ABOUT THIS GUIDE - Spira Care · • When the closest Care Center is at capacity, we work to...

Quick Reference Guide

ABOUT THIS GUIDE

This quick reference guide provides all the basics on Spira Care, to help members make the right decisions for them and get the most from their healthcare.

Select the section you’d like to view by clicking one of the buttons to the right.

For any questions not answered here, call one of our Care Guides at 913-29-SPIRA (77472).

HOW SPIRA CARE WORKS

APPOINTMENTS & SERVICES

IN-NETWORK CARE

PLANOPTIONS

RESOURCES

QUICK INDEX

https://spiracare.com/care-guides.html

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INDEX


• Spira Care 1, 2 , 3

Click on the questions and categories above to direct you to more information.

• Simplif ied care experience

• More personal connections

• Lower costs

• How does Spira Care work?

• What about services needed outside the

Care Center?

WHAT MEMBERS GET FROM SPIRA CARE

Spira Care Shawnee, KSS P I R A C A R E R E F E R E N C E G U I D E 5

Developed by Blue Cross and Blue Shield of Kansas City and the first offering of its kind in the KC metro — Spira Care combines integrated primary care and coverage in one place.

This improves members’ healthcare in three important ways:

SIMPLIFYING THE CARE EXPERIENCE

MAKING MORE PERSONAL CONNECTIONS

LOWERING COSTS

How? Read on for more about

Spira Care benefits.

SPIRA CARE 1,2 ,3


IN-NETWORK CARE

PLANOPTIONS

RESOURCES

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SIMPLIFIED CARE EXPERIENCE

• Care Centers at convenient KC metro locations.

• Access to Care Guides – real people with nursing or benefits expertise to answer questions and assist with care needs both in and outside the Care Center.

• More services in-house – Spira Care is different than most medical offices, and as you learn more about our services, you’ll see why.

• Easy online tools – Portals and virtual care simplify managing your wellness, care and health history.

S P I R A C A R E R E F E R E N C E G U I D E 6

MORE PERSONAL CONNECTIONS

Care Teams at our Care Centers (including Physicians, Nurse Practitioners, Behavioral Health Clinicians, Health Coaches and Care Guides) partner with members in their health journey and well-being, treating the whole person, not just symptoms. These connections keep member care smart, intuitive and personal.*

* https://www.nytimes.com/interactive/2018/05/16/magazine/health-issue-reinvention-of-primary-care-delivery.html

LOWER COSTS

• Health plans include options like personal primary care for no or low cost at Care Centers.**

• Easy access to services lowers short- and long-term healthcare costs.

• The BlueSelect Plus network passes on significant savings to employers and employees.

** For Spira Care members, there are no additional costs for any procedure at Spira Care Centers. Select prescriptions will be offered on-site at the regular copay level. Spira Care (HSA Eligible) members pay an affordable charge for non-preventive services at the Care Center.


IN-NETWORK CARE

PLANOPTIONS

RESOURCES

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https://www.nytimes.com/interactive/2018/05/16/magazine/health-issue-reinvention-of-primary-care-delivery.html




S P I R A C A R E R E F E R E N C E G U I D E 7

HOW DOES SPIRA CARE WORK?

Spira Care members have two options for receiving care — visiting a Spira Care Center for primary care needs or seeing a provider in their plan’s network.

WHAT ABOUT SERVICES NEEDED OUTSIDE THE CARE CENTER?Spira Care is backed by the BlueSelect Plus network in the KC metro area and by BlueCard nationally (cost applies toward your annual deductible). X-rays are available at select locations only,

but at no additional cost to members.*

Not sure where to go for your care? We help guide you to the right care at the right place at the right time. Coming soon!


IN-NETWORK CARE

PLANOPTIONS

RESOURCES

QUICK INDEX


INDEX

CONNECTING TO SPIRA CARE

• What’s the f irst thing a member should do?

• Plan, Prepare & Pave the Way.

• Unplanned need, l ike sick care? Call f i rst !

• Why are Care Guides the greatest resource?

MAXIMIZING MEMBERSHIP BENEFITS

IN THE CARE CENTER & BEYOND

• Where are the Spira Care Centers located? Are

there plans to expand and bui ld more Care

Centers in the future?

• Does Spira Care of fer vir tual care appointments?

• Who is included on a Spira Care team?

OUR SERVICES

• What services are provided at the Spira Care Centers?

• What type of behavioral health services are of fered on-site?

• Does Spira Care of fer pediatric services?

• What kind of lab work is included in “routine lab draws”?

• How does receiving lab work and X-rays work at a Spira

Care Center?

• What prescriptions are f i l led at Spira Care?

• What about prescriptions that can’t be f i l led at Spira Care?


WHAT’S THE FIRST THING A MEMBER SHOULD DO?

To transition primary care to a Spira Care Center, the first step is to schedule an appointment to review health history with a provider.

Both planned and unplanned care require appointments.

Our Care Centers have extended hours for appointments

and for member convenience.

S P I R A C A R E R E F E R E N C E G U I D E

CONNECTING TO SPIRA CARE

To schedule an appointment:

• Call 913-29-SPIRA (77472)

• Register and log in to your patient portal at MySpiraCare.com to schedule online

If you have any questions contact a Care Guide at 913-29-SPIRA (77472).

1 0

The many services and benefits at Spira Care Centers, including behavioral health consultations OR health coach sessions, become available after the first wellness visit with a Spira Care provider.

See next page for how to maximize your Spira Care membership.

IN-NETWORK CARE

PLANOPTIONS

RESOURCES

QUICK INDEX



http://MySpiraCare.com

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Spira Care makes healthcare simpler, but there are things members can do to keep it that way.

The previous page explained about appointment scheduling and portal registration. Here are more helpful tips on how to best use Spira Care services and benefits.


PLAN, PREPARE & PAVE THE WAY.

• Complete pre-appointment paperwork in the Patient Portal click on “My Health” and then “Medical Forms”.

• Bring any medical history or immunization records.

• Arrive 15 minutes before your scheduled appointment to check in.

UNPLANNED NEED, LIKE SICK CARE? CALL F IRST!

Call 913-29-SPIRA (77472) to ask a triage nurse about symptoms and a same- or next-day appointment.

• When the closest Care Center is at capacity, we work to schedule member appointments at other Care Centers, virtual care, or find an appointment option in their plan’s network (subject to deductible).

S P I R A C A R E R E F E R E N C E G U I D E 1 1

IN-NETWORK CARE

PLANOPTIONS

RESOURCES

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USE OUR GREATEST RESOURCE.

Get to know the Care Guides. They can answer questions about both care and benefits, or advise on in-network services and specialists. They’re a member’s biggest advocate and resource.

JUST A GENTLE REMINDER.

We understand that life happens and things come up. If you can’t make your appointment, PLEASE let us know at least 24 hours ahead. We’re all in this together, so help us assist other members and we’ll get you rescheduled.

S P I R A C A R E R E F E R E N C E G U I D E 1 2S P I R A C A R E R E F E R E N C E G U I D E 1 2

IN-NETWORK CARE

PLANOPTIONS

RESOURCES

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WHERE ARE THE SPIRA CARE CENTERS LOCATED? ARE THERE PLANS TO EXPAND AND BUILD MORE CARE CENTERS IN THE FUTURE?

To find a Spira Care Center near you, visit SpiraCare.com to view all locations, hours of operations and Care Teams.

As Spira Care membership grows, we will continue to add more Care Centers throughout the metro area in both Kansas and Missouri.

IN-NETWORK CARE

PLANOPTIONS

RESOURCES

QUICK INDEX



http://SpiraCare.com


DOES SPIR A CARE OFFE R VIRTUAL CARE APPOINTMENTS?

Yes. Spira Care offers virtual care for acute, sick and behavioral healthcare needs.

Spira Care (and Spira Care HSA eligible) members should use service key SPIRA when registering.

To make a virtual care appointment, download the Blue KC Virtual Care app or visit BlueKCVirtualCare.com


Acute and Sick Needs

Treatment for common conditions like: sinus pain, mild asthma, mild allergic reactions, minor headaches, cold sores, sprains, pink eye, nausea, vomiting, diarrhea, bumps, cuts, scrapes, coughs, sore throat, eye irritation, minor fever, colds, rashes, minor burns.

• No appointment necessary

• Spira Care members pay $0 for acute/sick virtual care appointments

• Spira Care (HSA eligible) members will have an affordable charge

Behavioral Health Needs

Treatment for conditions like: anxiety, bereavement/grief, bipolar disorder, depression, OCD, PTSD/trauma, panic attacks.

• Psychologists and counselors are available for scheduled sessions

• Visits start at $85 but vary by provider, and may be less based on your plan’s cost share (applies toward your deductible)

• Therapy services are provided by a network of doctoral level psychologists and master’s degree level therapists trained and licensed in virtual care prevention and therapy techniques

IN-NETWORK CARE

PLANOPTIONS

RESOURCES

QUICK INDEX



https://bluekcvirtualcare.com/landing.htm





WHO IS INCLUDED ON A SPIR A CARE TEAM?

In addition to the Spira Care Guides, all members have access to a team of first-class doctors, nurse practitioners and nurses known for an exceptional level of care. They are chosen for their medical expertise, their passion for family care and their member-centric dedication to ongoing wellness.

Primary Care Physicians

Family medicine practitioners who specialize in disease prevention, routine preventive care, health management, diagnosis and treatment of acute and chronic illnesses in adults and children and focus on overall health and well-being.

Nurse Practitioners

Clinicians who specialize in diagnosing and treating health conditions with an emphasis on disease prevention and health management.

Behavioral Health Consultants

Clinicians who work in tandem with the primary care physician or nurse practitioner to provide brief and focused behavioral health interventions for members, as well as consultation sessions designed to help them understand their medical conditions.

Health Coaches

Facilitators of behavioral change who help members move closer to their wellness vision by co-creating a personalized and strategic action plan.

Care Guides

Personal guides, many with nursing and benefit backgrounds, to support you on your health journey and answer questions regarding benefits, costs and care coordination.


IN-NETWORK CARE

PLANOPTIONS

RESOURCES

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OUR SERVICES

WHAT SERVICES ARE PROVIDED AT THE SPIRA CARE CENTERS?

• Adult and Pediatric Primary Care

• Sick Care

• Routine Preventive Care

• Chronic Condition Management

• Behavioral Health Consultations

• Health Coaching Sessions

• Routine Lab Draws

• Digital X-rays at Select Care Centers

• Limited Number of Select Generic Prescriptions Available On-Site

• Extended Full-Service Hours for appointments

• Online Scheduling and Care Team CommunicationFor questions on if a specific procedure or exam is available at a Spira Care Center, please call a Care Guide at 913-29-SPIRA.


IN-NETWORK CARE

PLANOPTIONS

RESOURCES

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OUR SERVICES

WHAT TYPE OF BEHAVIORAL HEALTH SERVICES ARE OFFERED ON-SITE?

Brief and focused interventions for members, as well as consultation sessions designed to help them understand their medical conditions, are available. Our Care Team can help support members with a variety of behavioral health needs such as chronic condition management, depression, anxiety, weight management and substance abuse. If a member has an ongoing or long-term behavioral health need such as therapy or psychiatric care, their Care Team will work with them to identify a provider in their plan’s network (costs for these in-network services to be paid out of pocket until a member’s annual deductible is met).

DOES SPIRA CARE OFFER PEDIATRIC SERVICES?

Yes. Spira Care physicians practice family medicine and offer primary care for both adults and children.


IN-NETWORK CARE

PLANOPTIONS

RESOURCES

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OUR SERVICES

WHAT KIND OF LAB WORK IS INCLUDED IN “ROUTINE LAB DRAWS”?

Routine lab services (like urinalysis, flu testing, glucose monitoring, pregnancy tests, annual bloodwork, etc.) ordered by a Spira Care physician are offered at every Spira Care Center, in partnership with Quest Diagnostics.

HOW DOES RECEIVING LAB WORK AND X-RAYS WORK AT A SPIRA CARE CENTER?

All lab work and digital X-rays completed at Spira Care Centers must be ordered by a Spira Care provider. Lab work is available at every Care Center, and digital X-rays are available at select Care Centers. If a member’s Care Center does not offer X-rays on-site, their Care Team will schedule an appointment at a Spira Care Center that does. Lab work or X-rays ordered by specialists outside of Spira Care cannot be completed at our Care Centers.


IN-NETWORK CARE

PLANOPTIONS

RESOURCES

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OUR SERVICES

WHAT PRESCRIPTIONS ARE FILLED AT SPIRA CARE?

A limited number of generic prescriptions are available on-site. This gets members started on medications quickly, based on primary care needs discussed in their visit. Members can pay by credit card at their regular copay/deductible level and pick up medications at appointments. Refills are set up through mail order or at the member’s preferred pharmacy.

Only select generic prescriptions ordered by Spira Care physicians can be filled at our Care Centers.

If a Spira Care provider prescribes a medication not available at the Care Center, the Care Team will facilitate prescription services through mail order or a member’s preferred pharmacy at their regular cost-sharing level.

WHAT ABOUT PRESCRIPTIONS THAT CAN’T BE FILLED AT SPIRA CARE?


IN-NETWORK CARE

PLANOPTIONS

RESOURCES

QUICK INDEX



IN-NETWORK CARE

INDEX

IN-NETWORK CARE

• Spira Care uti l izes two dif ferent insurance models,

EPO & PPO.

• What about special ists and hospital izations?

• What hospitals and providers are included in the

BlueSelect Plus network?


IN-NETWORK CARE

SPIRA CARE UTILIZES TWO DIFFERENT INSURANCE MODELS, EPO & PPO.

A member’s model type, EPO or PPO, is listed on the front of their member ID card.

See page 26 for card guidance

EPO • Members must receive all care from in-network

providers (BlueSelect Plus network in the Kansas City metro area or BlueCard network outside the 32-county service area).

• Emergency services in- and out-of-network are covered.

• Non-emergency services received out-of-network will not be covered.


PPO • Members are encouraged to receive care from

in-network providers (BlueSelect Plus network in the Kansas City metro area or BlueCard network outside the 32-county service area).

• Emergency services in- and out-of-network are covered.

• Non-emergency services received out-of-network are covered, but at a higher cost than those in-network.

Not sure where to go for your care? We help guide you to the right care at the right place at the right time. Coming soon!


PLANOPTIONS

RESOURCES

QUICK INDEX

IN-NETWORK CARE


IN-NETWORK CARE

WHAT IF I NEED TO SEE A SPECIALIST OR GO TO THE HOSPITAL?

Members have access to the BlueSelect Plus network within the 32-county Blue KC service area, and the national BlueCard network outside it. In-network services outside the Spira Care Centers are subject to a member’s plan deductible.* A Care Guide can help you (call 913-29-SPIRA), or you can find an in-network provider at MyBlueKC.com.

Members can find a list of in-network providers at MyBlueKC.com or by calling a Care Guide at 913-29-SPIRA (77472). More generally, the network offers:

WHAT HOSPITALS AND PROVIDERS ARE INCLUDED IN THE BLUESELECT PLUS NETWORK?


• 3,600+ Physicians & Specialists

• 11,000 Access Points

• Lower Overall Cost

• In- & Out-of-Network ER Coverage

• Access to 10 Hospitals

*Members are responsible for these costs until their deductible is met.


PLANOPTIONS

RESOURCES

QUICK INDEX

IN-NETWORK CARE


PLAN OPTIONS

Spira Care Spira Care (HSA Eligible)

Access to Spira Care Centers Yes Yes

Services and Procedures at Spira Care Centers No costAffordable charge per visit for non-preventive services; 100% covered once deductible is met

Rx/Prescriptions Subject to regular copay or deductible level Subject to regular copay or deductible level

In-Network Care BlueSelect Plus network in the KC metro area or BlueCard network outside the 32-county service area

BlueSelect Plus network in the KC metro area or BlueCard network outside the 32-county service area

Out-of-Network Care

EPO: Members must receive all care from in-network providers (above), except for emergency services. Non-emergency services received out-of-network will not be covered, and members will be responsible for 100% of costs. Emergency services are always covered at the in-network cost share. PPO: Members are encouraged to receive care from in-network providers (above), but have the option to receive care from an out-of-network provider at a higher cost, meaning higher out-of-pocket costs may apply. Emergency services are always covered at the in-network cost share.

EPO: Members must receive all care from in-network providers (above), except for emergency services. Non-emergency services received out-of-network will not be covered, and members will be responsible for 100% of costs. Emergency services are always covered at the in-network cost share. PPO: Members are encouraged to receive care from in-network providers (above), but have the option to receive care from an out-of-network provider at a higher cost, meaning higher out-of-pocket costs may apply. Emergency services are always covered at the in-network cost share.

PLAN OPTIONS


WHAT TYPES OF PLANS ARE AVAILABLE UNDER SPIRA CARE?

Employers may offer Spira Care and/or Spira Care (HSA Eligible) plans. It’s important to understand your plan option, whether you are on an EPO or PPO network and how it works at a Spira Care Center or with an in-network provider. For how to determine which plan and network type you are on, click here.


IN-NETWORK CARE

RESOURCES

QUICK INDEX

PLANOPTIONS


PLAN OPTIONS


If this area says, “Plan: EPO,” you are on the EPO network. “Plan: PPO” means you are on the PPO network.

See page 16 for more information.

PLAN

If this area is blank, you have the Spira Care plan. If it says, “HSA Eligible,” you are on the Spira Care (HSA Eligible) plan.

See page 25 for more information.

NATIONAL COVERAGEThe suitcase with “PPO” means you have access to the national BlueCard network for care needs when traveling outside the 32-county service area. The suitcase with ”PPO” means you have access to the BlueCard national network.

The most important number on your card is on the front: (913) 29-SPIRA. Call for appointments or for answers to any questions about Spira Care.

YOUR MEMBER ID CARDAPPOINTMENTS

& SERVICES

IN-NETWORK CARE

RESOURCES

QUICK INDEX

PLANOPTIONS


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RESOURCES

To register, visit MyBlueKC.com to enroll with your Blue KC member ID card.

To register, visit SpiraCare.com/Register or call 913-29-SPIRA.

RESOURCES


WHAT TOOLS OR ADDITIONAL RESOURCES DO SPIR A CARE MEMBERS HAVE ACCESS TO WITH SPIR A CARE?

Spira Care members have access to a patient portal (MySpiraCare.com) and an insurance portal (MyBlueKC.com). The diagram to your right will help you better understand what you can do where. See below or see to the right.

For any questions, please

call 913-29-SPIRA to speak with a Care Team member.


IN-NETWORK CARE

PLANOPTIONS

QUICK INDEX

RESOURCES


http://mybluekc.com

http://spiracare.com/register

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http://mybluekc.com

http://myspiracare.com

RESOURCES


Virtual ExperienceTake a look around one of our Care Centers and learn how Spira Care works

TestimonialsHear what people are saying about the Spira Care experience

SpiraCare.com• Directions to Care Centers

• Meet the Care Teams


IN-NETWORK CARE

PLANOPTIONS

QUICK INDEX

RESOURCES


https://spiracare.com/tour

https://spiracare.com/testimonials.html

http://SpiraCare.com

https://spiracare.com/care-centers.html

https://spiracare.com/care-centers.html


QUICK INDEX

If you don’t see what you’re looking for, call 913-29-SPIRA.

Appointments 08• Scheduling 10

• Required Paperwork 11

Behavioral Health 17• Consultants 15

• Consultations 17

BlueSelect Plus Network 23• Where to go for care 07

• Hospitals 23

• Providers 23

• Specialists 23

• Local Network 25

• National Network 25

Care Centers 13• Locations 13

• Hours 13

Care Guides 12, 15

Care Team 15• Communications

Call 02Send a Message 28

Chronic Conditions Management 16

Claims History 28

Copays 25

Deductible 25

Emergency Care 22, 23

Enrollment 28

Health Coaches 15

Health Coaching Sessions 16

HSA Eligible 25, 26

Imaging 18

Immunization History 28

Lab Work 18• Routine Lab Draws 18

• Quest Diagnostics 18

• Viewing Results 28

Member ID Cards 26

Member Portal 28• MySpiraCare.com 28


IN-NETWORK CARE

PLANOPTIONS

RESOURCES

QUICK INDEX


tel://19132977472


QUICK INDEX

If you don’t see what you’re looking for, call 913-29-SPIRA.

Membership 11

Network 22• EPO 22

• PPO 22

• In-network vs. out-of-network 22

Nurse Practitioners 15

Online Resources 28

Patient Portal 28, 29

• MyBlueKC.com 28

Pediatric Services 17

Plans 25

Preventive Care 16

Prescriptions 19• Filled At Spira Care 19

• Can’t Be Filled At Spira Care 19

Pharmacies 19

• Requesting A Refill 19

Primary Care 07

Primary Care Physicians 15

Rx 19

Services 16

Sick Care 11, 14, 16

Specialty Care 23

Unplanned Care 11

Urgent Care 23

Virtual Care 14

X-rays 18


IN-NETWORK CARE

PLANOPTIONS

RESOURCES

QUICK INDEX


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