2005 - Winter by Arkansas Blue Cross and Blue Shield

EPIDEMIC Winter 2005

Stopping the spread of contagious diseases

Medicare prescription drug coverage, p. 20

(For additional information and comparisons of survey results from the past three years, please visit the “Members” section of our Web site: www.HealthAdvantage-hmo.com.)

What Counts Most to Members

We’re here to serve you Health Advantage’s Member Satisfaction Survey reveals that members are happy with their health plan

he results of a 2005 member satisfaction survey indicate that Health Advantage continues to perform well with its members.

Results The survey, meeting requirements of the National Committee for Quality Assurance (NCQA), revealed the following results: • 95 percent of members were satisfied that their claims were handled in a reasonable amount of time; and 94 percent were satisfied that their claims were handled correctly. • 95 percent of those surveyed felt they were treated with courtesy and respect by office staff; and 90 percent felt that the office staff was as helpful as they thought they should be. • More than nine out of 10 doctors or other health-care providers are perceived usually or always to listen carefully to their patients, explain things in a way that the patient could understand and show respect for what the patient had to say. • Almost nine out of 10 doctors or other health-care providers are reported usually or always to spend enough time with their patients. • Overall, on a scale of 0 to 10, where 10 is the best possible health care, 94 percent of respondents gave their health care a 6 or higher. • On a scale of 0 to 10, where 10 is the best possible health plan, 90 percent of respondents gave their health plan a rating of 6 or higher. • On a scale of 0 to 10, where 10 is the best personal doctor or nurse, 90 percent gave their personal doctor or nurse a 6 or higher. • On a scale of 0 to 10, where 10 is the best specialist doctor or nurse, 91 percent gave their specialist doctor or nurse a 6 or higher. Blue & You Winter 2005

Based upon additional analysis of the survey results, the following service factors were determined to be the biggest predictors and drivers of members’ overall satisfaction with the health plan: • Questions or problems resolved on the ﬁrst call or contact with Health Advantage; • Claims handled correctly; • Self-service availability anytime either through a Web site or by calling Customer Service. (NOTE: Both of these services are available to Health Advantage members; go to My Blueprint at www.HealthAdvantage-hmo.com or call Health Advantage at 1-800-843-1329.) ❊

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

Customer Service Numbers Category

Little Rock Number (501)

State/Public School Employees

378-2364

Toll-free Number

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)

378-2531

1-800-482-6655

Health Advantage

378-2363

1-800-843-1329

378-3600

Pharmacy Customer Service: Arkansas Blue Cross Health Advantage BlueAdvantage Specialty Rx Medi-Pak (Medicare supplement)

1-888-872-2531 1-800-863-5561 1-800-863-5567 1-888-293-3748 1-866-295-2779

378-3062

1-800-338-2312

Medi-Pak Rx Membership

1-800-262-7095

Medi-Pak Rx Claims

1-800-698-8397

Medicare (for beneﬁciaries only):

1-800-MEDICARE (633-4227)

For information about obtaining coverage, call: Category

Little Rock Number (501)

Medi-Pak (Medicare supplement) Medi-Pak Rx Health insurance plans for individuals and families

Winter 2005 2 4 5 6 8 9 10

12 13 14 15 16 18 19 20 21 22 23

Toll-free Number

378-2937

1-800-392-2583

378-2937

1-800-392-2583

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:

this issue

1-800-482-8416

Arkansas Blue Cross and Blue Shield health insurance plans for individuals and families 378-2010

BlueAdvantage Administrators of Arkansas

Inside

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

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Blue Comes Through Contagious versus infectious: What’s the difference? What do you mean? Be smart about antibiotics: Know when to take them Hand-washing is good health insurance No cure in sight for common cold (with True or False Quiz) Protect yourself: Flu and pneumonia season is here Unraveling the mystery of the bird ﬂu Important, but uncommon, diseases affecting Arkansans (West Nile Virus, Rabbit Fever {Tularemia}, Rocky Mountain Spotted Fever and Whooping Cough) Measles & Mumps: Preventable with vaccinations Chickenpox: Very contagious; immunization available You have a sore throat. Is it strep? Get your child immunized! Information on staph infections Can an STD cause cervical cancer? Rabies rare in 2005 Overuse of diagnostic imaging and the dangers of radiation Prior authorization needed soon for certain radiology services BLUEINFO: Three tools to get the info you need Medicare prescription drug coverage begins Jan. 1, 2006 Questions and answers about Medi-Pak Rx Ask the Pharmacist InformationWeek picks Arkansas Blue Cross in 500 list A.M. Best upgrades rating of Arkansas Blue Cross Pinnacle Business Solutions, Inc. forms for Public Programs The Healthy Weigh! Education Program BlueSecure long-term care insurance product Is your company up to the Challenge? Get a free kit! Blue & You Foundation awards grants Medicare Support Call Center opens Helping those affected by Hurricane Katrina One new board member and two others honored Best of Blue recognizes Arkansas Fitness Challenge “One Class at a Time” grants helping Arkansas teachers Blue receives bronze Blue & Your Community “Don’t Start” 2006 gets started Blue Online

Blue & You Winter 2005

Contagious versus infectious: What’s the difference? W

hat’s the difference between a contagious and an infectious disease? The simple answer is that a contagious disease (or a communicable disease) is a disease that can be transmitted by direct contact from one living thing to another (for example, measles) or from indirect contact (for example, typhus). The agent responsible for the spread of disease is described as being infectious (for example, bacteria). People can be infected with dangerous contagious diseases in a number of ways. Some germs, like those causing malaria, are passed to humans by animals. Other germs, like those that cause botulism, are carried to people by contaminated food or water.

Still others, like the ones causing measles, are passed directly from person to person. An infectious agent, such as bacteria, spreads disease. Some disease-causing microbes, such as those that cause the ﬂu and Lyme disease, spend part of their lives in insects or other animals before infecting the human body. Other microbes live in soil and water, and are only harmful if a person swallows them or absorbs them through the skin. Soil microbes, for example, can enter the human body through a break in the skin or can be inhaled as dust. A third class of microbes, such as HIV and tuberculosis, can exist in feces or mucus — but they can’t exist for long outside a human host, so these microbes tend to remain in the human body for most or all of their life cycle. According to the Centers for Disease Control and Prevention (CDC), infectious diseases account for 25 percent of all visits to physicians each year. Economic losses associated with infectious diseases are estimated at $120 billion per year. This issue of Blue & You should help you understand — and avoid — the contagious and/or infectious diseases that affect Arkansans. ❊ Sources: Centers for Disease Control and Prevention. Bartleby.com and the American Museum of Natural History in New York City

What do you mean? S

ome terms associated with contagious diseases may be unfamiliar to many people. Here’s a list of some of those medical terms, and what they mean. Bacteria — Large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium. Endemic — Pertaining to diseases associated with particular locales or population groups. Epidemic — An outbreak of a contagious disease that spreads rapidly and widely. An epidemic is generally a widespread disease that affects many individuals in a population. An epidemic may

Blue & You Winter 2005

be restricted to one locale or may even be global (pandemic). An outbreak of a disease is deﬁned as being epidemic, however, not by how many members or what proportion of the population it infects but by how fast it is growing. Pandemic — An epidemic occurring throughout a very wide area, crossing international boundaries and usually affecting a large number of people. Virus — A tiny organism that multiples within cells and causes disease such as chickenpox, measles, mumps, rubella, pertussis and hepatitis. Viruses are not affected by antibiotics, the drugs used to kill bacteria. ❊

Be smart about antibiotics:

Know when to take them

efore your physician prescribes that antibiotic for you, make sure it is a necessary step in your journey to recovery from your illness. Overuse of antibiotics has been called “one of the world’s most pressing health problems” according to the Centers for Disease Control and Prevention (CDC). Antibiotics are drugs that fight infections caused by bacteria. Antibiotics are not effective against viral illnesses such as a common cold or the flu. Antibiotics transformed medical care in the 1940s and virtually eliminated many diseases caused by infection. They are very effective when used appropriately. The overuse of antibiotics has caused many diseases that were virtually wiped out (such as tuberculosis and malaria) to raise their ugly heads again. Antibiotics just don’t pack the same punch they once did. What is antibiotic resistance? The use of antibiotics promotes the development of antibiotic-resistant bacteria. Antibiotic resistance occurs when bacteria changes in some way that reduces or eliminates the effectiveness of drugs, chemicals or other agents designed to cure or prevent infections. Over time, the bacteria have grown stronger and now are able to survive powerful antibiotics. Drug resistance is a difficult problem for hospitals because they have critically ill patients who are more susceptible to infections. Basically, overuse of antibiotics has caused two major problems: it now is more difficult to remove infections from the human body, and the risk of getting an infection in a hospital setting is greater. According to CDC statistics: 1. Nearly two million patients in the United States get an infection in a hospital each year.

2. Of those patients, about 90,000 die each year as a result of their infection — up from 13,300 patient deaths in 1992. 3. More than 70 percent of the bacteria that cause hospitalacquired infections are resistant to at least one of the drugs most commonly used to treat them. 4. Persons infected with drug-resistant bacteria are more likely to have longer hospital stays and require treatment with additional drugs that may be less effective, more toxic and more expensive. Antibiotic resistance is driving up health-care costs, increasing the severity of disease and increasing death rates from certain infections.

What can you do? • Talk with your health-care provider about antibiotic resistance. Make sure you really need an antibiotic before accepting a prescription. • Do not take an antibiotic for a viral infection like a cold or the ﬂu. • Do not save some of your antibiotic for the next time you get sick. • Take an antibiotic exactly as the doctor tells you. • Do not take an antibiotic prescribed for someone else. The triumph of antibiotics over disease-causing bacteria is one of modern medicine’s greatest achievements. It’s now up to our generation to make sure our children and our grandchildren also will beneﬁt from this discovery. We can do this by being careful and diligent in the appropriate use of antibiotics. ❊ Sources: Centers for Disease Control and Prevention and National Institute of Allergy and Infectious Diseases

Hand-washing is good health insurance

old and ﬂu season is upon us. Did you know that hand-washing is the single most important means of preventing the spread of infection? We carry millions of microbes on our hands. Most are harmless, but we can pick up some germs that cause illnesses, such as colds, ﬂu and diarrhea. Forgetting to wash hands or not washing them properly can spread germs to other people or give them to ourselves when we touch our eyes, mouths, noses or cuts on our bodies. And there’s more to hand-washing than many people think. Here’s the “how to” when it comes to washing your hands : 1. Remove jewelry. 2. Wet your hands with warm water. 3. Apply soap and scrub for at least 15 seconds. Wash the front

and back of you hands and wrists, between ﬁngers and under the nails. 4. Rinse well. Let water run down your ﬁngers — not down your arms. 5. Dry hands with paper towel, air dryer or clean towel. Remember to wash your hands BEFORE you prepare or eat food; treat a cut or wound or tend to someone who’s sick; or put in or take out contact lenses. Also remember to wash your hands AFTER you go to the bathroom; handle uncooked foods, especially raw meat; blow your nose, cough or sneeze; handle garbage; tend to someone who’s sick; change a diaper; or play with or touch a pet, especially reptiles and exotic animals.

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Blue & You Winter 2005

No cure in sight S

niffles, sneezing, coughing, stuffy nose . . . we’ve all experienced the miserable symptoms of the common cold. Being common doesn’t make them any more pleasant, but most of us survive the attack of a cold virus without lasting effects or complications. More than 200 different viruses cause the common cold. After you have successfully fought one of these, you become immune to that particular virus. When you get another cold, it’s caused by a different virus. You “catch” a cold by touching a surface that has a cold virus on it and then touching your eyes or nose or by inhaling drops of mucus infected with a cold virus that are floating in the air. Cold viruses can live on surfaces, including your skin, for up to three hours. You can prevent colds by washing your hands frequently and not touching your face. Scrub hands vigorously with soap and water for at least 15 seconds. If you have a cold, you should stay away from other people and cover your nose or mouth when you sneeze or cough. There is no cure for the common cold. Any medications you take only treat the symptoms, and antibiotics don’t do any good at all. In fact, antibiotics do harm because their overuse allows bacteria to develop immunity to them. Cold symptoms last from two to 24 days but usually go away in about a week. Symptoms appear two to three days after contact with the virus and may include: • Mucus buildup in your nose • Difficulty breathing through your nose • Swelling of your sinuses • Sneezing • Coughing • Headache • Fever • Watery eyes • Sore throat Children get the most colds — about six to 10 a year — because they have developed immunity to fewer viruses and because they come in close contact with other children who have colds. Adults can expect two to four colds per year, although some people get fewer. Women have more colds than men, probably because of closer contact with children. People older than 60 have the fewest colds. You can relieve cold symptoms by resting in bed, drinking fluids, gargling with warm salt water, using throat sprays or lozenges, rubbing petroleum jelly on a raw nose, and taking aspirin or acetaminophen. The American Academy of Pediatrics advises against giving aspirin to children and teenagers because of the danger of Reye’s syndrome.

Blue & You Winter 2005

for common cold Complications of colds could require a visit to the doctor. You should consult your physician if you have high fever, significantly swollen glands, severe sinus pain, severe sore throat or a cough that produces mucus. A cold that lasts more than two weeks with little symptom relief might be sinusitis, which is infection or inflammation of the sinuses. Sinusitis can be acute or chronic and sometimes requires treatment with antibiotics. Other treatment may involve decongestants, steroid sprays or pain relievers. Avoiding allergens may help reduce the incidence of sinusitis. Your physician can help you decide whether allergy tests are needed. Bronchitis, which is inflammation of the airways in the lungs (bronchi), may result from colds or other viral or bacterial infections; smoking; or inhalation of irritants, such as chemical pollutants or dust. Bronchitis can make breathing difficult and painful. People who have asthma or chronic sinusitis are more likely to get bronchitis. In most cases, antibiotics are not needed to treat bronchitis. Your physician should make this determination. For acute bronchitis, treatment may include expectorants or cough suppressants, increased fluid intake, aspirin or acetaminophen, or cool-mist humidification. Antihistamines usually are not recommended because they can make a cough worse by drying up lung secretions. Bronchitis may be chronic with long-term inflammation, obstruction and degeneration of bronchi. Your physician should evaluate your case and recommend treatment for bronchitis that does not go away. A severe sore throat could be strep throat, which is caused by bacteria and requires treatment with an antibiotic. Your doctor can test for streptococcal infection. ❊

True or False? Exposure to cold weather or getting chilled causes a cold. False. The truth is that getting cold does not cause a cold, but there is a cold season. This is late August or early September through March or April. This may relate to schools being open and colder weather keeping more people indoors during those months. Also, cold weather may make the lining of your nose drier and more vulnerable to cold viruses. Damp, rainy weather causes a cold. False. The truth is that wet weather does not cause colds. In fact, the most common cold-causing viruses survive better when humidity is low. Echinacea prevents colds. False. The truth is that echinacea may help relieve cold symptoms if taken in the early stages, but it does not prevent them. Vitamin C prevents colds. False. The truth is that Vitamin C may reduce the severity or duration of symptoms; but there is no clear evidence of this. Large doses of Vitamin C over long periods of time might even be harmful. Antibiotics will help you get over a cold. False. The truth is that antibiotics will not help the common cold. They kill bacteria, not viruses. Overuse contributes to bacteria becoming more resistant and harder to kill. Smoking can cause you to get more colds. Smoking destroys cilia, the hair-like ﬁbers in your nose and lungs that help protect them. True. Psychological stress and lack of rest can make you more susceptible to cold viruses by lowering your resistance to infection. True. Cleaning environmental surfaces in your home with a virus-killing disinfectant might help prevent colds from spreading to other members of the family when one of them has a cold. A telephone is an example of a surface where viruses might be found. True. ❊ Sources: Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, Healthﬁnder, National Health Information Center and U.S. Department of Health and Human Services

Blue & You Winter 2005

Protect yourself: Flu and pneumonia season is here P

neumonia and inﬂuenza together are ranked as the seventh leading cause of death in the United States.

Flu (Inﬂuenza)

As directed in our “Ask the Pharmacist” section (see Page 22), you can protect yourself from the flu (influenza) by getting a flu shot. The flu is a highly contagious respiratory infection. The flu can cause fever, chills, headache, dry cough, runny or stuffy nose, sore throat and muscle aches. Unlike the common cold, the flu can cause extreme fatigue lasting several days to more than a week. The flu can be transmitted easily from person to person when an infected person coughs or sneezes. After someone has been infected, symptoms usually appear within two to four days. Each year, an estimated 10 to 20 percent of the population contracts influenza. October and November are the best months to get vaccinated, but you still can get vaccinated in December and later. Flu season can begin as early as October or as late as May.

Who should get a flu shot? If you want to reduce your chances of getting the flu, you should get vaccinated. Certain people should get vaccinated each year. People who should get vaccinated each year are: • People 65 years and older; • People who live in nursing homes and other long-term care facilities that house those with long-term illnesses; • Adults and children 6 months and older with chronic heart or lung conditions, including asthma; • Adults and children 6 months and older who needed regular medical care or were in a hospital during the previous year because of a metabolic disease (like diabetes), chronic kidney disease or weakened immune system (including immune system problems caused by medicines or by infection with human immunodeficiency virus [HIV/AIDS]); • Children 6 months to 18 years of age who are on long-term aspirin therapy. (Children given aspirin while they have influenza are at risk of Reye’s syndrome.); • Women who will be pregnant during the influenza season; • All children 6 to 23 months of age; • People with any condition that can compromise respiratory function or the handling of respiratory secretions (that is, a condition that makes it hard to breathe or swallow, such as a

Blue & You Winter 2005

brain injury or disease, spinal cord injuries, seizure disorders, or other nerve or muscle disorders). Because nearly one-third of people 50 to 64 years of age in the United States have one or more medical conditions that place them at increased risk for serious ﬂu complications, vaccination is recommended for all persons aged 50 to 64 years.

Pneumonia Pneumonia can affect anyone at any age. Pneumonia is an inﬂammation of the lungs caused by an infection. It is a common, serious illness that affects approximately one out of 100 people each year. It is caused by many different types of organisms and may range from a mild to a life-threatening illness. Pneumonia symptoms include: cough, chills with shaking, fever, fatigue, chest pain, headache, loss of appetite, nausea, vomiting and general discomfort. Additional symptoms that may be associated with this disease include: shortness of breath, excessive sweating, clammy skin, rapid breathing, coughing up blood and abdominal pain. Supportive therapy includes oxygen and respiratory treatments. Most patients will respond to the treatment and improve within two weeks. The pneumococcal vaccine is the only way to prevent getting pneumococcal pneumonia. Vaccines are available for children and adults. Consult your physician to see if you should receive a vaccine. ❊ Sources: Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases

Pneumonia Update According to an update from the Centers for Disease Control and Prevention (CDC), the CDC recommends that immunocompetent (the ability to develop an immune response) adults 65 and older do not need routine re-immunizations for pneumonia if they were immunized at age 65 or older. Those aged 65 and older should receive an additional vaccination only if they received the initial vaccination before age 65, or if they are not immunocompetent. This information was listed incorrectly (without the updated CDC recommendations) in the Autumn 2005 issue of Blue & You.

Unraveling the mystery of the

bird ﬂu

ou’ve heard about it. You’ve read about it. Now, you want to know what the bird flu means for you as an American and an Arkansan. The current outbreak of avian (bird) flu, a strain known as H5N1, is highly contagious among birds and rapidly fatal. It can infect domesticated birds, including chickens, ducks and turkeys. And, unlike other strains of bird flu, it can be transmitted to humans causing severe illness and death. According to current statistics, the fatality rate is 50 percent among humans who contract the disease. The good news is that there is no reason to panic. As of Dec. 5, 2005, the current bird flu has not been found in the United States. And, those in foreign countries who have contracted the disease had been handling sick or dead birds. There is no evidence that it can be passed from person to person. Here’s the problem. Flu viruses are unstable and can mutate rapidly jumping from one animal species to another fairly easily. Scientists fear the bird flu virus could mutate into a form that spreads easily to humans and become an extremely lethal disease. This could happen if someone already infected with a flu virus catches the bird flu virus. The two viruses could combine into a “new” virus that is spread from person to person. The resulting virus would be something no one has seen or been exposed to before.

The bird flu in 2005 In February and March 2005, the new strain of bird flu was discovered in humans in Vietnam. Additionally, Cambodia and 10 other countries reported human cases of bird flu. In April, the disease had spread to Thailand and North Korea. By August of 2005, the bird flu had been discovered in the Philippines, Indonesia, Japan, Siberia, Tibet, Russia and Kazakhstan. In October 2005, U.S. researchers announced that they had reconstructed the virus that caused the 1918 flu pandemic. They confirm that it was originally a bird flu that jumped to humans. Also, both Turkey and Britain reported cases of bird flu. In Britain, a quarantined parrot died from bird flu. In November 2005, the United States announced a $7.1 billion plan to fight a bird flu pandemic. The plan focuses on building stockpiles of drugs, encouraging companies to develop vaccines and asking states to make additional contributions. By November 2005, the avian flu had infected 122 people and killed 62. It has become entrenched in many of the poultry stocks throughout Asia and in some European countries.

History of the flu In 1918, the Spanish Flu pandemic (caused by a strain of bird flu), killed an estimated 20 to 50 million worldwide including 550,000 people in the United States. In 1957, a flu pandemic killed 100,000 people. In 1968, a flu pandemic killed 700,000 people, and this virus was likely caused by an exchange of genes between avian and human flu viruses. In 1997, the current bird flu was isolated for the first time in a human patient in Hong Kong. The virus infected 10 people who had close contact with poultry, resulting in six deaths.

Bird flu in humans Symptoms of bird flu in humans have ranged from typical flulike symptoms (fever, cough, sore throat and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications. It is believed that most cases of bird flu infection in humans have resulted from contact with infected poultry or contaminated surfaces. Studies done in laboratories suggest that the prescription medicines approved for human flu viruses should work in preventing bird flu infection in humans. However, flu viruses can become resistant to these drugs, so these medications may not always work. Additional studies are needed to prove the effectiveness of these medicines.

The risk The risk from bird flu is generally low to most people because the viruses occur mainly among birds and do not usually infect humans. However, during an outbreak of bird flu among poultry (domesticated chicken, ducks, turkeys), there is a possible risk to people who have contact with infected birds or surfaces that have been contaminated with excretions from infected birds. The current outbreak of bird flu among poultry in Asia and Europe is an example of a bird flu outbreak that has caused human infections and deaths.

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Sources: Centers for Disease Control and Prevention, MSNBC. com, CNN.com, Reuters UK, World Health Organization, MedlinePlus, and the National Institute of Allergy and Infectious Disease

Blue & You Winter 2005

Important, but uncommon, Avoid West Nile Virus by preventing mosquito bites

revention is the best solution to avoid West Nile Virus, a potentially serious illness that is viewed as a seasonal epidemic (summer and early fall) by the experts. In most cases, infected mosquitoes spread West Nile Virus. In a small number of cases, West Nile Virus can be spread through organ transplants, blood transfusions and breast-feeding. West Nile Virus cannot be spread through casual contact such as touching or kissing a person with the virus. The best way to avoid West Nile Virus is to prevent mosquito bites. Mosquitoes become infected when they feed on infected birds. Infected mosquitoes then spread the disease to humans and other animals. Here are some tips to avoid mosquitoes: • Be sure to use insect repellent when you are outside. • Mosquitoes are most active at dusk or dawn so try to stay indoors during these times. • Make sure you have secure screens and windows on your home to keep mosquitoes out. • Rid your yard of mosquito breeding grounds by emptying standing water from ﬂowerpots, buckets or barrels. Change the

water in pet dishes daily and, in birdbaths, weekly. Approximately 80 percent of people who contract West Nile Virus will experience no symptoms at all. Up to 20 percent will experience mild symptoms that may include fever, headache, body aches and nausea. Approximately one in 150 people will develop a severe illness caused by West Nile Virus. Those symptoms can include fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, and numbness and paralysis. According to statistics from the Centers for Disease Control and Prevention, there were 26 cases of West Nile Virus in 2003. No deaths were attributed to West Nile Virus in 2003. If you ﬁnd a dead bird, do not handle it. Contact your local health department for instructions on reporting and disposing of the body. Dead birds may be a sign that West Nile Virus is circulating between birds and mosquitoes in an area. However, it’s important to remember that birds die from numerous other causes. For more information on West Nile Virus, contact the Arkansas Department of Health (www.healthyarkansas.com) or call the West Nile Virus Information Line at 1-877-296-9555. ❊ Source: Arkansas Department of Health and Centers For Disease Control and Prevention

Chasing “rabbit fever”

hat ﬂuffy little wild rabbit scampering through your yard is something that should be seen but not touched. Same goes for the wild rodents running around your house or neighborhood. Many wild rabbits and rodents carry the bacteria that cause tularemia (rabbit fever). Every state in the United States (except Hawaii) has reported outbreaks of tularemia, and it is especially common in rural areas. Most people become infected by handling infected or dead animals, through the bite of an infected insects (usually, ticks or deerﬂies), by eating or drinking contaminated food or water, or by inhaling airborne bacteria. Tularemia is widespread among animals, and approximately 200 cases are reported in humans each year. Most cases occur in rural areas of the south central and western United States.

Blue & You Winter 2005

People who become infected with tularemia may develop skin ulcers, swollen lymph nodes, inﬂamed eyes, sore throat, mouth sores, diarrhea or pneumonia. If the bacteria are inhaled, a person may develop sudden fever, chills, headache, muscle aches, joint pain, dry cough and progressive weakness. People with pneumonia can develop chest pain, difﬁculty breathing, bloody sputum and respiratory failure. Tularemia can be fatal if the person is not treated with appropriate antibiotics. Tularemia cannot be passed from one person to another. If you are exposed to tularemia, you should seek medical care immediately. ❊ Sources: Centers for Disease Control and Prevention, U.S. National Library of Medicine and National Institutes of Health

diseases affecting Arkansans What is Rocky Mountain Spotted Fever?

t’s important to know that you don’t have to live in or near the Rocky Mountains to be infected by Rocky Mountain Spotted Fever. All of us living near the Ozarks can’t avoid the risk by virtue of our location. In fact, most recent cases of Rocky Mountain Spotted Fever or “tick fever” have been reported in the eastern United States (including in our neighboring state, Tennessee). Approximately 1,000 cases are reported each year, and most of the reported cases are in children. Rocky Mountain Spotted Fever is a disease caused by bacteria that are carried by ticks. Within a week after being bitten by an infected tick, a person will start having fevers or feeling nauseous. A few days after the fever begins, a person with this disease may experience a severe headache, mental confusion, joint pain, a rash on arms or ankles, stomach pain and diarrhea. Someone who becomes infected with Rocky Mountain Spotted Fever may not even recall being

bitten by a tick. That’s why prevention always is important: 1. When returning from potentially tick-infested areas, check yourself and your children for ticks, especially in the hair. Ticks also may be carried into the house through clothing or pets, so both should be examined carefully. 2. To prevent ticks from getting on your pets, consult your veterinarian. 3. Remove ticks carefully by using tweezers, pulling carefully and steadily. Treatment usually involves an antibiotic, and it usually cures the infection. Complications are rare. The death rate from Rocky Mountain Spotted Fever is ﬁve to seven percent and reﬂects a delay in seeking treatment. There is no vaccine against this disease. ❊ Sources: National Center for Infectious Diseases, U.S. National Library of Medicine and the National Institutes of Health

Whooping Cough poses danger for young children

hooping cough or pertussis is a highly contagious disease that can be prevented by vaccination. For those who contract the disease — mostly children — the symptoms include severe coughing, whooping and vomiting. Whooping cough is passed from person to person by direct contact with discharges from respiratory mucous membranes of infected persons. In the United States, 5,000 to 7,000 cases of whooping cough are reported each year. Incidence of whooping cough has increased steadily since the 1980s. Major complications are most common among young children and include seizures, pneumonia and malnutrition. In 2003, 13 children died in the United States from whooping cough. Most deaths occur in children who are not immunized or are too young to be immunized. Children who are too young to be fully vaccinated or who have not completed their vaccination series are at the highest risk for severe illness. In adults or older children, whooping cough isn’t as life threatening as it is for infants — although it may lead to bronchitis. This is because the airways are much larger, leaving room to breathe despite the buildup of mucus. If started early enough, antibiotics such as erythromycin and amoxicillin can make the symptoms go away more

quickly. Unfortunately, most patients are diagnosed too late, when antibiotics aren’t very effective. Infants under 18 months of age require constant supervision because breathing may temporarily stop during coughing spells. Infants with severe cases should be hospitalized. An oxygen tent with high humidity may be used. Intravenous ﬂuid may be necessary if coughing spells are severe enough to prevent the patient from drinking enough ﬂuids. Sedatives may be prescribed for young children. Cough mixtures, expectorants and suppressants are usually not helpful and should NOT be used. Consult your physician if you or someone in your family has been exposed to whooping cough.

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Sources: Centers for Disease Control and Prevention, U.S. Food and Drug Administration and MedlinePlus

Blue & You Winter 2005

Measles & Mumps: Preventable with vaccinations

wo diseases that were, at one time, closely associated with childhood are the measles and the mumps. While they both are viral infections and are often referred to in tandem, the two are quite dissimilar with regard to their symptoms. The measles (also called rubella) is best known for its skin rash. The mumps is know for its trademark “swollen cheeks.”

Measles

Measles is primarily a respiratory infection with the initial symptoms being irritability, runny nose, eyes that are red and sensitive to light, a hacking cough, and a fever as high as 105 degrees. The fever typically peaks with the ﬁrst appearance of the rash. This begins on the forehead and spreads downward over the face, neck and body. It usually takes approximately three days for the rash to spread to the feet, but once it does the symptoms begin to subside in another couple of days. The entire process takes about six days. Complications of measles include croup, bronchitis, bronchiolitis, pneumonia, conjunctivitis, myocarditis, hepatitis and encephalitis. Babies are usually immune to the disease for the ﬁrst eight months after birth as a result of antibodies shared from the mother during pregnancy and breast-feeding. While measles is considered a “childhood” disease, it is possible for adults to get it, and the symptoms and complications tend to be more severe. The best way to prevent the measles is vaccination. It can be given any time before and as late as three days after exposure to the disease. Currently, outbreaks of measles are most common on college campuses. This may be because the vaccine made prior to 1979 may not be as effective as current vaccines. Doctors do

recommend that everyone who was vaccinated before 1980 get a second vaccination in the event of a measles outbreak in their area.

Mumps Mumps is spread through saliva and can infect many parts of the body, especially the parotid salivary glands located at the back of each cheek. It is the swelling of these glands (which produce saliva for the mouth) that gives a mumps patient the “swollen cheeks.” The disease usually begins with a fever of up to 103 degrees, headaches and loss of appetite. Symptoms in the ﬁrst week include high fever, chills, headache, nausea, vomiting and drowsiness. In more serious cases, mumps can lead to swelling in the brain and other organs (although this in not common), encephalitis and meningitis. Mumps is contagious and spreads through tiny drops of ﬂuid from the mouth and nose of someone infected. It can be passed to others through sneezing, coughing and even laughing. The best way to prevent the disease is through vaccination. Treatment of both measles and mumps should be administered through a doctor. Non-aspirin fever medications such as acetaminophen or ibuprofen may be used to reduce fevers and relieve pain if instructed by your child’s physician. Aspirin should not be used in children with viral illnesses because the use of aspirin in such cases has been associated with the development of Reye’s syndrome. ❊ Sources: KidsHealth.com, Centers for Disease Control and Prevention and WebMD

Chickenpox: Very contagious; immunization available

t some point in your life, you’ve probably seen a child with the familiar red spots on his or her face and body. Most of us have had chickenpox (we may even have a scar or two) or have seen the tell-tale signs of the virus on someone else. Chickenpox is very contagious, and approximately 80-90 percent of those exposed will catch it. However, there now is a vaccine that is expected to decrease the number of those who catch chickenpox. The vaccine is recommended to be routinely given to children at 12 to 18 months of age. Older children, adolescents and adults who haven’t had chickenpox also should be immunized. Although children one to 12 years receive a single vaccine dose, adolescents and adults require two vaccine doses a minimum of four weeks apart. Chickenpox is a varicella-zoster virus that spreads in the air through coughs or sneezes or through contact with ﬂuid from inside the chickenpox blisters.

Although it’s more common in kids under the age of 15, anyone can get chickenpox. A person usually has only one episode of chickenpox in his or her lifetime. But the virus that causes chickenpox can lie dormant within the body and can cause a different type of skin eruption later in life called shingles, also referred to as herpes-zoster. Chickenpox is a viral infection that causes a red, itchy rash on the skin. The rash usually begins as small, red bumps that look like insect bites. They develop into blisters filled with clear fluid, which then becomes cloudy. The blister wall breaks, leaving open sores, which finally crust over to become dry scabs. One of the features of the chickenpox rash is that all stages of the lesions can be present on the body at the same time. Some children may develop a fever, abdominal pain or a simple Chickenpox, continued on Page 14

Blue & You Winter 2005

You have a sore throat. Is it strep?

f you have strep throat, you should seek medical care because it is a contagious disease, but how do you know? Strep throat is a contagious bacterial infection of the tissues in the back of the throat and the tonsils. The tissue becomes irritated and inflamed, causing a sudden, severe sore throat. It’s caused by infection with Group A streptococci (pronounced: strep-toe-koksigh) bacteria; and if you or someone in your family has strep throat, you’ll know within one to three days. If it is strep throat, your throat may be red with white patches, you may have trouble swallowing or you may have tender, swollen glands (lymph nodes) on the sides of the neck, toward the front. Usually the tonsils are red and enlarged. There also may be white craters, or specks of pus on the tonsils, or your tonsils may be covered with a gray or white coating. Other symptoms on strep throat include: • Headache • Abdominal (lower stomach) pain • Fever • General discomfort, uneasiness or ill feeling • Loss of appetite and nausea • Muscle pain • Joint stiffness • Rash The bacteria that cause strep throat tend to hang out in the nose and throat, so normal activities like sneezing, coughing or shaking hands can easily scatter the strep infection to other people. A visit to the doctor will confirm whether you have strep throat. The doctor can do a rapid strep test to check for strep bacteria by rubbing a cotton swab over the back of your throat. With this test, the doctor may be able to find out in less than one hour if you have strep throat. If the first test doesn’t prove anything, then the doctor may do a test called a throat culture, in which a swab from your throat will then be rubbed on a special dish and left to sit for two nights. If you have strep throat, streptococci bacteria usually will grow in the dish within one to two days. To treat strep throat, the doctor will prescribe 10 days of treatment with an antibiotic. While recovering, you should drink plenty of cool liquids (to prevent dehydration). However, avoid orange juice, grapefruit juice, lemonade or other acidic beverages, since these will irritate the throat. Warm liquids like soups, tea with honey or cocoa can be soothing. You will be contagious for about 24 hours after treatment starts. Therefore, it’s important to stay home for at least 48 hours, until the antibiotics have had a chance to work. ❊

Get your child immunized!

common misconception is that because formerly common and dangerous diseases have been all but eliminated, it is no longer important to make sure children are immunized. While it is true some diseases (like polio and diphtheria) are extremely rare in the United States, it also is true that they are becoming so because we vaccinate against them. Immunizing children remains an important priority in the battle against infectious diseases. At birth, infants have immunity to certain diseases because the antibodies of the mother have been passed through the placenta to the child. After birth, breast-feeding continues the beneﬁts of the antibodies. But, in both cases, the immunity is only temporary. It still is recommended that children be immunized against diphtheria, Haemophilus inﬂuenzae type b, hepatitis B, measles, meningococcal, mumps, pertussis (whooping cough), pneumococcal, polio, rubella, tetanus and varicella (chickenpox). The following chart shows the vaccinations recommended by age two: • 4 doses of diphtheria, tetanus and pertussis vaccine (DTaP) • 4 doses of Hib vaccine • 4 doses of pneumococcal vaccine • 3 doses of polio vaccine • 3 doses of hepatitis B vaccine • 1 dose of measles, mumps and rubella vaccine (MMR) • 1 dose of varicella vaccine It is true that some vaccines may cause mild reactions, such as soreness where the shot was given or a fever. Serious reactions are rare, and the risks from vaccinations are small when compared to the risks associated with the diseases they are designed to prevent.

❊ Sources: KidsHealth.com and Centers for Disease Control and Prevention

Sources: WebMD.com, KidsHealth.org and Centers for Disease Control and Prevention Blue & You Winter 2005

Not the kind of “staff” you want to work with — information on staph infections

ome unusual trends have developed in recent years concerning staph infections that have many health-care professionals curious. Staph infections, usually thought of as a hospital-acquired illness, are caused by the bacteria Staphylococcus aureus. When the bacteria enter through a break or puncture in the skin, they can cause infections and lead to other health problems like folliculitis, boils, scalded skin syndrome, impetigo, toxic shock syndrome and other types of infections. Interest among health-care professionals has increased because of a recent development where staph infections have become more common in settings where previously they did not typically develop. According to a recent report in the Arkansas DemocratGazette, the Arkansas Department of Health and Human Services has been receiving an increased number of reports of communityacquired staph infections. Since medical personnel are not required to report such infections, the Arkansas Department of Health and Human Services does not have the number of increase in infections. However, in the past ﬁve to 10 years, several states, including Arkansas, have reported cases of staph infections in patients who have not been in a hospital or health-care facility. Anywhere from 10 to 30 percent of the population carries the staph bacteria on their skin or in their nose. Most strains of the bacteria are controlled with anti-bacterial soaps and rarely cause infections. However, some staph bacteria are resistant to commonly used antibiotics and commonly cause infections in hospital settings through infected towels, sheets and wound dressings. Staph infections can spread through the air, through contaminated surfaces and person to person. Transferring the bacteria from one part of the body to another is possible via dirty hands and ﬁngernails, so hand-washing is considered the most important way to prevent staph infections. It also is a good idea to keep a child’s skin clean with frequent baths or showers and to make sure that skin injured by cuts, scrapes and rashes is kept clean and covered. The people most at risk for staph infections include prison inmates, participants in competitive sports (especially contact

sports like football and wrestling), injection drug users, homosexual men and people in close contact with patients who acquire staph infections. Most staph infections can be treated by washing the skin with anti-bacterial cleanser, applying antibiotic ointments as prescribed by a doctor, and covering the skin with a clean dressing. To prevent the spread of the infection, use a towel only once when you clean an infected area. For more serious infections, a doctor may prescribe an antibiotic. It is recommended that you contact a doctor whenever a child has an area of redness, irritated or painful skin, especially if whitish pus-filled areas are visible and the child has a fever or is acting sick. It also is a good idea to contact a doctor if the infection seems to be spreading from one family member to another or if two or more family members have skin infections at the same time. According to a report in the New England Journal of Medicine, the overall rate of staph infections has been increasing for several years, and some strains are becoming difficult to treat and are resistant to drugs. Taking the necessary precautions to prevent the spread of staph and using appropriate methods to treat it remain the best first line of defense. ❊ Sources: Arkansas Democrat-Gazette, Arkansas Department of Health and Human Services, KidsHealth.com and the New England Journal of Medicine

Chickenpox, continued from Page 12 sick feeling before the rash appears. Younger children often have milder symptoms and fewer blisters than older children or adults. Chickenpox usually is a mild illness, but some groups of people are more likely to have a more severe illness that could lead to complications. These include infants, adolescents, adults and people with weak immune systems from either illnesses or from medications such as long-term steroid use. Healthy children who have had chickenpox do not need the vaccine because they usually have lifelong protection against the illness. A virus causes chickenpox, so your child’s doctor won’t prescribe antibiotics (which are for bacterial infections). However,

your child may require antibiotics if the sores become infected by bacteria, a common complication. Most home treatment is aimed at relieving the annoying itch of chickenpox and the accompanying fever and discomfort. However, NEVER use aspirin to reduce pain or fever in children with chickenpox or certain other viral illnesses. Using aspirin in such cases has been associated with a serious disease, called Reye’s syndrome, which can lead to liver failure and even death. Call your child’s doctor if you’re uncertain about whether your child’s problem is chickenpox, if you have a question or if you’re concerned about a possible complication. ❊ Source: MedlinePlus

Blue & You Winter 2005

Can a sexually transmitted disease cause

cervical cancer? T

he answer is yes. Human papillomaviruses (HPV), a group of more than 100 types of viruses, now are recognized as the major cause of cervical cancer. It also is one of the most common causes of sexually transmitted infections in the world. According to the American Social Health Association, approximately 5.5 million new cases of sexually transmitted HPV infections are reported each year. Some types of HPV cause genital warts. Some types of HPVs are referred to as “low-risk” viruses because they rarely develop into cancer. HPVs that are more likely to lead to the development of cancer are referred to as “high-risk.” Both high-risk and low-risk types of HPVs can cause the growth of

abnormal cells, but generally only the high-risk types of HPVs may lead to cancer. However, most HPV infections do not progress to cervical cancer. An abnormal pap smear may indicate the possible presence of cervical HPV infection. HPV has no known cure. The only way to prevent getting an HPV infection is to avoid direct contact with the virus, which is transmitted by skin-to-skin contact. Having many sexual partners is a risk factor for HPV infection. According to the American Cancer Society, nearly 4,000 women will die from cervical cancer this year, and thousands more will undergo invasive surgeries and other treatment options. According to the drug manufacturer Merck & Co., they have developed a new vaccine that would guard against four types of HPV (which are the four most common causes of pre-cancerous conditions in the cervix). It’s important to note that this vaccine has not been approved by the U.S. Food and Drug Administration.

❊ Sources: National Cancer Institute, National Institute of Allergy and Infectious Diseases, Reuters Health and American Cancer Society

Rabies rare in 2005 I

n the early 1980s, author Stephen King put rabies in the public eye with his unsettling fictional story of “Cujo,” the family dog transformed into a terrifying, slobbering monster as a result of a bite from a “rabid” bat. And, in reality, rabies can be a scary disease. It is a viral disease usually transmitted through the bite of an infected or “rabid” animal. The majority of rabies cases reported to the Centers for Disease Control and Prevention (CDC) each year occur in wild animals like raccoons, skunks, bats and foxes. Domestic animals account for less than 10 percent of the reported rabies cases, with cats, cattle and dogs most often reported rabid. Rabies virus infects the central nervous system, causing encephalopathy and ultimately death. Early symptoms of rabies usually are not cause for alarm as they consist of fever, headache and general malaise. As the disease progresses, other symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation, difficulty swallowing and hydrophobia (fear of water). Death usually occurs within days of the onset of symptoms. In September 2005, a young boy from Mississippi died from a confirmed diagnosis of rabies. The source of the infection is unknown; however, bats are the only known source of rabies in Mississippi.

This is the ﬁrst report of a human rabies case in the United States in 2005. It is an extremely rare disease. Although this is a rare disease, people should avoid contact with wild or stray animals. One of the most effective methods to decrease the chances for infection involves thorough washing of the wound with soap and water. Medical assistance should be obtained as soon as possible after exposure (usually an animal bite). There have been no vaccine failures in the United States (i.e., someone developed rabies) when postexposure prophylaxis (PEP) was given promptly and appropriately after an exposure. In the United States, PEP consists of a regimen of one dose of immune globulin and ﬁve doses of rabies vaccine over a 28-day period. Mild, local reactions to the rabies vaccine, such as pain, redness, swelling or itching at the injection site, have been reported.

❊ Source: Centers for Disease Control and Prevention

Blue & You Winter 2005

Overuse of diagnostic imaging causes concern as radiation exposure increases for patients The risks of “false positives”

hile the benefits of high-tech radiology services — such as CT (computed tomography) scans — are well known when it comes to diagnosing diseases and trauma, the benefits are not without risks. Scientific studies leave little doubt that radiation commonly used in medical treatment poses a risk of cancer or other health concerns, according to research by the National Academy of Sciences.

The risks of radiation exposure

The effects of radiation are thought to be cumulative. According to the United States Nuclear Regulatory Agency, any increase in dose is assumed to result in increased risk. The higher the dose, the sooner the effects will appear, and the higher the risk of morbidity or incidence of disease. To put it all in perspective — if you are walking around an urban environment, you are being exposed to natural radiation. The amount of that exposure would depend on the size of the city, but almost everyone is being exposed at some level. In terms of radiation exposure, one chest X-ray would be the equivalent of walking around the city for three days (on average). The following chart from the National Radiation Protection Board (UK) should help you understand the doses from medical imaging compared to natural radiation: Imaging Study

Number of Chest X-rays

Equivalent Natural Radiation Exposure

Chest X-Ray Head CT Chest/Abdomen CT Heart (Nuclear Scan)

1 100 400 900

3 days 1 year 4 years 9 years

According to 2002 data from the National Institutes of Health, approximately two to three million CT examinations were performed on children, and children are at an especially high risk from radiation exposure. According to a study published in the American Journal of Roentgenology, the estimated lifetime cancer mortality risk attributable to the radiation exposure from an abdominal CT in a 1-year-old child is 0.18 percent (almost two per thousand). And, each year in the United States, approximately 600,000 CTs are performed on children less than 15 years of age. A rough estimate is that 500 of them will ultimately die from cancer attributable to that radiation exposure. (Adults are at considerably less risk from such exposure, but substantial concern remains.)

Blue & You Winter 2005

In addition to the concern about radiation exposure is the risk of chasing a “false positive” or a problem that doesn’t really exist. Here is a possible scenario to explain what “chasing a false positive” might involve. You visit your doctor for a pain in your side of unknown cause. After your physician reviews your medical history and takes into account your age, physical health and other factors — he’s not sure about the cause of the pain either. He decides to take an X-ray in his office. After reviewing the X-ray, he may see a small shadow or blip on the X-ray, but nothing definitive. If your physician is conservative, he may decide at this point that the risks of radiation exposure outweigh the possible benefits and may choose a conservative course, perhaps waiting three months to take another X-ray. He’s seen hundreds of these films, and he really suspects it is nothing but a shadow or remnants of an old scar. On the other hand, he may choose the more aggressive approach of ordering a CT scan. You have the CT scan, and the radiologist who reviews it also finds nothing definitive. His final report is “iffy,” and he notes a “questionable area, can’t be certain of the cause.” He recommends a follow-up CT or a biopsy. So what does the physician do? He feels compelled to order another CT, or he now refers you to a surgeon for an invasive procedure (such as a biopsy). And very possibly there is nothing wrong with you. You have taken time off work, you are stressed and worried, the cost continues to rise and all because the physician involved may be chasing a “false positive” from an advanced imaging test. This is a consequence of the overuse of high-tech imaging technologies, which may find images of questionable significance … high cost, loss of wages, stress and, eventually perhaps an invasive procedure. The risks may outweigh the possible benefits at this point. It is likely that the continued tests and procedures could result in a new health problem for you (something resulting from the tests and procedures) when you really didn’t have a problem at the beginning of this entire process.

The proliferation and cost of high-tech radiology services Besides being a health risk, high-tech radiology services also are very expensive. The government and private insurers have no choice but to take action to stem the staggering increase in the cost of diagnostic imaging due to increased use. According to IMV, a medical marketing research and consulting ﬁrm, there were 45.4 million CT procedures performed in 2002 compared to 39.6 million in

2001. Additionally, there was a 58 percent increase in the number of PET scans performed from 2002 to 2003. Many health insurance plans now pay more for imaging services than they pay for primary-care physician services. On a yearly basis, the use of diagnostic imaging is increasing at a rate of 19 percent per year. Scans are very costly: an MRI (magnetic resonance imaging) generally costs between $700 and $1,000; PET (positron emission tomography) scans cost between $1,800 and $2,000; and CT scans can cost from $300 to $500. Although patients may pay a small copayment, and their insurance company may pay the balance, the end result of the steep price tag could be higher premiums or higher copayments for you, the patient.

Why the increase in scanning? Between 1993 and 1999, there was an increase of 29.9 percent in the use of medical diagnostic imaging for Medicare beneficiaries. However, Medicare beneficiaries are not the only group seeing an increase in the use of scanning. Reasons for the increase in use are varied, but it could be attributed to the following: 1. Self-referral among non-radiologists who may operate their own in-office imaging equipment (and benefit financially from ordering tests). 2. Need to repeat exams due to poor-quality images. 3. Lack of familiarity of physicians with the complexities of ordering imaging. 4. Use of imaging in place of time-consuming history-taking and physical examination. 5. Constant threat of lawsuits. 6. Patient expectations. 7. Public infatuation with “high-tech” and its availability. From its own experience, National Imaging Associates, Inc. (NIA), a company that assists companies in evaluating the proper use of such tests, estimates that about one-third of advanced imaging tests are either inappropriate for the medical problem at hand or do not contribute to a doctor’s diagnosis or a patient’s outcome.

Benefits versus Risks As the understanding of radiation has increased, so has the concern for public safety. The use of medical imaging generally has been thought to have a positive risk/benefit ratio (in other words, the benefits outweigh the risks). However, the concern is not for one or two CT scans, but the fact that during a lifetime, many individuals will have multiple CT scans, resulting in significant radiation exposure. Radiologists always have been aware of the need to keep

radiation exposure to a minimum. However, a study in Radiology, published earlier this year by The Radiological Society of North America, indicated that when it comes to CT exposure, many radiologists and referring physicians are unaware of the radiation dose delivered during a CT scan and its possible risks. Of course, most diagnostic imaging is appropriate, and vigilant physicians will order scans if the beneﬁts outweigh the risks. However, patient demand for the newest technology, changing practice patterns of physicians who are increasingly dependent on laboratory and imaging tests results, and duplicate imaging all result in an increase in scanning. To reduce radiation exposure, it is important to educate the public and healthcare providers regarding radiation exposure. By practicing utilization management, a health plan can reduce costs and decrease radiation exposure for its members. According to researchers writing for The British Journal of Radiology in 2002, all CT scans should be clinically appropriate. They suggest that those ordering medical radiation imaging ask themselves the following questions: Will the information gained help the patient? Is the scan medically necessary? Is there an alternative imaging procedure? In other words, all scans should be problem-directed, not just a “ﬁshing expedition.”

What does this mean to you? 1. You should be aware that X-ray, CT and PET scans do involve some potential radiation risk. 2. Multiple exposures increase the risk. 3. Discuss all diagnostic imaging with your physician. 4. Diagnostic imaging tests “just to see how things are going” are unnecessary. You and your physician always must consider the effect of radiation when contemplating your treatment options.

Making the right decision Since any radiation exposure carries some risk, it is necessary to decide whether the beneﬁts of radiation justify its use. Before receiving X-rays or any other type of medical treatment involving radiation exposure or dose, it is sensible to discuss the need for and beneﬁts of the procedure and its alternatives with your physician.

❊ Sources: The British Journal of Radiology (UK), Radiology, U.S. Food and Drug Administration, AHIP Coverage, National Imaging Associates, U.S. Environmental Protection Agency, National Academy of Sciences, IMV, and CNN.com

Blue & You Winter 2005

Coming Soon Prior authorization required for high-tech outpatient radiology services

ost Arkansans are very aware of the rising cost of health care. The National Manufacturing Association has concluded that America’s standard of living will decrease in the coming years due to the transfer of jobs overseas. One major reason for this job loss is the cost of health care borne by American employees. Arkansans might not be aware that the fasted growing area of health care is medical imaging (radiological tests such as CT, PET, MRI, MRA and nuclear cardiology scans). Arkansas Blue Cross and Blue Shield currently pays approximately the same amount in claims for imaging as for prescription medications, and imaging costs are increasing at a much faster rate. In 2005, our members will receive one CT or MRI for every three people. In addition to the increased ﬁnancial burden this places on those paying health insurance premiums, the rapid acceleration in radiological imaging is exposing patients to worrisome doses of radiation. For example, each CT of the head delivers the radiation equivalent of 100 chest X-rays. For these reasons, Arkansas Blue Cross and Health Advantage have entered into an agreement with National Imaging Associates, Inc., (NIA) for outpatient imaging management services. Beginning Feb. 1, 2006, physicians who order high-tech outpatient radiology services, including PET, CT, MRI/MRA (magnetic resonance angiography) or nuclear cardiology, on an outpatient basis for any Arkansas Blue Cross or Health Advantage individual or group member (except Medi-Pak members) will have to obtain prior authorization (approval) before the service can be performed. BlueAdvantage Administrators of Arkansas groups can elect to add this service on a group-by-group basis, which would be indicated on the member’s ID card. These services will not apply to members of the Federal Employee Program (FEP) at this time. Prior approval will not be required for emergency, observation department of a hospital or inpatient services. It will be your physician’s responsibility to obtain prior authorization. Members (patients) are not required to gain prior authorization and will not be held liable for costs associated with

Blue & You Winter 2005

unapproved radiology services if a participating provider renders the service. The entire prior authorization process should take only a few minutes, so members will not have to wait for necessary radiology services. “Arkansas Blue Cross and Health Advantage are working to save our customers’ money in an era of exploding costs,” said Pete Marvin, M.D., associate medical director for Arkansas Blue Cross. “Additionally, there are risks and health concerns associated with the overuse of diagnostic imaging, and we want to educate our members and their families about the dangers involved with cumulative exposure. Our intent is to protect our members, not to inhibit beneficial testing. And, in this day and age, there’s no shame in saving everyone’s money.” What criteria will NIA use to approve or deny a prior authorization request from a physician? 1. American College of Radiology “Appropriateness Guidelines.” 2. Specialty society guidelines and diagnostic algorithms. 3. Literature reviews specific to a given test for a given condition or symptom. 4. Arkansas Blue Cross, Health Advantage or BlueAdvantage (if applicable) coverage policies. More information on the prior authorization program was distributed to physicians in early December. Now is the time to educate yourself on the benefits and risks of high-tech radiology services. As an informed consumer, you will know what to expect from these services and can participate with your doctor in making the right decision for you. ❊ Special Notice: You always should try to use an in-network provider when receiving one of these diagnostic imaging services. In the event that you use an out-of-network provider, this provider can “balance bill” you for the difference between billed and allowed charges, which could result in thousands of dollars in additional expense to you, the member.

BLUEINFO My Blueprint

www.ArkansasBlueCross.com • www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com

It’s easy to register to use My Blueprint, the online customer self-service center for Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas members. Visit our Web sites to use My Blueprint. Members can enter their health plan ID number, name, date of birth and Social Security number (SSN). If we have your SSN on ﬁle in our membership system, we can authenticate you and let you choose your own log-in ID and password. You will be able to access health tools immediately. You will receive an activation code via the U.S. Postal Service that will allow access to your personal data, such as medical and pharmacy claims. Remember that any covered person, not just the policyholder or group employee, can register. The Arkansas Blue Cross family of companies is trying to make our Web sites more user friendly while continuing to protect the privacy of your personal health information.

❊

My BlueLine 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, Health Advantage or BlueAdvantage, you can get answers to your claims or beneﬁts questions anytime, day or night. Call the telephone number on your ID card, or refer to Page 3 for Customer Service telephone numbers. 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 and select My BlueLine, it will prompt you with a question, and all you have to do is simply respond to the question. 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 you prefer, you immediately may choose the option of speaking to a customer service representative (during regular business hours).

❊

HealthConnect Blue HealthConnect Blue is a complimentary, conﬁdential health information service that puts members in touch with Health Coaches by telephone or e-mail and offers health information online to help members make more informed decisions about their health care. Currently all Health Advantage members and eligible Arkansas Blue Cross and Blue Shield members* have access to HealthConnect Blue. Members can call a toll-free telephone number (1-800-318-2384) to speak with a Health Coach to get the support and health information they need 24 hours a day, 7 days a week. Health Coaches are specially trained health professionals such as nurses, respiratory therapists and dietitians. Members may call as often as they like at no cost. A Health Coach can offer information and support to help members work with their doctors to make conﬁdent health decisions that are right for them. Members also can access free health information online by using the HealthConnect Blue link at www.HealthAdvantage-hmo.com or at www.ArkansasBlueCross.com. ❊ * Includes all Health Advantage HMO members, all public school employees and state employees covered by Arkansas Blue Cross or Health Advantage.

BLUEINFO Blue & You Winter 2005

Medicare prescription drug coverage B

eginning Jan. 1, 2006, thousands of Arkansas Medicare beneﬁciaries will have prescription drug coverage through Arkansas Blue Cross and Blue Shield. This drug coverage (Medicare Part D) is available only through private companies, and Medi-Pak Rx is the Arkansas Blue Cross, Medicare-approved plan. “Interest in our Medicare prescription drug program — MediPak Rx — has been extremely high,” said Ron DeBerry, vice president of Statewide Business at Arkansas Blue Cross. “As we expected, enrollment in Medi-Pak Rx is going smoothly. We have been traveling throughout Arkansas educating Medicare recipients about Medicare Part D, and we are pleased that many people are enrolling with Arkansas Blue Cross for their Medicare prescription drug coverage.” The initial enrollment period for individuals who are entitled to Medicare Part A or enrolled in Medicare Part B on or before Jan. 1, 2006, continues through May 15, 2006. So, it’s not too late to enroll in Medi-Pak Rx. If you enroll after May 15, 2006, the government will charge you a penalty unless you can show that you had creditable coverage under another drug plan. Creditable coverage is deﬁned as coverage that is, on average, at least as good as Medicare’s Prescription Drug Insurance. The penalty for late enrollment is approximately one percent of your premium for each month you delay, and you’ll pay it for as long as you stay in a Medicare prescription drug plan. Individuals who will become eligible for Medicare on or after Feb. 1, 2006, may enroll in a Medicare Part D prescription drug plan, such as Medi-Pak Rx, during the seven-month period surrounding Medicare eligibility. This period begins three months before the month an individual meets the eligibility requirements (for most people, this is when you turn age 65) and ends three months after the month of eligibility. As with all insurance plans, Medi-Pak Rx has a monthly premium. The monthly premium you pay depends on which of the three Medi-Pak Rx plans you choose. The premium for Medi-Pak Rx may be paid one of two ways: 1) By deducting the premium amount from your Social Security check (just as you do with **30-day supply

Blue & You Winter 2005

your Medicare Part B premium) or 2) Through a bank draft (automatic deduction from your checking or savings account). It’s important for Medi-Pak members to know that a Medicareapproved drug discount card is not the same as Medicare Part D. These discount cards served as a forerunner to the Medicare Part D program. If you currently have a drug discount card, please note that the Medicare drug discount card program will end May 15, 2006, or when your Part D coverage becomes effective, whichever comes ﬁrst. To be eligible for Medi-Pak Rx coverage, you must: • Be entitled to Medicare Part A or enrolled in Part B; • Reside in Arkansas.

Why should I enroll in Medi-Pak Rx? Prescription drugs are expensive. Even if you don’t take a lot of medications now, you shouldn’t have to worry about the cost if your health changes and you need them later. If you do take a lot of prescriptions, you should never have to skip a dose or a reﬁll to reduce your costs. Medi-Pak Rx offers a better way to help with prescription drug costs.

The Arkansas Blue Cross Medi-Pak Rx Plans Arkansas Blue Cross is offering three prescription drug plans: Medi-Pak Rx Basic, Classic and Premier. Medi-Pak Rx prescription drug plans work in the same way that other insurance plans work. After you have joined a plan, and your coverage is in effect, you will pay a portion of the prescription drug cost, and the plan will pay the rest. All Medi-Pak Rx insurance plans cover both brand-name and generic drugs. The chart below explains what your out-of-pocket costs will be based on the plan you choose.

Medi-Pak Rx Beneﬁts

begins Jan. 1, 2006 Getting your prescriptions filled with a Medi-Pak Rx insurance plan is simple. You will receive a Medi-Pak Rx insurance card. Just present your card when you have a prescription filled at any of our network pharmacies. Medi-Pak Rx members must use network pharmacies to receive plan benefits, except in emergency circumstances. In addition, mail-order prescription drug services are available. You can have your prescription filled by our network mail-order pharmacy, and your prescription will be delivered to your home.

Lowincome Medicare beneﬁciaries who are eligible for these special beneﬁts will be contacted by the Social Security Administration (SSA). If you think you qualify but have not been contacted by SSA, you may want to give them a call at 1-800-772-1213.

Questions? If you would like to receive a Medi-Pak Rx enrollment kit, please call 1-800-840-6424 toll free. The kit has everything you need to

Low-Income Benefit Medicare beneficiaries with limited savings and low incomes will receive a more generous benefit package with special provisions.

Medi-Pak Rx, continued on Page 22

Questions-and-answers about Medi-Pak Rx Q. Is Medi-Pak Rx included with Medi-Pak Medicare supplement insurance policies? A. No. Medi-Pak Rx prescription drug insurance plans are separate from our Medi-Pak Medicare supplement insurance policies. Both are backed by the strength and stability of Arkansas Blue Cross and Blue Shield, an Arkansas company you know and trust. For many, the Medi-Pak name equals savings, security and value. The same will be true of our MediPak Rx prescription drug insurance plans. Q. Are prescription drug insurance plans all the same? A. Not at all. While the government requires the plans to meet certain criteria, plans from different insurers and companies will vary in coverage, costs, drug lists (formularies), participating network pharmacies and service. Therefore, it’s important for you to carefully review the plans you’re interested in to make sure they meet your needs. Q. What is a formulary? A. A formulary is a list of prescription drugs covered by insurance. Q. What if I don’t see my prescription drugs on the formulary? A. The formulary is available on our Web site: www.ArkansasBlueCross.com. You can search the online formulary for your drugs and print a copy from your computer. You also will be able to view information on how to obtain an exception to the plan’s formulary or cost sharing, if needed. We also encourage you to talk to your physician about your prescriptions to see if there are any appropriate alternatives

that are included on the drug lists. Q. Will I benefit from Medi-Pak Rx even when I’m paying 100 percent of my prescription costs? A. Absolutely. When you give an in-network pharmacist your Medi-Pak Rx card, you are guaranteed to receive our negotiated discount price. Q. What if I am traveling out of state and need to fill or refill a prescription? A. Medi-Pak Rx has a large national network. To find the nearest participating pharmacy, call the toll-free telephone number on the back of your ID card, or go to our Web site at www. ArkansasBlueCross.com. Q. Can I still use my prescription drug discount card? A. Beginning May 15, 2006, the Medicare prescription drug discount card program will end. If you are interested in continuing to save on your prescription drugs, you will need to join a Medicare-approved prescription drug insurance plan, such as Medi-Pak Rx. If you join a prescription drug plan before May 15, 2006, your prescription drug discount card will expire on the date your new prescription insurance begins. Q. What if I change my mind after I join? A. If, after this initial enrollment period ends on May 15, 2006, you find a Medicare prescription drug plan that better meets your needs, you can switch plans during the next enrollment period. Enrollees will have the option to switch plans once a year, between November 15 and December 31, beginning in 2006. ❊

Blue & You Winter 2005

Ask the Pharmacist I

Flu worries? — Get a shot

nfluenza or “the flu” is a severe, viral illness affecting the respiratory tract of infected persons. There are three types of influenza: Types A, B and C. Types A and B are the more serious types and are covered in the influenza vaccine. The flu is passed from person to person through the respiratory tract (for example, coughing, kissing, drinking after someone who is ill, etc.) Once a person has been infected with the virus, its takes from one to five days for the symptoms to begin. These symptoms include: non-productive cough, fever, sore throat, runny or stuffy nose, headache and body aches. Most symptoms will improve in a few days, but the weakness may linger for up to two weeks. In addition, the flu can make you more vulnerable to bacterial and viral pneumonia. Each year, more than 20,000 lives are lost to influenza and pneumonia. Those at greatest risk for death include children, the elderly and persons with chronic illness. What can you do to avoid this potentially deadly illness? Get immunized! You can significantly reduce your risk of contracting influenza by taking a flu shot each

You can significantly reduce your risk of contracting influenza by taking a flu shot each year.

year. Many people avoid the influenza vaccination because of fear or misinformation. The shots are virtually painless and will protect you against influenza for six months. The most frequent side effect is mild redness and soreness at the injection site. Many people fear that an influenza vaccination will give them “the flu.” That is not true. The likelihood of body aches or fever after a flu vaccination is no more likely than if the person had been given a placebo. The influenza vaccination is safe, effective and virtually painless. Why take a chance? Protect yourself. Get immunized. ❊ — Lyn Fruchey, PharmD Freiderica Pharmacy, Little Rock, Arkansas

Medi-Pak Rx, continued from Page 21 know about Medi-Pak Rx and includes an abridged formulary (drug list) and a list of participating pharmacies. If you have a question concerning MediPak Rx, please call 1-800-960-6434 toll free. You also can visit our Web site at www.ArkansasBlueCross.com for more information. ❊

Blue & You Winter 2005

Arkansas Blue Cross named to InformationWeek Top 500 users of business technology I

nformation technologies supporting the emerging consumerdirected health market and secure electronic health records are two disciplines that helped Arkansas Blue Cross and Blue Shield make the 2005 InformationWeek 500, the 17th annual ranking of leading users of business technology. Each year, InformationWeek 500 provides insight into the businesstechnology practices of the nation’s most innovative users of information technology. Twenty-one industries and thousands of large U.S. companies submit applications. “Being named to the InformationWeek 500 list is a great acknowledgment of the ﬁne work that so many of our employees do on a daily basis to improve the operational relationships that support our members and business partners,” said Joseph S. Smith, vice president of Private Programs and chief information ofﬁcer. Smith said that the application was quite comprehensive, but that two technologies surfaced as particularly innovative: • Wireless Innovation for the development of an Electronic Health Record (EHR). A “wireless” EHR allows physicians to access their patients’ charts on a small laptop computer while in the exam room with a patient, or from anywhere in the clinic setting.

• Emerging Technologies for the continuing development of an Integrated Settlement application for the consumerdirected health market. To bridge the gap between health-care financing and financial services industries, Arkansas Blue Cross is designing a system to help people manage new financial accountabilities associated with of Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs) and Flexible Spending Accounts (FSAs). This will help members facilitate their member liability payment, and members also will receive a consolidated Explanation of Benefits (EOB). Other Arkansas companies that made the list include Acxiom Corporation, Alltel Corporation and the University of Arkansas for Medical Sciences. Capital One Financial Corp., Coca Cola, Eastman Kodak Company, Eli Lilly and Company, FedEx Corp., J.C. Penney, Land’s End Inc., General Motors Corp., Vanguard, and Verizon Communications and Wireless were among the U.S. companies listed. InformationWeek is the largest, most influential community of IT buyers and sellers focusing on, driving and setting the agenda for business innovation powered by ❊ technology.

A.M. Best upgrades rating of Arkansas Blue Cross

.M. Best Co. has upgraded the financial strength rating of Arkansas Blue Cross and Blue Shield to A (Excellent) from A- (Excellent). The rating outlook is stable. The Arkansas Blue Cross rating is based on continued favorable earnings over the past five years. According to A.M. Best, the primary drivers of the organization’s earnings trend are its significant market operations that are supported by a large membership base that is well ahead of the competition, as well as almost complete participation by provider networks within Arkansas. In addition, Arkansas Blue Cross exhibits a highly efficient administrative infrastructure, and reliable underwriting helps to ensure favorable operating margins, while maintaining a very strong capitalization that has grown in the past five years. Also, Arkansas Blue Cross has embarked on a definitive business diversification strategy that is expected to strongly influence and add cohesiveness among mutual and not-forprofit Blue Plans in the southern region of the United States after bringing renewed focus and innovation to a broad suite of traditional ancillary products. This evolving business profile is

expected to lower operating costs, help in alleviating geographic concentration risk and broaden Arkansas Blue Cross’ reach within the region, while establishing a national presence for non-branded products, according to A.M. Best. A decision to limit premium pricing inﬂation as a means of managing proﬁt margins and the resulting growth in risk-based capital will require some product re-engineering. Arkansas Blue Cross’ investment performance, though favorable, has delivered declining yields, even as average maturities have decreased. A.M. Best believes that Arkansas Blue Cross is in an optimal position to make the necessary changes to strengthen its operations and to promote itself as a regional player in the life/health insurance marketplace. A.M. Best also believes that innovation, which is the basis of strategic planning initiatives, must be prevalent in the execution phase over the next few years in order to reduce the likelihood of a regional competitor gaining market share. A.M. Best Co., established in 1899, is the world’s oldest and most authoritative insurance rating and information source. ❊

Blue & You Winter 2005

Pinnacle Business Solutions, Inc. forms to administer Public Programs for Arkansas Blue Cross

rkansas Blue Cross and Blue Shield has formed a separate corporation, Pinnacle Business Solutions, Inc. (PBSI) to administer its Public Programs operations that support Medicarerelated contracts, according to Sharon Allen, president and chief operating officer of Arkansas Blue Cross. The new corporation began using its new name on October 1. “On July 1, 1966, Arkansas Blue Cross began its administration of the Medicare Part A and Part B Programs in Arkansas and since then, the company’s Medicare business has grown tremendously,” said Allen. “Since day one, Arkansas Blue Cross has given priority attention to the administration of the Medicare program and the opportunity to reach out and provide services to the Medicare beneficiaries of our State … and beyond our borders.” Medicare beneficiaries, providers, and partners currently being served by Arkansas Blue Cross were notified of the formation of the corporation and new name. There was no interruption of service through the transition. The Pinnacle Business Solutions, Inc. logo now appears on all buildings housing Public Programs in Arkansas, Louisiana, Oklahoma, Missouri, New Mexico, Rhode Island and Florida. “When Arkansas Blue Cross began administering Medicare in 1966, there were approximately 45 employees who processed claims manually,” said Dennis Robertson, president and chief executive officer of Pinnacle. “Now, at Pinnacle Business Solutions, Inc., there will be more than 1,560 employees and contractors in nine states who will work with Medicare, effectively processing

more than 56 million claims for Parts A and B (paying out more than $6.2 billion in beneﬁts) for more than 2.6 million beneﬁciaries each year, handling the new Medicare Support Call Center inquiries regarding Medicare Part D, maintaining the Fiscal Intermediary Standard System (FISS), running the Arkansas Data Center, and administering the Retiree Drug Program.” The Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), has chosen Arkansas Blue Cross to administer Part A and Part B claims in additional states in the past 39 years. Arkansas Blue Cross has administered the Medicare Part A and B Programs in Arkansas since 1966; Louisiana Medicare Part B since 1985; Oklahoma/New Mexico Medicare Part B since 1997; Missouri Medicare Part B since 1999; and Rhode Island Medicare Parts A and B since 2004. Pinnacle Business Solutions, Inc. now will administer those contracts and will continue to serve as a Medicare Part A and B data center providing support services for contractors who process Medicare Part A claims for Alabama, Alaska, Maine, Maryland/ Washington, D.C., Massachusetts, Mississippi, New Hampshire, North Carolina, and Washington in addition to its own Arkansas and Rhode Island Part A and Arkansas and Louisiana Part B claims. In addition, Pinnacle Business Solutions, Inc. will continue to serve as the Medicare Part A maintenance contractor for FISS, which CMS awarded to Arkansas Blue Cross in 2002. ❊

The Healthy Weigh! Education Program

re you ready to make a change in your weight? Arkansas Blue Cross and Blue Shield can help! Arkansas Blue Cross offers a Health Education Program called The Healthy Weigh! If you are an Arkansas Blue Cross and Blue Shield, Health Advantage or BlueAdvantage Administrators of Arkansas member, you are eligible to participate in The Healthy Weigh! Education Program. The program is free to those who complete the enrollment form (to the right) and return it in the self-addressed postage-paid envelope included near Page 8 in this magazine. The information available through this program is based on the guidelines set forth by the National Institute of Health Obesity Education Initiative. As a participant in this program, you will

Blue & You Winter 2005

receive educational information in the mail including tips, a BMI chart, a list of wellness discounts that are available to you as an Arkansas Blue Cross, Health Advantage or BlueAdvantage member and much more. The program starts when you enroll. To enroll, simply complete, sign and return The Healthy Weigh! Enrollment form (to the right) in the self-addressed postage-paid envelope inserted in Blue & You near Page 8. You will begin to receive information through the mail, which you can read and use in the privacy of your own home, and at your own pace. The program is completely voluntary, and you may leave the program at any time. If you have further questions about the program, call the Health Education Program’s toll-free telephone number at 1-800-686-2609. ❊

BlueSecure long-term care insurance helps prepare for the unexpected

n a continuing effort to better meet the needs of Arkansans, Arkansas Blue Cross and Blue Shield now offers BlueSecure, an affordable, long-term care (LTC) insurance policy that can help policyholders protect their assets by helping them plan for long-term care when they need it. Long-term care includes in-home care, assisted living and nursing home care, Alzheimer’s facility or hospice. Accidents and catastrophic illness are unpredictable and may strike anyone at any time of life. The longer you live, the greater the chance is that you will need long-term care. Most people are familiar with health insurance that pays doctor and hospital bills, but they may not be aware of LTC insurance. Long-term care insurance can help defray the costs of the help needed when a prolonged illness or mental incapacity makes it hard to bathe and dress, take medicine properly, or perform other normal daily living activities.

Premiums for long-term care insurance are based on a person’s age at enrollment: the younger he/she is when enrolling, the lower his/her premiums will be throughout the life of the policy. BlueSecure includes optional riders that allow individuals to customize a plan that best meets their needs. Unique to BlueSecure are five choices of inflation protection riders. A 25 percent discount on annual premiums is available to couples that apply for coverage at the same time, even if one partner is turned down for coverage. Many people associate long-term care with nursing homes, but the majority of such care is actually delivered in assisted-living facilities or in the home. Medical insurance, disability income insurance, retirement health insurance, VA plans or Medicare supplements usually do not cover these costs. BlueSecure covers an array of long-term care choices and helps to protect financial assets from being eliminated. For more information regarding BlueSecure, call Arkansas Blue Cross toll free at 1-800-489-0463. ❊

Is your company up to the Challenge? Get a free kit!

ow’s the time for companies, organizations and groups of all kinds to consider participating in the 2006 Arkansas Fitness Challenge. The Arkansas Fitness Challenge is a contest during which employees from opposing teams participate in eligible exercises (cardiovascular focused) for a three-month time period. The 2006 Challenge will be held March 1 – May 31, and we have just the tool to help you get started. Whether your group wants to find a foe and face off for fitness, or simply get fit amongst the allies, the Employee Fitness Contest Kit is available free for employers and group leaders who want to step up to the Challenge. The Kit is a comprehensive guide for planning, organizing and executing a fitness contest in your company, your community or your circle of comrades. Banks, hospitals, schools, churches, colleges and universities, government agencies, physician offices and clinics, and more got in on the action in 2005 with improved fitness as the goal … and the outcome. The Employee Fitness Contest Kit was developed following the first Challenge in 2004 between the employees of Arkansas Blue Cross and Blue Shield and the Arkansas Department of Health. The Kit was presented as a gift to the Honorable Mike Huckabee, governor of Arkansas, in support of the Healthy Arkansas initiative

and to Arkansas companies/organizations to encourage worksite wellness initiatives — all in an effort to improve the health of Arkansans. The goals of the Arkansas Fitness Challenge were to: • Increase physical activity among employees by: 1) Engaging non-exercising employees in consistent exercise in eligible categories for 30 minutes at least three times per week, and 2) Engaging already exercising employees to exercise in eligible categories 30 minutes daily. • Begin to reduce incidence of obesity among employees. • Encourage other employers and Arkansans to join in the effort. All the contest details are outlined in the Contest Kit. Not every tool in the Kit is expected (or even appropriate) to be used by all companies conducting an employee ﬁtness contest but is provided as an example of how a contest can be planned and executed. The Arkansas Fitness Challenge Employee Fitness Contest Kit may be viewed, copied or downloaded free by visiting any of the following Web sites: • www.ArkansasBlueCross.com • www.HealthAdvantage-hmo.com • www.BlueAdvantageArkansas.com Click on the “Employers” tab; then click on the Kit logo. A Contest Kit notebook and/or CD also can be obtained from any Arkansas Blue Cross regional ofﬁce or by calling 1-800-686-2609. ❊ Blue & You Winter 2005

Blue & You Foundation

awards more than $1.5 million in grants

he Blue & You Foundation for a Healthier Arkansas announced its fourth annual grant awards to 23 recipients in an amount totaling $1,554,453 for funding of 2006 programs that seek to improve the health of Arkansans: Arkansas Children’s Hospital Foundation, Little Rock ($149,974) — to support the “Community Focused School-based Obesity Prevention Program.” Arkansas Educational Television Network (AETN) Foundation, Conway ($107,510) — to enhance the monthly program “Fighting Fat” and to add “Fitness Witness” and “Crazy, Busy, Fit!” programs. Arkansas Delta Rural Development Network, Ozark Mountain Health, Clinton ($90,000) — to support the 2006 Fall and Spring Arkansas Institute, which will help leaders in 20 rural networks in the delta region of Arkansas.

Arkansas Foodbank Network, Inc., Little Rock ($43,450) — to establish a new “Kids Café” site in Pine Bluff, and expand operations in seven existing sites in central Pulaski County, which provide nutritious after-school snacks and meals to children participating in Boys and Girls Clubs. Arkansas Human Development Corporation, Little Rock ($84,957) — to support “Promotoras de Salud (Health Promoters) Project” a program that uses community “health promoters” to address health concerns for Hispanics/Latinos. Christian Health Center, Camden ($34,640) — to support the “Community Cares Prescription Drug Program,” which targets poverty-level patients for receiving prescribed medications at no cost directly from the pharmaceutical companies. Coalition for Healthy Children, Jonesboro ($61,409) — to support “Ready, Set, Go Camp,” a two-week summer camp for fourth- and ﬁfth-grade youth who are overweight or at risk for becoming overweight due to their sedentary lifestyles. Committee for Healthier Children (CHC)/Beebe Public Schools, Beebe ($61,206) — to support “Beebe & Blue,” a nine-month after-school program to focus on obesity among prekindergarten through ninth-grade children. Community Clinic at St. Francis House, Springdale ($98,760) — to support the “Prenatal Pathways Program,” which provides prenatal care for 1,500 low-income expectant women in Washington County. Conway County Christian Clinic, Morrilton ($44,000) — to support this free clinic’s services to Conway and Perry Blue & You Winter 2005

County residents who are uninsured and whose income is below 125 percent of the poverty level. Crowley’s Ridge Rural Health Coalition, Paragould ($84,400) — to expand the Medicine Assistance Program into Poinsett, Sharp and Fulton counties to help patients receive medications they otherwise could not afford. Daughters of Charity Services of Arkansas (DCS-Ark), Dumas ($43,212) — to support the “Pharmacy Assistance Program,” which targets low-income clients from the Delta region helping patients obtain low-cost or free medications and teaches them proper medication usage. Easter Seals Arkansas, Little Rock ($61,649) — to expand the Grand Prairie Child Health and Development Outreach Project, which targets critical needs of obese children in the Mississippi River Delta region of Arkansas. Elkins Public Schools (Elementary), Elkins ($48,000) — to support the “I CAN” (Integrated Change Activity and Nutrition) pilot program, an integrated curriculum involving children, family and school to improve the health, physical fitness and weight of children to address the growing obesity problem in youth. Good Samaritan Clinic, Fort Smith ($65,000) — to support “Coping with Hypertension and Diabetes Program,” which targets the needs of diabetic and hypertensive patients with education, and medical supplies and services to help manage their disease. Greater Texarkana Peoples’ Clinic, Inc., Texarkana ($150,000) — to support funding for GTPC medical staff, to provide free medical treatment, prevention and educational services to uninsured residents of Miller County, Arkansas, and Bowie County, Texas. Ozark Health Medical Center, Clinton ($68,292) — to support “Fit Families Program,” which is a comprehensive family obesity prevention and intervention program that has been shown to reduce the systematic risk factors of obesity. Parenting and Childbirth Education Services, Inc., Jonesboro ($44,200) — to support the “PACES Coming Alongside Program,” an interactive case management project for high-risk adolescent young women who are pregnant or parenting. Safe Jonesboro Coalition, Jonesboro ($25,974) — to sustain the “Get Alarmed! Program,” which partners volunteers and firefighters to install fire alarms or replace batteries at no cost to families.

Southeast Arkansas Health Foundation, Monticello ($16,789) — to support “Fit Kids, Healthy Kids Program,” which targets children in the Monticello School District, to provide affordable options for those who have been identiﬁed as overweight or at risk for overweight.

University of Arkansas Division of Agriculture Cooperative Extension, Little Rock ($88,482) — to expand the “Arkansas HOPE Project,” which is a classroom-based intervention in elementary schools that teaches nutrition and physical activity lessons in Northwest and Southwest Arkansas.

University of Arkansas for Medical Sciences (UAMS)/ Helping Schools Help Themselves, Little Rock ($34,466) — to support the “Helping Schools Help Themselves: Resources for Schools Program,” which will provide school guidelines for healthy eating, physical activity and obesity prevention required by state and federal legislation.

White River Rural Health Center, Inc., Augusta ($48,081) — to expand the “Medication Assistance Program” through the White River Rural Health Center, Inc. For more information, visit the foundation Web site at www.BlueAndYouFoundationArkansas.org.

❊

Medicare Support Call Center opens to aid Medicare Prescription Drug Plan Inquiries

rand-opening ceremonies were held Oct. 4, 2005, for the Pinnacle Business Solutions, Inc. (PBSI) Medicare Support Call Center at the facility near Little Rock National Airport (in the space formerly occupied by Southwest Airlines). Call Center employees are responding to Medicare beneficiary questions nationwide regarding the Medicare Prescription Drug Plan. The Call Center subcontracts through Pearson Government Solutions, which contracts directly with the Centers for Medicare and Medicaid Services (CMS). “We are thrilled with the opportunity to provide new jobs for hundreds of people, reopen a beautiful building that has been vacant for some time, and to be able to answer America’s questions regarding the new Medicare Prescription Drug Plan,” said Regina Favors, executive vice president and chief operating officer of Pinnacle, during grandopening ceremonies. “We are committed to helping Medicare beneficiaries understand this new program so that they make informed decisions about their prescription drug coverage.” “Our Call Center employees have been educated about the Medicare program overall and about the Medicare Prescription Drug Plan extensively,” said Toni Starks, Pinnacle’s Medicare Support Call Center director. “We have set the bar high so that our operations can be excellent in every way. We want to continue the tremendous reputation Arkansas Blue Cross and Blue Shield established when it began working with Public Programs operations that support Medicare-related contracts back in 1966.” Pinnacle is a wholly owned subsidiary of Arkansas Blue Cross. The Pinnacle Medicare Support Call Center will operate

Monday through Friday from 7 a.m. until 7 p.m. More than 650 Call Center representatives will staff the telephones to cover Medicare Prescription Drug Plan inquiries from beneficiaries who call 1-800-MEDICARE. Medicare Part A provides basic hospital insurance coverage automatically for most eligible persons. Medicare Part B is a voluntary program that provides benefits to cover the costs of physicians’ services. Medicare Part C is a specialized program for beneficiaries who prefer to receive their benefits through health maintenance organizations, preferred provider organizations, etc. Medicare Part D (Medicare Prescription Drug Plan) is the result of the passage of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, and is dependent upon private companies selling new Medicare prescription drug insurance policies. Effective Nov. 15, 2005, all beneficiaries eligible for Medicare Part A or enrolled in Medicare Part B became entitled to purchase a new Medicare Part D drug insurance policy. There is a limitedtime initial enrollment period for joining a prescription drug plan. For beneficiaries enrolled in Medicare, that time is from Nov. 15, 2005, to May 15, 2006. Beneficiaries who join after May 15, 2006, must pay a penalty unless they show proof of creditable coverage. A Medicare-approved discount card is not the same as Medicare Part D. The discount cards served as a forerunner to the Medicare Part D program. The Medicare drug discount program will end May 15, 2006. Read more about Arkansas Blue Cross’ Medi-Pak Rx on Page 20 and 21. ❊

Blue & You Winter 2005

Just being neighborly: Helping those affected by Hurricane Katrina

rkansas Blue Cross and Blue Shield had 240 reasons to want to help those affected by Hurricane Katrina — its employees in Baton Rouge, Louisiana, who administer Medicare Part B for all beneficiaries in Louisiana. “We feel a special connection to the people of Louisiana,” said Sharon Allen, president and chief operating officer of Arkansas Blue Cross. “We have 240 co-workers in Baton Rouge who were affected by this tragedy. Our business is about helping people in need, and when the people affected by Hurricane Katrina needed us, we were there.” To help those affected by Hurricane Katrina, Arkansas Blue Cross: 1. Donated $100,000 to the relief fund set up by the Blue Cross and Blue Shield Association (the fund has raised more than $4 million). 2. Donated $5,000 specifically to the Louisiana Chapter of the American Red Cross. 3. Coordinated efforts by the Human Resource areas of Arkansas Blue Cross (in Louisiana and all other locations) to collect monetary donations from its own employees for a special fund to help Baton Rouge employees who took in friends and relatives impacted by Hurricane Katrina. Funds collected were used to purchase food and provide other assistance based on individual needs. 4. Sponsored a “Casual Day” where employees donated $5 for Hurricane Katrina victims in exchange for the chance to wear jeans to work. 5. Held several fund-raising events at its Oklahoma Medicare Part B office in Oklahoma City to support the

Blue & You Winter 2005

Louisiana employees. Arkansas Blue Cross has administered Medicare Part A and Part B in Arkansas since the inception of the programs in 1966 and has been the Medicare Part B carrier for Louisiana since 1985, maintaining a Medicare claims processing and customer service ofﬁce in Baton Rouge.

“It was not a happy experience, but a lot of good has come out of it,” said Ann Fendick, manager of Human Resources in the Baton Rouge ofﬁce. “The upside of this terrible tragedy is that it brought people together. The support has been amazing. It’s a wonderful thing to work for a company that cares as much as Arkansas Blue Cross.” “Those affected by this terrible tragedy needed our help,” said Allen, “and they can depend on our employees to offer assistance — whenever and wherever it is needed.” Arkansas Blue Cross always has been a friend to charitable organizations throughout Arkansas. In addition to making corporate contributions to many charitable causes, Arkansas Blue Cross established in 2001 the Blue & You Foundation For A Healthier Arkansas, which awards grants in excess of $1 million annually to programs that promote better health in Arkansas. (See related article on Page 26.) ❊

Sherman Tate elected to Arkansas Blue Cross and Blue Shield Board of Directors

herman Tate, vice president of external affairs for Alltel Corporation in Little Rock, has been elected to the board of directors of Arkansas Blue Cross and Blue Shield. “Sherman Tate brings to the Arkansas Blue Cross board a wealth of experience in both organizational and community development from a business service perspective,” said Hayes McClerkin, chairman of the board. Tate joined Alltel in 1998 as vice president/general manager for operations for Central Arkansas. Prior to Alltel, Tate served as vice president for the Arkansas distribution operations at ARKLA. Tate had been a co-owner of Fletcher-Tate Ford in North Little Rock until the dealership was sold in 2002.

Tate remains in the automobile business as co-owner of First Choice Chevrolet, GMC, Pontiac and Buick in Hope. Active in the business community, Tate is president of the 100 Black Men of America/Greater Little Rock Chapter; past chairman of the board of trustees of Philander Smith College; is a board member of the University of Arkansas for Medical Sciences Reynolds Institute on Aging; and is a board member of the Southern Bank Development Corporation. Tate was the ﬁrst African-American elected chairman of the Greater Little Rock Chamber of Commerce. A native of Marvell, Tate is a distinguished alumnus of Philander Smith College, where he received a bachelor’s degree in psychology in 1970 and a doctorate of humane letters degree in 1988. ❊

Dr. Sybil Hampton makes Hall of Fame

r. Sybil Jordan Hampton, a member of the board of directors of Arkansas Blue Cross and Blue Shield since 1998, was inducted into the Arkansas Black Hall of Fame on Oct. 15, 2005. She was honored for her many years of contributions as an educator, civic leader and president of the Winthrop Rockefeller Foundation. She was one of the ﬁrst African-

American students to graduate from Little Rock Central High School and was the ﬁrst African-American Central graduate to have attended 10th, 11th and 12th grades at the school. She has been named to the Arkansas Business Top 100 Women in Arkansas several times, received the Earlham College Outstanding Alumni Award in 1998, was listed in Who’s Who Among Black Americans in 1980 and 1981 and was the recipient of the National Conference for Community and Justice Humanitarian Award in 2002. ❊

Ben Owens named Business Executive of the Year

en Owens, a 25-year member of the Arkansas Blue Cross and Blue Shield board of directors and president of St. Bernards Healthcare in Jonesboro, recently was named one of the Business Executives of the Year by the Arkansas State University College of Business at its annual homecoming alumni breakfast. ❊

Best of Blue recognizes Arkansas Fitness Challenge

rkansas Blue Cross and Blue Shield was among six Blue Cross and Blue Shield Plans receiving top honors from the Blue Cross and Blue Shield Association at

its eighth annual “Best of Blue” National Awards Program at the Best Practices in Medical and Pharmacy Management conference. The Arkansas Plan won a “Best of Blue” Award for Innovations in Partnerships for the Arkansas Fitness Challenge. ❊

Blue & You Winter 2005

“One Class at a Time” grants helping Arkansas

o date, BlueAnn Ewe and Fox 16 News at Nine have awarded $500 grants to four deserving teachers in Arkansas:

Ann Ware/Bald Knob High School — to purchase a digital camera for her students to use to complete a project using visual images to communicate about peer pressure and the consequences of actions. The project will be used to teach younger students about decision-making.

Dwight Kelly/Jacksonville Middle School for Boys — to purchase a camcorder for his eighth-grade science classes to videotape their reports of the study of hurricanes and their effect on people and places. The students will complete their study, then present their reports as if they are reporting the news.

Teaching children and providing them with the tools necessary to learn is a top priority for Arkansas Blue Laura Grisham/Otter Creek Cross and Blue Shield and for FOX Elementary School, Little Rock — to 16, so we’re joining together to help purchase materials for students to reach teachers and students “One create “masterpieces” for the school. BlueAnn and Troy Bridges (left) present Ann Ware Class at a Time.” The art project not only will teach with “One Class at a Time” grant award. students about the different styles of Each month, FOX 16 News master artists, but also will serve as a at Nine and Arkansas Blue Cross will award a $500 grant school beautification effort. to a teacher/classroom around the state of Arkansas to help supplement class needs. Teachers in need of supplies, classroom Morgan Setzler/Pike View Elementary School, North Little tools, field trips, books, computers or other educational necessities Rock — to purchase tickets for the entire first grade to attend a can go online to www.FOX16.com and apply for a grant. Junie B. Jones play presented at Robinson Auditorium in Little Rock Each month, BlueAnn and FOX 16 news personalities will travel in October. The students are reading the Junie series of books and to a school to award a grant to the winning teacher. That award will got to see many of the characters come to life on stage, all in hopes be filmed and shown on FOX 16 News at Nine. The winners also of deepening their love of reading. will be posted on the Web sites. ❊

Blue receives bronze

rkansas Blue Cross and Blue Shield recently received nine awards from the Arkansas Chapter of the International

Association of Business Communicators for several of its programs: • Blue & You – member magazine • Agent Update – agent publication • Blue-by-Design Enrollment Web Site – commercial site • Arkansas Fitness Challenge – multiaudience communications • Arkansas Fitness Challenge Employee Contest Kit – manuals • “Don’t Start” Smoking Storyboard Contest – community relations program • Blueprint – employee newsletter (2 awards) • Blue & You New Employee Orientation Program – employee communications program. Judging was done by communications professionals in Dallas, Tulsa, Cleveland and Phoenix. ❊

Blue & You Winter 2005

Blue & Your Community 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.

Wild About Wellness

In Step for a Cure

Arkansas Blue Cross and Blue Shield was a sponsor again this year of the Wild About Wellness kids back-to-school health fair held at the Four States Fairgrounds in Texarkana in July. Members of our Southwest Regional Ofﬁce staffed a booth and BlueAnn Ewe came along to greet the more than 500 kids that attended the event. Parents could take advantage of free health screenings for kids, immunizations, health and safety education (including bike helmets), plus entertainment and opportunities to win fun prizes.

Hundreds of Arkansas Blue Cross employees donned the team T-shirt and put their best feet forward for the Central Arkansas Juvenile Diabetes Research Foundation (JDRF) “Walk to Cure” on September 24. The annual event was held at Riverfront Park in North Little Rock to raise money and awareness for helping ﬁnd a cure for this disease that strikes children of all ages. Employees raised almost $10,000 for the cause ... and a company match helped make the generous contribution stretch even farther. ❊

Hammering Out Dreams Staff members of the Northwest Regional Ofﬁce in Fayetteville joined 3,000 local residents to help the cast and crew of ABC’s television show “Extreme Makeover: Home Edition” to make some major renovations at Camp Barnabus in Purdy, Missouri. The camp is a nondenominational Christian organization for children with disabilities and illnesses. Kids attend weeklong sessions at the facility founded by Cyndy and Paul Teas. More than 1,000 children each summer get to canoe, swim, create arts and crafts, hike, ride horses and climb rocks.

BlueAnn greets kids for a cure.

Terry Rhoads, Joanna Patton, Paul DiMeo (of Extreme Makeover), and Lori McCartney lend hands and hammers.

“Don’t Start” 2006 gets started

rkansas Blue Cross and Blue Shield is once again joining the American Lung Association and the Arkansas Department of Education to encourage kids to not start smoking. Media partners KASN-TV/UPN Channel 38 and KLRT-TV/FOX Channel 16 are again joining the effort as well. The “Don’t Start” Smoking Storyboard Contest 2006 gets under way in January, in an effort to give kids in kindergarten through ﬁfth-grade an opportunity to write a story about why it’s important to never begin this dangerous habit. Deadline for entries is April 3, 2006. The winning entry will become a television public service announcement to be broadcast

statewide. Finalists from 2005 came from all four corners of the state. Storyboard Contest sheets and educational videos will be distributed to all public schools and are being mailed to private schools and home-school programs. Beginning in mid January, contest sheets may be picked up at any Arkansas Blue Cross location statewide, at the American Lung Association of Arkansas, and at Clear Channel Communications in Little Rock or by calling toll free 1-800-586-4872, ext. 118. The “Don’t Start” Smoking Storyboard Contest will help your kids draw a healthy message today ... as well as a good breath ... for life. ❊

Blue & You Winter 2005

Blue Helping members manage their health-beneﬁt plans is the focus of www.ArkansasBlueCross.com, www.HealthAdvantage-hmo. com and www.BlueAdvantageArkansas.com. Several online tools are available to members.

Provider Directory Enhancement A new feature recently added to the online provider directories for Arkansas Blue Cross and Blue Shield and Health Advantage displays demographic information that might be important to you when selecting a physician. Charts show the number, gender and age of a physician’s patients compared to those of physicians in the same specialty ﬁeld. The average number of days it takes a physician to ﬁle a claim in comparison to his or her peers also is available. This information is based on claims data for all Arkansas Blue Cross and Health Advantage members and is updated quarterly. To get to the charts, click on the “Provider Directory” link on the home page or the menu bar on the left side of any internal page of www.ArkansasBlueCross.com or www.HealthAdvantage-hmo. com. Enter your member ID number or select your health plan, then search for a physician. On the results page, you will see a “Detail” button beside each physician’s name. Click on this button to get to the physician’s background information and comparison graphs. Select the chart you want to see from the drop-down menu.

Online My Blueprint Tools My Blueprint, our online member self-service center, now includes a free tool, “Select Quality Care,” that allows you to review an independent comparison of hospital quality measures by procedure or diagnosis. This information can help you play a more active and informed role in your treatment decisions when a physician recommends surgery or another procedure that requires hospital care. Your My Blueprint account also opens access to an extensive encyclopedia of health information, the Healthwise® Knowledgebase. In the Healthwise® Knowledgebase, you’ll ﬁnd information about a wide variety of symptoms, health conditions, medical tests and treatments. This authoritative source for health information also contains illustrations and deﬁnitions of terms. Check the status of your medical claims through My Blueprint. Click the “Check claims status or history” link on the “Welcome” page. If you are the policyholder, you may choose to see your own claims or claims for any covered dependent. Covered dependents may see their own claims only. If you haven’t registered for My Blueprint, go to the log-in page and click on the “First-time user” link to get to the registration form. You will need the information printed on your health plan ID card to register. ❊

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

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

The detail page for most physicians will show you the provider’s educational background, hospital afﬁliations, board certiﬁcations, gender and language. For each physician, you may access a map and driving directions to the provider’s location. If you need assistance when you are searching for a provider, click on the “E-Mail Customer Service” link at the bottom of any page to request help in locating an in-network provider. Selecting an in-network provider reduces your out-of-pocket costs.