2004 - Autumn by Arkansas Blue Cross and Blue Shield

~ new, affordable individual products, P. 16-17 ~

Autumn 2004

Protecting your Identity Health Advantage and BlueAdvantage Administrators of Arkansas have entered the last phases of conversion from using Social Security numbers to new identification (ID) numbers for its members. Health Advantage converted all active and terminated member numbers, except for the Arkansas State Employee (ASE) and Public School Employee (PSE) groups, on Labor Day weekend, Sept. 36, 2004. Also, BlueAdvantage will complete its conversion by the end of 2004. After you receive your new ID card(s), you must present it each time you receive medical services or have a prescription filled in order for claims to be processed timely and accurately. Please inform all providers that you have a new member ID number and that all future claims for services must contain your new ID number.

Blue

Members may view claims details online

maximum. Medi-Pak members will not be able to see their EOBs at this time.

For better customer service, we ask all members to: 1. Become familiar with the requirements and procedures of Arkansas Blue Cross, Health Advantage and BlueAdvantage, as applicable. 2. Present your most up-to-date/current member ID card to your health-care provider when seeking care. 3. Maintain health levels by “living a healthy lifestyle.” 4. Provide information to health-care providers to assist them in the care needed to achieve health outcomes. 5. Follow all instructions given by health-care providers to achieve maximum benefits of the care, including instructions given in case management and disease management programs. 6. Meet all copayment, deductible and coinsurance obligations. 7. Communicate any complaint immediately. 8. Ensure all claims for services provided by non-plan providers are filed within 60 days. 9. Notify us when any person in the member’s family is covered by another group health plan. 10.Cooperate fully in the subrogation process to collect for services that are the legal responsibility of a third party.

Comes Through.

Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage members may log in to My Blueprint on their respective Web sites (see Page 3 for Web addresses) to retrieve explanation of benefits (EOB) statements. For a completed claim, the EOB shows details such as date and type of service, total amount billed, amount paid, who was paid, member’s minimum financial responsibility, and amount of coinsurance or deductible applied to your out-of-pocket

We’re here to meet your customer service needs

Call My BlueLine

for answers to your questions anytime

With My BlueLine, you have access to customer service 24 hours a day, seven days a week. If you are a customer of Arkansas Blue Cross and Blue Shield, Health Advantage or BlueAdvantage Administrators of Arkansas, you can get the answers to your questions anytime, day or night. My BlueLine is an interactive voice response (IVR) system that recognizes speech patterns to help answer questions when you call current customer service telephone lines. When you call a customer service line, My BlueLine will immediately answer the call. My

BlueLine will prompt you with a question, and you simply respond to the question. When you call, have your ID card on hand. For privacy purposes, the system will ask you questions to verify your identity — such as your member ID number from your membership card.

24/7 you can: • Check your eligibility • Check your benefits • Check the status of your claims • Check the status of your premium payment • Order a new ID card • Order a provider directory • Order a claim form Blue & You Autumn 2004

Customer Service Numbers Category

Little Rock Toll-free Number (501) Number

State/Public School Employees

378-2364 1-800-482-8416

Medi-Pak (Medicare supplement)

378-3062 1-800-338-2312

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

1-877-356-2368 1-800-482-5525

Arkansas Blue Cross and Blue Shield health insurance plans for individuals and families 378-2010 1-800-238-8379 Arkansas Blue Cross Group Services 378-3070

1-800-421-1112

BlueCard®

378-2127 1-800-880-0918

Federal Employee Program (FEP)

312-7931 1-800-482-6655

Health Advantage

378-2363 1-800-843-1329

BlueAdvantage Administrators

378-3600 1-800-522-9878

Pharmacy Customer Service: Arkansas Blue Cross Health Advantage BlueAdvantage Administrators Specialty Rx

1-800-863-5561 1-800-863-5567 1-888-293-3748 1-866-295-2779

For information about obtaining coverage, call: Category

Little Rock Toll-free Number (501) Number

Medi-Pak (Medicare supplement)

378-2937 1-800-392-2583

Health insurance plans for individuals and families

378-2937 1-800-392-2583

Regional Office locations are: Central, Little Rock; Northeast, Jonesboro; Northwest, Fayetteville; South Central, Hot Springs; Southeast, Pine Bluff; Southwest, Texarkana; and West Central, 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.BlueAdvantageArkansas.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, healthcare professionals and other persons interested in health care and wellness.

Blue & You Autumn 2004

INSIDE THIS ISSUE

~Autumn 2004~

Blue Comes Through ................................... 2 My BlueLine has the answers ........................ 2 Health by the numbers................................. 4 Practicing preventive health ......................... 4 Leading causes of death for state and nation ..... 5 Three things to prolong your life .................... 5 Estimating daily calorie requirements .............. 6 Calculate your BMI .................................. 6-7 What is 20/20 vision? .................................. 7 Charting your child’s course.......................... 8 Are you hot or cold? ................................... 9 Off the cuff: all about blood pressure............. 10 Diabetes numbers you need to know .............. 11 Cholesterol goals tightened .................... 12-13 Pumping to the beat ............................. 14-15 Understanding urinalysis............................ 15 New: HSA Blue PPO and HSA Blue PPO Plus...... 16 Blue Solution PPO now available .................. 17 On folic acid and birth defects..................... 17 How insurance plan coverage works .......... 18-19 HealthConnect Blue now available for PSE ...... 20 Providing specialized subrogation services ..... 20 Women’s Health and Cancer Rights Act .......... 21 Health Advantage Customer Service is moving.. 21 Curves for Women offers discounts ............... 21 From the Health files ................................ 22 Blue & Your Community ............................. 23 Blue Online ............................................ 24

Vice President of Advertising and Communications: Patrick O’Sullivan Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com Designer: Gio Bruno Contributors: Chip Bayer, Tammi Bradley, Janice Drennan, Damona Fisher and Kathy Luzietti

4 S

-----------HEALTH BY THE NUMBERS ------- --- ----

o, you are at your doctor’s office for your wellness checkup. Your blood has been taken, your blood pressure has been checked and your doctor has listened to your heart. He or she then may take a look at all the results, announce that everything looks good and send you on your way. Of course, you trust your doctor, and you are feeling pretty good, but have you ever been just a little bit curious about what the numbers and tests really mean? Let’s just say your blood pressure is 120/75, and you know from past experience that that is

good. But what does the 120 represent, and just what did it measure? And, how about the 75 … what does it mean? This issue of Blue & You is designed to clarify what the numbers mean from that checkup or test at your doctor’s office. Although this issue gives you the ranges for what is “normal” (and how to get there through healthy living) — it’s always important to talk to your doctor about the overall picture of your health and determine what each number might mean for you personally.

Practicing preventive health Don’t forget your wellness checkup P

art of living healthy is having a wellness checkup. The following recommendations for wellness screenings are from the U.S. Preventive Services Task Force. These guidelines provide the basics of preventive care for an average person. They do not replace clinical judgment. All referenced health services may not be covered under your health plan; please check your health plan or policy for coverage of services.

What History, physical exam Blood pressure Height & weight, or BMI Vision Colorectal cancer • Fecal Occult Blood • Sigmoidoscopy (Many organizations recommend colonoscopy and barium enemas as options for screening.) Active screening for problem drinking and assessment of tobacco use

Adults Age All adults Age 12 and older All adults Age 65 and older Starting at age 50

Frequency Periodic Every two years Periodic Periodic Yearly

What Mammography Pap smears

Chlamydia

Women Age Starting at age 40 Women who are or who have been sexually active and have a cervix (unless removed for cancer or its precursors). Opinions vary on when to discontinue screening. Consider discontinuing after age 65 if repeatedly normal paps. Age< 25 years if sexually active

Frequency Every 1-2 years Every 1-3 years

Frequency at discretion of provider

Men What Prostate Specific Antigen (PSA) All adults using CAGE, AUDIT or other tools

Periodic

Age ACP & AAFP recommend counseling men related to known risks and uncertain benefits of screening for prostate cancer.

Frequency Screening asymptomatic men

Blue & You Autumn 2004

What are the leading causes of death in Arkansas and the United States?

Heart disease, which can be prevented in some

cases, ranks as the leading cause of death for both Arkansas and the United States. In fact, many of the diseases or situations that cause death could be prevented with a healthy lifestyle and improved education. There are risk factors for disease that you can do something about, and there are risk factors that you can’t do anything about. For example, if heart disease runs in your family, there is nothing you can do about that. However, if you are a smoker (and smoking is a risk factor for heart disease), you can quit smoking. Another

example is that although you can’t control what other drivers do on the road, you can wear a seat belt to protect yourself in case of an accident. If you are at risk for heart disease, have diabetes or battle with respiratory illness, you may be qualified to enroll in one of the Arkansas Blue Cross and Blue Shield or Health Advantage Health Education Programs. Visit the Health Education Programs section of our Web sites at www.ArkansasBlueCross.com or www.HealthAdvantage-hmo.com for more information. — Source: www.healthyarkansas.com

Leading causes of death in Arkansas and the United States Cause of death Arkansas rank Heart Disease 1 Cancer 2 Stroke 3 Chronic lower respiratory disease 4 Accidents (transport and non-transport) 5 Flu/Pneumonia 6 Diabetes 7 Kidney disease 8 Septicemia (infection in the bloodstream) 9 Alzheimer’s 10 Suicide 11 Liver disease 12 Pneumonitis 13 Homicide 14 Parkinson’s 15 Hypertension *

United States rank 1 2 3 4 5 7 6 9 10 8 11 12 15 14 * 13

*Not in the top 15.

Three things YOU can do for a longer, healthier life 1. Eat right. Remember to eat a variety of foods. Choose a diet low in fat, saturated fat and cholesterol. Eat plenty of vegetables, fruits and grain. Use sugar, salt and alcoholic beverages in moderation. 2. Exercise regularly. Talk to your doctor about how much exercise is right for you. A good goal for many people is to work up to exercising four to six times per week for 30 to 60 minutes at a time. Remember that exercise has so many benefits that any amount is better than none. 3. Don’t smoke. If you do smoke, quit. Smoking causes lung cancer and emphysema. Smoking can kill you. Although it is very difficult to quit smoking, doing anything worthwhile can be tough. Have a realistic plan in place to prevent setbacks — and reach your goal. You can quit. Blue & You Autumn 2004

OW TO ESTIMATE HYOUR DAILY CALORIE REQUIREMENTS

f you are looking for an easy way to estimate your daily calorie requirements, look no further.

For sedentary people (couch potatoes) — Multiply your weight by 14 to get your estimated calories needed per day. For example: 150 (weight) x 14 = 2,100 (calories needed per day) For moderately active people — Multiply your weight by 17 to get your estimated calories needed per day. For example: 150 (weight) x 17 = 2,550 (calories needed per day)

For active people — Multiply your weight by 20 to get your estimated calories needed per day. For example: 150 (weight) x 20 = 3,000 (calories needed per day) Note: Moderately active is defined as three to four aerobic sessions per week. Active is defined as five to seven sessions per week. — Sources: The Fitness Jumpsite™ and the American Council on Exercise

Calculate your BMI T he Body Mass Index (BMI) is a tool used for determining weight status in adults. It utilizes the following formula to compare height and weight.

Example: A person who weighs 220 pounds and is 6 feet 3 inches tall will have a BMI of 27.5. BMI is categorized four ways: BMI Weight Status Below 18.5 Underweight 18.5-24.9 Normal 25.0-29.9 Overweight 30.0 and Above Obese A person’s BMI correlates with their body fat but it is not the same thing. The relation between “fatness” and BMI varies with age and gender. Women tend to have a higher percent of body fat than men for the same BMI. Likewise, older people tend to have more body fat than younger people with the same BMI. And, of course, variations among individuals play a role as well. There are some people, especially highly trained athletes, who are overweight according to the BMI, but have a very low percentage of body fat.

There also are people of a normal weight, according to the BMI scales, who are “over-fat” according to their percentage of body fat. The American Council on Exercise provides a chart for body fat percentages:

Essential fat Athletes Fitness Acceptable Obese

Women 10-12 percent 14-20 percent 21-24 percent 25-31 percent 32 percent plus

Men 2-4 percent 6-13 percent 14-17 percent 18-25 percent 26 percent plus

Why is this important? As your BMI and body fat percentage increase, so does your risk for a number of health problems. Overweight and obese individuals have an increased risk for: • High blood pressure • High blood cholesterol • Type 2 diabetes Blue & You Autumn 2004

• • • • • • • •

Coronary heart disease Congestive heart failure Stroke Gallstones Gout Osteoarthritis Obstructive sleep apnea Some types of cancer (including endometrial, breast, prostate and colon) • Complications with pregnancy

and teens, BMI is used to assess underweight, overweight and risk for becoming overweight. However, BMI and body fat percentages for children can change dramatically as they mature. For this reason, the BMI for children is highly age and gender-specific. — Sources: Centers for Disease Control and WebMD

It is important to remember that BMI is only one of many factors used to predict risk for disease. It cannot be used to tell a person of the presence of conditions like diabetes or cancer. If your BMI indicates you are overweight or obese, talk to your doctor to see if you are at an increased risk for disease and if you should lose weight. Even a small weight loss (as little as 10 percent) may help to lower risk for disease. It also is important to remember that BMI is used differently for children than it is with adults. In children

Common Myths: Myth 1: BMI measures body fat Two people can have the same BMI, but a different percent of body fat. A bodybuilder with a large muscle mass and a low percent of body fat may have the same BMI as a person who has more body fat because BMI only calculates using height and weight.

Myth 2: BMI is a diagnostic tool BMI alone is not diagnostic. It is one of many risk factors for disease and death. As a person’s BMI increases, the risk for many diseases increases as well.

What is

T he term “20/20” is so common that it’s used as an everyday phrase in our culture (i.e. hindsight is 20/20) and it’s even the name of a popular television show. But, what does the term “20/20” actually mean? Basically, by examining lots of people for many years, physicians have determined what a “normal” person should be able to see when standing 20 feet away from an eye chart. If you have 20/20 vision, it means that when you stand 20 feet away from the chart, you can see what a “normal” person would be able to see. So, if you have 20/20 vision, your vision is considered

Blue & You Autumn 2004

20/20 vision? normal. If your vision is 20/30, it means that when you stand 20 feet away from the chart, you can see what a normal person can see at 30 feet away from the chart. In the United States, the cutoff for legal blindness is 20/200. If you have 20/10 vision, it means your vision is better than what is considered normal. It means that you can see at 20 feet what a normal person would be able to see at 10 feet away from the chart. — Sources: HowStuffWorks, science.howstuffworks.com and AgingEye Times

Charting Your Child’s Course ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

M uch as the great explorers of the world charted their discoveries for those who came behind them, physicians and caregivers have charted the growth of a child to help parents have reference points in following their children’s development. After decades of recording children’s heights, weights and head circumferences at various ages, physicians have established guidelines for normal measures of growth and a schedule of when children should be measured. Pediatricians routinely monitor and record a child’s development, to see if he or she is on course for development. But because no two children are exactly alike, what is considered “normal” growth has broad limits. Since children differ genetically in size, normal growth cannot be based on just one examination. It is important to follow the child’s development over a period of time using special measurement systems. This way, it is not the size as such that is monitored, instead it is the growth and weight gain of the child. Since an infant changes so fast, you probably will see more of your pediatrician during your baby’s first year than at any other time with checkups scheduled every few months. Then, except for illnesses or other medical needs that dictate doctor visits, you will settle into a schedule of routine exams throughout early childhood, middle childhood and adolescence that range from every few months to every year (or so). Throughout a child’s life, he or she may be taller or shorter than the established measurements. Likewise, the weight of healthy children can vary substantially. That doesn’t really matter as long as the general pattern is normal. The key is to note if a child suddenly deviates sharply from the growth pattern they have been following. If your child’s growth pattern changes significantly

between routine checkups, you should contact your doctor. Children with short parents will often grow at the same rate as those with tall parents until around one year old. Then, they simply follow a slower growth curve. After an illness, it is normal for children to rapidly regain any lost weight and then revert to their original rate of growth. Babies who have grown too slowly in the womb grow proportionally more than other children after birth. Then they start to follow the correct growth curve. Babies born prematurely are often measured against a different growth chart. This is calculated by subtracting the number of weeks premature the baby was from the child’s current age in months. This correction can be applied until the child reaches 2 years of age. Hereditary factors play a role in a child’s rate of growth and the onset of puberty. For instance, sometimes a father and his son are both short in early puberty, but grow taller in late puberty. Or, a mother and her daughter might both be tall at the age of 12 and get their first period before other girls in their class. A child’s growth is determined mainly by a combination of genetics and environmental factors, especially diet and exercise. However, a number of diseases also may affect growth, including deficiency of the growth hormone or the thyroid hormone. A parent can be the best observer of a child’s growth patterns. Everyone can measure and weigh their children. However, a professional growth examination should be conducted regularly by a physician. These often take place during routine medical checkups. It is important to share observations, whether slight or dramatic — excessive weight gain or loss, energy levels, etc. — with your child’s doctor when you visit. Over time, your child’s doctor will measure and weigh the child and draw growth curves. The parents’ height and weight as adults, at puberty and as infants will be taken into consideration. The doctor will ask (Charting, continued on Page 13) Blue & You Autumn 2004

Are you

Your body temperature is nothing more than your body’s ability to generate or get rid of heat. The body is quite efficient at keeping its temperature maintained within a narrow, safe range — despite exposure to variations in temperature outside the body. When your body gets too hot, the blood vessels in your skin expand, or dilate, to carry the excess heat to the surface of your skin. In addition, you may begin to sweat. When the sweat evaporates, it helps to cool your skin. When you get too cold, the blood vessels contract to reduce the blood flow to your skin and conserve body heat. You also may begin to shiver, which is an involuntary, rapid contraction of the muscles. This generates heat. A normal temperature is usually considered 98.6 degrees Fahrenheit (F). However, this figure really is only an average of normal body temperatures. Healthy people can have a body temperature that varies from this average by as much as one degree either above or below. And, depending on a number of variables, such as a person’s activity level or the time of day, that temperature may vary even more.

High fevers between 103 and 106 F may cause hallucinations, confusion and convulsions. By contrast, a low-grade fever may actually be helping your body eliminate a virus.

Body temperature too low? An abnormally low body temperature is known as hypothermia and can be life-threatening. This can occur from exposure to cold, shock, alcohol and drug use, and metabolic disorders like diabetes or hypothyroidism. — Sources: WebMD and www.mayoclinic.com

Fevers The only time to become concerned about body temperature is when it gets to be either too high or too low. A body temperature that is too high (fever) is an indication that something is wrong in your body. It can be the result of a number of things such as: • Infection • Medications like antibiotics, narcotics and barbiturates • Severe trauma or injury • Other medical conditions like arthritis, hyperthyroidism and some cancers Because a fever can occur with a number of different conditions, it is important to look for other signs and symptoms that may be helpful in identifying the cause of the fever. Other symptoms may include: • Sweating • Shivering • Headache • Muscle aches • Lack of appetite • Dehydration • General weakness Blue & You Autumn 2004

WHEN TO SEEK MEDICAL ADVICE Infants: • Younger than 3 months with a rectal temperature of 100.5 F or more • Older than 3 months with a temperature of 102 F or higher • Newborn with temperature of less than 95 F • Has a fever and unexplained irritability or is lethargic and unresponsive. These may be signs of meningitis, an infection and inflammation of the membranes surrounding the brain and spinal chord. If you suspect meningitis, see your doctor immediately. Do not wait until the next morning. This is an emergency. Children: • A fever with listlessness or irritability • A fever with vomiting, severe headache or stomachache (Advice, continued on Page 13)

Off the cuff: all about blood

lood pressure is commonly known as “the silent killer” because the only way to know if it is high is to have it checked regularly. So in the words of Nike, just do it. Having your blood pressure checked is painless and simple. It is measured by a medical instrument called a sphygmomanometer. A rubber cuff is wrapped around your upper arm and inflated. This compresses a large artery in the arm, stopping the blood flow for just a moment. Next, the air in the cuff is released, and the person measuring the blood pressure listens with a stethoscope. When the blood begins to pulse through the artery again, it makes a sound. The sounds continue until the pressure in the artery is greater than the pressure in the cuff. The person listening will record two measurements: systolic and diastolic pressure. Systolic pressure is the pressure of the blood flow when the heart beats (when the first sound is heard). Diastolic pressure is the pressure between heartbeats (when the last sound is heard). Blood pressure is measured in millimeters of mercury, which is abbreviated mm Hg. A typical blood pressure for an adult might be 120/ 78 mm Hg, but readings vary depending on age and other factors. A range of values defines normal blood pressure, so don’t be alarmed if your own reading is either higher or lower. The important point to remember is that the harder it is for the blood to flow, the higher the numbers will be.

What is high blood pressure? High blood pressure, also known as hypertension, is elevated pressure of the blood in the arteries. High blood pressure results from two major factors, which can be present independently or together: 1. The heart pumps blood with excessive force. 2. The body’s smaller blood vessels narrow, so blood flow exerts more pressure against the vessels’ walls. Health dangers from high blood pressure may vary among different age groups and depending on whether the systolic or diastolic pressure (or both) is elevated. • High systolic pressure (the first number) appears to be a significant indicator for heart complications, including death, in all ages but especially in middle-

pressure

aged and older adults. In fact, elevated systolic pressure may present a significant danger for heart and stroke events. The wider the spread between systolic and diastolic measurements, the greater the danger. • High diastolic pressure (the second number) is a strong indicator of heart attack and stroke in young adults and people of all ages.

Blood pressure categories for adults Blood pressure may be divided into the following categories (systolic is the top number and diastolic is the bottom number): Normal Systolic: less than 120 Diastolic: less than 80

High blood pressure (Stage 1) Systolic:140-159 Diastolic: 90-99

Pre-hypertension Systolic:120-139 Diastolic: 80-89

High blood pressure (Stage 2) Systolic: above 160 Diastolic: above 100

What causes high blood pressure? Causes of high blood pressure include genetic factors; abnormalities in the angiotensin-reninaldosterone system (a group of hormones); inherited abnormalities in the sympathetic nervous system; insulin resistance and diabetes type 2; obesity; various medical conditions such as kidney disease and sleep apnea; certain medications such as corticosteroids and cold medicines; alcohol, coffee and smoking; and stress.

Who gets high blood pressure? Approximately 50 million Americans have high blood pressure. More than 30 percent of those with high blood pressure are unaware that their blood pressure is abnormal. More than half of those with high blood pressure are on medication, but only about one quarter of them have their blood pressure under control. Risk factors for high blood pressure include age, ethnicity, weight, family history and emotional factors. It is important to have your blood pressure checked regularly and to make appropriate lifestyle changes if necessary. If you have high blood pressure, consult your physician for treatment and recommendations. Blue & You Autumn 2004

Diabetes numbers you need to know O

ur bodies are made up of millions of tiny cells, which to stay healthy, need to be fed. The food the cells eat is called glucose (“GLOO-kose”), or sugar. When you eat a piece of fruit, for example, your body turns it into glucose and sends that glucose into your blood. The glucose travels through your blood to your cells, but the cells can’t eat the glucose all by themselves. They need help, which comes in the form of insulin. Insulin is a substance produced by beta cells in the pancreas (where diabetes actually begins). Insulin helps feed your cells. People with diabetes have a problem with insulin, so the cells don’t get the glucose they need to remain healthy. Knowing your blood glucose numbers is key to staying in control of your diabetes. Good control means getting as close to a normal (nondiabetic) blood glucose level as you safely can. There are two kinds of blood sugar checks. One is done at home or at work using a blood sugar meter. The other is done a few times a year at the lab with the A1C (A-one-C) check. Both checks help determine if you are in your target range. Blood sugar levels fluctuate all day, every day, and they vary from one person to the next. Your daily checks give you a personal snapshot of your blood sugar at that moment. So, how do you determine what target range is right for you? First let’s look at some “ideal” levels. You should aim for daily blood glucose levels between 90 and 130 mg/dl (milligrams per deciliter) before meals, and less than 180 two hours after starting a meal, Blue & You Autumn 2004

with a glycated hemoglobin level less than 7 percent. (The target number for glycated hemoglobin will vary depending on the type of test your doctor’s laboratory uses.) Also, your bedtime glucose levels should be between 100 and 140 mg/dL. The A1C test looks at your overall blood sugar levels for the past two to three months. It looks at the amount of glucose that has attached to the blood cells. As glucose levels rise, more glucose attaches to the blood cells. The A1C test result is shown as a percentage. The target range for A1C is 6.5 percent or less. Not only can high levels of fats in your blood stream lead to heart disease, heart attacks and strokes, fats also affect your diabetic health. Your doctor should check your blood fats (lipids) at least once a year. Your goals for lipids are: • LDL cholesterol (bad cholesterol) less than 100 mg/dL; • HDL cholesterol (good cholesterol) more than 60 mg/dL; and • Triglycerides less than 150 mg/dL. For diabetics, the optimum range for blood pressure is less than 130/80 mmHg. An important test for detecting kidney disease in its early stages is by measuring microalbumin (urine protein). Depending on which test your doctor uses, your goal numbers should be: • Less than 30 mg for a 24-hour urine sample; • Less than 20 µg/min on a timed urine sample; and • Less than 30 mg per gram of creatine on a random urine sample. Keep in mind, these numbers are the ideal levels. In reality, you should set your goals with your health-care team. While it may not always be possible, or practical, to maintain a normal level, every bit you lower your blood glucose level helps to prevent complications.

— Sources: National Institute of Diabetes and Digestive and Kidney Diseases, National Diabetes Information Clearinghouse, American Diabetes Association Guidelines, 2001, American College of Endocrinology Targets for Glycemic Control, 2001, www.cdc.gov/diabetes, www.jdrf.org and WebMD.com

Cholesterol goals tightened for those at highest risk for heart disease

he National Institutes of Health’s National Cholesterol Education Program (NCEP) recently recommended a new, lower cholesterol level for people who have a “very high risk” of heart attack. The old standard for LDL (bad cholesterol) was below 100 mg/dl (milligrams of cholesterol per deciliter of blood). The new target is below 70. For very high-risk patients whose LDL levels are already below 100, there also is an option to use drug therapy to reach the new goal of less than 70.

Why cholesterol matters Cholesterol is a waxy, fat-like substance occurring naturally in the body. You need cholesterol to produce hormones, vitamin D, cell membranes and bile acids. The liver makes cholesterol and links it to carrier proteins called lipoproteins, which let it dissolve in blood and be transported to all parts of the body. Excess cholesterol in the bloodstream is deposited in the arteries. As cholesterol builds up and hardens on the walls of your arteries, it restricts blood flow. This clogging of the arteries is sometimes called hardening of the arteries or atherosclerosis. Complete blockage will cause a heart attack.

How cholesterol is measured NCEP recommends that every five years anyone 20 or older should have a blood test (lipoprotein profile). Blood should be drawn after a 9- to 12-hour fast. This test will measure: • Total cholesterol • LDL (bad) cholesterol: These low-density lipoproteins cause buildup and blockage in the arteries. • HDL (good) cholesterol: These high-density lipoproteins help keep buildup from forming in the arteries. They carry cholesterol back to the liver, which processes it for elimination from the body • Triglycerides: These fats also are found in your blood. NCEP has issued the following cholesterol guidelines (using < for less than and > for greater than): LDL (Bad) Cholesterol <70 Optimal for very high-risk patients <100 Optimal for low- to high-risk patients 100-129 Near optimal/above optimal 130-159 Borderline high 160-189 High >190 Very high

Total Cholesterol <200 Desirable 200-239 Borderline high >240 High HDL (Good) Cholesterol >40 Acceptable >60 Protective against heart disease Triglycerides 150-200 Borderline high >200 High

How you can lower your risk If you find yourself at less-than-optimal levels, you need to reduce your risk of heart disease by changing your diet, controlling your weight and increasing physical activity. These actions are called therapeutic lifestyle changes (TLC). Your TLC diet should be low in saturated fat (found in whole milk, butter, cheese and ice cream; red meat; chocolate; coconuts, coconut milk and coconut oil) and trans fat (present in margarine, vegetable oil, many fast foods, many snack foods and commercial baked goods); and high in fiber. You should exercise at least 30 minutes at least three days a week. Walking is an easy way to start being more physically active. Always consult your doctor before beginning a diet or exercise program. Blue & You Autumn 2004

Another risk factor over which you have control is smoking. Quit if you smoke now, and don’t start if you don’t smoke. Smoking raises blood pressure and heart rate, lowers HDL (good) cholesterol, and increases the tendency for blood to clot. If you have high blood pressure, your risk of heart disease is greater. The steps you take to reduce cholesterol, such as following a low-fat diet, getting plenty of exercise and not smoking, also will help lower your blood pressure.

Risk factors beyond your control Some factors affecting your risk of heart disease and high cholesterol are beyond your control: • Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65) • Age (men 45 or older; women 55 or older) • Gender (women after menopause) By taking action to control the factors you can, such as diet and exercise, you may offset the influence of these factors over which you have no control.

How medications can help If you have a serious cholesterol problem, your physician may recommend cholesterol-lowering medications in combination with lifestyle changes. Statins, known by brand names such as Lipitor and Zocor, have proven effective in lowering LDL cholesterol levels. Standard doses of these drugs may lower LDL by 30 to 40 percent. However, like all medications, these drugs may cause serious side effects in some people, especially in higher doses. The American Heart Association recommends that people who are pregnant, have active or chronic liver disease, or who are allergic to statins shouldn’t use statin drugs. — Sources: “Live Healthier: Live Longer,” National Cholesterol Education Program of the National Heart, Lung and Blood Institute, National Institutes of Health (http://www.nhlbi.nih.gov/chd), “Cholesterol,” Medline Plus, U.S. National Library of Medicine and National Institutes of Health (http://www.nlm.nih.gov/ medlineplus/cholesterol.html), “Fats and Cholesterol,” Harvard School of Public Health (http:// www.hsph.harvard.edu/nutritionsource/fats.html), “Cholesterol-Lowering Drugs,” American Heart Association (http://www.americanheart.org/ presenter.jhtml?identifier=4510) Blue & You Autumn 2004

(Charting, continued from Page 8)

questions about the child’s diet, appetite, exercise habits, pattern of bowel movements and any social problems. The child is then examined for signs of disease and, possibly, puberty and/or tooth development. In addition, an X-ray of the left hand and wrist is sometimes taken so that the development of the bones may be examined. The so-called ‘bone age’ may be ahead or behind in relation to the child’s age. If there seems to be a problem, the doctor will probably recommend a consultation and further testing. In addition to physical exams, a pediatrician will conduct hearing, vision, blood pressure and other screening tests. As with many things in life, the journey of childhood is as important as reaching the destination of adulthood. Fortunately, there are professional maps and charts to help ensure your child is on the right growth course. — Source: Bright Futures, American Academy of Pediatrics, netdoctor.co.uk

(Advice, continued from Page 9)

Adults: • Your temperature is more than 104 F • Your temperature has been higher than 101 F for more than three days • You have a temperature of 100.5 F for three weeks or more, but no other symptoms • Your fever is accompanied by: • Severe headache • Severe swelling of your throat • Unusual skin rash • Unusual eye sensitivity to light • Significant stiff neck • Mental confusion • Persistent vomiting • Difficulty breathing • Abdominal pain or pain when urinating

Pumping to the

Your beating heart creates a pulse. As it beats and

forces blood through your body, you can feel a throbbing sensation (the pulse) by putting your fingers on one of your arteries at your wrist or neck. A pulse is commonly described in terms of its rate, which is the number of beats per minute (bpm). By counting your pulse rate, you can estimate how fast your heart is beating. Health professionals usually check your pulse rate measurement as a routine part of a physical examination or in an emergency.

Resting heart rate Age or fitness level

Beats per minute (bpm)

Babies to age 1

100–160

Children age 1 to 10

60–140

Children age 10+ and adults

60–100

How is your pulse rate measured?

Well-conditioned athletes

40–60

Your pulse rate usually is measured after you have rested for 10 minutes or more. This measurement is called a resting heart rate. You can measure your pulse rate anywhere an artery passes close to the skin, such as your wrist, neck, temple area, groin, behind the knee, or top of the foot. Most people use the wrist. Here’s how: • Place your index and middle finger over the underside of your opposite wrist, below the base of the thumb. • With the flat part of your fingers rather than the tips, press firmly but not so hard that you can’t feel the pulse. Do not use your thumb. • Count the number of beats for 30 seconds, then multiply that number by 2 to get the beats per minute.

Heart rate during exercise Many people take their pulse rate during or after exercise, to check their heart rate and to determine whether they are exercising at a healthy pace. Your heart rate (and pulse) during and after exercise will be higher than your resting heart rate. Your heart rate during peak exercise, and how quickly your heart rate increases as you exercise, can be used to estimate your level of fitness. During exercise, your heart should be working hard enough to obtain a healthy effect but not so hard that the heart is overworked. The recommended target heart rates during exercise are shown below. Most often, a person’s

Why is your pulse rate measured? Your pulse rate provides valuable insight concerning your overall health. It is used to: • Furnish clues about the function and health of the heart. In an emergency, the pulse rate can help determine whether the heart is pumping blood adequately. • Evaluate certain symptoms, such as an irregular or rapid heartbeat (palpitations), dizziness, fainting, chest pain or shortness of breath. • Assess circulation in an injured extremity or in an extremity with a blocked blood vessel. • Monitor medical conditions or the use of medications that slow your heart rate. • Check your general health and physical fitness.

Normal resting heart rate The heart beats about 60 to 80 times a minute when we’re at rest. It is best to measure your resting heart rate in the morning. Blue & You Autumn 2004

Understanding Urinalysis

beat

If you have ever had a baby, a work-up for a planned

target heart rate during exercise is 60 to 80 percent of their maximum heart rate. Age

Target HR Zone 50-75 percent

Average Maximum Heart Rate 100 percent

20 25 30 35 40 45 50 55 60 65 70

100-150 bpm 98-146 bpm 95-142 bpm 93-138 bpm 90-135 bpm 88-131 bpm 85-127 bpm 83-123 bpm 80-120 bpm 78-116 bpm 75-113 bpm

200 bpm 195 bpm 190 bpm 185 bpm 180 bpm 175 bpm 170 bpm 165 bpm 160 bpm 155 bpm 150 bpm

Your maximum heart rate is about 220 minus your age. The figures above are averages, so use them as general guidelines. You should contact a health professional if your pulse rate does not come down within a few minutes after you have stopped exercising. Note: A few high blood pressure medications lower the maximum heart rate and thus the target zone rate. If you’re taking such medicine, call your physician to find out if you need to use a lower target heart rate. There are several factors that affect normal heart rate, including age, activity level and time of day. For the most part, the lower your resting heart rate, the more efficient your heart is and the healthier your are. — Sources: www.americanheart.org, www.WebMD.com and www.kidshealth.org

surgery or an annual physical, you are probably familiar with the little plastic cup and what you are supposed to do with it. A urinalysis is a testing of the physical characteristics and composition of freshly voided urine. A urinalysis is used as a screening and/or diagnostic tool because it can detect different metabolic and kidney disorders as well as urinary tract infections. As a patient, you may be asked to relieve yourself of a small amount of urine (usually one or two ounces) in a sterile container for the health-care provider or assistant. Usually, tests can be conducted immediately in a laboratory. The chemical test is screening for: • Appearance and color (normal urine varies widely in color). • Bilirubin (bilirubin in urine is a sign of liver or bile duct disease). • Glucose (a sugar), protein and ketones (a by-product of fat metabolism and present in starvation and diabetes). There usually is no detectable glucose, protein or ketones in normal urine. • Nitrate and white blood cells (an indication of a urinary tract infection). • Urine pH (the acidity or alkalinity of the urine), • Urine specific gravity (how concentrated or diluted the urine is, which may indicate a kidney problem). During the microscopic examination, the urine will be tested for bacteria and other microorganisms, casts, crystals, fat, mucous, red blood cells, renal tubular cells, transitional epithelial cells and white blood cells (an indication of a urinary tract infection). A urine test causes no discomfort, and there are no risks involved. However, something as easy as a urine test may show additional medical problems, so it’s an important part of any physical exam. — Sources: National Institutes of Health, Lab Tests Online and CyberNurse

Blue & You Autumn 2004

HSA Blue PPO and HSA Blue PPO Plus products offer opportunity to take advantage of tax savings

Arkansas Blue Cross and Blue Shield introduced two new comprehensive, major medical health insurance plans in August — HSA Blue PPO and HSA Blue PPO PLUS — that will provide policyholders with the opportunity to take advantage of tax savings with a Health Savings Account (HSA). An HSA is a tax-exempt investment vehicle that works with a qualified, high-deductible health insurance plan to save policyholders money. With an HSA, policyholders can “self fund” out-of-pocket expenses such as deductibles, coinsurance and unreimbursed medical bills with tax-free money. Arkansas Blue Cross’ HSA Blue PPO and HSA Blue PPO PLUS meet all requirements for a qualified plan. “An HSA is like having an Individual Retirement Account (IRA), except the money placed in the savings account may be used for paying qualified medical expenses and you don’t have to wait until retirement to make withdrawals,” said Ron DeBerry, vice president of Statewide Business. “The insurance then covers against the risk of catastrophic medical bills. The new HSA Blue PPO and HSA Blue PPO PLUS plans are another way in which Arkansas Blue Cross is meeting the changing insurance needs of our customers.” Those eligible to open an HSA are people under age 65; not eligible for Medicare; not claimed as a dependent on someone else’s tax return; covered by a qualified, high-deductible health insurance plan; and not covered by another non-qualified health insurance plan. With an HSA, taxable income is reduced by the amount contributed to an HSA each year, up to the annual maximum allowed by law. Contribution maximums are based on individual or family coverage and the qualified insurance plan deductible. The government adjusts contribution maximums annually for cost-ofliving increases. Balances roll over year after year. Like an IRA, investment earnings on an HSA account accrue tax-free at a competitive rate. Tax-free withdrawals may be made for qualified medical expenses, including: • Health insurance deductible and coinsurance amounts; • Payments for the diagnosis, cure, mitigation, treat-

ment, or prevention of disease not reimbursed by a qualified health plan; • Dental and vision care; • Long-term care services and long-term care insurance; • Retiree health insurance premiums — including Medicare but not Medicare supplement (Medigap) premiums. (Medicare beneficiaries are ineligible to open an HSA. However, HSA contributions may be used to pay Medicare premiums in the future.) Individual and family health insurance coverage is available from Arkansas Blue Cross with HSA Blue PPO and HSA Blue PPO PLUS with a choice of deductibles that meet HSA laws for qualified plans — individual plan deductibles of $1,000, $2,600, and $5,000, and family plan deductibles of $2,000, $5,150, and $10,000. Covered services offered through HSA Blue PPO and HSA Blue PPO PLUS include: doctor visits, inpatient and outpatient procedures, hospitalization, optional maternity benefits, and $2 million of lifetime benefits per covered person. When choosing HSA Blue PPO PLUS with a $1,000 deductible ($2,000 family) or $2,600 deductible ($5,150 family), prescription medications are covered at 80 percent in-network once the annual deductible is satisfied. When choosing HSA Blue PPO PLUS with a $5,000 deductible ($10,000 family), prescription medications are covered at 100 percent in-network once the annual deductible is satisfied. Participating pharmacies must be used, or there is no coverage. There is no prescription drug coverage with HSA Blue PPO. Covered wellness care services — including physicals, routine gynecological exams and more — are paid at 100 percent in-network, up to $500 per year per person with no deductible to satisfy. The HSA Blue PPO and HSA Blue PPO PLUS plans access the Arkansas’ FirstSource network of 5,300 providers. No primary care physician is required for care direction, no referrals are needed and there are no claims to file when using in-network providers. Policyholders have the choice of receiving care outside the network, however it will cost them more. For more information about these new products, please call toll-free 1-800-392-2583. Blue & You Autumn 2004

Blue Solution PPO now available A

rkansas residents responsible for buying their own health insurance now have a new option available from Arkansas Blue Cross and Blue Shield. The Blue Solution PPO insurance plan is exclusively for Arkansans (individuals and families) under age 65 and not eligible for Medicare. Blue Solution PPO is a comprehensive, major medical insurance plan, utilizing the Arkansas’ FirstSource network (5,300 providers strong). Among the benefits available with Blue Solution PPO: • $30 copayment for routine in-network doctor visits • Prescription drug benefits • Children’s preventive care and immunizations • Rates among the lowest in Arkansas Applicants may choose from four deductibles ranging from $750 to $5,000 with lifetime benefits of $2 million. Wellness benefits include physicals, routine gynecological exams and more, up to $500 a year per person in benefits. Maternity benefits are available as an optional rider. Policyholders receive the maximum benefit coverage

by using in-network providers, but may use out-ofnetwork providers at a higher cost. “Blue Solution PPO is one of the most affordable insurance plans available in Arkansas for individuals and their families,” said Ron DeBerry, vice president for Statewide Business. “We’re always looking for ways to better meet the health insurance needs of our state’s residents, and we feel Blue Solution PPO helps do just that. We have found that PPO insurance plans, which give policyholders simplicity in use, access to quality care and more freedom of choice, are becoming increasingly popular.” For more information about this new product, please call toll-free 1-800-392-2583.

Take a multivitamin with folic acid before you get pregnant D

id you know that about 1,500 babies are born with birth defects each year in Arkansas? About half of all pregnancies in the United States are unplanned. Sometimes weeks go by before a woman realizes she is pregnant — yet this is a critical, dangerous time for the fetus. Birth defects can occur even before women know they are pregnant. If there is any chance you will become pregnant, you need a multivitamin with extra folic acid, a type of B vitamin. You need folic acid the most during the month before you become pregnant and through the early weeks of pregnancy. Folic acid supplements help prevent possible neural tube defects. These serious defects occur very early in a baby’s development, during the first four to five weeks after conception. During this period, the neural tube forms and closes to become the spinal cord, brain and bone surrounding these organs. When the neural tube does not close properly, a defect occurs. Spina bifida and anencephaly are two common forms of neural tube Blue & You Autumn 2004

by Jana Wiscaver, R.N., B.S.N.

defects. Spina bifida is a defect of the spinal cord sometimes called “open spine.” Anencephaly is a birth defect that results in babies being born with underdeveloped brains and incomplete skulls. Neural tube defects seem to result from a lack of folic acid. Any woman can have a baby with a neural tube defect. The following groups are at higher risk: • Women who have this type of defect themselves or have a close relative with one • Women who use valproic acid or carbamazepine to treat seizure disorders • Women who are of Hispanic ethnicity • Women who have diabetes • Women who have had previous pregnancies involving neural tube defects Fortunately, taking a daily supplement of folic acid before and during pregnancy can dramatically reduce the risk of birth defects from this cause. Research has shown that if all women received 400 micrograms of folic acid (Folic Acid, continued on Page 19)

How the coverage under your

To help you better understand what is and is not a covered benefit under your health insurance plan, Arkansas Blue Cross and Blue Shield recently has rewritten its benefit certificates for individuals insured through group policyholders. The easier-to-understand benefit certificates currently are being distributed to certificate holders when their group policy is renewed. You should review and become familiar with your new benefit certificate when you receive it because it is your guide to what is and is not covered. The philosophy and purpose behind Arkansas Blue Cross insurance plans is that the company wants its policyholders to have coverage for the vast majority of medical needs and emergencies, including most hospital and physician services, supplies and equipment. However, in order to keep the costs of health insurance plans within reasonable limits, Arkansas Blue Cross excludes or has limitations in coverage of a number of specific health “interventions” (defined as medical services, drugs, treatments, procedures, tests, equipment or supplies), which could make health insurance simply too expensive to afford. To meet the health-care needs of its customers, Arkansas Blue Cross now has established the “Primary Coverage Criteria” standard that all claims must meet to qualify for coverage under an Arkansas Blue Cross plan. The standard replaces the previous “medically necessary” standard, which many of our members found confusing. For any health intervention, there now are six general coverage criteria that must be met in order for that intervention to qualify for coverage under your plan: 1. The Primary Coverage Criteria must be met. 2. The health intervention must conform to specific limitations stated in your plan. 3. The health intervention must not be specifically excluded under the terms of your plan. 4. At the time of the intervention, you must meet the plan’s eligibility standards. 5. You must comply with the plan’s provider network and cost-sharing arrangements. 6. You must follow the plan’s procedures for filing claims. The following will give you a brief description of each of these qualifications.

Arkansas Blue Cross simplifies wording Primary Coverage Criteria The Primary Coverage Criteria: • apply to all benefits you may claim under your plan. • are designed to allow plan benefits for only those health interventions that are proven safe and effective. • provide benefits only for the less invasive or less risky intervention when such intervention would safely and effectively treat the medical condition; or they provide treatment in an outpatient, doctor’s office or home care setting when such treatment would be a safe and effective alternative to hospitalization. For interventions to be covered, the services must be recommended by a physician and meet the following requirements: 1. The intervention must be a health intervention intended to treat a medical condition. 2. The intervention must be proven to be effective. 3. The intervention must be the most appropriate supply or level of service, considering potential benefits and harm to the patient. 4. The intervention must be the most cost-effective option. Cost-effective means an intervention where the benefits and harm relative to the costs represent the efficient use of financial resources for the patient.

Specific Limitations Because of the high costs of some interventions or the difficulty in determining whether some interventions are really needed, Arkansas Blue Cross may include coverage for certain interventions, but the company must limit the extent of coverage (by limiting the number of provider visits or treatments, or by specifying a dollar limit for services or treatment received during a calendar year or other time period).

Specific Exclusions There are many possible reasons why Arkansas Blue Cross may have excluded particular conditions, healthcare providers, health interventions or services from your plan. Some exclusions are based on the availability of other coverage or financing for certain types of injuries. Other exclusions are based on the need to try to keep coverage affordable, covering basic health-care service needs but not covering all desired interventions. Other exclusions are based on the judgment of Arkansas Blue Cross that the need for certain interventions are questionable or the services have unproven benefits.

Blue & You Autumn 2004

insurance plan works for benefit certificates

Provider Network and Cost-Sharing Procedures

(Blue Online, continued from Page 24)

Health insurance plans do not provide coverage for health interventions unless the interventions are provided by a provider as defined by your health plan. Additionally, health insurance plans do not provide coverage for 100 percent of costs associated with covered health interventions. You are expected to pay an initial amount of covered allowable charges every year. This amount is called a deductible, and the amount of the deductible varies by plan.

plans also use a different pharmacy benefits administrator. Another new feature for BlueAdvantage members is an online accumulator tool that shows them how much they have met of their health plan deductible and calendar-year coinsurance maximum (out-of-pocket expense limit). Most Health Advantage members and some Arkansas Blue Cross members will see a new link on the My Blueprint “Welcome” page to HealthConnect Blue. This service gives members access to health and drug information and to personal Health Coaches. On all three sites, eligible members who are pregnant may enroll in Special Delivery, a prenatal health education program through My Blueprint. An online form makes it easy to enroll. BlueAdvantage members may enroll only if their employer includes this benefit in their health plan. My Blueprint and other online services will continue to grow to provide more service options for members. Watch the “What’s New” box on the home page of each site for updates.

Eligibility Standards You must be eligible for benefits under your plan at the time you receive health-care services.

Claim Filing Procedures Arkansas Blue Cross provides procedures that you and your provider must follow when submitting claims. Failure to follow these procedures could result in delays in claim processing, as well as potential denial of benefits.

Need more information? During the next 12 months, Arkansas Blue Cross and Health Advantage will be updating benefit certificates for group policyholders to reflect the Primary Coverage Criteria. For more information on the Primary Coverage Criteria (including definitions, the application and appeal of Primary Coverage Criteria, benefits and specific limitations in your plan), please visit the company’s Web site at www.ArkansasBlueCross.com in the “Members” section under Coverage Policy.

(Folic Acid, continued from Page 17)

every day before pregnancy, the occurrence of neural tube defects could be reduced by 50 to 70 percent. However, if you are in one of the high-risk groups listed on Page 17, ask your doctor if you should take a higher level of folic acid supplement. Trimethoprim, a component of a common antibiotic drug for the treatment of infections, is a folate antagonist. Women who are pregnant (or at risk of becoming pregnant), and who are taking this drug, may need to consult their physician about additional folic acid replacement while taking the antibiotic. Folic acid also may prevent birth defects of the heart, limbs and face. Blue & You Autumn 2004

Other important tips for planning a pregnancy: Eat a healthy diet, including foods high in folic acid, such as fortified grain products (including certain breakfast cereals), beans, leafy green vegetables and orange juice. See your doctor or health care provider for a pre-pregnancy checkup. Don’t smoke cigarettes, drink alcohol or use illegal drugs. Maintain a healthy weight. Get prenatal care as soon as you think you are pregnant. The March of Dimes provides much more information about planning a healthy pregnancy: www.marchofdimes.com. Jana Wiscaver, RN, BSN, is a health educator with the Arkansas Center for Birth Defects Research and Prevention, a program of the University of Arkansas for Medical Sciences (UAMS), Arkansas Children’s Hospital and the Arkansas Department of Health. The Blue & You Foundation for a Healthier Arkansas and the Arkansas Folic Acid Coalition support the center’s educational efforts.

HealthConnect Blue now available to public school employees

eginning Oct. 1, 2004, all public school employees covered by Arkansas Blue Cross and Blue Shield or Health Advantage will have access to HealthConnect Blue, a 24-hour health information resource. Beginning Jan. 1, 2005, all state employees covered by Arkansas Blue Cross or Health Advantage also will be able to take advantage of this service. Currently, all Health Advantage members* have access to HealthConnect Blue. HealthConnect Blue is a new, value-added telephone and Web-based information program. The confidential telephone line is staffed by Health Coaches (nurses, dietitians, and respiratory therapists) who are specially trained to provide tools and information that teach selfmanagement and decision-making skills, enabling you to

play a more active role in the management of your health. As a member of this program, you can: • Speak one-on-one with a Health Coach 24 hours a day, seven days a week. • Receive personalized follow-up calls with a Health Coach about a chronic condition or other health concerns. • Have educational materials mailed to your home, at no charge. • Visit the Health Advantage Web site (www.HealthAdvantage-hmo.com) to review a health encyclopedia containing in-depth health information on more than 1,900 clinical topics. * Includes all Health Advantage commercial HMO members statewide, BlueChoice PPO, Open Access PPO and Fort Smith Choice members.

Arkansas Blue Cross selects HealthCare Recoveries, Inc. to help recover subrogation claims A rkansas Blue Cross and Blue Shield has selected HealthCare Recoveries, Inc. (HRI) to help recover subrogation claims. HRI will provide specialized subrogation services for Arkansas Blue Cross and the Federal Employee Program. Arkansas Blue Cross’ affiliated companies, Health Advantage and BlueAdvantage Administrators of Arkansas, currently use HRI services. What is subrogation? Subrogation generally refers to the “substitution of one for another.” For Arkansas Blue Cross, it refers to those instances when another insurance carrier may be responsible for payment of medical care. For example, when an injury occurs because of an accident in which someone other than the plan member is at fault, the insurance carrier of that individual may be responsible for the plan member’s medical treatment. In those cases, the health plan may be entitled to recover the value of the services from the other carrier. This helps in reducing health-care costs. If you or a family member are injured in an accident,

you will receive a letter from HRI asking you to contact their customer service department to provide details about the injury. If the injury was caused by someone else, on another party’s property or in an automobile accident, HRI will contact the responsible party and request reimbursement to Arkansas Blue Cross for the cost of medical care provided because of the injury. A successful subrogation program helps the health plan keep the cost of health care reasonable for you and your employer.

Blue & You Autumn 2004

Women’s Health and Cancer Rights Act T

he Women’s Health and Cancer Rights Act of 1998 introduced changes in current insurance coverage for mastectomy. In accordance with the law, all group and individual health plans that provide medical and surgical benefits for mastectomy now cover reconstructive breast surgery, if elected by the covered individual following mastectomy, including: • Reconstructive surgery on the breast on which the mastectomy was performed. • Reconstructive surgery on the unaffected breast needed to “produce a symmetrical appearance.” • Prostheses and treatment of complications of any stage of a mastectomy, including lymphedema. The provisions of the Women’s Health and Cancer Rights Act of 1998 apply to all group health insurance

coverage effective on the first day of the plan year (which in most cases is the anniversary date of the group contract) after Oct. 21, 1998. The law went into effect on all individual insurance policies (BlueCare PPO and PPO Plus, Blue Select®, etc.) issued, renewed or in effect on or after Oct. 21, 1998. These provisions apply to all policies issued by Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas and are subject to the applicable copayments, coinsurance, benefit limitations, exclusions and benefit maximums. If you have questions about your insurance coverage, contact your group benefits administrator or a customer service representative at your local Arkansas Blue Cross office.

Health Advantage Customer Service is moving! T

he Health Advantage Customer Service division, currently located at 26 Corporate Hill Drive in Little Rock, is moving to the third floor of the USAble Corporate Center at 320 W. Capitol Avenue in downtown Little Rock. The Customer Service department will close at noon on Friday, Oct. 8, 2004, to complete the move. Normal hours of

operation will resume on Monday, Oct. 11, 2004. The Health Advantage Customer Service telephone number (1-800-843-1329) and mailing address (P.O. Box 8069) will remain the same. Health Advantage apologizes for any inconvenience this may cause and looks forward to continued service to our members from its new location.

Curves for Women offers discounts to members T

wo new Curves for Women facilities, located in Jacksonville and Searcy, recently have joined the Arkansas Blue Cross and Blue Shield discount wellness program. The Curves program allows participants to get an aerobic and strength training workout in just 30 minutes. The system is built around easy-to-learn hydraulic resistance machines, and the routine is set to lively music. It’s a fun atmosphere where women can get fit. Visit www.ArkansasBlueCross.com,

Blue & You Autumn 2004

www.HealthAdvantage-hmo.com, or www.BlueAdvantageArkansas.com for a complete listing of participating Curves facilities and other health and fitness companie offering discounts. Look for the Wellness Discounts link.

from the n e w s

s t o r i e s

HEALTH f r o m

Anti-fraud efforts result in huge savings Blue Cross and Blue Shield Plans’ combined anti-fraud efforts in 2003 yielded $240 million in savings and recoveries, an increase of more than 52 percent from the previous year. The Blue Cross and Blue Shield Association (BCBSA) released the system-wide figures at a recent forum in Washington, D.C., that showcased the Blues’ efforts to reduce fraud and its impact on the rising cost of health care. To bolster the Blues’ ongoing efforts to combat health-care fraud, the BCBSA system recently created the “BCBS Anti-Fraud Strike Force.” The group is composed of investigators from 10 Plans and is designated to enhance the coordination of anti-fraud activities within the Blue system.

New food labeling to help people with common food allergies Congress has approved a bill designed to help people with common food allergies and some food-related diseases identify dangerous ingredients on grocery labels. The bill requires food manufacturers to make labels that will identify allergens in easy-to-understand language. They will have to state on their products eight foods most likely to cause allergic reactions and autoimmune disorders such as celiac disease. Up to 11 million Americans suffer from food allergies, and approximately 100 people, most of them children, die each year from food-related reactions, according to the National Institute of Allergy and Infectious Diseases (NIAID.) Under the measure, beginning in 2006 food labels must plainly identify milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, and soy if they are present. The bill also requires listing of the ingredients even when they are used as flavorings, additives or spices. Manufacturers now are allowed to use the general term “natural flavors” for ingredients present in minute amounts. Supporters say everyday language is key to helping consumers avoid danger ous allergens since labels sometimes use scientific terms for certain ingredients.

files

a c r o s s

t h e

c o u n t r y

Research shows Americans feel depressed three days a month A new study shows American adults feel sad or depressed an average of three days a month. Researchers found people who were depressed more often than that were also more likely to engage in unhealthy behaviors, such as cigarette smoking and physical inactivity. The study also showed that women reported an average of one more day of feeling sad per month than men (3.5 days versus 2.4 days). But young adults aged 18-24 reported the highest number of days with depressive symptoms, and older adults over age 60 reported the fewest. In the study, researchers at the CDC analyzed how more than 166,000 American adults answered the question: “During the past 30 days, for about how many days have you felt sad, blue or depressed?” The information was gathered as a part of the annual U.S. Behavioral Risk Factor Surveillance System telephone surveys from 1995 to 2000 and the results appear in the current issue of Health and Quality of Life Outcomes.

Siblings are good for kids Sibling rivalry may make parents want to scream, but the lessons learned help young children forge easier friendships with their classmates. The findings come from a national study of more than 20,000 kindergarten students in which teachers rated students on their social and interpersonal skills, such as how they interacted with different people and how quickly their tempers flared. The study showed that kids who grow up with at least one brother or sister have an easier time making and keeping friends than do children without siblings. The study was published in the May 2004 issue of Journal of Marriage and Family.

Blue & You Autumn 2004

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. Good Health in pine bluff Members of the Arkansas Blue Cross Southeast Regional Office staff in Pine Bluff and BlueAnn Ewe recently attended “Good Health and More 2004” at the Civic Center in Fordyce, sponsored by the Dallas County Alliance Supporting Health (DASH). The community health fair included health providers in and around Fordyce. Booklets titled “Understanding Your Health Care Costs,” “Preserving Your Choices in Health Insurance,” and “Brand-Name or Generic Drugs?” and an “Important Questions to ask Your Doctor” pocket guide were distributed by the staff. In addition, parents could enroll their kids in the BlueAnn Health Club and take away a “Wild and Woolly Health Tips for Kids” coloring book. The attendance was greater than anticipated from folks who took advantage of cholesterol and blood sugar screenings, prostate and mammogram screenings, dental and vision exams, seat belt and car seat safety checks, and more. Everyone attending the event also enjoyed a nutritious meal donated by a local caterer. Adults visiting the Arkansas Blue Cross booth learned about the importance of asking questions of physicians about their care and treatment plans. It was a great day for learning about health and taking steps toward healthier lifestyles.

out with a white picket fence around the tent, ferns and a picnic complete with fried chicken. The team placed second in the Lip Sync contest with their rendition of Ray Stevens’ song “United We Stand” and in the “Hats off to Cancer” hat decorating contest with their picnic table topper. The team also participated in the box-decorating contest and walked away with the “Best Team Spirit” award. The event raised more than $81,000 for the cause with the company team contributing $2,000 to the total. The Relay for Life benefits the American Cancer Society’s education and assistance programs. Hot Springs Kid’s Fest From our South Central Regional Office in Hot Springs, our staff and BlueAnn participated in the annual Kid’s Fest, hosted by Heritage Physician Group/PEDS on June 12. More than 300 kids came by to enjoy healthy food and games and learn healthy facts. Kids could join the BlueAnn Health Club, and everyone received a “Wild and Woolly Health Tips for Kids” BlueAnn welcomes Kid’s Fest visitors. coloring book. Hot Springs Gymnastics provided entertainment with continuous performances, and KLAZ Radio’s Phil O’Brien broadcast live from the event with games and lots of prizes. It was great fun in the sun!

Red, White and Blue in jonesboro The Northeast Regional Office staff in Jonesboro teamed up and paraded proudly at the annual Relay for Life on June 11-12. The Arkansas Blue Cross crew dressed in red, white and blue, pitched a patriotic tent, and showed their stars and stripes for the 12-hour relay. The Independence Day Northeast Region team sings for the red, white and theme was carried blue at the recent Relay for Life. Blue & You Autumn 2004

www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com

embers of Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas have several ways to find answers to questions about their benefits online. “Frequently Asked Questions,” “E-mail Customer Service” and My Blueprint provide help in different ways.

Frequently Asked Questions (FAQ) All three company Web sites (www.ArkansasBlueCross.com, www.HealthAdvantagehmo.com and www.BlueAdvantageArkansas.com) contain a section of frequently asked questions. Look for the Find Help (FAQ) link at the bottom of each page and on the left navigation bar of each internal page of the Arkansas Blue Cross and Health Advantage sites. On the BlueAdvantage site, look for the link on the “Customer Service” page. Questions are grouped by topic on each site.

E-mail Customer Service If you don’t find your question in the FAQ list, you can send your own question to Customer Service by using the “E-mail Customer Service” link at the bottom of each page of the Web sites. You need to select whether you are a member, employer, provider or not a member. You then choose the appropriate plan (Arkansas Blue Cross, Health Advantage, Arkansas State Employee, Public School Employee, Federal Employee, BlueCard) and topic (benefits, bill, claim status, rate quote, other). The plan choices vary by site. After you select a plan and topic, you will see a simple form to fill out online. The requested information will help a customer service representative respond to your question more quickly. The e-mail form is secure. Information you enter is encrypted to protect your personal information. Providers who use the e-mail form will be able to inquire about more than one patient without filling out the entire form again. Only the additional patient’s information is required.

Self-Service through My Blueprint Members seeking claim status or history, eligibility information or a replacement ID card can log on to My Blueprint, our customer self-service center to accomplish the task Blue & You Autumn 2004

without the help of a customer service representative. Most members now have the capability to view their explanation of benefit (EOB) statements for completed medical claims. Medi-Pak members are not able to see their EOBs at this time. An EOB allows members to view details, such as date and type of service, total amount billed, amount paid, who was paid, member’s minimum financial responsibility, and amount of coinsurance or deductible applied to the member’s out-of-pocket maximum. To view an EOB for a claim, click on the word complete under status on the “Claims Summary” chart. Additional features vary by site. BlueAdvantage members can view a summary of their benefits, and Health Advantage members soon will have this capability. Health Advantage members can order a certificate of coverage through My Blueprint when they need proof of insurance.

New Features Several new features have been added to My Blueprint this year. For members with prescription drug coverage, pharmacy claims history and benefits information are available now through My Blueprint. Some BlueAdvantage members will not have this feature because some employer health plans do not use the pharmacy benefits administrator under contract to BlueAdvantage. Arkansas state and school employee (Blue Online, continued on Page 19)

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