~ cover up this summer for a healthier you ~
Take Care of the
SKIN
Special insert booklet:
You’re In
Understanding Your Health Care Costs
Summer 2002
F.A.Q. ons frequently asked questions frequently asked questions frequently asked questions Q: For state and public school employees, what is the age limit for dependent coverage? A: Dependent coverage is provided for the following: 1. A child less than age 19 and living in the home. 2. A child less than age 27 (who is financially dependent on the employee) and is enrolled and regularly attending on-campus classes as a full-time student at an accredited college, university or vocational training school. 3. A child of any age who is medically certified as total disabled due to mental or physical incapacity and chiefly dependent on the employee for financial support.
Q: Will I be notified when you have reviewed my claim? A: Yes. An Explanation of Benefits (EOB) will be mailed to you. This notice will give you the name of the provider of service, explain the type of service, and indicate the date(s) of service as well as the reported, allowed and non-covered charges. An explanation of non-allowed amounts also is provided. The amount paid by Arkansas Blue Cross and Blue Shield and the total patient’s share will be indicated on the bottom of the notice. This is the only copy you will receive, so it should be retained for your records.
Q: If I think an error has been made on my claim, how do I ask for a review? A: After you receive the EOB (and need clarification of the action taken), write or call Customer Service. The telephone number and address are located on the front of the EOB. When writing, provide your identification number and refer to the claim number indicated on the upper portion of the EOB. When calling, having the EOB in hand will save time.
Q: What is the qualifying event for COBRA coverage? A: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers with 20 or more employees to continue to offer coverage in their group health plans to certain former employees, retirees, spouses and dependent children, if they have one of the following qualifying events: 1. Termination of an enrolled employee’s employment (other than for gross misconduct) for any reason (layoff, resignation, retirement, etc.). 2. Reduction of work hours. 3. Death of the covered employee. 4. Divorce or legal separation from the covered employee. 5. Dependent child ceasing to meet eligibility requirements. 6. Retiree or retiree’s spouse or child loses coverage within one year before or after the commencement of proceedings under Title 11. 7. When dependent loses coverage due to covered employee becoming entitled to Medicare.
... from Federal Employees Q: Is a root canal or a crown covered by dental benefits? A: Standard Option offers basic preventive dental coverage. Eligible services are paid on a fee schedule. Major dental work, such as orthodontics, root canals or crowns, is not covered. For more information, refer to your Benefit Plan brochure.
Q: What is the Blue Health Connection? A: Blue Health Connection is a 24-hour nurse telephone service that is available 365 days per year by calling the toll-free telephone number 1-888-258-3432 or accessing the Internet Web site www.fepblue.org. The service, called the Blue Health Connection, features health advice or health information and counseling by registered nurses. Also available is an Audio Health Library with hundreds of topics, ranging from first aid to infectious diseases to general health issues.
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.USAbleAdminArkansas.com, www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.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
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~Summer 2002~
The skinny on skin ....................................... 4 Age and your skin ........................................ 5 Sun damage: cool tips, hot topic ................. 6 Sun-smart tips ............................................. 7 Face to face with acne ................................ 7 Skin cancer prevention and treatment ......... 8 Understanding Your Health Care Costs ... insert Beware of poison ivy ................................... 9 Who’s at risk for rosacea? ........................... 9 The irritation of AD .................................... 10 The bottom line on diaper rash .................. 10 Understanding psoriasis ............................ 11 The whys and what-to-dos of cradle cap ... 11 The pharmacist is in .................................. 12 Blue & You Foundation established ........... 12 New Open Access POS plan introduced ...... 13 National Medicare Part A contract ............ 14 Blue & Your Community ............................. 15 Coverage policies now on-line ................... 15 Blue On-line ............................................... 16 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 W
SKINNY
hat do you really know about your skin? You know you want it to have a healthy glow, and you know you don’t enjoy sunburns, blemishes and rashes on it. You also know there are a million and one products on the market to help you recover from skin ailments … or just moisturize. However, understanding your skin will help you realize what it takes to keep it healthy for a lifetime. The skin is the largest organ of the body, both by weight and surface area. In adults, the weight of your skin accounts for about 16 percent of your total body weight. Its main purpose is to act as a shield from external stress. Your skin is constantly in contact with bacteria, viruses and other harmful agents from the environment such as sun, wind, heat, dryness, cold weather, pollution and cigarette smoke. It helps regulate your body’s temperature through sweat glands, and because skin interacts with other organs, it can alert you to other health problems. The skin is composed of several layers. The lowest layer is called the dermis and it is composed of connective tissue, blood vessels, nerve endings, hair follicles, and sweat and oil glands. The top layer is called the epidermis. The thickness of the epidermis varies with your age, your gender and the location on your body of the skin. For example, the epidermis on your forearm is about five cell layers thick while the epidermis on the bottom of your foot might be 30 cell layers thick. The epidermis is renewed every 15 to 30 days; but in some disease states, it may be renewed in about 7 to 10 days. There are several cell types in the epidermis. The outer layer is made of flattened epithelial cells, and they are called keratinized layers because of the build up of keratin in those cells. Keratin is a strong protein that is specific to the hair, skin and nails. This layer of skin, for the most part, is composed of cells that are almost pure protein. The most abundant type of cell in the epidermis is the keratinocyte. Dandruff and
on skin hair are dead keratinocytes. Other skin cell types are: • Fibroblasts which produce the collagens and elastins that make skin very durable from within. • Melanocytes, which produce the pigment melanin. • Langerhans cells, also called macrophages, protect the body from injury or illness; they are immune cells. • Merkel’s cells, which are more numerous in the palms of hands and soles of feet, are probably sensory mechanical receptors that respond to stimulus, such as pressure or touch. The skin has two types of glands: sebaceous and sweat. The sebaceous glands produce sebum, an oil substance that also contains waxes and lipids. They are more concentrated in the scalp, face and forehead. Sweat glands secrete mostly water, salt, urea, ammonia, and uric acid. Urea, ammonia and uric acid are toxic waste products of protein metabolism. The glands secrete sweat for three main purposes: to moisten skin, excrete waste and regulate body temperature. The skin is a large and complex organ, and taking care of your skin requires diligence and regular care. Remember to use gentle non-drying cleansers and apply moisturizers, use sunscreen with SPF 15 or higher when outside and avoid exposure to sun and artificial tanning; wear protective gloves when washing dishes, working with harsh chemicals or gardening; and check your skin regularly for discoloration, moles or new lumps. With your help, your skin will look healthy for a lifetime. — Source: American Academy of Dermatology and Skin-Information.com.
W
e can’t avoid it. We are all getting older every day. The wrinkles and broken blood vessels are natural signs of aging. Although we can’t stop the aging process, we can look and feel better by taking care of our skin. Intrinsic aging results largely from unknown internal body and genetic factors with a person’s chronological age. Extrinsic aging results mostly from environmental factors, with the most significant being sun exposure. Photodamage describes the structural damage to skin caused by long-term sun exposure. Aging skin appears to be rough, leathery, wrinkled and unevenly pigmented. In time, facial skin becomes progressively lax, usually sagging along the jaw line and under the eyes. A network of dilated blood vessels may be visible on the cheeks and nose, making the face red and ruddy. Various blemishes, precancerous and cancerous lesions become more prevalent. The skin also becomes more fragile and may bruise easily and take longer to heal. Age spots or “liver spots” as they are often called, have nothing to do with the liver. Rather, these flat, brown spots are caused by years of sun exposure. Many older people also notice an increased number of bruises, especially on their arms and legs. That is because the skin becomes thinner with age and sun damage. Loss of fat and connective tissue weakens the support around blood vessels, making them more susceptible to injury. The skin undergoes many changes during the course of the aging process. We can’t stop the aging process, so what’s the best way to take care of our skin as we age? 1. Avoid the sun. The sun damages your skin; no doubt about it. Avoiding sun exposure is the best way to keep your skin looking young and healthy. 2. Use sunscreen when you are outside even for brief periods of time. Reapply the lotion as needed. Also, wear protective clothing to keep your skin away from direct sunlight. 3. We can’t say it enough. You are what you eat, so eat foods that are good for you. The super-size nachos may be tasty, but eat them sparingly. Junk food is just that — junk. Drink milk, eat fruits and vegetables and eat fiber-filled foods. The antioxidants from fruits and vegetables help prevent cancer from developing by fighting off free radicals, the by-products of the body’s everyday processes that damage DNA, cells and tissues.
It’s an 5 age thing 4. A humidifier can add moisture to the air. Bathing less often and using mild soaps to cleanse your skin and mild lotions to soften skin can relieve dry skin. However, the American Academy of Dermatology warns people that over-the-counter creams and lotions may soothe dry skin but do little or nothing to reverse wrinkles. 5. Drink lots of water. It is so good for your skin! 6. Do not smoke. It is unhealthy for you in so many ways and causes you to look older sooner. 7. Exercise. It makes you look and feel better. 8. Laugh a little. Laugh lines are beautiful! — Sources: American Academy of Dermatology, WebMD and the National Institute on Aging.
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Sun damage:
ou’ve heard the message over and over: Avoid the Y sun. Sun exposure causes skin cancer. Tanning is not “cool.” Yet young people flock to the beach. And tanning booths are popping up even in small towns. What’s the real danger? Whether you tan or burn, the result is the same. You are damaging your skin. It’s pretty obvious that a sunburn indicates skin damage, especially if it causes blistering and peeling. Physicians warn that tanning, when the body produces the pigment melanin, also is a response to injury. Whether emitted from the sun or a tanning lamp, ultraviolet (UV) rays kill and injure cells. No UV ray is a safe UV ray — although there are two kinds, UVA and UVB. UVB radiation was once thought to be the only damaging kind, but scientists now believe that both types damage the skin and can lead to skin cancer. Tanning booths, which emit primarily UVA rays, are not safer than the sun. In fact, UVA rays actually penetrate deeper into the skin and are linked to the most serious type of skin cancer, melanoma. You need to be aware of the two kinds of UV radiation because some sunscreens do not protect against UVA rays. Be sure that your sunscreen protects against both types and has an SPF (sun protection factor) of at least 15. The U.S. Food and Drug Administration (FDA) suggests a sunscreen of no higher than 30 SPF because anything above that level offers little additional benefit and might expose people to harmful levels of chemicals. You should not use sunscreen at all on babies younger than six months because of the chemicals it contains. Protect them with shading, hats and clothing. Damage from the sun extends beyond increasing
COOL
TIPS, HOT TOPIC
the risk of skin cancer. Premature aging of the skin; leathery, wrinkled skin; age spots; actinic keratoses; and skin discoloration also may result from too much sun exposure. Actinic keratoses are reddish, rough skin growths that occur on parts of the body exposed to the sun. These can be precancerous. Sun exposure can even damage your immune system and make you more susceptible to illnesses. Some diseases, such as lupus and herpes simplex (cold sores), worsen with sun exposure. Some people are even allergic to the sun’s rays and develop bumps, hives, blisters or red blotches after exposure. Another danger related to sun exposure is increased sensitivity caused by some medications, such as antibiotics, antihistamines, birth control pills and nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen. These medications contain photoreactive agents, which cause chemical changes that increase a person’s sensitivity to light. Photoreactive agents also are present in some deodorants, antibacterial soaps and artificial sweeteners. Getting a tattoo can even increase sun sensitivity because of the cadmium sulfide injected into the skin during the process. No age is immune to sun damage. People typically get 80 percent of their lifetime exposure to the sun by the age of 18. One in five Americans develops skin cancer at some time in their life. If you have fair skin; blue, green or gray eyes; red, blond or light brown hair, you are at greater risk for sun damage — but people with dark eyes, hair and skin also are at risk. People who have a family history of melanoma should take precautions any time they are outside. — Sources: U.S. Food and Drug Administration, U.S. Environmental Protection Agency, National Center for Chronic Disease Prevention and Health Promotion, National Institute on Aging.
Face to face with Acne . ..
.
A
Sun-Smart Tips 1. Plan outdoor activities before 10 a.m . and after 4 p.m. during daylight savings time (9 a.m. and 3 p.m. standard tim e). 2. Apply sunscreen 20 minutes befo re you go outdoors. Apply liberally and reap ply often. Don’t overlook any exposed skin , including places people often forget, such as ears, neck and tops of feet. 3. Make sure your sunscreen has an SPF factor of at least 15 and protects aga inst both UVA and UVB radiation. 4. Wear protective clothing, includin g sun glasses, hats made of tightly woven fabric, long-sleeved shirts, long pants and dark colors whenever you can. 5. Check the UV forecast. The Nationa l Weather Service forecasts the UV inde x for 58 U.S. cities daily. On a scale of 0 to 10+, the higher the number, the grea ter the risk of exposure to dangerous UV radiation. A UV index of only 3 to 4 means that fair-skinned people will bur n in less than 20 minutes. 6. Avoid a false sense of security. Clo uds do not provide much protection sinc e they block only as much as 20 percent of UV rays. Being in water offers no protection from UV rays, and wet clot hes protect less than dry clothes. Sand, sno w and concrete increase UV exposure sinc e they reflect the sun’s rays. 7. Sun exposure is cumulative, so you need protection even during short outings , such as walking the dog, doing yard work, jogging and window shopping. 8. Avoid tanning beds, lamps and tann ing pills. The large amount of color additive in tanning pills could be dangerous to your health. Bronzing products are not harmful but can result in an uneven color and offer no protection from UV rays.
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t one time or another almost everyone over the age of 12 has had to face acne. As the most common skin disease, acne affects more than 17 million Americans, predominantly adolescents and young adults. Technically, acne is a disorder resulting from the action of hormones on the skin’s oil glands (sebaceous glands), which leads to plugged pores and outbreaks of lesions commonly called pimples or zits. In reality, it’s just plain annoying and often times embarrassing, especially for teens. So what causes acne? The exact cause is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). Hormonal changes related to pregnancy or starting or stopping birth control pills also can cause acne. For some people, it’s simply in their genes. Researchers believe that the tendency to develop acne can be inherited from parents. Despite its popularity, the belief that chocolate and greasy foods cause acne is not true. In fact, foods seem to have little effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Finally, stress does not cause acne. Acne flare-ups result from changing hormone levels in adolescent girls and adult women two to seven days before their menstrual period starts or friction caused by items that rub the skin, such as bike helmets, backpacks or tight collars. Even environmental irritants, such as pollution and high humidity, can trigger or lead to acne. There are some simple steps you can take to lessen the occurrence of acne outbreaks. To begin with, be gentle to your skin. Curb the urge to rub, squeeze, pinch or pick blemishes, or you risk developing scars and dark blemishes. Avoid scrubbing your skin and using strong detergent soaps and rough scrub pads to cleanse the skin. The truth is this will not improve acne; in fact, it can make the problem worse. Most doctors advise people with acne to gently wash their skin with a mild cleanser. Astringents are not recommended unless the skin is very oily, and then they should be used only on oily spots. And if you use cosmetics, switch to oil-free products. To treat mild acne outbreaks, doctors usually recommend an overthe-counter topical of which benzoyl peroxide, resorcinol, salicylic acid and sulfur are the most common, or a prescription topical medication, which is applied directly to the acne lesions or to the entire area of affected skin. Patients with moderate to severe inflammatory acne should consult a dermatologist (a doctor who specializes in skin problems) for treatment options. — Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases.
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Don’t let cancer get under your skin
S
kin cancer is the most common type of cancer in the United States. About a million people in America learn they have skin cancer each year. In fact, it is estimated that 40 to 50 percent of Americans who live to age 65 will have skin cancer at least once. The good news? Skin cancer is now almost 100 percent curable if found early and treated promptly, and it is preventable if you treat the skin you’re in with care from very early in life.
Melanoma spreads. These cancer cells can spread to the lymph nodes (or glands), and then it may mean that cancer cells have spread to other parts of the body such as the liver, lungs or brain. When this happens, the cancer cells in the new tumors are still melanoma cells, and the disease is called metastatic melanoma. Malignant melanoma diagnosed at a late stage is more likely to spread and cause death.
Most Common Skin Cancer
The first sign of melanoma is usually a “change” in the size, shape, color or feel of an existing mole. The National Cancer Institute (NCI) recommends that when looking for melanoma, you remember “ABCD.” Asymmetry — One side does not match the other. Border — The edges are often ragged, notched, blurred or irregular in outline; the pigment may spread into the surrounding skin. Color — The color is uneven; shades of black, brown and tan may be present. Areas of white gray, red, pink or blue also may be present. Diameter — There is a change in size, usually an increase. Melanomas are usually larger than the eraser of a pencil (5mm or 1/4 inch).
The two most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. (Carcinoma is cancer that begins in the cells that cover or line an organ.) Ninety percent of all skin cancers in the United States are basal cell carcinomas. It is a slow-growing cancer that seldom spreads to other parts of the body. Squamous cell carcinoma also rarely spreads, but it does so more often than basal cell carcinoma. Basal and squamous cell carcinoma are sometimes called nonmelanoma skin cancer. Left untreated, these cancers can cause substantial illness, considerable damage and disfigurement.
Most Serious Skin Cancer Melanoma is another type of skin cancer that occurs in the skin and begins in the melanocytes. Melanoma is the most serious cancer of the skin. In America, the number of new cases of melanoma has more than doubled in the past 20 years. Melanoma occurs when melanocytes (pigment cells) become malignant. Most pigment cells are in the skin. Sometimes, though rarely, melanoma can occur in the eye, the meninges, the digestive tract, lymph nodes or other areas where melanocytes are found. Melanoma can occur on any skin surface. In men, it is often found in the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the lower legs. Melanoma is rare in black people and others with dark skin. When it occurs in dark-skinned people, it may be found under the fingernails or toenails, or on the palms or soles.
Signs and Symptoms of Melanoma
Curing This Cancer Melanoma can be cured if it is diagnosed and treated when the tumor is thin and has not deeply invaded the skin. However, if a melanoma is not removed at its early stages, cancer cells may grow downward from the skin surface and invade healthy tissue. When a melanoma becomes thick and deep, the disease is difficult to control and often spreads to other parts of the body and is difficult to control. The standard treatment for melanoma is surgery; in some cases, doctors may also use chemotherapy, biological therapy or radiation therapy, or some combination of methods.
Causes/Risk Factors/Prevention The causes of melanoma are not fully known at this time. Some of the risk factors associated with this disease are: family and/ or personal history of melanoma, abnormal moles, weakened immune system, more than 50 ordinary moles, ultraviolet radiation exposure, severe blistering sunburns, and fair skin. — Sources: National Cancer Institute and the Centers for Disease Control and Prevention.
IT’S EVERYWHERE YOU WANT TO BE POISON IVY — PROLIFIC, PERSISTENT AND SOMETIMES PAINFUL L
eaves of three, let it be. Berries white, run in fright. That folk rhyme is something you might want to share with your children, so they can beware of poison ivy. Poison ivy is a plant despised by man but is more abundant today than in the past. Poison ivy (and its cousins poison oak and poison sumac) can be found anywhere and everywhere. It thrives in the woods, on roadsides, in your neighborhood and even empty lots. Where people go, it seems to follow. Depending on how many times a person has been exposed to poison ivy, a person’s reaction to the plant may be as soon as a few hours or as late as two weeks after exposure. Poison ivy causes a severe skin reaction in humans when its leaves come in contact with skin. The result is a red, bumpy rash on areas of the body where the skin is thin (arms, shins, face, etc.). It spreads easily and may cause swelling. The rash usually progresses to itchy blisters that ooze, harden and then crack. Four to five days after it begins, the blisters usually break open releasing a watery liquid. Healing usually takes one to two weeks. To care for a poison ivy rash at home: 1. Wash the area with warm water. The sooner you wash
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the area, the less likely you are to develop a rash. 2. Apply cotton cloths soaked in cool water or colloidal ointment to the area. 3. Try soaking in a slightly warm bath with Aveeno or baking soda to aid with healing. 4. Apply calamine lotion or a paste of baking soda and water on the rash. 5. Take an antihistamine. If the rash becomes painful or does not seem to be healing, or the following symptoms appear, consult a physician. 1. Blisters ooze for more than two weeks. 2. A fever develops. 3. The lymph nodes under your arms, in your groin area or in your neck become sore and swollen. 4. You have insomnia, nervousness, upset stomach or weight gain. 5. The rash covers more than 20 percent of your body or develops in sensitive areas such as eyes or mouth. — Sources: Woodall Publications, Inc., www.yourhealth.com and WebMD.
Are you at risk for rosacea? R
osacea, sometimes called acne rosacea, is a chronic skin disease (that also affects the eyes) characterized by redness, bumps, pimples and, in advanced cases, thickened skin on the nose. Rosacea is most likely to occur on the face, but the neck and upper chest are also sometimes involved. In more than 50 percent of people, there is a mild degree of eye involvement. Those most likely to develop rosacea are fairskinned adults, especially women, between the ages of 30 and 50, although it may affect men or women of any age and even children. For some unknown reason, women get rosacea more often than men, and some cases of this disorder have been associated with menopause. Rosacea usually develops over a long period of time. It may first seem like a tendency to blush easily, a ruddy complexion, or an extreme sensitivity to cosmetics. An occasional embarrassment or a tense
moment also may trigger flushing. There are other factors known to aggravate rosacea including heat, strenuous exercise, sunlight, wind, cold, hot drinks, spicy foods, emotional stress, and coughing. Although rosacea cannot be cured, it can be treated and controlled. Treatment options include topical antibiotics and oral antibiotics (for more severe cases). In some patients, electrosurgery and laser surgery may be options to improve skin appearance. If you have been diagnosed with rosacea, sunscreens are recommended to protect the skin from ultraviolet light. For more information about rosacea, consult your physician. — Sources: National Institute of Arthritis and Musculoskeletal and Skin Diseases and the American Academy of Dermatology.
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That itchy, scratchy feeling
A
topic dermatitis (AD), often referred to as “eczema, is a chronic (long-lasting) disease that affects the skin. It is the most common of the many types of eczema, a general term for certain kinds of dermatitis, among which are contact eczema, allergic contact eczema, seborrheic eczema and nummular dermatitis. All types of eczema cause itching and redness. With AD, the skin becomes extremely itchy and inflamed, causing redness, swelling, cracking, weeping, crusting, and scaling. It is not contagious. The itchy feeling is an important factor in AD because scratching and rubbing in response to itching worsen the skin inflammation characteristic of this disease. Those with AD seem to be extra sensitive to itching and feel the need to scratch longer. They develop what is referred to as “the itch-scratch cycle.” Some treatments reduce specific symptoms of the disease. Antibiotics are used to treat skin infections, and antihistamines, which may cause drowsiness, reduce nighttime scratching. Phototherapy (treatment with light)
Diaper rash:
that uses ultraviolet A or B light waves or both together, can be an effective treatment for mild to moderate dermatitis in older children (more than 12 years old) and adults. AD usually affects infants and young children, but it can continue into adulthood or first show up later in life. Most often, there are periods of time when the disease is worse, followed by periods when the skin improves or clears up entirely. Although sometimes the problem fades, people with AD tend to have dry skin, occupational skin disease (hand dermatitis), skin infections and eye problems, as well as a disruption of family and social relationships. While the symptoms of AD can be irritating and uncomfortable, the disease can be successfully managed. Many people with AD can, and do, lead healthy, normal lives. As researchers discover more about AD and what causes it, they continue to work toward effective treatments, and perhaps, ultimately, a cure. — Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases.
how to care for it and when to be concerned
Diaper rash is the most common skin ailment for infants and, more than likely, most babies and young children will experience it. While a diaper rash may make the skin look red and blotchy, normally it is not serious. The most common causes of diaper rash are: infrequent changing of wet or dirty diapers, irritation from rubbing caused by a diaper, a skin reaction to perfumes in the disposable diaper or detergents and fabric softeners used to clean cloth diapers. To care for a diaper rash on your baby: change diapers frequently; when changing the diapers, use plain water or mild soapy water to clean baby’s bottom (use a cotton cloth or cotton balls for cleaning and avoid disposable baby wipes); avoid bulky diapers that can create a “hothouse” effect next to baby’s skin; try to give your baby some “diaper-free” time each
day; to aid with healing (and with your pediatrician’s permission), try an overthe-counter diaper rash cream or ointment with zinc oxide; avoid using talcum powder or cornstarch; use a mild detergent when washing cloth diapers; make sure the diaper fits the baby correctly and is not too tight; when your baby is ready for food, try one at a time so you can identify and withdraw any food that causes an allergic reaction; and if your baby seems especially prone to diaper rash, use a barrier cream with each diaper to keep moisture away from skin. Consult your pediatrician if the diaper rash contains blisters, crusty areas or bright red spots that together form a solid red area with a scalloped border or if the diaper rash shows no improvement after two days of home treatment. — Source: WebMD and the Disney Encyclopedia of Children’s Health.
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Understanding psoriasis P soriasis is a chronic skin disease, which is characterized by scaling and inflammation. The scaling occurs when cells in the outer layer of the skin reproduce faster than normal and pile up on the skin’s surface. While psoriasis occurs in all age groups and almost equally in men and women, it is more prevalent among adults. Patients with the disease may suffer discomfort, including pain and itching, restricted motion in their joints and emotional anguish. Diagnosis of the disease may be difficult because psoriasis can look like other skin diseases. There are several forms of psoriasis, the most common of which is plaque psoriasis (psoriasis vulgaris). In this form of psoriasis, lesions have a reddened base covered by silvery scales. Other types of psoriasis include guttate psoriasis, characterized by small, drop-like lesions that appear on the trunk, limbs and scalp; pustular psoriasis, where blisters of noninfectious pus appear on the skin (this may affect small and/or large areas of the body). Patients with inverse psoriasis may develop large, dry, smooth, vividly red plaques in the folds of the skin near the genitals, under the breasts or in the armpits. In erythrodermic psoriasis, itching or pain often accompanies extensive reddening and scaling of the skin. It may
be precipitated by severe sunburn, use of oral steroids (such as cortisone) or a drug-related rash. Doctors generally treat psoriasis according to the severity of the disease, size of the affected areas, the type of psoriasis and the patient’s responsiveness to initial treatments. This is sometimes known as the “1-2-3” approach. In step 1, medicines are applied to the skin (topical treatment). Step 2 focuses on light treatments (phototherapy). Step 3 involves taking medicines internally, usually by mouth (systemic treatment). Also, a treatment that works very well for one person may have little effect for another. Thus, doctors commonly use a trialand-error approach to find a treatment that works, and they may switch treatments occasionally. Researchers continue to search for genes that contribute to the inherited and other causes of psoriasis. They also are working to broaden our understanding of what happens in the body to trigger this disease. In addition, research is focused on developing new and better treatments.
— Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Why do some babies wear the cradle cap? C radle cap is a form of seborrheic dermatitis that forms crusty, yellowish scales on a baby’s scalp thus looking somewhat like a “cap.” Don’t be alarmed if your baby has cradle cap because almost 50 percent of newborns are affected. Although it may be somewhat unsightly, it is harmless. It causes no discomfort or itching and usually disappears with proper scalp hygiene. Cradle cap is probably linked to the oilproducing sebaceous glands, which are located primarily on the scalp. If the hair is infrequently shampooed, secretions accumulate on the scalp and cause cradle cap. Removal of the crusts and regular, thorough cleansing of the scalp will eliminate cradle cap in virtually every case. To remove the scales, massage mineral oil or olive oil into the baby’s scalp and allow it to soften the scales. Use a soft wash cloth to gently remove the crust.
Be sure to follow this procedure by washing the baby’s hair and scalp with a mild shampoo. Oil left on the baby’s scalp can aggravate cradle cap. Once the condition has cleared up, frequent shampooing and daily brushing will keep it from reappearing. Be sure to consult your child’s pediatrician if the cradle cap does not respond to home treatment, the rash spreads to other parts of your baby’s body, or the rash becomes itchy or inflamed and shows signs of infection. — Source: The Disney Encyclopedia of Children’s Health.
The Phar macist is in Do you have any questions? The side effects of medications Both pharmacists and physicians receive numerous questions about the side effects of potential medication therapies prescribed or about medications patients are taking. This is proper and intelligent thinking on the part of the patient. There always will be side effects associated with the taking of prescribed or over-the-counter medications. Most side effects are not very noticeable and may be overlooked, considering the advantages of the therapy. However, the benefits do not diminish the potential seriousness of the side effects of medications. Please contact your physician if side effects such as vomiting, diarrhea, blurred vision, extreme drowsiness, and others severely hamper your daily activities or create a potential safety concern. Taking excessive amounts of a prescribed or overthe-counter medication, or taking too many different medications from various physicians may produce adverse side effects, which may be exaggerated beyond normal levels and may create a potentially dangerous situation. Taking chemicals into our bodies to correct a medical
problem is an important gift in most cases. However, we must be careful not to abuse this gift. Medications are a physician’s primary tool in the non-invasive attempt to control or correct a medical problem presented by a patient. Although many people have a profound respect for pharmaceutical drugs and take them as directed by their physician, some have become complacent about taking medications and have little concern for the potential adverse events that can happen. The advertising of physician-prescribed drugs tends to accommodate this lack of respect for powerful drugs and promotes increased utilization. Minor side effects are a part of normal medication therapy. The fact is — there will be side effects of some kind, whether noticeable or unnoticeable by the patient, associated with every drug. Patients must evaluate whether these are endurable or not. Also, remember that there may be situations where a drug mishap may occur, for whatever reason, and may require immediate medical assistance.
New Foundation to award up to $1 million to promote better health A
rkansas Blue Cross and Blue Shield has provided $5 million to establish a charitable foundation to promote better health in Arkansas. The foundation is accepting its first grant applications through Sept. 16. The Blue & You Foundation for a Healthier Arkansas anticipates awarding up to $1 million in grants in 2002 to non-profit or governmental organizations and programs that positively affect the health of Arkansans. Particular emphasis will be given to projects affecting health care delivery, health care policy and health care economics. “We have a health care crisis in Arkansas that must be addressed,” said Robert L. Shoptaw, chief executive officer of Arkansas Blue Cross and chairman of the foundation’s board of directors. “The poor health status of our citizens ranks 46th in the nation and contributes to rising medical costs. By providing funding and working together with other organizations, we hope to establish or expand a number of diverse health care projects that will benefit all Arkansans over the long term,” Shoptaw said.
The Blue & You Foundation for a Healthier Arkansas will accept proposals for its first grants through Sept. 16, with awards being announced before Dec. 31. Foundation grants will be made to non-profit or governmental organizations only and not to individuals. In addition to these grants, Arkansas Blue Cross expects to continue its support of Arkansas charitable organizations through direct corporate contributions. A board of directors will govern the foundation and make the final selection of grant awards. The current board of directors includes: Sybil J. Hampton, president, Winthrop Rockefeller Foundation, Little Rock; Hayes C. McClerkin, Of Counsel, Dunn, Nutter and Morgan, Texarkana; George K. Mitchell, M.D., Little Rock; and Robert L. Shoptaw. The foundation is a 501(c)(3) organization. For information on how to apply for a grant, write to Blue & You Foundation, 601 S. Gaines Street, Little Rock, AR 72201 — or visit the foundation Web site at www.BlueAndYouFoundationArkansas.org.
Health Advantage introduces a new OPEN ACCESS POS plan W
hen choosing a health insurance plan, people should look for two things —the right insurance coverage for their needs and the right level of customer service.
Right Coverage In response to customer requests for direct access to network providers and a lower-priced health plan, Health Advantage is now offering a new product — Open Access Point-of-Service (OAPOS). OAPOS is an innovative plan that combines the characteristics of traditional health maintenance organization (HMO) coverage with the extra provider options of a point-of-service (POS) plan. OAPOS provides preventive and routine services with co-payments required for visits to primary care physicians (PCPs). Members of the OAPOS plan also may visit their in-network specialty physicians without a PCP referral; however, this is where the lower-priced health plan becomes apparent with benefit choices of deductibles, co-payments OAPOS and co-insurance for specialty and hospital services. Open Access means that members have choices when visiting health care providers and in using their Health Advantage benefits. Open Access gives members the ability to visit any in-network provider without going through the PCP for a referral and receive the highest level of benefits available under the in-network benefit program. Members also have the option of using out-ofnetwork providers and receiving the out-of-network benefit coverage. The OAPOS plan offers: • In-network deductible — Options include no deductible, $250 in-network deductible, $500 in-network deductible, or $1,000 in-network deductible. The innetwork deductible is applied to specialty care physician services, hospital services, maternity services as well as rehabilitation, home health and skilled nursing facility services. This deductible for innetwork services is applied after the member pays the applicable co-payment for the services. • Co-payments — These vary depending on service. Physician co-payment options are $25 or $35. The inpatient admission co-payment is $200 or $500, and the outpatient facility co-payment is $100. Benefit determination requires that co-payments are always subtracted first, followed by the deductible and co-insurance. • Preventive services — PCP services are not subject to deductible.
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• Emergency services — The $100 co-payment and coinsurance are not subject to deductible. • Co-insurance — The in-network options are 20 percent and 30 percent. • Out-of-network — Out-of-network services are applied after deductibles. The deductible options are $1,000 or $2,000. There is no out-of-pocket limit for out-ofnetwork services. • Pharmacy – Options include co-payments of $10/$20/ $30, $10/$30/$50 and 20 percent co-insurance with co-payments of $10/$30/$50.
Right Service Quality service may be the single most important factor for employers (and employees) when choosing a health insurance plan. To assess a company’s quality of service, employers should check references from other similarly sized businesses. Insurance companies are unlikely to release references from anyone but satisfied customers, so the best way to get information is to conduct personal research. Call the customer service departments of the insurance companies you are considering. To make accurate comparisons, try to call each company at the same time of the day. It may take extra time, but you should be able to tell whether calls for service get routed through the circuit of automated menus with long waits and if the insurance company has staff skilled in handling your call. Another way to obtain information concerning service is to ask the office manager at your own physician’s office for his or her opinion. He or she has the unique experience of working with many insurers on a day-to-day basis. That experience can give you an accurate picture of each health insurance company. Most health insurance companies now have Web sites. Be sure to visit these, if possible. Many times employers will find value-added services from the health insurance company that may enhance the employees’ benefits and overall health. These may include such things as frequently asked questions, wellness programs, disease management programs, and on-line provider directories. Finally, check with the Insurance Department to find out about the stability of the company, and check with the Arkansas Department of Health to obtain the results of its periodic HMO reviews. Please call Health Advantage at (501) 221-3733 or 1-800-843-1329 for more information.
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Arkansas Blue Cross and Blue Shield Selected Maintenance Contractor for National Medicare Part A System
rkansas Blue Cross and Blue Shield has been A awarded the Medicare Part A maintenance contract for the Fiscal Intermediary Standard System (FISS) by the Centers for Medicare and Medicaid Services (CMS), previously the Health Care Financing Administration. As a result of the contract, Arkansas Blue Cross becomes the sole national maintenance contractor (“maintainer”) of the computer software system used to process more than 160 million Medicare Part A claims nationwide. Arkansas Blue Cross was selected to provide computer software services to support FISS, including maintenance, development enhancements and special projects. Arkansas Blue Cross will be responsible for maintaining and improving the FISS software and with distributing the software to seven regional data centers, which process Medicare claims. FISS is the primary component of Medicare’s claim processing function under Medicare Part A. Ed Person, manager of Medicare Systems at Arkansas Blue Cross, has been named FISS project director. The contract was effective Feb. 13, 2002, at which time an anticipated six-month transition period began with the current maintainer, First Coast Service Options in Florida, to ensure a smooth transition from one maintainer to another. “This is a noteworthy accomplishment for an Arkansas company and a significant vote of confidence from CMS,” said Robert L. Shoptaw, president and CEO of Arkansas Blue Cross. “Since July 1, 1966, when we started as a Medicare claims processing program, Arkansas Blue Cross has given priority attention to the administration of the Medicare program and the opportunity to provide services to the senior citizens of our state. The excellent reputation we have built in Arkansas also has allowed us to gain Medicare roles in other states.” Charlie Clem, Arkansas Blue Cross vice president for Public Programs, said, “We are pleased to be given this opportunity to serve an even greater role in the national Medicare program as maintainer of the FISS. We will continue to do whatever we can to provide the best
possible service. We believe this reinforces our standing with CMS as an efficient and effective Medicare contractor.” In the 1980s, CMS began a push toward national standardization in processing Medicare claims by moving toward standard software systems in claims processing and shared processing across one hardware platform. The goal was to reduce variation in hardware and software used for Medicare processing, to achieve savings in system development and maintenance as well as a reduction in processing costs. In 1996, CMS decided to move all Medicare Part A contractors to one system, FISS. Currently, there are six contractors remaining to be transitioned to FISS from the Arkansas Part A Standard System (APASS), which has been used successfully for many years to process Medicare Part A claims. When Arkansas Blue Cross began administering Medicare in 1966, there were approximately 45 employees who processed claims manually. Today, Arkansas Blue Cross has more than 750 employees in five states who work with Medicare. Arkansas Blue Cross currently administers Medicare Part A and Part B programs in Arkansas and also administers Part B claims in Louisiana, Oklahoma, New Mexico and eastern Missouri. As of Dec. 31, 2001, Arkansas Blue Cross serves 2,524,613 Medicare beneficiaries in five states. The number of Medicare claims processed annually by Arkansas Blue Cross for these five states is more than 42 million (Part A and Part B) and the Medicare benefit dollars paid out annually is more than $3.8 billion. Arkansas Blue Cross also serves as the data center for contractors who process Medicare Part A claims for Alabama, Alaska, Maine, Maryland, Massachusetts, Mississippi, New Hampshire, North Carolina, Rhode Island and Washington. “We have moved from a small contractor to a major player,” said Clem. “This is due to our increased contractor jurisdictions, systems role, and desire and ability of our employees to be innovative and strive for excellence. Our success is due to our dedicated employees.”
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15 rkansas Blue Cross and Blue Shield strives to be a A good corporate citizen. Our employees raise money and spend many hours helping those causes near and dear to the hearts of Arkansans. Stompin’ in Gurdon There was some stompin’ going on in Southwest Arkansas recently. Juniors and seniors who were selected at Gurdon High School to lead the charge against tobacco in their primary schools visited with fifthgraders in their school district to teach students about the dangers of smoking and smokeless tobacco use. BlueAnn Ewe was on hand to support their presentations and perform the “BlueAnn Stomp” rap/ BlueAnn poses with dance with the Heroes and middlenew High School schoolers. The American Lung Heroes at Gurdon. Association developed the High School Heroes student mentoring program; Arkansas Blue Cross and Blue Shield sponsors it statewide. Brownies meet BlueAnn In an effort to earn “Try-Its,” staying healthy was the topic being reviewed recently by Brownie Troop 291 in Maumelle. And to help make the learning a whole lot of fun, BlueAnn Ewe made a special appearance at the troop’s February meeting ... on Valentine’s Day. The big, blue sheep presented her wellness lesson for the girls in an effort to teach them about health and safety with a focus on their particular issues: “Healthy Habits” and “Eat Right, Stay Healthy.” Each Brownie got a copy of BlueAnn’s “Wild & Woolly Health Tips for Kids” coloring book and watched her “BlueAnn Rocks” musical health messages at their next meeting. A “sweet” time was had by all. Sheep serves up soup on Sunday BlueAnn was dishing out some fun for kids on Soup Sunday, the annual fundraiser for the Advocates for Women and Children held in February. Chefs from restaurants around the central Arkansas area served up their signature soups d’jour for thousands of people supporting the organization and big appetites! BlueAnn
Ewe was on hand to entertain little ones in the Kids’ Area BlueAnn boogies for a portion of the event with a and even kicked up her hooves on the dance floor to little chef at Soup the tunes of Little Joe and Sunday the BKs. The event helped event. raise money to support battered women and awareness of the need to help stop domestic violence. It was a “soup-er” day. Walking for the heart Arkansas Blue Cross and Blue Shield and Health Advantage served as corporate sponsors of the American Heart Association’s Faulkner County Heart Walk on April 6 in Conway. Our Blue team joined almost 900 other walkers, along with BlueAnn Ewe, to raise money for research and education. The team was the second largest corporate team at the event, raising $5,453 to support the more than $56,500 collected to fight heart disease. BlueAnn posed with survivors ranging in age from 10 months to 70 years. It was a beautiful day for walking and a great day for talking to those who have suffered and survived heart problems.
Coverage Policies now on-line T he Arkansas Blue Cross and Blue Shield Coverage Policy recently was added to the Arkansas Blue Cross and Health Advantage Web sites. The purpose of the Coverage Policy is to inform members and their physicians about what is and what is not covered under Arkansas Blue Cross insurance contracts and Health Advantage health plans. Within the Coverage Policy section, users may search by key word, policy title, policy number or procedure code. In addition, users may access explanations of the following: • What is the Coverage Policy? • How are coverage decisions made? • What is a CPT code? The new Coverage Policy section may be found in the “Members” and “Providers” sections of both Web sites.
www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.USAbleAdminArkansas.com www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com
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ur on-line world is growing. The Arkansas Blue Cross and Blue Shield family of companies hosts six sites on the World Wide Web: • ArkansasBlueCross.com — for members of Arkansas Blue Cross and the providers, employers and agents who help serve our members; • HealthAdvantage-hmo.com — for members of Health Advantage group plans and the providers, employers and agents who help serve our members; • USAbleAdminArkansas.com — for members of selffunded health plans administered by USAble Administrators who have “Blue-branded” products such as BlueCard®; • USAbleAdmin.com — for members of self-funded health plans administered by USAble Administrators who have non-branded products; • BlueAndYouFoundationArkansas.org — with information about the charitable foundation to promote better health in Arkansas; • BlueAnnEwe-ark.com — targeted toward younger children but with something fun for everyone.
Blue Business On the four business sites, you will find information about our companies, health plans and services, as well as the “Provider Directory.” Each site has an e-mail link so that you can send questions to Customer Service. Each site also has a “Frequently Asked Questions” section, where you might find answers to your questions. If you need to contact us by telephone or mail, you will find that information in the “Contact Us” section. The newest feature of our business sites is the customized “Provider Directories” for USAble Administrators members. To find an in-network doctor or hospital, a member enters the member ID number from the USAble Administrators ID card. This number opens the key to the member’s customized search page. Later this year, members will be able to register for self-service features, such as “Check Claim Status” and “Order a Replacement ID Card.”
New Business If you or a family member needs information about an individual health insurance policy or Medi-Pak, visit the “Individuals and Families” page in the “Health Plans and Services” section of ArkansasBlueCross.com. You can
get a free, no-obligation rate quote on-line. You also may request an information packet for BlueCare PPO®, BlueCare PPO Plus®, Blue Select® or Medi-Pak®. When you complete the on-line form, you will receive a packet in the mail. Summaries of each of the individual plans are available on-line. If you would like to apply immediately, you may fill out, print and mail an on-line application form. For now, we need an original signature on the application form, although plans are under way to develop a method of accepting an electronic signature.
Educational Fun Children of all ages will find something fun to do at BlueAnnEwe-ark.com. BlueAnn recently added a fun and educational game called “Who Wants To Feel Like a Million Bucks?” Other games include “Concentration” and “BlueAnn’s Wild and Woolly Word Search,” which offer challenges even for adults. The “Healthy Habits Coloring Page,” “Fan Mail” and “Scrapbook” are easy for younger children to explore. Other features allow children to e-mail BlueAnn, watch her colorful TV spots and listen to her radio commercials. Health related information changes each month in the “Healthy Goodies” section. Parents can feel confident that BlueAnn’s site is a safe and beneficial one for their children to visit. If you have suggestions for improving our sites, please e-mail us from any site. Thanks for visiting!
Arkansas Blue Cross and Blue Shield P.O. Box 2181 Little Rock, AR 72203-2181