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Moore: Great Risk Management

  • National

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 copays or deductibles. The Blue Cross Blue Shield program even covered the labs, at 100%.

James Moore

James Moore

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

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 it will provide a $25 gift card. Do you think that the health insurance carrier would offer to pay $25 per person if it were 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.
  • Work-related medical conditions where the employee worked with the condition to keep his job. 
  • Serious unknown pre-existing condition at the time of hire. I will leave this one alone other than to say an aggravation of a pre-existing condition counts just like an on-the-job injury. I have one on my screen out of West Virginia 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  flow chart for presentations to governmental organizations.

A recent Workers Compensation Research Institute 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’ health care provider.

We have come full circle back to the reason for my email from the Blue Cross Blue Shield program. 

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.

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