Page 8 - Catasys Benefit Guide 2020-2021

Medical Benefits

Tips For Using Your Medical Benefits

 Examples of URGENT CARE situations
Ask questions when in doubt.
If you are having a procedure or planning an
upcoming procedure, make sure you know how the Any illness or injury that would prompt you to see your
procedure will be covered and what your out-of- primary care physician
pocket cost will be, if any.
Including, but not limited to:
 Accidents and falls
Utilize your free preventive care benefits to
  Sprains
stay healthy.  Back problems
Preventive care benefits are covered at no charge to  Breathing difficulties
you. Regular preventive care can reduce the risk of  Abdominal pain
disease, detect health problems early, protect you  Minor bleeding/cuts
from higher costs down the road, and most  High fever
importantly… save your life! Take advantage of these  Vomiting, diarrhea or dehydration
no cost benefits now to hopefully avoid major  Severe sore throat or cough
illnesses and costs in the future.  Mild to moderate asthma

 Examples of EMERGENCY situations
Use urgent care centers versus hospital
emergency rooms whenever possible. Any accident or illness that may lead to loss of life or limb,
Frequently, patients seek the services of the hospital serious medical complication or permanent disability
emergency department for ailments or injuries that
could be treated more economically, and just as Including, but not limited to:
effectively, at an urgent care center. It is not always easy  Chest pain*
to determine when you should choose urgent care over  Seizures
the hospital emergency department. The following lists  Shock
offer some guidance, but are not necessarily all-inclusive.  No pulse
 Unconscious or catatonic state
  Sudden dizziness, loss of coordination or balance
Use generic and over the counter drugs
when available.  Severe abdominal pain
The best way to save on prescriptions is to use  Severe or uncontrollable bleeding
generic or over the counter medications as opposed  Broken bones or compound fractures
to brand name drugs. When you use generic  Severe difficulty breathing or shortness of breath
 Spinal cord or back injury
medications, you will pay the lowest copay. Generic
 Severe burns
drug companies do not have to develop a medication
from scratch, so the costs are significantly less to  Major head injuries
bring the drug to the market. Once a generic  Ingestion of poisons or obstructive objects
medication is approved, several companies can  Animal, snake or human bites
produce and sell the drug. This competition helps
*If you believe you may be experiencing a heart attack, call 911
lower prices. In addition, many generic drugs are well
-established medications that do not require immediately! Do not drive yourself to the emergency room!
expensive advertising. Generic drugs must use the
same active ingredients as the brand name version of
the drug. A generic drug must also meet the same
quality and safety standards.


Use the mail-order prescription drug benefit
for maintenance medications.
As a Blue Shield member, you can receive a 90 day
supply of your maintenance medications for the cost
of only 2 copays (compared with a typical 30 day
supply for a single copay at your walk-in pharmacy).
In addition, your medications will be delivered to
your home.
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