2004 - Spring

~ benefits & claims questions? my blueline, P. 18 ~

Spring 2004

from the n e w s

s t o r i e s

HEALTH f r o m

Coming Soon: health savings accounts Consumer-directed health insurance — based on the idea that people will avoid unnecessary care if they’re required to pay for it themselves — has taken a big step forward. When President George W. Bush recently signed the high-profile bill adding a prescription drug benefit to Medicare last month, he also authorized the creation of health savings accounts (HSAs). HSAs are available to people under age 65 covered by high-deductible insurance policies. These accounts allow individuals to set aside up to $2,600 per year ($5,200 for families) in untaxed money that can be used to pay medical expenses. Any money that is not spent may

a c r o s s

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be carried forward indefinitely. (Arkansas Blue Cross and Blue Shield and BlueAdvantage Administrators of Arkansas will offer HSA plans later this year.)

Health care spending rises to record level Spending for health care services and products accounts for nearly 15 percent of the nation’s economy — a record level — according to the U.S. Department of Health and Human Services. Health care spending shot up 9.3 percent in 2002, the largest increase in 11 years, to a total of $1.55 trillion.

That represents an average of $5,440 for each person in the United States.

Coming May 3 for Health Advantage members*— Your 24-hour health information resource

H

ealthConnect 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 an automatic member of this program, you can: • Speak one-on-one with a Health Coach 24 hours a day, 7 days a week.

• 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.

Watch your Mail. Additional information will be mailed to Health Advantage member homes around May 3. Stay tuned … * Includes all Health Advantage commercial HMO members statewide, BlueChoice PPO, Open Access PPO and Fort Smith Choice members. Does not include state and school employees.

Members: Show your insurance ID card when receiving health care services I f you are an Arkansas Blue Cross and Blue Shield, Health Advantage, BlueAdvantage Administrators of Arkansas or Federal Employee Program member and you are receiving services for covered benefits, be sure to present your current health insurance ID card to the physician, health care professional, hospital or facility at the time of services.

If you do not present your ID card at the time of services, the provider may not file the claim or may incorrectly file the claim. If the claim is not filed within 180 days from the time of service, as required in your policy or summary plan description, it is no longer an eligible claim and payment for services becomes your responsibility.

Blue & You Spring 2004

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

Category

State/Public School Employees 378-2364 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)

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

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

378-3070

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 and Blue Shield Health Advantage BlueAdvantage Administrators Specialty Rx

1-800-421-1112

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

BasicBlue®, BlueCare PPO & PPO Plus (individual products) 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, health care professionals and other persons interested in health care and wellness.

Blue & You Spring 2004

INSIDE THIS ISSUE

~Spring 2004~

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From the Health files ................................... 2 It’s new! HealthConnect Blue ...................... 2 Member alert: show ID card ......................... 2 The human life-control center .................. 4-6 Myths about the brain .................................. 6 Exercise your brain ...................................... 7 Managing with cerebral palsy ..................... 8 Early signs of multiple sclerosis .................. 9 Understanding Alzheimer’s disease ...... 10-11 Encephalitis and meningitis ...................... 12 Facts on Parkinson’s disease .................... 13 Epilepsy: disrupting brain activity ............. 14 Myths about epilepsy ................................. 14 Stroke — what are your risks? .................. 15 Preventing traumatic brain injuries ........... 16 Health Advantage customer service Q&A .. 17 My BlueLine at your service ...................... 18 The pharmacist is in .................................. 19 New pharmacy vendor, new ID cards ......... 20 HEDIS survey reveals happy customers ...... 20 Blue & You and Web sites get high marks . 21 In Memory: Louis Ramsay .......................... 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

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Brain and spinal cord form T

he human central nervous system (CNS), consisting of the brain and spinal cord, distinguishes us from other life forms. It makes us human. This intricate network allows us to perceive, think, respond and create.

It enables us to talk, laugh, cry, love and hate.

To understand more about how your body works (and how things go wrong), you need to understand the biology of how your CNS works.

Neurons: Body messengers The basic component of the CNS is the neuron (nerve cell). The brain contains about 100 billion neurons. You are born with almost all the neurons you will ever have, but your brain does continue to grow after birth. At age 2, you have achieved about 80 percent of your total brain growth. Brain development, mostly in the form of new “connections,” continues past this initial growth period.

Neurons are similar in structure to other body cells. Because some parts of neurons are covered by an insulating sheath containing myelin, a fatty substance with a white appearance, they are sometimes referred to as “white matter.”

Unlike other cells, neurons have extensions (fibers) called axons and dendrites. These extensions come into play when neurons do something other cells don’t — they communicate with each other through electrochemical signals. All sensations, thoughts, movements, memories and feelings are the result of signals that pass through neurons.

Neurons rely on axons to send electrical signals and dendrites to receive them.

Many smaller branches, varying in length, originate from the main axon in each neuron.

These small branches end at nerve terminals, where chemical messengers called neurotransmitters are released from tiny containers called vesicles.

The gap between two neurons where the information transfer takes place is called a synapse. An axon of one cell sends signals across a synapse to a dendrite of another cell. The dendrites look like branches of a tree, reaching out to receive signals from axons. The electrical impulses transmitted from the axons may travel a distance of only a fraction of an inch to as far as three or more feet. This communication process is so precise that the chemical messengers (neurotransmitters) communicate only with the type of cell for which they have an exact fit, much as a key fits into a lock.

Brain: Command center The brain is a soft, spongy mass of tissue, which weighs about three pounds.

In addition to neurons, it contains support cells called glia. Glia provide neurons with nourishment, protection and structural support. The part of the skull that protects the brain is called the cranium. In addition to brain tissue, the cranium contains three thin, covering membranes called meninges and a cushioning, watery fluid called cere-brospinal fluid. This fluid flows through spaces within the brain called ventricles, where it is produced.

The three major functional parts of the brain are the cerebrum, cerebellum and brain stem.

1. Cerebrum (forebrain): The largest part of the brain, located at the top of the cranium, processes information from our senses to tell us what is going on and how to respond. It is the center for reading, thinking, learning, speech and emotions. A fissure or groove separates the cerebrum into two hemispheres, which are joined by the corpus callosum, where a thick Blue & You Spring 2004

human life-control center tract of nerve fibers allows the two halves to communicate with each other. The left hemisphere is dominant for language in most people. The right half helps us interpret visual and spatial information. The left hemisphere controls primarily the right side of the body, and MRI picture of the right hemisphere the human brain controls primarily the left side of the body.

The cerebral hemispheres are further divided into four lobes by sulci (grooves) and gyri (bumps), resulting in a folded look.

The four lobes that appear in each hemisphere and their functions are: Pons • Frontal: reasoning, planning, movement, emotions and problem-solving; • Parietal: perception of stimuli related to touch, pressure, temperature, taste, smell and pain; • Temporal: hearing, memory (hippocampus), speech and language; • Occipital: associated with vision. The occipital lobes process images from the eyes, linking those with images stored in memory.

2. Cerebellum: Located under the cerebrum at the back of the brain, the cerebellum controls balance and complex actions such as walking and talking.

3. Brain stem: Connecting the brain with the spinal cord, the brain stem controls hunger and thirst, breathing, body temperature, blood pressure and other basic body functions. The brain stem consists of the midbrain, pons and medulla oblongata. The midbrain is responsible primarily for eye movement. The pons relays messages between the higher regions of the brain and the cerebellum. The medulla oblongata controls involuntary functions, such as breathing, blood pressure and swallowing.

A layer of gray tissue about the thickness of a stack of two or three dimes coats the surface of the cerebrum and cerebellum. From the Latin word for bark, this layer is called the cortex and is often referred to as “gray matter.”

The folds of the brain increase the amount of gray matter

Spinal cord: Vital communication The spinal cord, an extension of the brain, coordinates movement and sensation. It contains neurons, supporting cells and long nerve fibers (axons) that run to and from the brain. Many of the axons are covered with insulating myelin. The center of the spinal cord, with a butterfly shape, houses the neurons, which along with their branch-like dendrites, make up the “gray matter.”

Like the brain, the spinal cord is surrounded by cerebrospinal fluid and covered with meninges.

The spinal cord has 31 segments. A pair of spinal nerves, which connect to specific parts of the body, exit from each segment. Higher segments control movement and sensation in upper parts of the body, and lower segments control lower parts of the body. The back bone (vertebral column) protects the segmented spinal cord, which is much shorter (Brain, continued on Page 6)

Blue & You Spring 2004

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that can fit into the protective skull. If unfolded, the total surface area of the cerebral cortex would be about 324 square inches or about the size of a full-size newspaper page.

Deep within the brain are other small Cerebral Cortex (Cerebrum) but important structures that come in pairs, with one on each side of the brain. The hypothalaMidbrain mus, about the size of a pearl, sends messages Cerebellum to the pituitary gland, which controls hormonal functions. The Medulla hypothalamus also receives information from the autonomic nervous system. Behavior related to eating, sex, sleeping and emotions are affected by the hypothalamus. It also regulates body temperature.

The thalamus serves as a relay station for information going to and coming from the cerebral cortex.

Pain sensation, attention and alertness are affected by the thalamus.

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(Brain, continued from Page 5)

than the back bone itself.

The spinal cord functions as the main pathway for information connecting the brain and peripheral nervous system. The peripheral nervous system sends messages to skeletal muscles, internal organs, glands and the gastrointestinal tract. All the messages going from the brain to the limbs travel through the spinal cord. Bladder functions, sensory functions and movement all are dependent on information traveling up and down the spinal cord.

Neuroscience: Understanding this complex system The study of the nervous system is called neuroscience. Because of the accelerating pace of research and development of new techniques in recent years, neuroscientists have learned more about the brain in the past 10 years than in all previous centuries.

Understanding the nervous system is critical because about 50 million people in the United States alone suffer from some form of damage to the nervous system. The more we know about the brain and spinal cord, the more we can help people who endure often devastating physical and mental illnesses and disability related to the nervous system. A healthy nervous system enables the miracle of life.

— Sources: “Anatomy of the Brain,” Health Resources: Neurosurgery://On-Call®, American Association of Neurological Surgeons and Congress of Neurological Surgeons; “Anatomy of the Spine,” Health Resources: Neurosurgery:/ /On-Call®, American Association of Neurological Surgeons and Congress of Neurological Surgeons; “Brain Basics: Know Your Brain,” National Institute of Neurological Disorders and Stroke; “Brain Facts, A Primer on the Brain and Nervous System,” Society for Neuroscience; “Neuroscience for Kids,” University of Washington, Seattle, Eric Chudler, Ph.D.; “Spinal Cord Injury: Emerging Concepts,” National Institute of Neurological Disorders and Stroke; and “What You Need to Know AboutTM Brain Tumors,” Cancer.gov, National Cancer Institute

Myths about the brain MYTH: Most people only use 10 percent of their brain.

FACT: There is no evidence to suggest that people only use 10 percent of their brain. That is false; a myth.

People use all of their brain.

MYTH: Men have bigger brains than women, and that means they are smarter.

FACT: Although men may have bigger brains, it is because they are usually bigger in overall body size, giving them larger skulls. It doesn’t make them smarter.

MYTH: Women are better in certain language abilities and men are better in certain spatial abilities.

FACT: Research has found very few meaningful differences within the brains of men and women.

MYTH: Adults cannot learn certain skills after childhood.

FACT: There are certain prime times in development when learning is easier. Learning may be more difficult when the prime times have passed, but it can still happen.

MYTH: Children need special help and expensive toys to develop their brain power.

FACT: What children need most are loving care and new experiences.

MYTH: Everyone’s memory fades as they get older.

FACT: Studies show that memory loss is not a normal part of aging. Keeping your mind active is the key ingredient to maintaining brain function.

MYTH: Dietary supplements such as gingko biloba and vitamins can improve memory.

FACT: Although gingko has been shown to increase blood circulation, which in turn has been shown to aid brain function, the exact role of using gingko beyond some placebo effects is not known.

MYTH: Television stunts the growth of the brain. It zaps a child’s brain waves.

FACT: Brainwave patterns during television viewing are similar to brain activity during other activities.

— Sources: National Institutes of Health, www.executiveparent.com, http://faculty.washington.edu/ chudler/neurok.html — Neuroscience for Kids, and The Smart Parent’s Guide to Kids TV by Milton Chen, Ph.D. Blue & You Spring 2004

The intellectual equivalent of the “97-pound weakling” I n a classic Charles Atlas advertisement, featured in countless comic books and magazines, a beach bully kicks sand in the face of a “97-pound weakling” named Mac and yells, “Hey, skinny” in front of his girlfriend.

Mac orders Charles Atlas’ workout program through the mail, bulks up, and returns to the beach for a little payback. Being publicly humiliated on the beach, according to the ad, was the “insult that made a man out of Mac.” And, of course, his girlfriend swooned.

It may not be the case that members of the science club have ridiculed you for not being able to articulate Einstein’s theory of relativity. You may have never had English Lit majors kick manuscripts of Shakespeare in your face. But you may have been asked a question and found the answer right on the “tip of your tongue.”

Perhaps you’ve wasted time searching for a misplaced item that you know you had right in your hand only moments ago. You probably are not the intellectual equivalent of the “97-pound weakling,” but perhaps you would benefit from a little cerebral “beefing-up.”

While it has long been known that physical activity and exercise will strengthen muscles, it is only with more recent studies that the same can be said of the brain.

While it is not a muscle, the brain can benefit greatly from increased use. In the same way aerobic exercise will strengthen a person’s heart and lungs, “neurobic” exercise (using one’s brain in challenging new ways) will strengthen the branches of nerve cells responsible for receiving and processing information. Unfortunately, the converse also is true.

According to a report in the New England Journal of Medicine, if you do not use your mind regularly through activities like reading, playing cards, doing puzzles, playing musical instruments and the like, you risk losing some of your cognitive abilities as you get older. The old adage “use it or lose it,” long attributed to your muscles, now is applicable to your mind as well.

Studies have shown that middle-age people who regularly used their brains in games of logic and reasoning maintained better short-term memory, math skills and verbal skills than those who did not. These Blue & You Spring 2004

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types of activities keep the connections in the brain strong.

Research has shown that the reason many people have an answer right on the “tip of their tongue” is not because the information is missing in their brain. It is stored there just fine. The reason is the connections between brain cells that create the path to get that information are weak. The path is not one well traveled.

Working out our brains can keep those connections strong and those paths fresh.

A variety of activities can be considered “neurobic” in nature, and performing just a few of these on a daily basis can keep your mind sharp.

Researchers recommend playing board games, reading, doing crossword puzzles and writing for pleasure as ways of pumping up the old gray matter. For a more vigorous workout, try learning a new language or writing with the wrong hand.

In order to be considered “neurobic,” an exercise should contain one or more of the following aspects: 1. Involve one or more of your senses in a manner out of the ordinary for you.

2. The activity should engage your attention.

3. The activity should break your normal routine in an unexpected way.

A lifestyle that includes “neurobic” exercise will provide you with a sharper mind and the ability to focus better. It also can reduce the risk of Alzheimer’s and dementia later in life. It probably won’t help you look like the people in the Charles Atlas ad, but a steady regimen of neurobics can help you stay mentally “buff.”

— Sources: Popular Science Magazine, National Institute on Aging, http:// www.meridianhealth.com, American Psychological Association, http:// www.neurobics.com

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Near-normal

lives enjoyed by those with cerebral palsy

lthough cerebral palsy cannot be cured, those with the chronic disorder can enjoy near-normal lives if their neurological problems are properly managed.

Cerebral palsy is an “umbrella” term used to describe a group of chronic disorders that impact the brain’s control of body movement. The disorder usually appears early in life and does not worsen with time. The disorders are caused by a problem in the development of (or by damage to) the motor areas of the brain. These problems or damage disrupt the brain’s ability to control posture and movement. Symptoms include difficulty with fine motor skills (such as writing or using scissors), and difficulty walking and maintaining balance. These disorders also may cause involuntary body movements. Some people with cerebral palsy also may have other medical complications such as seizures or mental impairment.

However, having cerebral palsy doesn’t mean a person cannot have a normal life; it isn’t always a profound handicap.

Early signs of the disorder usually appear before 3 years of age. Babies with cerebral palsy may develop more slowly than others their age; they are frequently slow to reach development milestones such as learning to roll over, sit up, crawl, smile or walk. Cerebral palsy may be congenital or acquired after birth.

Several of the causes of cerebral palsy (identified through research) are preventable and/or treatable: head injury, jaundice, Rh incompatibility and German measles (rubella).

Doctors can diagnose cerebral palsy by testing motor skills and reflexes, reviewing the patient’s medical history and employing a

variety of specialized tests. And, although the symptoms of cerebral palsy may change over time, the disease is not progressive. If a patient shows increasing problems or impairments, the problem may be something other than cerebral palsy.

Treatment options There is no standard treatment for everyone with cerebral palsy. Drugs may be used to control seizures and muscle spasms, and special braces may be worn to help patients control muscle imbalance. Other helpful therapies may include surgery, mechanical aids to help overcome impairments, and speech, physical and occupational therapy. There is no cure for cerebral palsy at this time.

Research Research suggests that one of the causes of cerebral palsy is the result of incorrect cell development early in pregnancy. Researchers also are studying how other events, such as bleeding in the brain, seizures, breathing and circulation problems, and lowbirth weight affect the brain of a newborn baby.

Although a diagnosis of cerebral palsy in their young child may be startling or upsetting for parents, parents can learn to cope with the situation. A 1997 study in North Carolina by researchers at Wake Forest University found that 90 percent of parents who have children with cerebral palsy reported that learning to manage their child’s disabilities increased their own self esteem, and it brought the family closer together.

— Sources: United Cerebral Palsy (UCP National) and National Institutes of Health

Blue & You Spring 2004

C

urrently in the United States, there are 350,000 to 500,00 people who have been diagnosed with multiple sclerosis (MS). It is more common in men than women and appears more frequently in whites than minority groups. Approximately 90 percent of MS patients are diagnosed between the ages of 16 and 60, but it can be diagnosed in early childhood or after age 60.

Although a diagnosis of MS may sound foreboding, there are treatment options with early diagnosis, and most patients live full lives after a diagnosis. The vast majority of MS patients are mildly affected, but in the worst cases, MS can cause a person to be unable to write, speak or walk.

Symptoms The most common symptoms of MS include fatigue, weakness, spasticity, balance problems, bladder and bowel problems, numbness, vision loss, tremors and vertigo. MS patients may not experience all symptoms,

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discussions between the physician and the patient, and after a careful medical history has been taken. Symptoms and signs are reviewed and other illnesses must be ruled out. Sometimes the diagnosis is obvious, and sometimes it may be more difficult. The physician must be able to find neurological evidence of lesions or plaques in the central nervous system. For some patients, no tests beyond medical history and neurologic exam are necessary to diagnose.

Causes of MS A specific cause of MS has not been determined, but several theories are now considered plausible. Some studies suggest that viruses, environmental factors or genetic factors (such as susceptibility to autoimmune diseases) may play a role in the development of MS.

MS Treatments The earlier a person receives treatment for MS the better. Early treatment seems to delay disability by

Fatigue, weakness, vision loss: Early signs of MS and symptoms may be constant or may cease occasionally. Although there is no cure for MS, most people with MS have a normal life expectancy and are gainfully employed. MS is not contagious or fatal.

What is MS? MS is a chronic disease usually diagnosed in young adults. During an MS attack, inflammation occurs in areas of the white matter of the central nervous system (nerve fibers that are at the site of MS lesions) in random patches called plaques. This process is followed by destruction of myelin, which insulates nerve cell fibers in the brain and the spinal cord. Myelin assists in the smooth, high-speed transmission of electrochemical messages between the brain, spinal cord and the rest of the body. The destruction of myelin disrupts nerve communication. As a result, a person with MS experiences varying degrees of neurological impairment.

MS is an “autoimmune” disease, in which, for unknown reasons, the body’s immune system begins to attack normal body tissue.

Diagnosis of MS The diagnosis of MS usually emerges after Blue & You Spring 2004

decreasing the injuries to the nervous system. Treatment options usually include prescription medications and alternative healing remedies. It is up to the patient and the physician to create the appropriate treatment. Also, remember that a well-balanced diet is vital to treatment plans to reduce complications from MS.

Research Scientists are looking into the body’s own immune system, infectious agents and genetics as possible culprits behind MS. Studies have shown that MS has no adverse effects on the course of pregnancy, labor or delivery.

As with all disorders and diseases, an early diagnosis is beneficial. Regular check-ups and open communication with their physicians are important for all patients, including those with a diagnosis of MS. — Sources: Multiple Sclerosis Foundation and The National Institute of Neurological Disorders and Stroke

10 UNDERSTANDING I

n a normal day, any of us can forget another person’s name, where we left our wallet, the item we went into the other room to get, the right word to say or even how to do a simple math problem. For most of us, it’s a temporary condition. But for an estimated 4.5 million Americans with Alzheimer’s disease (pronounced AHLZ-hi-merz), it is a way of life that becomes progressively worse.

Alzheimer’s disease is one of several disorders that cause the gradual loss of brain cells. German physician Dr. Alois Alzheimer first described the disease in 1906.

Once considered rare, research has shown that Alzheimer’s disease now is the leading cause of dementia.

Dementia is an umbrella term for several symptoms related to a decline in thinking skills, according to the Alzheimer’s Association. Common symptoms include a gradual loss of memory, problems with reasoning or judgment, disorientation, difficulty in learning, loss of language skills, and decline in the ability to perform routine tasks.

People with dementia also experience changes in their personalities and behavioral problems, such as agitation, anxiety, delusions (believing in a reality that does not exist), and hallucinations (seeing things that do not exist).

Several disorders that are similar to Alzheimer’s disease can cause dementia. These include frontotemporal dementia, dementia with Lewy bodies, Parkinson’s disease, Creutzfeldt-Jakob disease and Huntington’s disease. All of these disorders involve disease processes that destroy brain cells. Vascular dementia is a disorder caused by the disruption of blood flow to the brain. This may be the result of a massive stroke or several tiny strokes.

Some treatable conditions — such as depression, drug interactions and thyroid problems — can cause dementia, but the effects can be reversed.

Progression of Alzheimer’s disease As with many diseases, Alzheimer’s disease advances at different rates with different people. The areas of the brain that control memory and thinking skills are affected first, but as the disease progresses, cells die in other regions of the brain. Eventually, the person with Alzheimer’s will require complete care. If the individual has no other serious illness, the loss of brain function itself will cause death.

Causes and Risk Factors Most researchers agree that the cause of Alzheimer’s disease may be a complex set of factors, but no one knows exactly what causes it.

There are two abnormal structures in the brain associated with Alzheimer’s disease — amyloid plaques (clumps of protein fragments that accumulate outside of cells), and neurofibrillary tangles (clumps of altered proteins inside cells). Scientists have not determined exactly what role plaques and tangles play in the disease process and whether they are key factors, but they may provide clues about why cells die.

The greatest known risk for developing Alzheimer’s is increasing age. As many as 10 percent of all people 65 years of age and older have Alzheimer’s. As many as 50 percent of all people 85 and older have the disease.

Family history of the disease is another known risk. In addition, scientists have identified three genes that cause rare, inherited forms of the disease that tend to occur before age 65, and have identified one gene that raises the risk of the more common form of Alzheimer’s that affects older people.

Much dementia research has focused on vascular risk factors, which are factors related to the blood circulation system. A great deal of evidence shows that disorders such as high cholesterol and high blood pressure — factors that cause strokes and heart disease — also may increase the risk for developing Alzheimer’s.

Blue & You Spring 2004

11 ALZHEIMER’S DISEASE Ten Warning Signs Some change in memory is normal as we grow older, but the symptoms of Alzheimer’s disease are more than simple lapses in memory. People with Alzheimer’s experience difficulties communicating, learning, thinking and reasoning — problems severe enough to have an impact on an individual’s work, social activities and family life. The Alzheimer’s Association has developed a checklist of common symptoms: 1. Memory loss.

2. Difficulty performing familiar tasks.

3. Problems with language.

4. Disorientation to time and place.

5. Poor or decreased judgment.

6. Problems with abstract thinking.

7. Misplacing things.

8. Changes in mood or behavior.

9. Changes in personality.

10. Loss of initiative.

Early diagnosis of Alzheimer’s disease or other disorders causing dementia is an important step in getting appropriate treatment, care and support services.

Should you recognize any of the signs in yourself or a loved one, please consult a physician.

Stages of Alzheimer’s Disease Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer’s disease and have developed a Global Deterioration Scale to use as a framework for determining the progression of Alzheimer’s disease. Staging systems provide useful frames of reference for understanding how the disease may unfold and for making future plans, but it is important to note that these are artificial benchmarks in a process that varies from one person to another.

Stage 1 — No cognitive impairment Stage 2 — Very mild cognitive decline

Blue & You Spring 2004

Stage 3 — Mild cognitive decline (Early-stage Alzheimer’s disease can be diagnosed in some but not all people) Stage 4 — Moderate cognitive decline (Mild or early-stage Alzheimer’s disease) Stage 5 — Moderately severe cognitive decline (Moderate or mid-stage Alzheimer’s disease) Stage 6 — Severe cognitive decline (Moderately severe or mid-stage Alzheimer’s disease) Stage 7 — Very severe cognitive decline (Severe or late-stage Alzheimer’s disease) Not everyone will experience every symptom and symptoms may occur at different times in different individuals. Progression of symptoms generally corresponds to the underlying nerve cell degeneration that occurs in Alzheimer’s disease. Nerve cell damage usually begins with cells involved in learning and memory, and gradually spreads to cells that control every aspect of thinking, judgment and behavior. The damage eventually affects cells that control and coordinate movement.

People with Alzheimer’s live an average of 8 years after diagnosis but may survive from 3 to 20 years.

There is no cure for Alzheimer’s disease; however, there are several drug treatments that may improve or stabilize symptoms and several care strategies and activities that may minimize or prevent behavioral problems.

The Alzheimer’s Association believes that it is essential for people with dementia and their families to receive information, care and support as early as possible. For more information about Alzheimer’s disease and support for families, visit its Web site at www.alz.org.

— Sources: Alzheimer’s Association; www.alz.org; Alzheimer’s Disease Education and Referral Center (a service of the National Institute on Aging)

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Potentially deadly diseases attack the brain and spinal cord

E

ncephalitis and meningitis are inflammatory diseases of the brain and the membranes that surround the brain and are caused by bacterial or viral infections.

While very similar in symptoms and causes, encephalitis and meningitis are two different diseases.

Encephalitis, which means literally “inflammation of the brain,� is severe and potentially life threatening. It is categorized in two ways, according to how infection reaches the brain.

1. Primary encephalitis is when a virus directly invades the brain and spinal cord.

2. Secondary encephalitis is when a virus first attacks another part of the body and then enters the brain.

The primary form of the disease is more serious, but the secondary version is more common. Some instances where encephalitis may occur as a secondary infection include occurrences after childhood diseases like measles, mumps and rubella. A much more common cause of encephalitis results from viruses transmitted by mosquitoes and ticks.

In the United States, there are five primary forms of this type of encephalitis: 1. Eastern equine encephalitis 2. Western equine encephalitis 3. St. Louis encephalitis 4. La Crosse encephalitis 5. West Nile encephalitis Most people infected with viral encephalitis have only mild symptoms; however, more serious cases can include drowsiness, confusion, seizures, sudden fever, severe headache, nausea, vomiting, convulsions, stiff neck and a bulging in the soft spot of the skull in infants.

The disease also is more likely to strike young children or older adults. It typically will be worse in people with weakened immune systems as a result of other health problems.

Experts encourage everyone to seek professional medical help immediately if symptoms of the more severe condition develop.

Meningitis, while similar to encephalitis, is actually an inflammation of the membranes (meninges) and fluid (cerebrospinal fluid) surrounding the brain and spinal cord. In the United States, approximately 300 people die of meningococcal meningitis. Most of these cases occur in children under the age of 5.

Meningitis is most often caused by a bacteria or virus. The bacterial form of the disease is typically much worse than the viral form. It usually develops as a result of an infection in some other part of the body that traveled to the brain through the bloodstream. But bacteria also can spread directly to the brain as a result of a severe head injury or from an infection in the nose, ears or teeth.

The symptoms of meningitis are similar to those of the flu and can be mistaken for the flu. But meningitis can be fatal within a matter of hours, so paying close attention to symptoms is vital. Symptoms of meningitis include a high fever that prevents you from eating or drinking, severe headache, vomiting, confusion, seizures, drowsiness, stiff neck, a skin rash (especially near the armpits or on hands and feet), rapid progression of small hemorrhages under the skin and a sensitivity to light.

As the disease progresses, the brain swells and may begin to bleed. The disease is fatal in about 10 percent of cases. In many other cases it can cause serious long-term complications like deafness, blindness and loss of speech.

While the disease is most common in children under the age of 5, it is becoming increasingly common in young people between the ages of 18 and 24. College students living in dormitories, personnel on military bases and children in daycare centers are at an increased risk of infection.

Treatments for encephalitis and meningitis include the prescribing of antibiotics for bacterial infections and corticosteroids for swelling and inflammation. Over-thecounter drugs are often used for pain and fever. People with encephalitis or bacterial meningitis are often hospitalized for treatment. — Sources: National Institute of Neurological Disorders and Stroke, http://www.mayoclinic.com, http:// www.neurologychannel.com and National Meningitis Association Blue & You Spring 2004

Get the facts on

Parkinson’s Disease P

arkinson’s disease is a chronic neurological condition. It is a progressive disease that affects a small area of cells in the midbrain known as the substantia nigra, where dopamine is produced. Dopamine is a chemical messenger, or neurotransmitter, that the brain uses to help direct and control movement. This decrease in dopamine can produce one or more of the classic signs of Parkinson’s disease including resting tremor on one side of the body, slowness of movement, stiffness of limbs and gait or balance problems.

Although the involuntary shaking that is often seen in patients who develop resting tremors is upsetting (because it is visible to others), this symptom rarely leads to serious disability. And, in fact, 25 percent of Parkinson’s patients do not develop tremors.

Other symptoms of Parkinson’s, which vary greatly from person to person, may include: • Small cramped handwriting.

• Lack of arm swing on the affected side.

• Decreased facial expression.

• Lowered voice volume.

• Feelings of depression or anxiety.

• Episodes of feeling “stuck in place” when initiating a step ... called “freezing.”

• Slight foot drag on the affected side.

• Increase in dandruff or oily skin.

• Less frequent blinking and swallowing.

It is estimated that up to 1.5 million Americans (one in every 100 people age 65 and older) are affected by Parkinson’s. However, the cause of this condition still is a mystery. Most people who develop symptoms of primary Parkinson’s have “idiopathic” Parkinson’s disease (idiopathic meaning that the exact cause is unknown).

Some people who have Parkinson’s may attempt to link the onset of their symptoms with some acute trauma, such as an accident, surgery or extreme emotional distress. But most neurologists discount any direct link; a traumatic event might trigger symptoms before they would otherwise manifest; however, this should not Blue & You Spring 2004

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be confused with actually causing Parkinson’s. After all, not everyone who experiences these traumatic events develops a movement disorder such as Parkinson’s.

While there is, as yet, no cure for this condition, progressive treatments, including medication, diet and exercise allow many patients to maintain a high level of function throughout their lifetimes. It is vital to note that Parkinson’s disease is not a fatal illness.

If you are a patient with Parkinson’s, some other suggestions to help manage and control the disease include: 1. Consciously lift your feet to avoid shuffling and falling due to the slight foot drag common to Parkinson’s.

2. Avoid prolonged standing with your feet too close together because this increases the risk for falls.

3. Avoid the instinctive “pivot” maneuver; instead, practice reversing your direction by using a forward-facing wide U-turn pattern.

4. Is balance a problem for you?

Learn to use a single point cane with a large rubber tip. It takes practice to use a cane with ease, but be persistent; once mastered, the classic “walking stick” is portable, affordable and invaluable.

5. If your feet feel frozen or “glued to the floor” when initiating movement, practice these physical strategies to help break the pattern: Step over an actual or imaginary obstacle that is in your way to continue forward motion, and rock from side to side to help break the sense of being “stuck in place.” Understand that it is not helpful for your companion to pull you forward or urge you to “hurry up” because this will often prolong the freezing episode.

6. Never carry objects in both hands while walking because this affects your ability to maintain your balance.

— Sources: The National Parkinson Foundation, Inc., Parkinsonscare.com and WebMD.com

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Epilepsy:

a disruption of normal brain activity

Epilepsy is a neurological condition in which

groups of brain cells, called neurons, sometimes signal abnormally. In epilepsy, also known as seizure disorder, the normal pattern of neurological activity is disrupted by a sudden surge of electrical activity resulting in strange sensations, emotions, behavior and sometimes in seizures.

Seizures are not a disease, but rather a symptom of some other disorder. They can take a number of forms but typically include the stiffening and jerking of the arms and legs, slurred speech, facial distortions, falling, rapid blinking and even loss of consciousness.

Having a seizure does not necessarily indicate the presence of epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. In most cases, the cause for the development of the condition is completely unknown.

However, there are certain factors that can make a person more at risk for having epilepsy. Some of these include brain tumors, abnormal collections of blood vessels in the brain, bleeding in the brain or lack of oxygen or blood flow to the brain. Other factors, like brain infections, cerebral palsy, Alzheimer’s disease, stroke resulting from blockage of arteries or veins, alcohol abuse or the use of illegal drugs, make it more likely a person will develop the condition.

A family history of epilepsy also can increase the risk that a person will develop the condition. This is particularly true if the types of seizures experienced originate in both sides of the brain at once rather than if the seizure begins in a limited portion of the brain.

Even so, heredity only slightly raises the risk of developing epilepsy.

Regardless of the cause, once a doctor has diagnosed epilepsy, it is important to begin treatment immediately.

For approximately 80 percent of people with epilepsy, the seizures can be effectively controlled with medicine or surgery. Two-thirds of those with the condition, when effectively treated, can stay free of seizures for up to five years. Many may never experience seizures again.

The longer a person goes without having a seizure the greater the chances that he or she will not have another one. Many children diagnosed with epilepsy will outgrow the condition when they reach adulthood.

Scientists continue to study the benefits of drugs for enhancing the treatment of epilepsy. Research continues on how neurotransmitters in the brain interact with brain cells. This is providing valuable insight into the prevention of seizures.

The bad news is that more than 1.5 million Americans have suffered from epilepsy in the past five years. The good news is that with ongoing research and the improvements in available treatments, most of them are leading outwardly normal lives.

Myths about epilepsy Hippocrates, the famous Greek doctor, recognized a long time ago that epilepsy is a brain disorder and wrote a book about it. His book, entitled “On the Sacred Disease,” refuted a number of myths about epilepsy, including the ideas that epilepsy was a curse from the gods or that people with the disorder were prophets. But myths have always abounded about epilepsy and continue even today. Here are some more common myths about epilepsy: • People with epilepsy are brain damaged. They are not.

• People with epilepsy are mentally handicapped.

They are not.

• People with epilepsy are violent or crazy. They are not.

• Seizures cause brain damage. They may be a result of brain damage but don’t usually cause it.

• Epilepsy is inherited. Having a family history of epilepsy may increase the risk of developing the condition but only slightly.

• Epilepsy is a life-long disorder. Most people with epilepsy require medication for only a small portion of their lives.

— Sources: National Institute of Neurological Disorders and Stroke, http://www.epilepsy.com Blue & You Spring 2004

Stroke — What are your risks?

S troke, or cerebrovascular disease, is the third leading cause of death and disability in the United States, behind diseases of the heart and cancer. Stroke strikes about 700,000 Americans each year, but the vast majority of people survive. It is estimated that someone in the United States has a stroke every 45 seconds.

A stroke occurs when a blood vessel (artery) that supplies blood to the brain bursts or is blocked by a blood clot. Within minutes, the nerve cells in that area of the brain become damaged and die. Because of this, the part of the body controlled by the damaged section of the brain cannot function properly. One type of stroke is ischemic stroke, and it is caused by a blocked or narrowed artery. Another, hemorrhagic stroke, occurs when an artery in the brain leaks or bursts and causes bleeding inside the brain tissue or near the surface of the brain.

The symptoms of a stroke begin suddenly and include numbness and weakness or paralysis of the face, arm or leg (especially on one side of the body). Other symptoms include: • Difficulty seeing in one or both eyes, for instance, dimness, blurring, double vision or loss of vision.

• Confusion, trouble speaking or understanding.

• Difficulty walking, dizziness, loss of balance or coordination.

• Severe headache with no known cause.

If you have symptoms of a stroke, seek emergency care, just as if you were having a heart attack. The sooner you seek medical care after symptoms are noticed, fewer brain cells are likely to be permanently damaged.

The major risk factors for stroke are tobacco use and uncontrolled hypertension. Preventing stroke and controlling its risk factors are fundamental to reducing health care costs and improving the quality of life among older Americans. The good news is that while there are some risk factors for stroke you cannot prevent, there are some that you can.

Those risk factors you cannot change include your age, race, gender, family history and any prior history of stroke or transient ischemic attack (TIA), often called mini-strokes.

The risk for stroke increases with age, and risk doubles every 10 years after age 55. At least 66 percent of all people who have a stroke are age 65 or older.

Blue & You Spring 2004

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African-Americans and Hispanics are at a higher risk for stroke than people of other races. In comparison to Caucasians, young African-Americans have twice to three times the risk of ischemic stroke, and African-American men and women are more likely to die from stroke.

• Gender is a risk factor that you cannot change. Stroke is more common in men than women until age 75, then more women than men have strokes. At all ages, more women than men die of stroke.

• The risk for stroke is greater if you have a family history (parent, brother or sister) of stroke or TIA. • Your risk for stroke also increases if you have a prior history of stroke or TIA, which is a temporary interruption of the blood flow to an area of the brain. The symptoms are like those of a stroke, however, unlike a stroke, a TIA does not cause lasting symptoms.

Symptoms usually go away after 10 to 20 minutes, but they can last up to 24 hours.

Controllable risk factors include high blood pressure, diabetes and high cholesterol.

Lifestyle choices are perhaps the most controllable of all stroke risk factors. Smoking and secondhand smoke increase your chances of having a stroke, as does lack of physical activity and obesity.

Certain diseases — lupus, peripheral vascular disease, syphilis, hemophilia, pneumonia and periodontal disease — increase the risk for stroke. By controlling the disease, you lower the risk.

If you experience symptoms of a stroke, do not take a “wait and see” approach. Emergency medical care is critical to prevent or treat any possible life-threatening complications. Immediate treatment may prevent extensive damage to the brain and decrease permanent disabilities from the stroke.

— Sources: http://www.cdc.gov/ cvh/fs-stroke.htm and WebMD.com

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HEAD STRONG: You can prevent traumatic brain injuries

Each year in the United States, approximately 1.5

million people sustain a traumatic brain injury — that’s eight times the number of people diagnosed with breast cancer each year and 34 times the number of new cases of HIV/AIDS. A traumatic brain injury — usually a jolt or blow to the head — can disrupt the normal function of the brain and can range from mild to severe. A mild injury may be a brief change in mental status or consciousness, while a severe injury may result in extended unconsciousness (30 minutes or more), prolonged amnesia or brain damage resulting in short- or long-term disabilities.

The physical, behavioral or mental changes that may result from head trauma depend on the areas of the brain that are damaged. Most traumatic brain injuries cause focal brain damage (damage to a small area of the brain).

The focal damage is usually at the point of impact — where the head hits an object or where an object enters the brain. In addition to focal brain damage, closed head injuries frequently cause diffuse brain damage, or damage to several areas of the brain. The diffuse damage occurs when the impact of the injury causes the brain to move back and forth against the skull. The frontal and temporal lobes of the brain and the major speech and language areas usually receive the most damage. Other problems that may occur with a head injury include difficulty swallowing and walking, as well as changes in the ability to smell and in the memory and cognitive (or thinking) skills.

Approximately 50,000 people die each year from a traumatic brain injury, and each year 80,000 to 90,000 people experience the beginnings of long-term or lifelong disabilities associated with a traumatic brain injury.

Among children from birth to age 14, traumatic brain injury results in an estimated 3,000 deaths, 29,000 hospitalizations and 400,000 emergency room visits. In the United States, the total cost of traumatic brain injury is an estimated $37.8 billion each year.

Based on statistics from the Centers for Disease Control and Prevention (CDC) for 2000, Arkansas ranked 44th in the rate (per 100,000 people) of fatalities from traumatic brain injury when compared to all other U.S. states.

Massachusetts ranked first with the lowest rate of fatal injuries from brain trauma, while Wyoming

had the highest rate.

According to the CDC, in Arkansas in 2000 there were 750 fatalities resulting from traumatic brain injury, 2,878 people were hospitalized as a result of brain trauma, and 1,019 people were disabled from a brain injury.

The leading causes of traumatic brain injuries are auto accidents, firearms and falls. Accidents involving motor vehicles, bicycles, pedestrians and recreational vehicles are the primary causes of traumatic brain injury.

The use of firearms is the leading cause of death in relation to traumatic brain injury, and nearly two-thirds of firearm-related traumatic brain injuries are suicidal in intent. Falls around the home are the leading cause of injury for infants, toddlers and elderly people. Violent shaking of an infant or toddler is another significant cause. Males are twice as likely as females to sustain a traumatic brain injury, and people age 15 to 24 and those above age 75 are the two age groups at the highest risk.

The bad news is that a traumatic brain injury can be devastating, but the good news is that many brain injuries can be prevented. With the following preventative measures, it’s possible to reduce the incidence of traumatic brain injuries.

1. Increasing helmet use during recreation and sports activities. Note to parents: Make sure your children are wearing safety helmets that fit when they are riding their bicycles, skateboarding, etc.

2. Buckle up when driving or riding in a motor vehicle.

3. To prevent falls among children and older adults, change the environment to reduce fall hazards. (For example, make sure toys are picked up or sharp edges are covered, and for older adults, place non-slip mats in the bathtub and on the shower floor.)

4. Enhance violence-prevention programs designed to decrease the occurrence of self-inflicted gunshot wounds and violent firearm acts aimed at others.

Keep firearms stored unloaded in a locked cabinet or safe, and store bullets in a separate location.

5. Improve use of child safety seats.

6. Do not drive if you are under the influence of drugs or (Injury, continued on Page 17) Blue & You Spring 2004

Customer Service Q & A from Health Advantage

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Q. What do I do if I am away from home (but still in Arkansas) and need medical care?

A. If you have an emergency, seek care from the nearest hospital facility. If you are visiting another town in Arkansas and can’t make it back to see your primary care physician (PCP), you may see any Health Advantage participating PCP in the area where you are located at the time. Please call Health Advantage Customer Service with the name of the PCP that will be treating you so that it can be documented. Claims are subject to review when received, based on your benefit plan. Note: If you have the Open Access health plan, you may visit any Health Advantage participating provider.

Q. How can I get current provider information?

A. To receive the most current provider information, please remember that you can access this information from the provider directory listed at www.HealthAdvantage-hmo.com.

Q. What’s the difference between a copayment and coinsurance?

A. Coinsurance is the percentage of allowable charges for covered services that you are responsible for paying. Coinsurance that you pay is applied to your out-of-pocket maximum. When you have met your annual maximum out-of-pocket, coinsurance will no longer be applied to your claim. Please note that mental health/substance abuse copayment/coinsurance do not apply to the annual coinsurance limit.

Copayment is the amount you pay to the provider for covered services. Although most copayments are a specific amount ($15, $20, etc.), some benefits are listed with a percentage (for example, 50 percent copayment).

Q. What if there is something wrong on my Health Advantage ID card?

A. Please review your ID card as soon as you receive it, and make sure the information that appears on it is correct.

Please call Customer Service or access My Blueprint on our Web site to report any errors and to request a corrected card.

Providers file claims according to the information on the ID card, and incorrect information could cause a delay in payment.

Q. How do I order covered supplies if I have diabetes?

A. Health Advantage has participating providers who carry most diabetic supplies. If you prefer to purchase your diabetic supplies from a pharmacy or non-participating provider, please remember that you must submit the itemized receipt to Health Advantage in order to be reimbursed. If a non-participating provider is used, you are subject to pay the difference in the billed and allowed amount in addition to the applicable coinsurance/copayment based on your benefit plan.

(Injury, continued from Page 16)

alcohol. Do not let others drive who are under the influence of drugs or alcohol.

If you suspect someone in your family has sustained a traumatic brain injury, watch for the following symptoms: 1. Low-grade headache or neck pain that won’t go away.

2. Problems with memory, concentration, etc.

3. Slowness in speaking, thinking, acting or reading.

4. Getting lost or easily confused.

5. Feeling tired all the time, lacking energy or motivation.

6. Change in sleeping patterns (sleeping more than usual or having trouble going to sleep).

7. Feeling light-headed or dizzy, loss of balance.

8. Blurred vision, eyes that tire easily, increased sensitivity to light.

Blue & You Spring 2004

9. Loss of the sense of smell or taste.

10.Ringing in the ears.

11. Mood changes (feeling sad or angry for no reason).

Some general tips to aid in recovery after a mild brain injury include getting lots of rest, avoiding anything that might cause another jolt or blow to the head, following your physician’s orders when it comes to everyday activities, and taking only the medications prescribed by your physician. If the brain injury was severe, the injured person may need therapy to learn skills that were lost, such as speaking or walking.

— Sources: National Institute on Deafness and Other Communication Disorders, Centers for Disease Control and Prevention and the National Center for Injury Prevention and Control

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My BlueLine never sleeps, so you can rest easy

A

t Arkansas Blue Cross and Blue Shield, we want to make sure that you get the information you need when you need it. With My BlueLine, you have access to customer service 24 hours a day, seven days a week. This enhanced benefit, designed specifically with your convenience in mind, makes your personal health insurance information available with a simple telephone call. Many customers asked for telephone self-service — now it’s here.

If you are a customer of Arkansas Blue Cross, Health Advantage or BlueAdvantage Administrators of Arkansas, you can get the answers to your questions anytime, day or night.

“My BlueLine has been a tremendous help to us and our customers,” said Betty Chadduck, manager of Customer Service for Health Advantage.

“Approximately 20 percent of the calls that come in are being handled by My BlueLine. This gives our customers access to information immediately, seven days a week, 24 hours a day. And, of course, the customers always have the option of speaking to a customer service representative during business hours. We have received many positive comments from callers. If a customer has suggestions for improvement of the system, we will consider them also.”

Just a few of the customers comments have been: “I called after hours to check on the status of my son’s • Check your eligibility claim and was very • Check your benefits impressed with how • Check the status of easy it was to use.” your claims “The menu options • Check the status of on My BlueLine are your premium very good.” payment My BlueLine is an • Order a new ID card interactive voice • Order a provider response (IVR) system directory that recognizes speech • Order a claim form 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 (no waiting!). My BlueLine will prompt you with a question, and all you have to do is simply respond to the question.

New voice recognition technology answers your questions 24/7

Get answers to your questions anytime There are no buttons to push.

With My BlueLine you can get numerous questions answered quickly and easily anytime. The new system can help you if you have questions about status of claims and premium payments, and help you order a new ID card, provider directory or claim form. Benefit information also is available through My BlueLine for Arkansas Blue Cross and Health Advantage customers.

When you call, remember to have your ID card on hand. For privacy purposes, the system will ask you questions to verify your identity as the caller — such as your member ID number as it is listed on your membership card. If Arkansas Blue Cross does not have up-to-date information on your home address, there could be a delay, or the system may not be able to provide the requested information. In that case, the call will be transferred to a customer service representative during business hours or a voice mailbox (Arkansas Blue Cross and Health Advantage) after regular business hours.

Try it, you’ll like it. If, during your telephone call to My BlueLine, you have trouble understanding what the system is asking, simply say “help” and My BlueLine will rephrase the question. During regular business hours, at any time during the telephone call, you can request to speak to the next available customer service representative by simply saying “customer service.” For Arkansas Blue Cross and Health Advantage customers who request customer service after hours, the call will be forwarded to a voice message mailbox to leave a message, and your call will be returned during regular business hours.

My BlueLine is a new member benefit to help you get answers to your personal health insurance questions.

However, because My BlueLine can’t help customers with all of their needs, Arkansas Blue Cross and its family of companies will always have customer service representatives available during regular business hours.

And, don’t forget, if you prefer to get your answers on the Web, you have another self-service option by accessing the secure My BluePrint section on our Web sites (see Page 24).

Blue & You Spring 2004

The Phar macist is in Do you have any questions?

H

ow well do you know your pharmacist? Some people select a pharmacy for their pharmaceutical services but do not select a particular pharmacist. However, a personal relationship with your pharmacist is becoming even more important as changes occur regarding medication availability.

The U.S. Food and Drug Administration (FDA) recently began approving some medications for over-thecounter (OTC) use that have historically required a physician’s prescription. This trend began with Zantac®, Pepcid®, and Tagamet® (for indigestion and heartburn), then moved on to antihistamines with Claritin® and finally, Prilosec OTC®. This trend will continue. As brandname medications lose their patent life, the manufacturers are finding another productive market by gaining FDA approval to sell medications OTC without physician supervision while significantly lowering the price. This marketing strategy allows these brand-name

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products to survive generic competition through a new marketing approach. This will become more common as additional patents expire. The consumers benefit from this marketing strategy since OTC prices are lower than most copayments.

As the FDA relaxes these restrictions, allowing more prescription medications to be available OTC, it will be important for consumers to seek professional medical/ pharmacy help to ensure their safe use. Your pharmacist, having your other medication records, will be able to offer valuable assistance regarding medication interactions. While Prilosec® and Claritin® are now much less expensive, are just as effective and can be obtained without a doctor’s prescription, remember that selfmedication carries an element of risk because the physician is removed from the picture. That’s why the advice of your pharmacist can help.

(Blue On-Line, continued from Page 24)

Replacement cards are mailed to the policyholder’s address. Finally, you can update your password, secret questions, secret answers or an e-mail address by going to “Update My Blueprint Registration Information.”

For each page, a “Help” section offers an overview, keyword definitions and answers to frequently asked questions.” You will see “Contact Technical Support” at the bottom of the registration page of My Blueprint.

When you submit the linked form, the Help Desk will respond to answer questions or resolve problems. You will see “Trouble-shooting Tips” on the page that contains the form. These tips might solve your problem immediately. Once you log in, you will see a link to “Contact Customer Service” for any questions about your account information. You should receive an answer to your question by the next business day.

Registration “First-time users” will need to register before they can access their health plan information. For now, only the policyholder (or group subscriber) may register, but that person can see information for a covered spouse or dependents. The following information from your health plan ID card is needed to register: Blue & You Spring 2004

• Member ID number • First and last name and middle name or initial • Date of birth The only other information required is selection of two secret questions and answers to be used if you forget your ID or password. Save your secret answers in a safe place in case you need them later.

When you successfully complete the on-line registration form, you will receive a log-in ID on screen. You should print this screen and save it in a safe place because you will need this computer-generated ID any time you enter My Blueprint. To comply with HIPAA privacy regulations, your password will be sent through the U.S. Postal Service to the address we have on record for the policyholder. Once you receive your password, you are set to go to the log-in page.

After registering, you must enter your log-in ID and the password you received by mail to activate your account. Then you can change your password to something easier to remember, but you will always need to save that initial log-in ID.

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New pharmacy vendor,

new ID cards for members

E

ffective April 1, 2004, Arkansas Blue Cross and Blue Shield will be changing vendors for pharmacy claims processing from Advance PCS to Argus Health Systems, Inc.. Argus will provide claims processing, call center services and decision support assistance for the pharmacy program.

As a result of the change, customers of Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas will be receiving new ID cards in March. The only change on the ID cards will be a new Bank Identification Number (BIN) to direct the claims to the new claims processor.

What does having a new pharmacy vendor mean for our customers? Customers will see no changes in their pharmacy benefits, the Preferred Drug List or the pharmacy network due to this transition. Also, the

pharmacy customer service numbers will remain the same.

Besides the new ID cards, customers will notice very few other changes. There will be a new Pharmacy Web site that resembles the current Web site.

This change to a new vendor will allow the Arkansas Blue Cross family of companies to better serve our customers and providers. Although there is a new vendor behind the scenes, the pharmacy program is administered by Arkansas Blue Cross, with support from Argus. The pharmacy program is a benefit to our customers developed and coordinated by the Arkansas Blue Cross pharmacy team.

Customers express satisfaction with Health Advantage H

ealth Advantage continues to score well with its commercial health maintenance organization (HMO) members, according to the results of the 2003 Health Plan Employer Data Information Set (HEDIS) member satisfaction survey. This information also is available at www.HealthAdvantage-hmo.com.

As with the HEDIS surveys conducted in both 2001 and 2002, members who responded to the 2003 survey gave excellent ratings in several categories including rating of personal doctor, rating of specialist and rating of all health care services. Health Advantage received higher marks in numerous categories (including customer service, claims processing and the ratings for overall satisfaction of the health plan) than similar local, national and regional health insurance companies that participated in the survey.

Only 2 percent of those surveyed said that it was a big problem to get the care, tests or treatment that the member or their doctor believed was necessary, and only 3 percent reported a big problem with delays in waiting for approval from the health plan for services. Only 6 percent of respondents reported a big problem getting the help they needed from their health plan when calling customer service, and not one respondent said there was a big problem with paperwork at Health Advantage.

The survey, a requirement of the National Committee for Quality Assurance (NCQA), also revealed the following results:

• 94 percent of members were satisfied that their claims were handled in a reasonable amount of time • 91 percent of members were satisfied that their claims were handled correctly.

• 97 percent of members felt that the office staff treated them with courtesy and respect.

• 92 percent of members felt that the office staff was as helpful as they thought they should be.

• 92 percent of members felt that their doctors listened carefully to them.

• 96 percent of members felt that their doctors explained things in an understandable way.

• 93 percent of members felt that the doctors showed respect for what they had to say.

• 88 percent of members felt that doctors spent enough time with them.

• 92 percent of members felt that their claims were always or usually processed in a reasonable time.

• 94 percent of members felt their claims were always or usually handled correctly.

• 90 percent of members felt they always or usually received the help or advice they needed when they called the doctor’s office during regular office hours.

• 86 percent of members felt they always or usually received the appointment for health care they needed as soon as they wanted it.

• 92 percent of members felt they always or usually received care quickly for an illness or injury.

Blue & You Spring 2004

Blue & You readers give high marks to magazine, Internet services

Readership Survey Thanks to in-depth health-and-wellness and health insurance information, Blue & You readers sent a message to Arkansas Blue Cross and Blue Shield that they appreciate Blue & You, and have made changes in their lifestyle due to the information they have received in Blue & You. The Autumn 2003 issue contained a readership survey (an annual process) for members to return with comments, and customers gave Blue & You an average of 4.34 on a five-point scale (with five being the highest rating). Survey respondents gave Blue & You a satisfaction rate of 4.43 in the “Helpful” category and 4.36 in the “Attractive” category.

This year, we asked an additional question of our members: “Have you made a healthy change in your behavior because of something you’ve read in Blue & You?” Seventy-five percent of survey respondents answered “yes” to that question.

More members visit Web sites, find information useful The results of the 2003 Internet Survey showed that Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas members have an increasing awareness of the companies’ Web sites and find them useful.

A survey card was enclosed in the Autumn 2003 issue of Blue & You. Those who responded found the most useful sections of the sites to be “Provider Directory,” “Prescription Drug Information” and “Health Plans and Services.”

When asked to rate self-service features they would most like to see on the site, the top three were: 1. Review benefits.

2. View health and wellness information.

3. See out-of-pocket expense accumulation.

Blue & You Spring 2004

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This question addressed features not currently on the sites today but under consideration for development in the near future. Several of the features listed in the 2001 and 2002 surveys already have been added to the sites, so those were removed from the 2003 survey. One example is “check claims status,” which is available now on the Arkansas Blue Cross, Health Advantage and BlueAdvantage sites in the My Blueprint section.

The number of respondents who said they have Internet access decreased from 79 percent in 2002 to 64 percent in 2003. The number who have visited the Web sites jumped from 44 percent in 2003 to 54 percent in 2003. Seventy-seven percent of those responding rated the value of the site at 4 or 5 on a five-point scale, with 5 being the highest. This was up from 63 percent in 2002.

Gift certificate winners!

From the Blue & You satisfaction survey, we randomly selected three winners who each received a $50 gift certificate to Wal-Mart. The winners were Marie Arnold of Jonesboro, Robin Selman of Fayetteville and Clifford Tribble of Little Rock.

From the Web site satisfaction survey respondents, we also randomly selected three winners who each received a $50 gift certificate to Best Buy. The winners were Helen Jones of Prescott, Levona Morrison of Rover and Mildred Poindexter of Morrilton.

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in Memory

ouis Ramsay, 85, a long-time member of the Association and many more.

Arkansas Blue Cross and Blue Shield board of directors, He was the recipient of the Arkansas died on Sunday, Jan. 4, 2004, after a two-year battle with Bar Association and Arkansas Bar Foundaliver cancer. Ramsay was Of Counsel to the Pine Bluff tion Outstanding Lawyer Award in 1966. He law firm of Ramsay, Bridgforth, Harrelson & Starling. He is the second person in Arkansas history to was chairman of the executive committee have been elected and serve and emeritus director of Simmons First as president of both the National Corp., and the past chairman Arkansas Bar Association and chief executive officer of Simmons and the Arkansas Bankers’ First National Corp.

Association.

“Mr. Ramsay was so very special in In 2003, he has inso many ways … a trusted friend, ducted into the Walton mentor, valued business colleague and School of Business Arkansas energetic community leader,” said Bob Business Hall of Fame. On Shoptaw, chief executive officer of Oct. 13, 2003, Simmons and Arkansas Blue Cross.

Arkansas Blue Cross “He was truly a caring person with established a $250,000 every fiber of his being. He never really faculty fund at the Univermet a stranger nor encountered anyone sity of Arkansas Walton that he couldn’t find something positive College of Business in to comment about. His optimism, his zest honor of Mr. Ramsay and for life, and his love for the state of his wife.

Arkansas and its people were infectious.”

Mr. Ramsay is survived Mr. Ramsay was born on Oct. 11, by his wife of 58 years, Joy Louis Ramsay 1918, in Fordyce. He attended the Fordyce Bond Ramsay; daughter and Public Schools and received an athletic scholarship from son-in-law, Joy and Ron Blankenship of the University of Arkansas at Fayetteville. He played Pine Bluff; son and daughter-in-law, Rick quarterback for the Razorback football team, lettering in and Clair Ramsay of Little Rock; sister, 1940 and 1941. After graduating from the University of Frances Holcombe of Texarkana, Texas; and Arkansas, he served as a pilot in the U.S. Army Air Corps grandchildren, Drew, Ben and Kate in World War II and was awarded four Oak Leaf Clusters.

Blankenship; Jimbo and Liz Ramsay; and He received his juris doctor degree from the University of Alex and Clancy Graham.

Arkansas School of Law in 1947. After graduating from Services were held on Wednesday, law school, he joined the law firm of Coleman and Gantt, Jan. 7, 2004, at the First United Methodist the firm that now bears his name. In 1970, he was Church in Pine Bluff. named president of Simmons First National Bank, where “Mr. Ramsay added ‘quality of life’ to he also served as chairman and chief executive officer everyone with whom he came in contact. from 1973 to 1983.

We have lost a true friend and an untiring Mr. Ramsay joined the Arkansas Blue Cross board of ambassador for our state,” Shoptaw said. directors in 1978 and served as chairman of the board from 1981 to 1997. He served as chairman of the executive committee of the board from 1997 until his death. He also served on numerous boards throughout the state including the Board of Trustees for the University of Arkansas, Razorback Foundation, Inc., Arkansas Bar Association, Jefferson County Bar Association, Arkansas Bankers’ Association, the University of Arkansas Alumni

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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.

“Don’t Start” Smoking With more than 3,000 kids in the United States starting to “light up” every day, Arkansas Blue Cross and Blue Shield has teamed up with the American Lung Association, the Arkansas Department of Education, KASN-TV/UPN Channel 38 and KLRTTV/FOX Channel 16 for the third year to encourage kids not to start smoking. The “Don’t Start” Smoking Storyboard Contest, which runs through Students from Central Arkansas Christian School in Sherwood visit March 26, gives kids with Jason Harper during “Good in kindergarten through fifth grade an Morning Arkansas” on KATV-TV. opportunity to write a story about why it’s important to never begin this dangerous habit. Kids can “draw their way” to some great prizes and an opportunity to have their story transformed into an actual television Public Service Announcement (PSA) to be broadcast in Arkansas in the summer and fall of 2004. (In 2003, more than 10,000 students participated in the contest.) Storyboard Contest sheets and educational videos have been distributed to all public schools through the Department of Education and have been mailed to private schools and home-school programs. For more information, visit BlueAnn’s Web site at www.BlueAnnEwe-ark.com. The “Don’t Start” Smoking Storyboard Contest will help your kids draw a healthy message today ... as well as a good breath ... for life.

“Stomp” out Smoking From the Rock to the Prairie to the Delta, BlueAnn Ewe has been hanging out with some cool kids and treading on a stinky habit. The blue, woolly health ambassador has been performing with cape-less crusaders (a.k.a.

High School Heroes) from McGehee High School, Hall High School in Little Rock and Lakeside High School in Blue & You Spring 2004

Lake Village to show middle-schoolers that smoking is not hot. These High School Heroes are specially trained high school students who present an anti-smoking program targeted to fourth-, fifth- and sixth-graders in their school district. High School Heroes serve as role models for the kids, pledging to remain smoke-free, and delivering a strong testimony about the dangers of smoking and the appeals of tobacco advertising. BlueAnn Ewe was able to join the Heroes recently and perform the “BlueAnn Stomp,” a rap-dance about saying “no” to cigarettes.

Body Walk gets on the Inside Oak Grove Elementary School students got to take a walk on the “inside” recently to learn about how their bodies function and how the things they put into their bodies affect their health. The Arkansas Body Walk, a program funded by the Blue & You Foundation for a Healthier Arkansas, teaches healthy behaviors to Arkansas children, grades K-4, to help reduce the incidence of obesity and chronic disease resulting from poor eating habits, substance abuse and lack of physical exercise. The handson walk-through exhibit represents the human body and provides students an entertaining activity that teaches and reinforces the skills and choices for a healthier lifestyle.

The goal is to reach 30,000 students in Arkansas in 2004.

The Arkansas Body Walk made one of its first appearances at BlueAnn learns about the skeletal system from Oak Grove Elementary Oak Grove Elemenstudents. tary in Pulaski County, and BlueAnn was on hand to take a walk with the students through the brain, the tummy, the skeletal system, the circulatory system and more.

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

Personal Benefits and Claims Tracker Almost 10,000 Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas members have registered to use My Blueprint, our Web-based, member self-service center. My Blueprint provides secure, 24-hour access to eligibility and claims information, and several new features that will make the service even more useful are under development.

My Blueprint is available on www.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com and www.BlueAdvantageArkansas.com. Click on the My Blueprint button on the home page of the site of the company you see listed on your health plan ID card.

When you have successfully logged in, you will see a “Welcome to My Blueprint” page, displaying your name and containing a menu of self-service links. Current selections on all three sites include: • Check member eligibility; • Check claim status (including your claims history); • Order replacement ID card; • Update My Blueprint registration information.

The menus on each company site differ somewhat.

On the Health Advantage site, members may review their primary care physician (PCP) history; and on the BlueAdvantage site, they may review a benefit summary or search their customized provider directories.

Health Advantage and BlueAdvantage members have been able to review and print their Explanation of Benefits statements (EOBs) for some time. Soon, most Arkansas Blue Cross members (except Medi-Pak members) will be able to view their EOBs. To access an EOB, click on Check claim status on the “Welcome” page, select the member to whom the claim applies, and click on complete in the “status” column for Blue & You Spring 2004

the claim for which you want to see an EOB. EOBs are in portable document format (PDF).

Health Advantage members will gain two new features this year. They will be able to order a certificate of coverage (COC), which contains information useful for proof of prior coverage when changing jobs. They also will be able to access benefit summaries, which will outline what is covered under their health plan.

Self-Service Features The “Check Member Eligibility” section allows you to see who is eligible for coverage under the registered health plan. The member name, date of birth, member number, relationship to policyholder, effective date and termination date are displayed for each covered member.

“Check Medical Claim Status” allows you to select the member and a time range for claims to be viewed.

Selection of “all claims” pulls the member’s claims history. The status will be either complete or in process.

Click on complete to pull up an EOB. Not all EOBs are available on-line at this time.

“Check Primary Care Physician” allows you to select a member to see each PCP that member has chosen, the physician’s provider number, date selected and date terminated.

“Order Replacement ID Card” allows you to select a member or all members enrolled under your ID number.

(Blue On-Line, continued on Page 19)

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