Spira Care
Dave is enrolled in a Spira Care plan (without a Health Savings Account). What is the cost for a visit with his PCP to manage his diabetes?
Spira Care Centers - No Cost for primary care services at Spira Care Centers.
His plan's network: Costs apply towards his annual deductible.
What is an EOB and what information will be included?
Explanation of Benefits is the statement from Blue KC showing how claims were processed including member responsibility.
True or False - Spira Care plans are only available as an EPO Plan Type
False - Spira Care plans can be offered as EPO or PPO Plan Types
BlueCard is available for HMO members?
HMO members have access to the local Blue Care network. Non-emergency services received from out-of-network providers will not be covered
When was the first Spira Care Center opened?
The first Spira Care Center opened in January 2018 in Olathe, Kansas.
Dave's PCP recommends that he see an endocrinologist to better manage his diabetes. What cost can Dave expect?
Spira Care members who need to see a specialist have the support of the plan network where costs are applied toward an annual deductible.
What is EviCore?
They are the third-party vendor that serves as the preauthorization manager for all free-standing and outpatient high-tech radiology services
What is AHY and as an HMO member, do I have access to this program?
Yes, A Healthier You is Blue KC's health and wellness program focused on achieving outcomes by improving the health of our members.
What does the suitcase displayed on an ID card represent?
The suitcase represents access to the BlueCard national network.
Name the various professionals that make up a Care Team at Spira Care
Physicians, PAs, NPs
Behavioral health consultants
Diabetic educators and health coaches
Care Guides
Dave's Endocrinologist prescribes metformin to treat his diabetes. Can Dave fill his prescription at Spira Care?
No. Spira Care offers on-site prescription services for a limited number of generic medications. Spira Care can only fill prescriptions ordered by Spira Care physicians.
Help! I am new to the Blue KC plan and need to register online. I have not received my ID card yet. Can I still register?
YES! You can register at MyBlueKC.com even if you don't have your member ID card.
True or False - I will automatically receive notifications regarding pharmacy savings opportunities through RXSS
FALSE - AFTER registering for RXSS, you will receive emails and/or texts about opportunities to save on the medications you and your family already take.
What are the two hospital systems locally that make up the Blue High Performance Network?
What are St. Luke's Health System and CHildren 's Mercy?
The amount of the affordable charge for an office visit at a Spira Care Center for members enrolled on a Spira Care HSA plan
$60 - Affordable charge for a visit to a Spira Care Center, which includes follow-up services like routine lab draws and digital x-rays as ordered by a Spira Care physician
Dave's son Caleb thinks he may have fractured his foot after falling hard from the game winning slam dunk at his high school basketball game in Liberty. He would like an x-ray but wants to avoid the cost of the ER. Can he go to the closest Spira Care center in Liberty for an x-ray?
Digital x-rays are available at all Care Centers EXCEPT Lee's Summit and Liberty.
Tammy's coverage is effective 1/1/22. She presents her new ID card at her Dermatologists office but they are unsure of her copay. How can Tammy help verify her copay amount?
Use the camera on her mobile device to scan the QR code to view her benefit summary
I have access to the BlueCard network if enrolled on a Blue High Performance plan
BlueHPN members must receive services from in-network, BlueHPN providers
Which two hospital systems are excluded from the Blue Select Plus network?
What are HCA and St Luke's Health Systems
Steve is enrolled on a Spira EPO plan and is at a business conference in Miami, FL. He unknowingly ate shellfish at dinner and needs to go to the ER. What steps should he take to find an in network hospital?
He should go to the nearest ER to seek care. Emergency services are covered at the in network benefit level
Fortunately Caleb only bruised his foot so he is able to recover in time for the next basketball game in St Louis, MO. Unfortunately, he had a reoccurring injury during the game and needs to seek treatment at an urgent care center. 1) How can he find an in network provider in STL and 2) what is the cost?
Spira members have access to the BlueCard network which offers coverage nationwide. Visit MyBlueKC.com to find in network providers.
What is the phone number to reach the Spira Care Wyandotte location?
(913)29-SPIRA :)
Carter is enrolled on the Spira HSA plan and needs help finding an in network specialist. It is after hours so he cannot call Spira Care to speak with a Care Guide. Can he search online at SpiraCare.com?
No, he will need to go to MyBlueKC.com to find an in network provider.
Name the 10 hospitals that make up the Blue Select Plus network
Advent Health, Cameron Regional Medical Ctr, Childrens Mercy (Hospital Hill and South), Liberty Hospital, North KC Hospital, Olathe Medical Ctr, University Health (Hospital Hill and Lakewood), UKHS
When would a check be included with your EOB?
Plan payment for an out of network claim is included with the EOB that is sent to the member.