More Fulton County employees and dependents are going to the see the doctor, but not enough for the insurance company’s liking.
Melissa Bodey of CEBCO (County Employees Benefits Consortium of Ohio) presented the third quarter update to the Fulton County Board of Commissioners Dec. 29 and reviewed the status of the county’s members. The report gives an insight as to how members are using the coverage they pay for.
Through the third quarter of 2016, 177 of 601 unique members (anyone who was covered at any time) had not visited a doctor. This compares with 221 of 602 in 2015.
The finding of 23 members who had nine or more visits did concern Bodey, but after her own experience, she learned that some conditions require a higher number of office calls. A diagnosis of diabetes can mean multiple trips to the primary care physician and specialists, she said.
She estimates about 73 members (6 or more visits) have had a serious diagnosis this year.
“What really concerns me are the 177 that haven’t gone at all,” Bodey said.
While there’s no requirement for member to visit their physicians, and many members are younger with no cholesterol or blood sugar problems, Bodey stressed that preventative care is covered 100 percent.
“We do like our members to have a relationship with a doctor’s office,” Bodey said. “In case something does come up, that way they will be able to get in and see a doctor.”
There are no requirements to see a doctor, but the Wellness Program awards point for seeing a doctor and those points can lead to prizes and financial rewards. Bodey said. But there’s no mandate, she said.
Two hundred one members had at least 1-2 visits, compared to 194 in 2015. More had at least three to five visits this year than last as well.
Of the 601 member, 236 are employees. Last year there were 244 employees.
The average age for members in Fulton County is 33.9, compared to 34 for CEBCO as a whole. Males account for 47.3 percent of the membership, females are 52.7 percent. CEBCO is comprised of 47.6 percent male and 52.4 percent female.
There are 313 dependents.
Dependents accounted for more than half of the dental and vision claims. Employees led on medical claims.
The top three physical health conditions (by highest claim costs) were:
By total paid: Breast cancer, diabetes and lymphoma.
By average plan paid by member: Lymphoma, Multiple Sclerosis and Breast Cancer.
By number of conditions: Hypertension, T &A Pharyngitis and mood disorder.
By total drug cost: Diabetes, Multiple Sclerosis and asthma.
The top three facilities visited were: Fulton County Health Center, Cleveland Clinic and Toledo Clinic.
The top three pharmacies were: Rite-Aid, Accredo and Kroger.
Nearly all prescriptions were generic where it was an option. This saves the member and the county money, Bodey said. However, specialty medications accounted for 78.2 percent of the cost of prescriptions.
Through the end of September, total claims stood at $31,127 of which employees accounted for $13,795.
James Pruitt may be reached at email@example.com
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