.
Regence BlueCross BlueShield provides this disclosure statement on our Web site and various group and member materials and forms:
Disclosure
Your broker or agent provides a valuable service, and we want you to know that Regence BlueCross BlueShield of Oregon may at times provide incentives for that service. Brokers or agents may receive bonuses, commissions, administrative service fees or other compensation, including non-cash compensation, from Regence BlueCross BlueShield of Oregon. These incentives may be based on any of several factors, including the size of group business, the products you buy, your broker’s or agent’s volume of business with Regence and the other services your agent or broker provides to you. At times, these incentives may have an indirect impact on your rates. Your broker or agent can provide you with more information about incentives.
Important Changes to RegenceRx Prescription Medication Prior Authorization List
June 20, 2003
We are making the following changes to our Prescription Medication Preauthorization
list:
Medications requiring preauthorization effective July 1, 2003 (additions):
- Amevive (injectable medication used for psoriasis)
- Forteo (injectable medication used for osteoporosis)
- Xolair (injectable medication used for allergic asthma)
Medications with dispensing limits effective July 1, 2003 (additions):
- Emend (oral medication used to relieve nausea from chemotherapy) if over 1
trifold pack that contains 1x125 mg plus 2x80 mg capsules per 34 days. - Relpax (medication used for migraines) if over 12 tablets in 34 days.
The following medications will require preauthorization effective September 1, 2003:
- Actos (oral medication for diabetes to lower blood sugar levels)
- Avandia (oral medication for diabetes to lower blood sugar levels)
We’ll continue to cover Forteo, Actos, Avandia, and Amevive for our members who have
taken these medications within the last four months.
We're not sending our prescription plan members notification of these changes because:
- Our contracts state that preauthorization requirements and dispensing limits are
subject to change. - We encourage you to contact Customer Service if you have any questions about these changes. They are happy to assist you!
Consumer Privacy Notice (PDF)
Current Appeals Process (PDF)
Effective July 1, 2002