2002 - Spring

health Care Costs” inside ~ ~ “Holding Down Health

Digestive Health: The Inside Story

Spring 2002

F.A.Q. ons frequently asked questions frequently asked questions frequently asked questions ... about USAble Administrators Q: USAble Administrators is called a third-party administrator or TPA. What does that mean?

A: A third-party administrator is a company that provides claim-processing services to employer groups that are selffunded. The employer group designs the benefit package and establishes the guidelines for processing claims. The thirdparty administrator issues the claim Explanation of Benefits (EOB)/payments in accordance with these guidelines. The employer group reimburses the claim payments, as well as a fee for administration of the claims.

Q: How do I file a claim?

A: Most providers will file your claim for you. You can file the claim when the provider does not.

You may download a claim form from the USAble Administrators Web site at USAbleAdminArkansas.com. If you need help completing the form or if you need a form, please call Customer Service at the number on your identification (ID) card or e-mail Customer Service.

Q: If I need to mail in the claim form, where should I mail it?

A: Please mail the claim form to: USAble Administrators P.O. Box 1460 Little Rock, AR 72203

Q: Will I be notified when you have processed my claim form through USAble Administrators?

A: Yes, an EOB form will be mailed to you. The EOB details the amount paid to the service provider, any amount denied with the reasons for denial, and the portion you are responsible for paying.

Q: If I have received an EOB explaining payment of a claim, and I have questions about the EOB, whom do I contact?

A: Most inquiries concern benefits. Refer to your Summary Plan Description (SPD) provided by your employer. Other options are to retrieve benefit information on the USAble Administrators Web Site, call the Customer Service number on your ID card or e-mail Customer Service. For more information about reading your EOB, visit the “Understanding Your EOB� section of our Web site at USAbleAdminArkansas.com or call the Customer Service number on your ID card.

Q: If I have questions about claim status or benefits, whom do I contact?

A: Refer to your SPD or call Customer Service at the number on your ID card.

Q: If I lose my ID card, how do I replace it?

A: Simply call Customer Service at 1-888-USABLE-1 to request a new card.

Q: Why is it important to show my ID card to my provider of service?

A: Your ID card contains important information regarding program participation. It lets your provider of service know whether you participate in specific physician networks so that you may receive the highest benefit you are allowed. It also provides the ID number that is reflected in our claim processing system. This number is necessary to match the claim with the member when the claim is submitted, and it expedites the processing of your claim payment. Also, always have your ID card on-hand if you ever need to call Customer Service.

Customer Service Numbers Little Rock Toll-free Number (501) Number

Category

State/Public School Employees 378-2437 1-800-482-8416 e-mail: publicschoolemployees@arkbluecross.com stateemployees@arkbluecross.com Medi-Pak (Medicare supplement)

378-3062 1-800-338-2312

Medicare (for beneficiaries only): Part A (hospital benefits) Part B (physician benefits)

378-3151 1-877-356-2368 378-2320 1-800-482-5525

UniqueCare, UniqueCare Blue, Blue Select®, BlueCare PPO & PPO Plus (individual products) 378-2010 1-800-238-8379 Group Services

378-2070

1-800-421-1112

BlueCard®

378-2127 1-800-880-0918

Federal Employee Program (FEP)

378-2531 1-800-482-6655

Health Advantage

221-3733 1-800-843-1329

USAble Administrators

378-3600 1-800-522-9878

For information about obtaining coverage, call: Category

Little Rock Toll-free Number (501) Number

Medi-Pak (Medicare supplement)

378-2937 1-800-392-2583

Blue Select®, BlueCare PPO & PPO Plus (individual products) 378-2937 1-800-392-2583

Regional Office locations: Central Northeast Northwest South Central Southeast Southwest West Central

Little Rock Jonesboro Fayetteville Hot Springs Pine Bluff Texarkana Fort Smith

Customers who live in these regions may contact the regional offices or call the appropriate toll-free telephone numbers above.

Web sites:

www.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com, www.BlueAnnEwe-ark.com, www.USAbleAdminArkansas.com

is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, health care professionals and other persons interested in health care and wellness.

INSIDE THIS ISSUE

~SPRING 2002~

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The Inside Tract ........................................... 4 Colon cancer screenings for over 50s ......... 6 Obesity-related illnesses ............................. 8 Extra pounds can lead to extra problems ..... 9 Why fiber is important ............................... 10 Diverticulosis & diverticulitis .................... 11 Constipation is no laughing matter ............ 12 Irritable Bowel Syndrome ........................... 13 Inside indigestion ...................................... 14 Facts about food poisoning ....................... 15 Digestive disease quiz ............................... 16 Focus on digestive health .......................... 17 The pharmacist is in; member discounts ......... 18 Health Advantage member info .................. 19 On-line discounts & you; Don’t Start ............. 20 Readership survey; Medi-Pak info .................. 21 Member rights and responsibilities ........... 22 Maternity & Baby Fair ................................ 22 Blue & Your Community; Texarkana move ....... 23 Blue On-line ............................................... 24 Vice President of Advertising and Communications: Patrick O’Sullivan Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com Designer: Gio Bruno Contributors: Tammi Bradley, Janice Drennan, Damona Fisher and Kathy Luzietti

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THE INSIDE TRACT

drink are taken in and move like an ocean wave through elow the surface of your epidermis, nestled the esophagus, pushing slowly down the organ. beneath the protective cover of your muscles lies a long, winding road of organs that turn food into fuel for your The Organs body. The digestive system is a series of hollow organs Food is pushed down the esophagus toward the joined in a long, twisting tube about 30 feet long, from stomach. A valve (esophageal sphincter) closes the the mouth to the anus (see diagram this page). Two solid passage between the two organs. However, when food digestive organs, the liver and the pancreas, also help the and drink are being digested, the muscles around the digestive process, as do nerves and blood. ring-like valve relax and allow food to pass into the The digestive system consists of the mouth (32 teeth stomach. A malfunction of this valve is the start the breakdown of food), esophagus, most common cause of heartburn. stomach, gallbladder, liver, pancreas, The stomach then has three tasks to appendix, small intestine (duodenum, perform in its digestive role. At first, the jejunum and ileum), large intestine (ascendstomach serves as a storage facility for ing, transverse, descending and sigmoid food and liquid. The stomach relaxes to colon), rectum and anus. allow large volumes of swallowed food to Digestion is the process by which food accumulate. Next, the lower part of the Esophagus and drink are broken down into their stomach flexes its muscle to mix up the smallest parts so that the body can use Duodenum deposited food with the digestive juices it them to build and nourish cells and to Liver Spleen produces. Finally, the last task of the provide energy.

Stomach Gall Bladder stomach is to empty its contents into the Pancreas Food must be changed into smaller small intestine, slowly.

Transverse Colon molecules of nutrients before it can be Descending Ascending Colon The small intestine (about 20 feet in Small Intestine Colon absorbed into the blood and carried to cells length) is the next organ on food’s journey Cecum throughout the body. Digestion involves the Sigmoid to fuel, processing about two gallons of Appendix Colon mixing of food, its movement through the Rectum food, liquid and digestive secretions each Anus digestive tract, and the chemical breakdown day. As food is digested in the small intesof the large molecules of food into smaller tine and dissolved into the juices from the molecules. pancreas, liver and intestine, the contents of the intestine Although eating and drinking are voluntary proare mixed and pushed forward to allow further digestion. cesses, digestion is an involuntary process controlled Digested nutrients are absorbed through the intestiby the nerves. Once food is swallowed, the digestion nal walls. The waste products of this process include process begins. undigested parts of the food, known as fiber, and older Mucosa is the substance that lines the mouth, cells that have been shed from the mucosa. These stomach and small intestine. Mucosa contains tiny materials are propelled into the colon, where they glands that produce juices to help digest food. The remain, usually for a day or two, until the feces are hollow organs of the digestive system have muscles that expelled by a bowel movement. There is no nutrient cause their walls to move and contract. Food and drink absorption in the colon — its main job is to reclaim the are broken down by the digestive juices excess water from the intestinal waste and recycle it back and move through the system by into your bloodstream for reuse. muscles mixing with the contents of each organ for processing.

The Glands and “Juices” “Peristalsis” is the movement If you’ve ever wondered why it is so important to of the esophagus, stomach and drink water, understanding the digestive process can help intestine. The esophagus connects you see the need to replenish liquid in the body. the throat and stomach. Food and Throughout the digestive process, there are lots of

Your Digestive System and How it Works “liquids” required.

The salivary glands produce the first liquid needed for digestion.

Your body produces up to two quarts of saliva daily. Saliva contains an enzyme that begins to digest the starch from food into smaller molecules.

The stomach lining is the next set of glands used for digestion. They produce stomach acid and an enzyme that digests protein.

When food passes from the stomach to the small intestine, enzymes from the wall of the intestine continue to break down food. The juices from the pancreas and the liver also kick in to digest food. The pancreas produces a juice that contains a wide array of enzymes to break down the carbohydrates, fat and protein in our food. The liver produces bile — another digestive juice. Bile is stored between meals in the gallbladder. At mealtime, it is squeezed out of the gallbladder into the bile ducts to reach the intestine and mix with the fat in our food. The bile acids dissolve the fat into watery contents of the intestine. Once fat is dissolved, it is digested by enzymes from the pancreas and the intestinal lining.

Nutrients Digested molecules of food, water and minerals from the diet are absorbed from the cavity of the upper small intestine. The absorbed materials cross the mucosa into the blood and are carried off in the bloodstream to other parts of the body for storage or further chemical change. Different types of nutrients are absorbed at different rates.

• Carbohydrates —␣ Some of the most common foods contain mostly carbohydrates: bread, potatoes, candy, pastries, pasta such as spaghetti, rice, vegetables and fruit. Many of these foods contain both starch (which can be digested) and fiber (which cannot be digested).

Starch is digested in two steps: saliva and pancreatic juice breaks starch into molecules called maltose; then an enzyme (maltase) splits the maltose into glucose molecules that can be absorbed into the blood.

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Glucose is carried through the bloodstream to the liver where it is stored or used to provide energy for the work of the body. Table sugar is converted into glucose and fructose which are absorbed into the blood. Milk contains lactose, another kind of sugar, which is changed into absorbable molecules by an enzyme called lactase.

• Protein — Meat, eggs and beans consist of giant molecules of protein that must be digested by enzymes before they can be used to build and repair body tissues. Enzymes in the stomach and small intestine digest large protein molecules into small molecules called amino acids. These small molecules can be absorbed into the blood and carried to all parts of the body to build walls and other parts of cells.

• Fats — Fat molecules are a rich source of energy for the body. The first step in digestion of a fat such as butter is to dissolve it into the watery content of the intestinal cavity. Bile acids act as natural detergents to dissolve fat in water and allow enzymes to break fat down into fatty acids and cholesterol. Bile acids combine with fatty acids and cholesterol and help move newly formed molecules back into the cells of the mucosa. These converted molecules (called

(Inside Tract, continued on Page 14)

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Everyone 50 or older

olorectal cancer (cancer of C the colon or rectum) will cause more than 56,000 deaths in the United States this year. Colorectal cancer is the second leading cause of cancer-related deaths after lung cancer. If everyone aged 50 and older had the recommended screening tests, one third of the deaths from this type of cancer could be avoided.

Risks Both men and women are at risk for colorectal cancer, but 93 percent of cases occur in people aged 50 or older. Certain risk factors increase the chances of getting colorectal cancer. These include: • Diagnosis of inflammatory bowel disease, including ulcerative colitis or Crohn’s disease; and • Personal or family history of colorectal cancer or colorectal polyps.

Also suspected of contributing to risk are: • Lack of physical activity; • Low fruit and vegetable intake; • Low-fiber, high-fat diet; • Obesity; • Alcohol consumption; and • Tobacco use.

Early Detection Colorectal cancer almost always develops from precancerous polyps in the colon or rectum. Symptoms are not always present, especially in the early stages, when the disease is more treatable. That’s why it’s important for everyone 50 or older to have the screening tests. A proactive course of action also should include exercise, a healthy diet, limited alcohol intake and no tobacco use.

The American Cancer Society, American Medical Association and other major medical societies, and the U.S. Centers for Disease Control and Prevention (CDC) agree that

should have colon cancer screening colorectal cancer screening is necessary to find and remove precancerous polyps and to find and treat earlystage cancers. These institutions also agree on the recommended type and frequency of testing, but statistics show that testing is far underused. Many people fear the tests, which can be uncomfortable but are usually not painful.

Arkansans fall in the lower tier in CDC statistics, with less than 39 percent of adults aged 50 or older having recommended screening tests.

Screening Tests Your doctor will recommend one or a combination of the screening tests for colorectal cancer. The currently available tests and generally recommended frequency are: • Fecal Occult Blood Test (FOBT) or Stool Test: Annually beginning at age 50 This is a noninvasive test. Your doctor gives you a test kit to take home. Stool samples you return are checked for blood, which can be a symptom of cancerous polyps.

• Flexible Sigmoidoscopy (Flex Sig): Every three to five years beginning at age 50 Your doctor inserts a short, thin, flexible, lighted tube into your rectum. The doctor checks for polyps, bleeding, inflammation, abnormal growths and ulcers in the rectum and lower third of the colon, which is called the sigmoid colon.

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for this test involves a liquid diet for up to two days before the test and sometimes laxatives and an enema.

Symptoms Although symptoms are not usually present in the early stages of colorectal cancer, you should consult your physician immediately regardless of your age if you have any of the following conditions: • Blood in or on your stool; • Unexplained and frequent pain, aches or cramps in your stomach; • A change in bowel habits, such as having stools that are narrower than usual; and • Unexplained weight loss.

Innovation in Screening

Preparation for the test involves 12 to 24 hours of following a liquid diet and sometimes calls for laxatives and an enema.

Colonoscopy: Every 10 years beginning at age 50 as recommended by your physician Your physician may recommend a colonoscopy as a follow-up test if any of the other screening tests are abnormal. This test allows the physician to use a longer, thin, flexible lighted tube to check for polyps, inflamed tissue, abnormal growths, ulcers, bleeding and muscle spasms inside the rectum and the entire colon. Preparation for the test takes one to three days to clean out the colon through diet, laxatives and an enema. When you have a colonoscopy, you usually are given pain medication or a mild sedative to help you relax during the exam. If the physician finds anything unusual, he or she takes a small sample to send to a lab for testing.

Double Contrast Barium Enema (DCBE): Every five to 10 years beginning at age 50 as recommended by your physician In this test, you are given an enema using barium, which makes it easy for the doctor to see the outline of your colon in a series of X-rays taken while you are in different positions. The doctor examines the X-rays for evidence of polyps or other abnormalities. Preparation

Researchers at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins have developed an experimental noninvasive colorectal cancer screening test. The test detects a mutated gene that is a marker of colon cancer in stool samples. The New England Journal of Medicine reported results of the first feasibility trials of the new test in the Jan. 31, 2002, issue. The trial detected gene mutations in 61 percent of the early-stage colorectal cancer patients tested and returned no false positives.

Innovations such as this test usually reach your doctor’s office about five years later, after further research and clinical trials.

— Sources: 1.

2.

3.

4.

U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases American Medical Association Quality Care Alert, “Colorectal Cancer: Screening and Surveillance,” Oct. 19, 2001 Johns Hopkins Medical Institutions Office of Communications and Public Affairs, news release entitled “Stool Test for Colon Cancer Reported by Kimmel Cancer Center at Johns Hopkins,” Jan. 30, 2002

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SURVEY SHOWS OBESITY-RELATED ILLNESSES ARE TARGETS OF HEALTH PLAN PROGRAMS More than 90 percent of U.S. health insurance plans

responding to a recent survey offer a wide variety of programs to promote regular physical activity, an essential component of reversing some of the nation’s most troubling health trends. The survey results were released recently as part of a study by the Blue Cross and Blue Shield Foundation on Health Care in collaboration with Partnership for Prevention and the Centers for Disease Control and Prevention.

Responding to concerns addressed by U.S. Surgeon General David Satcher, M.D., Ph.D., who named obesity-related illnesses as one of the major causes of death in the United States, the study is intended to establish a baseline for health plans’ efforts to promote physical activity among their members and in the community.

“Health plans recognize the advantages of increased physical activity, but there has been a limited amount of objective data available to increase the scope of the programs,” said Scott Serota, Blue Cross and Blue Shield Association (BCBSA) president and chief executive officer. “Blue Cross and Blue Shield Plans already play an active role in promoting physical fitness by integrating it into broader preventive and disease management programs. This study begins to provide the industry with a baseline to develop new programs.”

“From this study, it appears that health insurance plans recognize the seriousness of this public health problem,” said Dr. Satcher, who addressed a roundtable meeting of health leaders recently at the Washington offices of BCBSA, where the study was released. “The insurance industry must continue to work creatively and cooperatively with its members, others in the health care delivery system, communities, schools, employers, and the media if we are going to have a real impact on this national public health priority.”

Ninety-five percent of the responding health plans routinely provide healthy-lifestyle messages to members and half of all health plans offer financial incentives for members such as discounted health club memberships and health education classes.

Sixty health plans, or about one-fourth of all health plans in the U.S., responded to the survey, providing information on more than 373 initiatives that incorporate physical activity and exercise in some way. Eighty-five percent sponsor fitness-oriented community events, such as races and health fairs, 60 percent have various partnerships with community organizations, and 17 percent of health plans provide grant support in the community to encourage fitness activities.

Nearly all health plan respondents, 92 percent, said they offer such programs to improve health and increase member satisfaction. More than half said the reduction of long-term health care costs was a goal.

Extra pounds can lead to

extra problems If you need to lose a few pounds because you would

rather partake of apple pie ĂĄ la mode than an apple, you are not alone. Approximately 60 percent of Americans aged 20 and older are overweight.

Genetic, environmental, psychological and other factors all play a part in keeping Americans from tipping the scales at their appropriate weight for their height and body shape. Obesity tends to run in families, suggesting a genetic cause; but families also share lifestyle and diet habits. Americans also tend to eat high-fat foods and put taste and convenience ahead of nutrition. They also tend to put physical activity on the back burner. Many people also eat in response to negative emotions, such as boredom, sadness or anger.

Obesity is more than a cosmetic problem; it is dangerous to your health. Serious illnesses that are linked to obesity include diabetes, heart disease, high blood pressure, stroke and even certain types of cancer. Other diseases linked to obesity include: gallbladder disease and gallstones, liver disease, osteoarthritis, gout, pulmonary (breathing) problems, and reproductive problems in women. The more obese a person is, the more likely the person is to develop health problems.

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Get healthy by eating right 1. Eat a variety of foods.

2. Balance the food you eat with physical activity.

3. Choose a diet with plenty of grain products, vegetables and fruits.

4. Choose a diet low in fat, saturated fat and cholesterol.

5. Choose a diet moderate in sugars, salt and sodium.

6. If you drink alcoholic beverages, do it in moderation.

The Food Guide Pyramid, which was developed by the U.S. Department of Agriculture and supported by the Department of Health and Human Services, is a general guide to help you choose a healthful diet that is right for you. The Food Guide Pyramid recommends the following daily essentials: 6-11 servings of breads, cereals, rice and pasta; 3-5 servings of vegetables; 2-4 servings of fruits; 2-3 servings of milk, yogurt, cheese; 2-3 servings of meat, poultry, fish, dry beans, eggs and nuts; and the use of fats, oils and sweets sparingly.

Make the commitment A weight loss of just 5 to 10 percent of your total weight can do much to promote your overall health. The best way to lose weight is to make a lifelong commitment to your health — eat healthy, exercise and get plenty of sleep.

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Why is fiber important

to your digestive system?

Whether you call it roughage, bulk or bran, it all means fiber, and it is important to

your digestive health. Fiber is found in breads, fruit, cereals, vegetables and grains. It is the part of the plant foods that cannot be digested by humans. So, if fiber can’t be digested, why do you need it?

Everyone needs fiber because it helps keeps your bowels working regularly and helps reduce your risk for diseases associated with the bowels (diverticulosis, constipation, hemorrhoids and more). Some fiber may have a cholesterol-lowering effect and may be helpful in controlling diabetes.

Fiber comes in two basic forms: soluble and insoluble fiber. Soluble fiber dissolves in water and is found in fruits, vegetables, oat bran, barley and some beans. Insoluble fiber retains water and is used by the body to soften and build up stool and can be found in vegetables, whole grains and wheat bran.

It is recommended that Americans eat 20-35 grams of fiber per day. Eating fiber keeps your bowels working regularly. Increasing food fiber gives your brain more time to realize that your body is no longer hungry and helps prevent overeating. It is also important to eat a variety of fiber-rich foods; achieving balance in eating is a key concept. It is also important to drink six to eight glasses of fluid per day along with your fiber intake.

Here are some examples of food with fiber and grams per serving (this will help you get started on creating a healthier you): Food Oatmeal Apple (with skin) Banana Orange Grapes Green beans Cabbage Potato (with skin) Turnip greens Kidney beans Green peas Pork and beans White bread Wheat bread Rice (cooked) Spaghetti (cooked)

Serving Size 1 cup 1 medium 1 medium 1 medium 20 1/2 cup 1/2 cup 1 medium 1/2 cup 1/2 cup 1/2 cup 1/2 cup 1 slice 1 slice 1/2 cup 1 cup

Total Fiber (grams) 4.45 2.76 1.94 2.49 1 1.27 1.19 5.05 2.05 6.66 2.80 5.63 .65 2.59 .41 2.10

Soluble fiber (grams) 1.64 .28 .57 .79 .10 .34 .07 1.21 .08 1.41 .24 1.79 .15 .57 .10 .56

Insoluble fiber (grams) 2.81 2.48 1.37 1.70 .90 .94 1.12 3.84 1.97 5.25 2.56 3.84 .50 2.02 .31 1.54

— Sources: American Dietetic Association and the National Institutes of Health

Questions & Answers about diverticulosis and diverticulitis Q. What is diverticulosis?

A. Diverticulosis is tiny pouches or sacs that protrude through weak points in the colon.

Q. How many Americans are affected by diverticulosis?

A. Nearly 50 percent of all Americans between the ages of 60 and 80 have it, and almost everyone over 80 has diverticulosis.

Q. What causes diverticulosis?

A. Medical experts believe the main cause of diverticular disease is a low-fiber diet.

Q. How is a low-fiber diet related to diverticular disease?

A. Diverticular disease is more common in industrialized countries, such as the United States, England and Australia, where low-fiber diets are common. This condition is rare in places such as Asia and Africa, where the people eat high-fiber diets.

Q. What are the symptoms of diverticulosis?

A. Generally, none. However, symptoms may include mild cramps, bloating and constipation. You should visit your doctor if you have these troubling symptoms.

Q. Why should I be concerned about diverticulosis?

A. Fifteen to 20 percent of people with diverticulosis will develop diverticulitis.

Q. What is diverticulitis?

A. Diverticulitis is inflammation of the pouches or sacs that will sometimes develop into abscesses.

Q. What causes this inflammation?

A. The cause is unknown, but medical experts believe it is related to infection in the sac.

Q. What are the symptoms of diverticulitis?

A. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause of the pain — fever, nausea, vomiting, chills, cramping and constipation may occur as well.

Q. Can diverticulitis lead to other complications?

A. Diverticulitis can lead to complications such as infections, perforations or tears, blockages or bleeding.

These complications always require treatment to prevent them from progressing and causing serious illness.

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Q. What is the treatment for diverticulitis?

A. For mild cases: oral antibiotics, rest and a liquid diet.

For more severe cases, hospitalization with IV antibiotics. Your doctor should make that decision.

Q. What happens if diverticulitis is not treated?

A. The outcomes can be very similar to appendicitis because if the abscess ruptures, then peritonitis can ensue with major complications, including death. For severe episodes, surgery also may be required.

Q. How do I prevent diverticulitis?

A. It is recommended that you eat 25 to 30 grams of fiber each day and drink at least 8 cups of fluid a day to avoid constipation. In addition, many physicians have recommended avoiding foods with very small seeds such as strawberries and tomatoes, or even very hard foods, such as nuts and popcorn, because of the belief that these particles could lodge in the sacs and cause inflammation. This point is being debated. The bottom line is to increase the fiber in the diet.

Q. How do I prevent diverticulosis in the first place?

A. Increase the fiber in the diet and drink more fluids.

Q. Will diverticulosis ever go away?

A. No. Once you have been diagnosed with it, it is yours for life, but with proper preventative measures, there is an excellent chance you never will have problems from this.

Q. Is diverticulosis/diverticulitis associated with colon cancer?

A. No, but the symptoms of these two may be similar.

Always check with your doctor if you have a prolonged unexplained change in bowel habits.

Q. Where may I get more information about this?

A. Contact your physician. — Source: National Institute of Diabetes, Digestive and Kidney Diseases

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C

onstipation

B

athroom humor aside, constipation is no laughing matter. At some point or another, everyone gets constipated — even children. Constipation is simply this: bowel movements that are hard, dry and difficult to pass.

More likely than not, poor diet and lack of exercise usually are the causes of constipation. In most cases, it is temporary and not serious. Understanding the causes, prevention and treatment will help almost everyone find relief.

Remember, just because you don’t have a bowel movement every day does not mean you are constipated.

Normal may be three times a day or three times a week, depending on the person. Signs of constipation include difficulty in having a bowel movement or feeling bloated, uncomfortable or sluggish.

What causes constipation?

The most common causes of constipation are: not enough fiber or fluids in the diet; lack of exercise; certain medications; changes in life or routine, such as pregnancy, older age and travel; irritable bowel syndrome; abuse of laxatives; ignoring the urge to have a bowel movement; specific diseases, such as lupus and multiple sclerosis; and problems with the colon, rectum or intestinal function.

In most cases, constipation can be treated through diet and exercise (see article on Page 9 for more information on fiber). In some cases, constipation can lead to complications and should be treated by a doctor. Complications include hemorrhoids and anal fissures (tears in tissue around the anus).

is no laughing matter

Constipation in children As with adults, it is important for children to drink plenty of fluids, have fiber in their diet and get plenty of exercise to avoid constipation. Children also may become constipated because they ignore the “urge” when they are playing, don’t want to use a public restroom, or lack confidence if a parent is absent. Medications or disease also may cause constipation.

Symptoms of constipation in children include: no bowel movement for several days or daily bowel movements that are hard and dry; cramping; abdominal pain; nausea; vomiting; weight loss; or liquid or solid, clay-like stool in the child’s under clothes (an indication that stool is backed up).

Usually, eating more fiber, drinking more fluids and getting more exercise will alleviate the problem. However, a child should see a physician if any of the following occur: 1. Episodes of constipation lasting more than three weeks.

2. Child is unable to participate in normal activities.

3. Small, painful tears around the anus.

4. Hemorrhoids appear.

5. Normal pushing is not enough to expel stool.

6. Liquid or soft stool leaks out of the anus.

Although constipation is a common health problem that almost everyone experiences at some point, you can help prevent it through a proper diet and exercise.

— Source: National Digestive Diseases Information Clearinghouse

Irritable Bowel Syndrome

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When a good colon goes bad I

rritable bowel syndrome (IBS) is a common disorder of the intestines that leads to cramping, gassiness, bloating, and changes in bowel habits, including constipation, diarrhea or both. Occasionally, the person with IBS has a crampy urge to move the bowels but cannot do so. For most people, IBS is just a mild annoyance, but for some, it can Experts have be disabling. Most people with IBS, however, are able to control their labeled it as a symptoms through medications functional prescribed by their physicians, diet, disorder and stress management.

IBS sometimes has been referred because there to by other names — colitis, mucous is no sign of colitis, spastic colon, spastic bowel, and functional bowel disease; disease when however, most of these terms are the colon is misleading. Colitis, for example, is the inflammation of the large intestine examined. (colon). IBS, on the other hand, does not cause inflammation and should not be confused with another disorder, ulcerative colitis.

However, IBS does affect the colon, which is about six feet long and connects the small intestine with the rectum and anus. The colon’s major function is to absorb water and salts from digestive products that enter from the small intestine and then help the remaining stool move through until a bowel movement occurs.

What causes IBS? Although it is a common disorder, the cause of IBS is not known, and, to date, there is no cure. Experts have labeled it as a functional disorder because there is no sign of disease when the colon is examined. IBS can cause a tremendous amount of discomfort and distress, but it does not cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel or to a serious disease such as cancer.

It is thought that the cause of IBS may be rooted in emotional conflict or stress, because doctors have yet to find an organic cause. Also, researchers have found that the colon muscle of a person with IBS begins to spasm

after only mild stimulation, which leads to the assumption that this person’s colon is more sensitive and reactive than usual, so it responds strongly to stimuli that would not bother most people.

Does a good diet help IBS? Relaxation and stress reduction techniques, counseling and support can help relieve IBS symptoms in some people; and for others, eating a proper diet with plenty of dietary fiber may help. Whole-grain breads and cereals, beans, fruits, and vegetables are good sources of fiber. High-fiber diets keep the colon mildly distended, which may help to prevent spasms from developing. This kind of diet also helps keep water in the stools, thereby preventing hard stools that are difficult to pass. Be aware that high-fiber diets may cause gas and bloating, but within a few weeks, these symptoms often go away as your body adjusts to the diet. Doctors generally recommend that you eat just enough fiber to produce soft, easily passed and painless bowel movements.

Can Medicines Relieve IBS Symptoms?

Your doctor may prescribe fiber supplements or occasional laxatives if you are constipated. Other options are prescribed drugs that control colon muscle spasms, drugs that slow the movement of food through the digestive system, tranquilizers or antidepressant medications, all of which may relieve symptoms.

— Source: National Institute of Diabetes and Digestive and Kidney Diseases

14

Bubble, bubble, toil and tummy troubles E

ver felt as though something strange was brewing in your tummy? Well, you’re not alone. Indigestion, sometimes called upset stomach or dyspepsia, is a common condition often accompanied by nausea, abdominal bloating, belching, and sometimes vomiting.

While the painful or burning feeling in the upper abdomen might be caused by a disease or an ulcer in the digestive tract, it most often results from eating too much, eating too quickly, eating high-fat foods or eating during stressful situations.

Other factors contributing to indigestion are smoking, drinking too much alcohol, using medications that irritate the stomach lining, and being tired. Even having ongoing stress can cause indigestion or make it worse.

So, how is indigestion diagnosed? The doctor first rules out other problems, like

ulcers. This process of diagnosis may include X-rays of the stomach and small intestine or endoscopy, in which the doctor uses an instrument to look closely at the inside of the patient’s stomach.

The most successful way to treat this particular type of tummy trouble is by avoiding the foods and situations that seem to cause indigestion. If you’re a smoker, quitting smoking or at least not smoking right before a meal can ease your indigestion.

Believe it or not, your mother may have been right, exercising with a full stomach may cause indigestion, so scheduling exercise before a meal or at least an hour afterward might help. Everybody out of the pool!

To treat indigestion caused by a functional problem in the digestive tract, the doctor may prescribe medicine that affects stomach movement.

Because indigestion can indicate or imitate a more serious disease, you should see a doctor if you have: • Vomiting, weight loss or appetite loss; • Black tarry stools or blood in vomit; • Severe pain in the upper right abdomen; • Discomfort unrelated to eating; and • Indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck or arm.

— Source: National Institute of Diabetes and Digestive and Kidney Diseases

(Inside Tract, continued from Page 5)

lymphatics) or reformed fat are carried to the veins of the chest, and the blood carries the fat to storage depots in different parts of the body.

• Vitamins — Another part of food that is absorbed from the small intestine is the class of chemicals called vitamins. There are water soluble vitamins (all the B vitamins and vitamin C) and fat-soluble vitamins (vitamins A, D, and K).

• Water and Salt — In a healthy adult, more than a gallon of water containing an ounce of salt is absorbed from the intestine every 24 hours. Most of the material absorbed from the cavity of the small intestine is

water in which salt is dissolved. The salt and water come from the food and liquid we swallow and the juices secreted by the many digestive glands.

Hormones The hormones that control digestion are gastrin, secretin and cholecystokinin (CCK).

These hormones are the digestive system’s own regulators and are released into the blood of the digestive tract, travel back to the heart and through the arteries and return to the digestive system, where they stimulate digestive juices and cause organ movement.

Don’t eat raw cookie dough! (and other tips to avoid foodborne illnesses)

T

15

hat cookie dough may taste good going down, but is it worth the chance that the eggs you used might contain the harmful bacteria Salmonella? You won’t think so if abdominal cramps, nausea, vomiting, diarrhea, fever, and dehydration are the result of your weakness for cookie dough.

Harmful bacteria are the most common causes of foodborne illness. Bacteria may be present on food when you purchase items at the grocery store, so remember, raw foods are not sterile.

Chew on these facts.

• Raw meat and poultry may become contaminated at any point during the processing.

• Seafood may become contaminated during harvest or through processing.

• One in 20,000 eggs may be contaminated with Salmonella inside the eggshell.

• Produce (lettuce, tomatoes, melons, etc.) can be contaminated during growing, harvesting, processing, storing, shipping or final preparation.

• Food contamination can occur in a restaurant or in your very own kitchen.

The good news is that most cases of food poisoning are mild and can be treated by increasing fluid intake.

A doctor should be contacted if there are signs of shock (such as a weak or rapid pulse; shallow breathing; and/ or chest pain); signs of severe dehydration (such as dry mouth, dizziness, and/or low blood pressure); and/or confusion or difficulty reasoning.

Here are some tips to help you avoid the discomfort of foodborne illnesses.

1. Refrigerate food promptly. Set your refrigerator at 40 degrees Fahrenheit and lower your freezer to zero degrees Fahrenheit.

2. Cook food to the appropriate temperature to kill the harmful bacteria (145 degrees for roasts, steaks and chops of beef, veal and lamb; 160 degrees for pork, ground veal and ground beef; 165 degrees for ground poultry; and 180 degrees for whole poultry).

3. Prevent cross contamination. Keep foods away from each other during preparation.

4. Handle food properly. Wash your hands; clean surfaces.

5. Keep cold food cold and hot food hot.

6. Maintain hot cooked food at 140 degrees or higher.

7. Reheat cooked food to at least 165 degrees.

8. Refrigerate or freeze perishables, prepared food and leftovers within two hours.

9. Do not defrost food on the kitchen counter; use cold water, the microwave or the refrigerator.

10. Do not marinate food at room temperature; always use the refrigerator.

11. Do not pack the refrigerator. Cool air must circulate to keep food safe.

Nerves

Intrinsic nerves make up a very dense network embedded in the walls of the esophagus, stomach, small intestine, and colon and are triggered to act when the walls of the hollow organs are stretched by food. Intrinsic nerves release different substances that speed up or delay the movement of food and the production of juices by the digestive organs.

Two types of nerves help to control the action of the digestive system: extrinsic (outside) nerves and intrinsic (inside) nerves. Extrinsic nerves come to the digestive organs from the unconscious part of the brain and from the spinal cord and release chemicals called acetylcholine and adrenaline. Acetylcholine causes the muscle of the digestive organs to squeeze and increases the push of food and juice through the digestive tract. It also causes the stomach and pancreas to produce more digestive juice. Adrenaline relaxes the muscle of the stomach and intestine and decreases the flow of blood to these organs.

— Sources: U.S. Department of Agriculture and the National Institute of Diabetes, Digestive and Kidney Diseases

— Sources: National Digestive Disease Information Clearinghouse/National Institutes of Health, the American Medical Association, and the Crohn’s & Colitis Foundation of America, Inc.

16

How much do you know about digestive health?

Take our quiz and test your knowledge!

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D i g e s t i v e

Crohn’s Disease Crohn’s disease is an inflammatory bowel disease (IBD) and is a chronic illness requiring long-term medical therapy. Crohn’s disease causes inflammation in the small intestine and usually occurs in the lower part of the small intestine (called the ileum), but it can affect any part of the digestive tract.

The inflammation of Crohn’s disease extends deep into the lining of the affected organ, can cause pain and can make the intestines empty frequently, resulting in diarrhea.

Crohn’s can be difficult to diagnose because its symptoms are similar to other intestinal disorders such as irritable bowel syndrome and another type of IBD called ulcerative colitis.

Crohn’s disease affects men and women equally and seems to run in some families. In fact, about 20 percent of people with Crohn’s disease have a blood relative with some form of IBD. The most common symptoms of Crohn’s disease are abdominal pain (often in the lower right area) and diarrhea. In addition, rectal bleeding, weight loss and fever may also occur. Sometimes bleeding may be serious and persistent, leading to anemia. Children with Crohn’s disease may suffer delayed development and stunted growth.

Although there is no known cause for Crohn’s disease, the most popular theory is that the body’s immune system reacts to a virus or a bacterium by causing ongoing inflammation in the intestine. A thorough physical exam and a series of tests may be required to diagnose Crohn’s disease, including blood tests, stool sample tests, upper

gastrointestinal (GI) series, colonoscopy and/or X-rays of the digestive tract.

Currently there is no cure for Crohn’s disease. Treatment for the disease depends on the location and severity of the disease, complications and response to previous treatment.

Treatment may include medication, nutrition supplements, surgery or a combination of these options.

GERD Gastroesophageal reflux disease (better known as GERD) occurs when the lower esophageal sphincter (LES) does not close properly and the contents in your stomach may splash back (or reflux) into the esophagus.

When refluxed stomach acid touches the lining of the esophagus, it causes a burning feeling in the throat or the chest (heartburn) or the fluid may be tasted in the back of your mouth (acid indigestion).

Most everyone (including infants, children and pregnant women) experiences heartburn occasionally. If heartburn occurs more than twice a week, it may be considered GERD, which may lead to more serious problems. The main symptoms are persistent heartburn and acid regurgitation. Others may experience pain in the chest, hoarseness or trouble swallowing. GERD also may cause a dry cough and bad breath.

In infants and children, GERD may cause repeated vomiting, coughing and other respiratory problems. Most babies outgrow GERD by their first birthday. Simple strategies such as burping the baby several times during feeding or keeping the baby upright for

17 30 minutes after feeding may work to avoid reflux.

Medical experts cannot pinpoint one particular reason why people get GERD, however there are things that may contribute to GERD: 1. A hiatal hernia (when the upper part of the stomach is above the diaphragm); 2. Alcohol use; 3. Being overweight; 4. Pregnancy; 5. Smoking; and 6. Foods such as citrus fruits, chocolate, beverages with caffeine, fatty and fried foods, garlic and onions, mint flavorings, spicy foods, and tomato-based foods such as chili.

If you suspect you have GERD, consult your physician. Your physician may recommend lifestyle changes such as quitting smoking, losing weight, eating small meals, avoiding alcohol, wearing loosefitting clothing, avoiding lying down for three hours after a meal, and raising the head of your bed six to eight inches. He also may recommend some over-the-counter medications that stop acid production or help the muscles empty the stomach.

— Sources: National Digestive Diseases Information Clearinghouse/ National Institutes of Health, and the Crohn’s & Colitis Foundation of America, Inc.

The Phar macist is in Do you have any questions?

“The Pharmacist is in” is featured on a regular basis in Blue & You. The Arkansas Blue Cross and Blue Shield pharmacy director answers questions submitted by members and employers.

Q: What can be done about the high cost of medications used for indigestion and gastritis? If Prilosec® and Nexium® cost almost $150 for one month’s supply, how can I lower this expense?

A: Indigestion and gastritis both present a burning, painful sensation in the throat or esophagus, usually caused by a reflux of acid from the stomach into the lower part of the esophagus. This may result from various causes (see article on Page 14), and your physician should determine the origin of the problem if this is a chronic condition.

Fortunately, there have been many drug discoveries that make our lives more comfortable and enjoyable, and some people believe that medications are always the answer to problems related to our health. As a healthconscious society, we are becoming more attuned to fixing problems with medications rather than through preventive measures. However, due to the steeply rising costs of drugs, and for our own good health, we must readjust our thinking to try to reduce the cause or severity of gastric problems where possible, rather than taking stronger prescription medications.

The secretion of acid from cells in the lining of the stomach is necessary to establish a condition where enzymes work best to begin the breakdown or digestive process. A little acid is helpful in aiding digestion, but a lot of acid may cause some pain. Before turning to expensive acid reducers, or even in addition to the use of

prescription medication, we must also do our part to maintain our health.

Consider the following for a healthier digestive system: • Eat more frequent but smaller meals during the day rather than one or two; • Lean toward bland foods and drinks; • Avoid highly seasoned food or food that is known to cause indigestion; • Avoid overeating; • Drink adequate amounts of water and fluids; • Eat your evening meal as early as possible; and • Raise the head of your bed six to eight inches if you have a hiatal hernia.

These are simple disciplines, but they require some restraint. Expense is secondary to proper care of our body, but it may take an effect on our pocketbook to refocus our attention on taking better care of ourselves.

Remember, “an ounce of prevention is worth a pound of cure.”

Arkansas Blue Cross is dedicated to working closely with our members to help them understand more about what is transpiring in the area of pharmacy and why particular things are happening with medications. If you have a question about medications or drug coverage policies, please submit your question via e-mail to BNYEd@arkbluecross.com. Questions submitted by customers will be answered in this column in future issues of Blue & You as space permits.

More member discounts for you!

Arkansas Blue Cross and Blue

Shield continually investigates new opportunities for “wellness” discounts with health clubs, fitness centers and more — specifically for our members.

The Upper Room Yoga in Russellville, Russellville Yoga Center, Bryant Fitness Zone, The Gym & Café in Little Rock, and Lady of America Fitness Club in Little Rock are the newest fitness centers in Arkansas to offer discounts to our members.

If you are curious about whether your favorite fitness spot offers a discount, visit the Arkansas Blue Cross Web site at www.ArkansasBlueCross.com for a complete list of participating fitness vendors. If you don’t see your work-out site on the list but would like Arkansas Blue Cross to contact it about offering a discount to our members, just send the name and location of your fitness center to BNY-Ed@arkbluecross.com, and we’ll take it from there.

ge Health Advanta members —

take note!

Health Advantage ID Card If you are a Health Advantage member and have received a new Health Advantage identification (ID) card, please review the card and verify that the correct information appears on your card. Please ask your physician and any facility you receive services from, to make a copy of your card.

The provider should file your claim exactly as the information appears on the card. Incorrect information on your claim form will cause the claim to be rejected by the system, and then it will not be processed.

If you received ID cards for only certain members of your family and believe other cards should have been issued, please call Customer Service at (501) 227-3133 or 1-800-843-1329 so they can verify the person’s eligibility and re-issue the card, if appropriate. If you wait and call from the provider’s office during an appointment (and information has not been received from the employer or there is a problem), the customer service representative may not be able to verify the benefits to the provider, and the provider may ask you to pay for the services received that day.

OB Care If you currently are receiving care from an obstetrician and have had a plan change in the middle of your care, please note that your benefits may have changed.

Please make sure your OB/GYN is aware of the benefit change. If you have questions regarding your benefits, please call Customer Service at (501) 227-3133 or 1-800-843-1329.

Incorrect bills If you receive a bill from a provider and believe it is incorrect, please contact the provider for the following information before calling Health Advantage: • Individual physician’s name if the statement is from a clinic; • Date of service for each procedure; • Individual amount for each procedure billed; and • Referral number if applicable.

After you know the details of the statement, please call the Customer Service Department with any questions. Without the detailed information, the customer service representative may not be able to appropriately assist you.

19

Referral information

Health Advantage does not issue referrals to participating providers. Your primary care provider (PCP) has a script referral pad and will issue the referral. If you or the specialist needs to know the referral number, contact the PCP. Health Advantage encourages members to take a copy of the referral to the specialist’s office or have your PCP mail or fax a copy to them prior to the visit. Referrals to nonparticipating providers for the in-network benefit level must be requested by your PCP in advance for approval

by Health Advantage. If not prior approved, the service may be ineligible, or if you have a Point-of-Service product, it will be paid at the lower out-of-network benefit level.

Dependent living out-of-state?

If you have a dependent living or attending school outside of Arkansas, contact Customer Service at (501) 227-3133 or 1-800-843-1329 and ask about an Away From Home Care Guest Membership. These memberships are available in most states and could provide savings to you.

Oral contraceptive list updated Since 1996, Health Advantage has offered a preferred list of oral contraceptives for members. Recently, the list of covered oral contraceptives has been updated and, beginning May 1, 2002, the following will be the preferred list of covered oral contraceptives: Ortho-Cyclen Ortho-Tri-cyclen Ortho-Cept Ortho-Novum 7-7-7 Ortho-Novum 1/35 Ortho-Novum 1/50 Ortho-Novum 10/11 Modicon

Micronor Ortho-Evra patch Loestrin Loestrin Fe Estrostep Tri-Norinyl Yasmin

If you are a Health Advantage member currently taking oral contraceptives, you will need to consult with your physician to change to one of the preferred oral contraceptives mentioned or self-pay for oral contraceptives not on the preferred list. If generic forms of the above-mentioned oral contraceptives are available, the generic will be covered. No other contraceptives will be covered. If you currently are taking an oral contraceptive, you will be notified of this change again through a personal letter from Health Advantage.

20

ON-LINE DISCOUNTS & YOU

A

t Arkansas Blue Cross and Blue Shield, we continually work to find ways to save our members money, and one of those ways is through our Discount Wellness Program.

Through this program, members of Arkansas Blue Cross, Health Advantage and USAble Administrators can save money in retail outlets, fitness centers, health clubs and more. For more information about the discounts available, log on to one of our Web sites at www.ArkansasBlueCross.com, www.HealthAdvantagehmo.com or www.USAbleAdminArkansas.com.

Expecting a baby or needing to childproof your home?

One of our newest discount programs is with Safe Beginnings — a company committed to keeping families safe and making parenting more enjoyable with a large selection of well-designed, durable, childproofing products, popular baby care accessories and home safety items. Members may access Safe Beginnings through the Arkansas Blue Cross and affiliated companies Web sites, and receive a 20 percent discount automatically (you

don’t need a code and the discount shows up on the screen so you can see exactly how much money you are saving). You will find Safe Beginnings in a new section of the wellness discounts listings, “Statewide and Internet Discounts.”

No Internet access? No problem! Members may simply call Safe Beginnings toll-free at 1-800-598-8911 (Monday-Friday, 8 a.m. – 9 p.m. EST and Saturday, 9 a.m. – 3 p.m. EST) to place an order or request a catalog. Every time a member orders an item from Safe Beginnings, the member will receive a 20 percent discount. Just use the special discount code, BCAR, to receive your discount.

To access Safe Beginnings directly, members can find it on-line at www.safebeginnings.com. However, the discount does not show up automatically as it will when members enter the Web site through the links on the Arkansas Blue Cross, Health Advantage and USAble Administrators Web sites, so remember to enter the code, BCAR, to receive your discount.

“Don’t Start” Gets Started A

rkansas Blue Cross and Blue Shield is again joining the American Lung Association and the Arkansas Department of Education to encourage kids to not start smoking. Media partners UPN Channel 38 and FOX Channel 16 will be helping spread the word. In March, BlueAnn Ewe will help launch the new “Don’t Start” Smoking Storyboard Contest, which will give kids in kindergarten through fifth-grade an opportunity to write a story about why it’s important to never begin smoking.

“Don’t Start” Smoking Storyboard Contest sheets will be available beginning March 18 and are free to kids in this age category. Then kids will have until April 26 to “draw their way” to some great prizes and an opportunity to have their story transformed into a real television public service announcement (PSA) to be broadcast in Arkansas during the summer and fall of 2002 on FOX16 and UPN38 television.

The object of the program is to get kids thinking about why they should not use tobacco products and what they can do because they aren’t sick from smoking.

Kids simply use storyboard sheets to write a story and draw pictures depicting their story. They can draw

animals, people, cartoon characters or anything their creative minds can think of to tell their story.

A panel of judges will select three finalists in each grade level. From those 18 finalists, judges will select an overall winner, who will receive a $100 savings bond in addition to having his/her story turned into a PSA. All finalists will receive fun prizes.

Storyboard Contest sheets will be mailed to elementary schools throughout Arkansas. In addition, Storyboard Contest sheets can be picked up at any Arkansas Blue Cross location statewide, at the American Lung Association and at Clear Channel Communications in Little Rock, or may be requested directly by completing and returning the Business Reply Card found inside this issue of Blue & You. Parents may request individual contest sheets for their children, or teachers may request enough sheets for their entire class. The contest is open to public schools, private schools and homeschoolers.

Request a “Don’t Start” Smoking Storyboard Contest sheet today and have your kids draw a healthy message ... as well as a good breath ... for life.

21

Blue & You surveys show members pleased with magazine, Internet Readership survey Thanks to plenty of health-and-wellness and health insurance information, Blue & You readers told Arkansas Blue Cross and Shield loud and clear that Blue & You is something they appreciate and find helpful. The Winter 2001 issue had a readership survey (an annual process) enclosed for members to return with comments, and customers gave Blue & You an average rating of 4.4 on a five-point scale (with five being the highest rating). The 3,339 survey respondents gave Blue & You a mean satisfaction rate of 4.62 in the category of Design; a 4.71 in the category of Easy to Read; a 4.54 in the category of Content; and a 4.44 in the category of Value to You.

Internet Survey A total of 2,363 members responded to the 2001 Internet Survey mailed with the Autumn 2001 issue of Blue & You. “We were pleased that the number of responses was more than adequate for a valid sample to aid us in planning for our sites,” said Patrick O’Sullivan, vice president of advertising and communications for Arkansas Blue Cross.

Members indicated that the top three Web features they would most like to see on their health plan sites are: • Check claims status; • Review my benefits; and • View health and wellness information.

A substantial number of members (41 percent) who responded said that they do not have Internet access. Of those members indicating that they have access, 29 percent said that they were aware of the Web sites, while 58 percent said they were not. Of those who indicated they had visited the Web sites, roughly 88 percent thought the Web sites were valuable.

Survey results and comments will be used for improving current content and planning for additional customer self-service features for the Web sites of Arkansas Blue Cross, Health Advantage and USAble Administrators.

Gift certificate winners!

From the Blue & You satisfaction survey, we randomly selected three winners who each received a $50 gift certificate to Wal-Mart. The winners were Sonya McCaslin of Greenwood, Lena Evans of Bentonville and Dorothy Parker of Pine Bluff.

From the Web site satisfaction survey respondents, we also randomly selected three winners who each received a $50 gift certificate to Best Buy. The winners were Linda Henry of Pine Bluff, A.W. Waldo Jr. of North Little Rock and Sheila Williams of Malvern.

Medi-Pak and Retiree Information A

rkansas Blue Cross and Blue Shield entered into an agreement, effective April 1, 2001, with Health Data Management (HDM) Corporation to begin electronically submitting our members’ Medicare Part A and B supplemental claims. These claims will be submitted from Medicare Fiscal Intermediaries/Carriers throughout the United States directly to Arkansas Blue Cross. (HDM is a national clearinghouse for Medicare Part A and B claims.)

This agreement will allow HDM to electronically submit Medicare Part A and B supplemental claims from providers nationwide. This means that Providers from states other than Arkansas no longer have to submit paper claims to Arkansas Blue Cross. They only need to complete the “other insurance” information on their claims submitted to Medicare, which includes the

Arkansas Blue Cross member’s identification number, and the claims will be electronically submitted to Arkansas Blue Cross.

Arkansas Blue Cross remains committed to continually finding more efficient ways to serve our customers, such as our new electronic claims process. If you have any questions, please call Customer Service at (501) 378-2010 or 1-800-238-8379.

22 A

Member rights and responsibilities A

member has a right to:

1. Information about Health Advantage, its services and providers, and members’ rights and responsibilities.

2. Access to a Plan physician.

3. An Explanation of Benefits (EOB) as applicable.

4. Be treated with respect and recognition of their dignity and right to privacy.

5. Confidential treatment of medical information.

6. Participate with practitioners in decision-making regarding their health care.

7. A candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.

8. Change primary care physicians.

9. Voice complaints or appeals about Health Advantage or the care provided.

10. Provide, to the extent possible, information that Health Advantage and its practitioners and providers need in order to care for them.

11. Decide, for Point-of-Service plans, whether to access plan providers or out-of-network providers.

member has the responsibility to:

1. Become familiar with their Evidence of Coverage (policy) and the requirements and procedures of Health Advantage.

2. Present member ID card to the health care provider when seeking care.

3. Select a primary care physician.

4. Maintain health levels by living a healthy lifestyle (for example, stopping smoking).

5. Coordinate all health care through the primary care physician.

6. Provide information to health care providers to assist them in the care needed to achieve healthy outcomes.

7. Follow all instructions given by health care providers to achieve maximum benefits of the care.

8. Meet all co-payment, deductibles and co-insurance obligations and any billed charges in excess of allowable charges.

9. Notify Health Advantage of any status change.

10. Communicate any complaint or grievance immediately to Health Advantage.

11. Ensure all claims for services provided by non-Plan providers are filed within 60 days.

Annual Maternity & Baby Fair

Sponsored by BAPTIST HEALTH

BAPTIST HEALTH will be sponsoring its annual Free immunizations will be offered throughout the Maternity & Baby Fair on Saturday, April 27, 2002, from day. Parents simply need to bring individual immuniza10 a.m. until 3 p.m. in the J.A. Gilbreath Conference tion records for each child to be immunized. Also, from Center at BAPTIST HEALTH, located at 9601 Interstate 10 a.m. until 1 p.m., there will be car seat safety checks 630, Exit 7, in Little Rock. at the Hickingbotham Outpatient Center, located behind The free event will feature numerous exhibit booths the hospital. Additionally, special informational sessions where parents and parents-to-be may find helpful will be held throughout the day to help parents cope information or purchase baby supplies. Scheduled with having a new baby in their lives. Scheduled sesexhibitors include Coleman Dairy, MyKidsClothes.com, sions and speakers are: Gary Alan Strain Photography, Trademarks, Stork 10-10:45 a.m. The Labor & Delivery Experience Certified Childbirth Educators Sisters, Junior League, Creative Memories and 11-11:45 a.m. Breastfeeding Sharon Houston, RNC, IBCLC Infant & Child Development Susan Averitt, M.D. many more. Besides the booths, there will be door 1-1:45 p.m.

2-2:45 p.m.

Baby Slings: How to “Tie One On” Jessica Donahue, RN, IBCLC prizes, free food (popcorn, Pepsi products, pickles, The BAPTIST HEALTH Annual Maternity & Baby Fair ice cream, and cotton candy) and a is sponsored by BAPTIST HEALTH Women’s & Children’s special area just for the kids. As part Services, Alice 107.7, B98.5 and Today’s THV, Channel 11. of the fun, there will be stage For more information, please call BAPTIST HEALTH shows for all to enjoy, featuring HealthLine at B-A-P-T-I-S-T (227-8478) or the River City Cheer All-Stars, 1-888-B-A-P-T-I-S-T, or visit their Web site at the Magic of Derrick Rose and www.baptist-health.com.

Melissa’s School of Dance.

23 A

rkansas Blue Cross and Blue Shield strives to be a good corporate citizen. Our employees raise money and spend many hours helping those causes near and dear to the hearts of Arkansans.

Pinnacle Mountain Rendezvous Golden leaves and teepees were the backdrop for the annual Pinnacle Mountain State Park Rendezvous in October. Thousands of people attended the weekend event to learn a little about American heritage and take part in fun activities including a settler’s reenactment, Indian dances and native crafts. Again last year, BlueAnn Ewe took a stroll down the midway to meet and greet hundreds of kids enjoying the festivities.

BlueAnn greeted kids and distributed stickers and her coloring book.

East End FallFest Batman on the right. Super Woman on the left.

BlueAnn in the middle ... of hundreds of costume-clad kids that is ... at the East End Elementary School FallFest in October. Hundreds of residents from the East End community in Pulaski County got a chance to try out their Halloween costumes early and enjoy lots of games and activities at the school cafeteria and gym. BlueAnn was surrounded by princesses and Power Rangers, genies and gypsies, super heroes and local heroes, clowns and cowboys, ghosts and goblins. It was a fun day to play ... and learn a little about health and safety too!

Northeast Fall Festival The Craighead County Fairground was the place to be in November for the Ridgefield Christian School annual Fall Festival fund-raiser. Children and families enjoyed games, food, autumn activities and a silent auction. BlueAnn Ewe lent a helping hoof to raise money for scholarships and to purchase equipment for the chemistry and comBlueAnn makes new buddies. puter labs.

Blue basketball The Arkansas Blue Cross Southeast Regional Office in Pine Bluff recently sponsored a youth basketball team (fifth and sixth grade boys) through the Seabrook YMCA in Pine Bluff.

Michael Mozeak, financial risk manager for the region, served as volunteer head BlueAnn Ewe made a visit to cheer on coach for the the youth basketball team during their team. Coach league tournament.

Mozeak said that coaching is a very rewarding experience and encourages others to get involved with young people.

Southwest Regional Office moves to new location in Texarkana A rkansas Blue Cross and Blue Shield’s Southwest Regional Office recently moved to a new location in Texarkana.

Since the ice storm of 2001 damaged the previous location on Arkansas Boulevard, the Southwest Regional Office staff has operated from a temporary location. The new office now is located on the Fourth Floor of the Regions Bank Building in downtown Texarkana.

The mailing address will remain P.O. Box 2018, Texarkana, Ark., 75504-2018. The telephone and fax numbers will stay the same: (870) 773-2584 or toll-free 1-800-470-9621; fax number, (870) 779-9138.

The Southwest Region consists of 11 counties: Calhoun, Columbia, Hempstead, Howard, Lafayette, Little River, Miller, Nevada, Ouachita, Sevier, and Union.

“We appreciate the trust and confidence our customers have placed in Arkansas Blue Cross and the patience they have shown as we operated in our temporary facilities,” said Jason Mann, regional executive.

“We are pleased to have secured new office space to put us back in a permanent home in southwest Arkansas and look forward to serving the health insurance needs of our customers for many years to come.”

www.ArkansasBlueCross.com & www.HealthAdvantage-hmo.com & www.USAbleAdminArkansas.com

USAbleAdminArkansas.com goes live USAbleAdminArkansas.com, the Web site for USAble Administrators customers who have health plans that include products branded with the Blue Cross and Blue Shield, made its Internet debut Jan. 31. A second site, USAbleAdmin.com, which serves customers who do not have Blue-branded products, went live Feb. 20.

Operated by a wholly owned subsidiary of Arkansas Blue Cross and Blue Shield, USAble Administrators serves more than 120,000 employees and their family members. USAble Administrators processes claims and manages enrollment and benefits for self-funded groups.

The USAble Administrators sites are similar in design and navigation to ArkansasBlueCross.com and HealthAdvantage-hmo.com. Members, employers, providers and guests have customized portals with entry buttons on the home page.

Features for Members A major feature of the USAble Administrators site is the “Benefits” section under “Customer Service.” Members may type in their ID number to obtain a summary of their health plan benefits.

Additional features of interest to members and accessible from their portal page include: • Frequently Asked Questions (FAQ), answers to common questions about USAble Administrators products and services; • How To File a Claim, a description of how to file a claim for health care services; • Referral Process for PCN, how to use the referral process to lower out-of-pocket costs in a primary care network (PCN) if your health plan offers the Primary Care Network program; • Understanding Your EOB, help in interpreting the Explanation of Benefits (EOB), a statement mailed to the member after a claim is processed; • Glossary of health insurance terms; and • Wellness Discounts, a list of health clubs and fitness equipment companies and other vendors that offer discounts to members.

Features for Employers A “Products and Services” section explains options employers may include in their health plans administered

by USAble Administrators, including: • Arkansas’ FirstSource PPO • Excess Loss • Hospital Bill Audits • USAble PCN • Managed Pharmacy • BlueCard® • Blue & Youth Health Program • Subrogation • Utilization Management • Case Management • Coordination of Benefits (COB)

Company Information Company information is located in sections called “About Us” and “Contact Us.” The “Contact Us” section contains a regional office map and directory.

Customized Provider Directories One section of the site that is not available now will go live by April 1. The “Provider Directories” will feature directories customized to match the member’s ID number. When a member enters the member number from the USAble Administrators ID card, he or she will see a page that lists all the networks accessible through that member’s health plan. The menu of networks will be ordered from the highest benefit level to the lowest.

Navigation Help Other areas of the new site that should be helpful to members and other site visitors are “Search” and “Site Map.” The “Search” section allows keyword searches of the site (excluding databases), and the “Site Map” gives links to all sections of the site.

Arkansas Blue Cross and Blue Shield P.O. Box 2181 Little Rock, AR 72203-2181

SPECIAL PULL-OUT SECTION

What can you do to help hold down health care costs?

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W hen health insurance pays for your medical care, you

tend to think that “someone else” is paying for it. But it’s your money. When you, your family and your co-workers use more and more medical services, you pay for it in higher insurance premium costs, and through higher co-payments and deductibles. Unfortunately, the total cost of health care — how much it really costs — is often invisible to individuals, because they usually think only about the portion they pay when they go to the doctor or hospital.

Whether you buy your own health insurance or are covered through a group health plan provided by your employer, you should be concerned about the rising cost of health care. As costs go up, employers have few options. Companies can either reduce wages for their employees, reduce company profits, pass along the cost to their customers, ask their employees to pay a larger share of the insurance cost, cut benefits or discontinue providing health insurance to employees altogether.

Everyone can play a part in helping to hold down health care costs. Here are some things you can do:

Practice Prevention

Take Care of Yourself • The most effective way of keeping medical problems and health care costs under control is to develop a healthy lifestyle, with lifelong habits that keep you healthy. A

recent study suggests that the average adult could add fourto-seven years to his or her life expectancy by adopting a healthier lifestyle.

Exercise regularly.

Eat a balanced diet that is low in fat and high in fiber.

Observe and teach all family members good dental hygiene.

Maintain a healthy weight.

Stay mentally active and involved with self, family and community.

Keep a sense of humor about life.

Get adequate sleep.

Keep stress to a minimum.

Limit the amount of alcohol you drink.

Wear a seat belt.

Never drink and drive.

Eliminate unsafe conditions at home and work.

Keep guns locked up.

Install smoke detectors and fire extinguishers.

Wear a sunscreen.

If you smoke, stop. You’ll reduce heart, lung and circulatory problems.

If you won’t stop smoking for your sake — try to stop for others. Exposure to cigarette smoke in the household increases your child’s likelihood of developing asthma, pneumonia, ear infections, sudden death syndrome, meningitis and learning problems.

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• Ask your physician to recommend a medical guide you can use to recognize early signs, symptoms and remedies for routine illness.

• Use self-care health remedies whenever possible. You can reduce the cost of health care for yourself and others by solving health problems at home when appropriate. Eight out of 10 health problems can be treated at home.

• Learn the early warning signs of potential health problems and consult a physician when needed. If you have a persistent problem, get it taken care of as soon as possible.

• Get regular checkups and physical exams.

• Visit a dentist regularly for checkups.

• Check public health centers in your area. They usually give immunizations free of charge or for very little cost. Share the results with your physician.

• Schedule the health screening tests recommended for your age, sex and risk group. It’s important that you keep up to date with blood pressure and cholesterol screenings, Pap smears and mammograms.

SPECIAL PULL-OUT SECTION

What can you do to help hold down health care costs? What can you do to help hold down health care costs?

Know Your Benefits • Read and understand what’s covered by your health insurance policy.

• For maximum cost savings, use participating or in-network providers for your medical care. Choose your doctors or hospital from your health plan’s provider directory (available on-line or in a printed form).

• If you are covered by an HMO, coordinate your care through your chosen Primary Care Physician (PCP). Obtain referrals to specialists through your PCP. • To save money on your prescription medications, become familiar with your health plan’s drug formulary. It lists generic drugs, preferred brandname drugs, non-preferred drugs and non-covered drugs.

• For more information about your covered benefits, drug formulary and provider directories, call your health plan’s Customer Service area or visit our Web sites (www.ArkansasBlueCross.com, www.HealthAdvantagehmo.com, www.USAbleAdminArkansas.com).

• If you develop a medical condition that requires extensive medical treatment, contact one of our registered nurse case managers at the Arkansas Blue Cross office nearest your home to see if you qualify for case management services.

• Don’t encourage the state legislature to pass insurance mandates. When insurance companies are required to cover additional treatments and services, costs go up for everyone.

Consider what level of care should be mandated by the state and whether you can afford it.

Take an Active Role in Your Care • Choose a family doctor. Coordinating your care through a family doctor has been shown to improve individual health.

• Be prepared before you see a specialist. Specialists have indepth training and experience in particular areas of medicine and can give you the care and information you need for a major medical problem in their specialty area.

Specialty care is usually more expensive.

You can help get the most out of specialty care through good communication and preparation.

• Before you see a specialist, understand what your primary doctor’s diagnosis is and what your primary doctor wants the specialist to do. Bring any X-rays or test results with you when you visit the specialist. Ask about your options for treatment, keep your regular doctor involved and have test results sent to both you and your PCP.

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• Take an active role in health care decision-making. Take the time to build a good relationship with your doctor.

Making sure that your doctor understands your expectations and needs can result in a more effective treatment plan.

• Ask your doctor about every prescribed medication and medical test. Also ask what will happen if you choose not to take a drug or have a test. Each test and drug has some risk involved. Your doctor may be able to suggest an alternative that is less risky.

• You have the right to be involved in your care and treatment. Have questions ready ahead of time to ask your doctor, insurance representative and hospital: ¤ What do my symptoms mean? ¤ What tests do I need, and why do I need them? ¤ What risks are involved if I have surgery? ¤ How long does the surgery take, and how long do I need to stay in the hospital? ¤ How much of the cost will my insurance cover? ¤ Which items and services are included in the hospital charges? ¤ What kind of recovery may I expect? ¤ How soon can I return to my normal activities?

• Avoid unnecessary medical tests. In certain situations the cost and risk of medical tests can outweigh the benefits.

Sometimes tests are given simply as standard procedure.

You do not have to take any test. Before consenting to a test, ask: ¤ What is this test for? ¤ How will it help me get better? ¤ How much will the test cost? ¤ Could it be done for less somewhere else? ¤ Is there a less costly test that could provide the same information?

• Avoid unnecessary treatment. Your doctor’s decisions about your care can account for as much as three-quarters of your medical bills. You can save time and money by seeking the best treatment for your needs. You can be more confident of your treatment and reduce unforeseen costs if you choose a good insurance plan, use preferred providers, and get second opinions. Find out your options by asking questions such as: ¤ Is a surgery or medication necessary? Why? ¤ Can my tests or surgery be done somewhere else besides the hospital? ¤ Does my health insurance plan cover services outside of the hospital setting? ¤ What other treatments are available?

SPECIAL PULL-OUT SECTION

What can you do to help hold down health care costs? What can you do to help hold down health care costs? ¤ ¤ ¤ ¤

¤ Can I make any changes, such as diet and exercise, that might help my condition?

• Avoid hospitalization whenever possible. Over half of all health care costs are for inpatient and outpatient hospitalizations. Consider outpatient services or same day surgery.

Find out if there are alternatives to surgery.

• Learn as much as you can about your medical needs. By conducting your own medical research, you may discover more options and be better prepared to decide which course of action is best for you. You can start your research by asking your doctor for information or calling the hospital’s medical library or using medical resources (such as Web sites) recommended by your physician or other health care professional. Steer clear of health Web sites not endorsed by a national health researcher such as the Centers for Disease Control or the National Institutes of Health.

• If it’s safe, wait. Sometimes physicians are afraid patients will think they’re not doing their best if they don’t take action right away. But, in many situations the old standby “take two aspirin and call me in the morning” is valid advice. On the other hand, waiting until a mild condition becomes serious can be both unpleasant and costly. Let your doctor know you’re willing to wait if that’s appropriate. He or she may consider it helpful to know you’re willing to let time and nature take their course, but only if it’s safe to do so.

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Use the Emergency Room (ER) Only for Emergencies • An emergency medical condition is one of recent onset and severity, including severe pain, that would lead a prudent layperson, acting reasonably and possessing an average knowledge of health and medicine, to believe that the absence of immediate medical attention could reasonably be expected to result in one of the following: ¤ Placing the health of the individual — or with respect to a pregnant woman, the health of the woman or her unborn child — in serious jeopardy. ¤ Serious impairment to bodily function. ¤ Serious dysfunction of any bodily organ or part.

• Emergencies often include the following: ¤ Severe bleeding that does not stop after 15 minutes of direct pressure. ¤ Sudden severe pain and swelling in a joint. ¤ Blacking out (fainting). ¤ Swallowing poison. ¤ Choking.

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A gaping wound (the edges don’t come together).

A broken bone.

Suddenly not being able to speak or move.

Chest pain, especially if associated with sweating, shortness of breath, spreading pain, nausea (feeling sick to your stomach), vomiting (throwing up), dizziness or a fast or irregular heartbeat.

More than half of all ER visits are for minor, non-urgent problems. These visits can be two to three times more expensive than a visit to the doctor’s office. If you get sick and believe that it is something that will not go away on its own, try first to see your doctor rather than going to the ER. Call your doctor as early in the day as possible so you can be seen as soon as possible.

Tell your doctor’s nurse about your symptoms and ask her to speak to the doctor regarding the need for immediate medical care. Many emergency symptoms may be relieved with self-care if the individual is able to share pertinent information with your physician’s medical staff. If your symptoms are unresolved, your physician can provide you with the best directions for receiving the appropriate level of care at the appropriate time. Your physician arranges for another physician to care for you when your doctor is out of the office. In the ER, you may see a physician who is not familiar with your current treatment or medical history and, therefore, medical testing may be ordered that is a duplication of the testing your physician already has done for you.

The ER is one of the most expensive units in the hospital and often one of the busiest. You’ll be paying top dollar, and if your symptoms aren’t severe, you could wait for several hours in the ER before you receive any treatment.

Modern emergency services are invaluable in trauma or life-threatening situations but are inefficient for routine care.

When deciding whether to go to the emergency room, use your best judgment. In case of a true emergency, go immediately to the emergency room. Call ahead to let them know you’re coming and notify your regular doctor, if possible. Your family doctor can provide the emergency room staff with important medical information.

Reduce Your Doctor Bills • If you have minor medical problems, phone your doctor rather than scheduling a visit. When an Arkansan sees a physician for a common cold, for example, an average of $200 is spent, including the doctor’s fee, lab/X-rays and prescriptions. In reality, there is usually nothing a doctor

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What can you do to help hold down costs?

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can do to speed your recovery from a cold. In all likelihood, he or she will simply recommend over-the-counter medications and plenty of rest and fluids.

Before you walk into your doctor’s office, write down issues you want to discuss and questions you want to ask. You may want to note: ¤ Your symptoms or changes in your condition. ¤ Medications you’re currently taking, including complementary and alternative medications (herbs, vitamins, etc.). ¤ Changes in your life, such as more stress at work or changes in your home life. ¤ Questions regarding Web sites or articles you’ve read about your illness and how it’s treated.

Ask for the following during your appointment to help you make the right decisions about your care: ¤ Explanations of tests and procedures. ¤ Clarifications of any treatment you don’t understand.

Take notes so you can remember the details later.

Do your part. Answer the doctor’s questions completely and truthfully. If you believe you’ll have trouble sticking with a suggested treatment, say so.

Don’t expect a prescription for medicine each time you visit the doctor. You can help keep costs low by finding out how the medication will help you, whether there is a generic or similar, less-expensive version of the drug, and whether you can try a free sample first.

Ask your doctor about the value of complementary or alternative medicine treatments, such as herbal medicine, meditation or acupuncture.

Avoid defensive medicine. Defensive medicine refers to tests and services performed primarily to protect physicians from possible malpractice suits. Ask lots of questions about why the tests are being done, if they are really necessary and what your options are. You may decide to take a more conservative approach.

After the visit, take responsibility for your care outside the doctor’s office. You should: ¤ Follow through with the recommended treatment.

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What can you do to help hold down costs? ¤ Take all medications as directed for as long as required. ¤ Practice preventive care; it’s the best way to reduce your health care costs.

• Don’t repeat medical tests needlessly. If you should change doctors, don’t waste your time and money on tests that you’ve already had done. Simply get your previous practitioner to forward your records to your new doctor.

Lower Your Hospital Costs • Before you’re admitted to the hospital, read your health insurance policy thoroughly, and be sure to understand exactly what is and isn’t covered by the policy.

• If you need to go to a hospital, try to save on an extra night’s stay by checking in the day of your surgery. Avoid being admitted on a weekend, because most procedures will be put on hold until Monday.

• Keep a log. If at all possible, you or a family member should try to keep a daily record of all the services, medications and other supplies you receive.

That way, you’ll have a record with which to compare the final bill.

• Look over your bill carefully before you check out.

Make sure that you are given a detailed bill that itemizes every procedure, service and medication.

• Be on the lookout for duplicate billings, inaccurate admission or check-out dates, and the billing of supplies, medications and tests that you didn’t receive. Be suspicious of any charges that are labeled “miscellaneous” on your bill. Always ask for an explanation of what they are.

• If you notice an error on your bill, call the hospital’s accounting office immediately and explain the details of the error to them. Next, notify your insurance company of the error. Put everything in writing and keep copies.

• Save all medical-related receipts.

If you itemize deductions on your income tax return, you can deduct non-reimbursed expenses that exceed 7.5 percent of your adjusted gross income.

Deductible expenses are those not covered by insurance.

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SPECIAL PULL-OUT SECTION

What can you do to help hold down health care costs? What can you do to help hold down health care costs?

Cut Your Medication Bills • Discuss prescriptions with your doctor. Ask if you really need a particular prescription or whether an alternative diet or exercise regimen could provide the same results.

• Ask your doctor about overthe-counter medications.

They’re usually less expensive than prescription drugs and can be as effective for minor health problems.

• Ask your doctor if a generic drug is appropriate for your condition. Generic drugs are safe, and most are as effective as their brand-name equivalents; they generally cost considerably less.

• If your doctor writes a prescription for a brand-name drug, ask the pharmacist to check on the difference between the brand-name drug and the generic substitute, which is less expensive. If the two are medically equivalent, ask for the generic.

• Request samples when trying a new medication. You’re wasting money and medicine if you can’t tolerate a new medication and must stop taking it after only a few doses.

Ask your doctor if he or she has samples you can try before filling your prescription.

• If you’re prescribed a drug that’s been on the market for fewer than five years, ask your doctor if it offers distinct advantages in cost, effectiveness or reduced side effects.

If not, ask if an older drug is more suitable. That way, you’ll avoid possible toxic effects that may not have shown up yet.

• Avoid overuse of antibiotics. The American Academy of Family Physicians estimates that Americans take 50 million unnecessary prescriptions for antibiotics each year. Antibiotics do not help viral infections. Viruses commonly cause colds, bronchitis, sore throats, flu and sinusitis. Using unnecessary antibiotics can cause bacterial resistance (super bugs), as well as side effects from the drug.

• When you receive a prescription for an antibiotic, it never hurts to ask your doctor if the antibiotic is absolutely necessary. Only 15 percent of sore throats are caused by strep and therefore require an antibiotic. Often a common cold will start with a sore throat. If you have a sore throat, you can take over-thecounter medications such as acetaminophen, ibuprofen or naproxen for the pain. If the soreness in your throat does

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not feel better after two days, call your doctor. He or she can then run tests to determine if you need an antibiotic or other treatment.

• Have one pharmacy fill all your prescriptions. This will keep your drug profile updated, and your pharmacist can track drug interactions. Over-the-counter products also can cause interactions, so check with the pharmacist before using them if you regularly take a prescription drug.

• Store drugs properly in a cool, dry place. Don’t store them in your car’s glove compartment or in your bathroom closet, where excessive levels of heat and humidity can affect them. Be sure to keep all medications and vitamins out of the reach of children and pets.

• Take your medicine the right way. Fifty percent of Americans take their medicines incorrectly. Ask your doctor the following questions when you’re given a new prescription: ¤ What is the name of the medicine, and what is it supposed to do? ¤ How much of the medicine should I take, when should I take it and for how long? ¤ What are the possible side effects, and what should I do if they occur? ¤ What foods, beverages, other prescriptions and nonprescription medications should I avoid? ¤ Can you provide me with written information about this medicine?

• Monitor your use of medications: ¤ Tell your doctor and pharmacist which other medicines — including nonprescription drugs — you are taking. ¤ Discuss with your doctor any problems, such as allergic reactions or side effects, you’ve had with medications. ¤ Ask your doctor to review all the medications you take to help you determine which ones are necessary and which ones may not be. ¤ Don’t take another person’s prescription medicine, even if your symptoms are similar. ¤ Take all the medication in a prescription if you’re instructed to do so. ¤ Don’t combine different drugs in one container. Drugs can react with one another, making them ineffective. ¤ Check the label each time you take your medication to verify the drug and the dosage you’re about to take.

This is the third in a series of articles on understanding health care costs. The first (Autumn 2001) was “Why are health care costs so high?” The second (Winter 2001) was “What are we doing to help hold down health care costs?” The fourth (Summer 2002) will be “How is Arkansas Blue Cross different from other health insurers?”