Welcome to LiveWise
Do I need to be preauthorized?
When you or a family member are advised that non‐emergency care is needed by your physician, it is your responsibility to immediately contact Apostrophe at (866) 810-7766. Apostrophe will provide guidance on Centers of Excellence and/or alternative options when appropriate.
What healthcare procedures require preauthorization?
Preauthorization is generally needed for diagnostic services such as MRI’s, inpatient and outpatient surgeries, specialty drugs, non‐ER hospital services and continuing care services.
How long does preauthorization take?
You are required to provide a minimum of 14 days notification for all non‐emergency care or procedures. It’s best to call Apostrophe as soon as your physician recommends a procedure.
What happens if a procedure should have been preauthorized, but wasn’t?
In non‐emergency cases, you will be responsible for additional costs if the procedure wasn’t preauthorized.
Why did DBM Global move to the new healthcare model?
For years, DBM has worked to provide the best healthcare plan for our employees, while attempting to minimize the employee cost. Facing ever additional increases from our prior insurance carrier, we realized remaining with in the old BCBS’ plan model would have resulted in significant cost increases to the employee and potentially reduced benefits to their family. With our employees’ best interests in mind, we have moved to a new type of plan using a Medicare Reference Based Pricing program, which we call the “Transparent Open Network”. This is a new approach to healthcare benefits focusing on managing the overall cost while providing a level of care we expect.
Why use Medicare as a Reference?
Medicare is the largest healthcare payer in the country, and only Medicare has established and published prices for healthcare services. Medicare rates are the most commonly accepted pay rates, for example, hospitals receive 60% of their payments from Medicare. Our plan is not in any way affiliated with Medicare or Medicare Advantage, the Medicare data is simply used for a pricing benchmark to level the costs.
What is Reference Based Pricing?
Reference Based Pricing (RBP) is a common methodology used to calculate the amount a healthcare provider is paid for a specific service by paying a specific, pre-determined percentage of that standard Medicare rate. Reference Based Pricing closes the gap on how much different hospitals charge for the same services and saves our employees and their families money. In contrast, BCBS determined what you paid for a doctor visit by their PPO network discount, where the price was unknown until after services are rendered, increasing the total healthcare costs.
How does Reference Based Pricing affect DBM Global Plan Members?
If a member has a service at a hospital or physician’s office, the benefits will function exactly as they did before. You pay towards your deductible, and the Plan pays based on the predetermined, referenced based reimbursement on the member’s behalf.
How does this impact your healthcare providers?
Insurance companies like BCBS, Cigna have established connections with providers. Apostrophe is not an insurance company and not as well known, requiring the provider to establish the communication and billing with them. Because this takes an extra step, it is highly beneficial to communicate with your provider prior to the appointment to work out the communication and billing with Apostrophe.
Your retirement is secure
As of July 1, 2019, Wells Fargo Institutional Retirement and Trust was acquired by Principal Financial Group. As a participant, you shouldn’t experience any noticeable changes throughout the transition. Eligibility, investment fund options or fees will all stay the same. In 2020, Principal Financial Group will launch combined offerings and plan enhancements in collaboration with DBM Global. As always, we are committed in helping you achieve your retirement goals. For more information, click here.