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Network Health made me feel like they really cared. They truly, truly did. -Diane S., Network Health member
Inside Page 7 Getting Ready for a New Start Mary’s Story, Part II Page 15 How to Manage Chronic Pain Page 25 A Vaccine to Prevent Cancer
P U B L I C A T I O N
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L I F E , H E A LT H & W E L L N E S S
3 Letter from the President and CEO 4 Using Your Member Portal 4 Customer Service is Member Experience 5 Getting Social with Network Health 5 Network Health Website Update
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6 SilverCloud - Available for State of Wisconsin Employees
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Palliative Care
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Getting Ready for a New Start - Mary’s Story, Part II
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How Do You Want to Communicate with Network Health?
EDITORIAL STAFF President Coreen and CEO Dicus-Johnson Chief Administrative Penny Ransom Officer Strategic Marketing Jon Race and Communications Coordinator Visual Design Lead Debra Sutton
EDITORIAL BOARD
14 One-on-One Care Management
COVER STORY
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Surviving a Heart Attack, a Stroke and a Blood Disorder
15 How to Manage Chronic Pain
22 Network Health Outperforms When It Comes to Quality
17 MDLIVE® Online Doctor Visits 18 It’s Not Too Late to Get the Flu Shot 18 How Do Health Plans Make Decisions? 19 COVID-19 After Getting the Vaccine - Chad’s Story 20 Ensuring You Receive the Service You Deserve
© 2021 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.
TELL US YOUR STORY 21 Your Right to Request an Independent Review 21 Volunteer Needed
16 The Importance of Exchanging Information
Balance is published by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals.
- Diane’s Story
14 How Your HMO Plan Works
16 Where to Get Care
Melanie Draheim, Angela Keenan, Mallory Mueller, Alice Parks, Stacy Schwandner, Romi Norton, Kimberly Swanson, Theodore Regalia, Kacey Werner, Hannah Neylon
22 Have You Moved Recently? 23 What Is Population Health Management? 24 Financial Questions to Ask Your Doctor When Prescribed a New Medication
If you have questions or suggestions or would like to tell us how Network Health improved your life, send us an email at marketing@networkhealth.com.
You can also write to us at: Network Health Attention: Jon Race 1570 Midway Pl. Menasha, WI 54952
HAVE A QUESTION?
Call our member experience team.
25 A Vaccine to Prevent Cancer
HOURS Monday, Wednesday–Friday: 8 a.m. to 5 p.m. Tuesday: 8 a.m. to 4 p.m.
25 Clinical Practice Guidelines
PLANS THROUGH AN EMPLOYER 800-826-0940
26 Rewards for Healthy Choices 27 Prevent T2 - Patrick’s Story BACK COVER Turning 65 Soon? Network Health Has You Covered
PLANS FOR INDIVIDUALS AND FAMILIES 855-275-1400 STATE OF WISCONSIN EMPLOYEES/MEMBERS 844-625-2208 Monday–Friday: 8 a.m. to 4:30 p.m.
WANT MORE HEALTH TIPS? HMO and POS plans underwritten by Network Health Plan. Self-insured plans administered by Network Health Administrative Services, LLC. 3723-01-1021 2 | balance • W i n t e r 2 0 21
Check out our blog at networkhealth.com/blog
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Letter from the President and CEO As we look forward to 2022, it is only natural to reflect on this past year. In 2021, we received many stories from our members about their experiences with Network Health and the difference we made in their lives. We heard about the compassionate and exceptional service our members received and how we helped them live healthier lives. These stories are a testament to Network Health’s focus on doing the right thing, even when it is difficult, and how we help our members achieve the health and wellness results they want. This issue of Balance also features stories of member and employee resilience. Member Diane Stuckrath shares her inspiring story about her unexpected battle through a heart attack, stroke and more. We also catch up with member Mary Bruch, she was featured in this past summers’ Balance issue, to learn how her move into retirement and Medicare went. Stories from our own Network Health employees include Patrick Liebmann and Chad Rettler. Patrick found success with our Prevent T2 diabetes program, and Chad shares his experience with COVID-19. Their stories, along with Diane and Mary’s, are just a few examples of the resilience all around us. Thank you for being a valued member of our Network Health family. We truly appreciate your membership and look forward to serving you in 2022. Sincerely,
Coreen Dicus-Johnson President and Chief Executive Officer
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life. health. wellness.
Using Your Member Portal Our goal at Network Health is to make it easy for you to manage your health insurance. We work hard to ensure you understand and are comfortable with your insurance plan. That’s why we used member feedback to create an easy-to-use and navigate online resource for you—the Network Health member portal. The member portal is your personalized online account where you can find information specific to your health insurance plan. It is a secure, password-protected account that keeps you well informed and provides plan information at your fingertips. • Benefits and coverage overview • Out-of-pocket expenses tracker • Claims detail and status • Your mobile ID card • Secure messaging with our local member experience team • FAQs • And more
The portal works great on your mobile phone and is built to be viewed on any device at any time. That means you have access to your important insurance information wherever you go—the pharmacy, doctor’s office or even on vacation. Plus, it greatly reduces the use of paper. Just visit login.networkhealth.com.
If you haven’t already registered, visit login.networkhealth.com. It’s quick and simple to do.
Customer
Service is
Member
The member portal also provides seamless connections to other valuable resources. • Wellness programs and tools* • Pharmacy benefits and claims information* • Communication preferences • Virtual visits • Your health questionnaire
*Not all Network Health plans have a wellness program or pharmacy benefit.
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s a reminder—our customer service team has changed its name to member experience. This new name considers your entire journey, which is made up of all the experiences you have when interacting with Network Health. The member experience team name is about supporting what’s most important to us at Network Health—you, our member. This team still provides the same great service you’ve come to expect—assistance with benefits, claims, authorizations, pharmacy and more. The only difference is a name that accurately describes what we do. If you ever need to contact the member experience team, just call the number on the back of your ID card.
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Getting Social with Network Health By Jordan Kapellusch, digital marketing specialist at Network Health
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o support our mission of building healthy and strong Wisconsin communities, Network Health has several social media profiles, connecting you to us and each other. You can contact us with questions about Network Health, our member events, the benefits of membership and more. You can also find access to health and wellness content to help you improve and maintain your health.
Grow in the Know Blog
Written by experts from our integrated health team and local health care providers, our Grow in the Know blog features exclusive content on a variety of health care topics. Some of the subjects we’ve featured include–Everything to Know About Diabetes, Which Fitness Tracker Should I Buy?, 7 Hidden Gems to Visit in Wisconsin During the Summer and 8 Steps to Take to Better Focus on Mental Health. You can find our blog at networkhealth.com/blog.
On Facebook, we regularly share content from Grow in the Know. In addition, you’ll find great discussions about health and wellness topics, as well as events and organizations in your community. We also feature groups that allow you to dig in to great articles and inspiring shareables in this great online community. All of this can be found on our Facebook page at facebook.com/networkhealthwi.
If you’re looking for even more behind-the-scenes Network Health action or craving interesting shareables and graphics, our Instagram page (@NetworkHealthWI), has plenty. Regularly updated, this page is an excellent way to stay in touch and see photos and videos of our Network Health values in action.
Maybe you prefer the brief and direct nature of Twitter. We frequently share our content and boost helpful health, wellness and insurance advice through our Twitter profile. We’re @NetworkHealthWI.
Like Facebook, LinkedIn is a great place to learn more about what makes Network Health so unique. As a local, Wisconsin-based health plan, we’re plugged in with the businesses we support. LinkedIn is the place to go to see updates from our business partners and read about events we host and attend. Learn more by visiting us on LinkedIn at linkedin.com/company/networkhealth-wi.
YouTube
Finally, our YouTube channel not only gives you access to our library of video content, answering frequently asked questions about health insurance topics and showcasing healthy recipes, but it also has frequent updates featuring our media appearances and our local business partners. We’re on YouTube at youtube.com/user/NetworkHealthWI.
As always, if you have any questions about Network Health services or your plan, we’d love to hear from you.
Network Health Website Update We have made some enhancements to networkhealth.com. The links at the top of the site have been updated to feature a more intuitive and user-friendly design. We want to make things as easy as possible for you. All the same information is still present on our site. How you get there, however, may be quicker. It may take a visit or two to get used to the new look. In the long run, we hope you find what you are looking for more easily and quickly. Check it out for yourself at networkhealth.com.
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life. health. wellness.
SilverCloud
Available for State of Wisconsin Employees
By Mary Zamost, quality care coordinator at Network Health
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ver 16 million adults in the U.S suffer from depression, about one in three adults have an anxiety disorder and nearly 66 percent of adults are stressed due to uncertainty about the future or health issues.
Most of us have experienced some sort of sadness, stress or anxiety sometime in our lives. It’s important to recognize and know how to manage these feelings before they become overwhelming. Studies show that good mental health can also have a positive impact on other aspects of your life, including quality of life and physical health. Network Health is offering State of Wisconsin members access to SilverCloud, an online, self-guided mental health resource program. This online resource provides secure modules with therapeutic exercises and behavioral interventions to help you take control of your mental health. The program provides online tools to help with the following and more. • Managing day-to-day stresses and anxiety • Improving resilience • Learning skills to understand thoughts, feelings and behaviors • Reducing symptoms of depression and anxiety SilverCloud is available 24 hours a day, and can be used on any device (smartphone, tablet and computer). It’s easy to use and offers information and support if you’re experiencing mental health challenges such as anxiety, depression and stress. SilverCloud can be used daily and is an effective tool to learn new coping skills and help reduce symptoms. Program modules contain text, video and audio clips, as well as interactive activities. Each one takes about 40 minutes to complete, but you can work through them at your own pace.
Palliative Care By Yvonne Morrow, RN, oncology care manager at Network Health
Palliative care is often misunderstood and confused with end-of-life care. It’s important to understand the difference, because palliative care may be necessary during a serious, long-term or life-threatening illness.
What is palliative care?
Palliative care is specialized medical care for people, regardless of age, who are living with a serious illness. This type of care focuses on providing relief from suffering or symptoms. Palliative care provides valuable benefits, including the following. • A resource for anyone living with a serious, long-term or life threatening illness, such as cancer, heart failure, chronic obstructive pulmonary disease (COPD), dementia, Parkinson’s disease and many others • Helps you understand choices for medical treatment • The organized services available through palliative care may be helpful to anyone having a lot of general discomfort and disability late in life While palliative care is helpful at any stage of illness, it is best to
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receive it soon after you’re diagnosed. The goal is to improve your quality of life and that of your family throughout diagnosis and treatment.
Who provides palliative care services?
A palliative care team is a group of specially trained doctors, nurses, social workers, nutritionists and chaplains. This team works with you, your family, caregivers and providers to give medical, social, emotional and practical support. To begin palliative care, you can get a referral from your doctor. If your doctor doesn’t suggest it, and you feel you would benefit from these services, ask for a referral. If you meet home care requirements, in-home palliative care may be covered under the home care benefit. If hospice is recommended, palliative care may be covered under hospice benefits. Network Health Care Managers can assist you as you navigate your health journey. They can help you understand diseases and diagnoses, clarify treatment goals and options, understand and support your ability to cope with illness and help connecting everyone on your care team to make sure everyone’s on the same page. If you have questions about your health care, please call care management at 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.
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Getting Ready for a New Start –
Mary’s Story, Part II
By Jon Race, strategic marketing and communications coordinator
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hen we last talked with Mary, it was June 2021 and she was looking forward to her retirement in August. She was also working her way through the process of transitioning to Medicare. At the time, she had a lot of questions about that next step in her life. Probably the same questions many Network Health members have, whether for themselves or for members of their family. What now? What next? How do I/we make this transition? It’s the beginning of November when we pick up with Mary’s story again. Mary’s original plan was to retire on her birthday, August 14. However, like many things in life, the plan changed. In fact, she decided to put off her retirement until January 2022 to help out the company she has been a part of for the last 38 years. She did reduce her hours, however. “I cut back to 16 hours a week,” Mary said. “I think it was a good thing to do that, though, because for me to totally stop working … it would have been a shock for me, honestly. But I’m getting used to more time off. It’s nice to have that flexibility.” Mary may not be retired yet, but she did sign up for Medicare in August. “I did the whole thing online. It was super easy. And, when I was done, a little while later I got my red white and blue card in the mail,” Mary said. “So, I guess that makes it official,” she added laughing. “I signed up for Original Medicare. I’m now signed up for Medicare Parts A and B.” The concerns she had six months ago have evaporated and she’s even helping others sign up now.
Mary said, “Back in July I was scared. I thought, ‘I know nothing about this. What am I going to do?’ But you talk to people who’ve already done it and then go through it yourself, and you just learn. It’s actually pretty simple. In fact, I’m helping my brother go through it now.” “It was so foreign to me six months ago, but now it’s all good. And when I retire in January, I’m going to get a Medicare Advantage plan with Network Health, and I’ll be all set. I keep telling my brother, ‘You have to go with Network Health.’ I think he will,” Mary said. Since July, things haven’t gone quite the way Mary anticipated, but she’s fine with the way they’ve turned out. “I’ve had a chance to ease into the idea of retirement, which I think was good for me,” Mary said. “And, I had such a great summer. We even brought the e-bikes back home to use in Little Chute a couple of times. It was such a blast.” As of now, Mary’s new-start story isn’t quite complete. And she seems fine with that. She’s still looking forward to seeing how it’s going to turn out. If you missed Mary’s story from our 2021 Summer Balance issue, you can read it online at networkhealth.com/marys-story.
How Do You Want to Communicate with Network Health?
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etwork Health lets you choose which information you want to receive in the mail and which information you want to receive via email. You can go paperless for some communications and receive emailed information. Or, if there are communications you’d rather receive in the mail, you can select that preference. The choice is yours. You can select your preferences through your member portal at login.networkhealth.com. Simply log in to the portal, click your name in the upper right corner and select Change My Communication Preferences. From there, you can choose email for any or all the available categories. Make sure to click Next to save your choices.
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feature story
Surviving a Heart Attack, a Stroke and a Blood Disorder - Diane’s Story By Jon Race Photographs by Beth DesJardin, Trove Photography
Looking at Diane Stuckrath,, you would never suspect she was a heart attack victim. The idea that six months ago she was being operated on, seems absurd. She’s too young. She’s too fit. She has too much energy. She’s too … healthy. If you were to get her to step away from her flowers or volunteer work or grandkids long enough to sit down and ask her about her story, you’d find out that not only has Diane had a heart attack, she’s also had a stroke. And she has a blood disorder, too.
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feature story I
t’s October 21, 2021. Six months after Diane’s heart attack. Earlier in the day, the doctor’s office called Diane to let her know her follow-up appointment scheduled for October 22 had been set up with the wrong doctor. And, the doctor she was supposed to see wasn’t going to be in. So, they had to reschedule. The only time they had available was the afternoon of the 21st. Today. It doesn’t seem like that big of a deal. However, considering the road Diane has travelled the last year or so, any minor twist or turn or bump along the way, can easily, and quickly, turn into a significant detour. Thankfully, that was not the case.
A Little History Diane has been working for the Heart of the Valley Chamber of Commerce for a little over six years. Her office is in Kaukauna, ten minutes away from her Sherwood home. “I wear a number of different hats based on what’s needed, but my primary focus is business development and event management,” Diane said. “I really like what I do. I like being involved in the community, helping out small businesses and connecting people.” She had been at her job for two years when Network Health approached the Chamber about creating a partnership. The two organizations teamed up to provide an affordable health insurance offering for small businesses and their employees. The plan was only available to Heart of the Valley Chamber members and could only be sold by insurance agents who were also members. It was a great way to offer high-quality insurance to businesses while also encouraging Chamber membership. It was a win for everyone involved. “When I came to the Chamber six years ago, they didn’t offer health insurance as a benefit.” Diane explained. “So, I went into the Marketplace where I purchased my own insurance. That’s how I was first introduced to Network Health. Even before they partnered with the Chamber.” Fast forward a few years to 2019. During the open enrollment period for the 2020 plan year, Diane decided to go with a different health insurance company. She signed up with a larger, national insurance carrier because they had lower premiums. “I had no health issues whatsoever,” Diane recalled about her decision. “The only time I went to the doctor was for my annual health exam. That was it. I thought I’d save a couple of bucks and go with a cheaper plan.” It wasn’t long before Diane was questioning her choice to move on from Network Health. “It was horrible. It was horrible customer service. I would be on hold for hours, just to get set up for something like an automatic payment. Or to ask a question about what was covered or getting more information about what’s covered with my wellness exam. It was an awful, awful experience,” Diane said. Despite the bad experience, when enrollment time came along for the 2021 plan year, Diane chose to stay with the national insurance carrier. “I’m just going to renew with [them]. At the time it seemed to make sense. I don’t have any health issues and it’s easy. I don’t have to do anything. I’m just going to re-up with them,” Diane explained.
“Today was my six-month follow-up with cardiology,” Diane said. “I had to have an echocardiogram. The doctor said everything looks fine. He said, ‘Your heart looks strong. I’ll see you in another six months.’ It felt good to hear that.”
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By the time January rolled around, Diane was having doubts about her insurance company again. “I don’t know what it was,” Diane said. “I had some sort of premonition. Dear God, if I have a health issue, this is going to be awful.” Medically speaking, at the time, Diane was absolutely fine. But she
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When my heart attack happened, I didn’t even have my member ID card yet. I had nothing. But I couldn’t believe how good Network Health’s customer service was. They were like, ‘Here you go, you’re all set. We’ve got you covered. Don’t worry about a thing.’ They were amazing.” “I mean … They called me after I had my surgery to see how I was doing. Who does that?” - Diane S.,
Network Health member
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couldn’t shake the feeling that something was about to happen. Worse, she was afraid that if something did happen, her health insurance company was going to be more of a hindrance than a help. The Phone Call As luck would have it, not long after Diane started having misgivings, she had a phone call with Network Health regarding their partnership with the Chamber. She used the opportunity to ask if there was any way she could go back to Network Health. Diane told the Network Health representative, “I’m sorry. I am so sorry I left Network Health. The little experience I had away, was like night and day. You guys really do live your Hometown Advantage motto.” In years past, there would have been very little that Diane could have done to switch insurance companies. However, because of the COVID-19 pandemic and related issues, the government extended the 2021 open enrollment period. This allowed people who purchased their insurance through the Marketplace the opportunity to switch their insurance plans. Diane said, “All it took was a few phone calls. My insurance agent helped me navigate through it and what do you know, by the beginning of March 2021, I was back with Network Health.” On March 30, Diane had a heart attack. “When my heart attack happened, I didn’t even have my member ID card yet. I had nothing. But I couldn’t believe how good Network Health’s customer service was. They were like, ‘Here you go, you’re all set. We’ve got you covered. Don’t worry about a thing.’ They were amazing.” “I mean … they called me after I had my surgery to see how I was doing. Who does that?” Before the Heart Attack Prior to her heart attack, on February 8, 2021, Diane went in for a wellness exam. She had been having some issues that concerned her, so she described them to her doctor during her visit. Diane said to her doctor, “If I didn’t know any better, and I’ve never had a heart attack, but my
gosh, when these episodes happen, I feel like I could be having a heart attack.” The doctor did not think Diane was having a heart attack. Diane accepted her doctor’s diagnosis. “I thought okay … you’re the professional. It must be indigestion or reflux or something.” The symptoms grew in frequency and severity as the weeks went by and began waking her up at night. A radiating sensation of pressure and heat would start in her chest and move up through her head. When it started to move into her left arm, Diane knew something was going on. She had to call the doctor again. “On Monday, I called Network Health because I didn’t have any of my insurance info,” Diane said. “No problems there, they gave me what I needed. On Tuesday, March 30, I went into work, told my boss I had to make a quick phone call and I called my doctor’s office. I explained what was happening and the symptoms I was having. The nurse said, ‘You need to have someone bring you to the emergency room. You need to come in right now.’” Bill, Diane’s significant other, picked her up at the Chamber and drove her to the emergency room. “I check in, literally, with my insurance information on a sticky note,” Diane said. “Twenty minutes later the doctor tells me I have tested positive. I said, ‘For what?’ He said, ‘You’ve had a heart attack.’” The troponin levels in Diane’s blood signified she had had a heart attack. The doctor informed Diane she had a blockage in her artery, and they were going to need to go in and fix it. The plan was to go through her arm with a catheter. However, if they couldn’t access the blockage that way, they would have to do open heart surgery. Diane was floored. “I was like, umm, ok. Could someone bring Bill in here. Because all I heard was blah, blah, blah, heart attack, blah, blah, blah, open-heart surgery.” The surgery went as planned. Diane had an 80 percent blockage in two of her arteries. She had two stents put in.
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feature story After the Heart Attack After the successful heart surgery, Diane needed to make followup appointments with her personal doctor. However, after the heart attack experience, she decided to find a new doctor. As her first appointment approached with her new personal doctor, Diane began to think more about her past wellness visits. Were there any health needs that could be looked at in more depth? Two items in particular stood out in Diane’s mind. Her health assessment numbers (cholesterol, glucose, blood pressure, etc.) and an episode of weakness on her left side. Her previous doctor had put her on medication to address her high cholesterol, but Diane was still concerned about her other numbers. As far as the weakness in her left side, Diane couldn’t get past the feeling that it may be more than just the pinched nerve her doctor suspected. Her instincts about a heart attack were correct back in March, so she decided to trust them once again. When Diane discussed her concerns with her new doctor, she ordered a new health assessment to establish a baseline and she ordered an MRI of Diane’s head. The MRI showed evidence of a stroke. Third-Party Assessment
printouts of Diane’s bloodwork when she asked, “Anybody ever talk to you about this?” “It was something in my blood,” Diane said. “Something with my kidney or liver function. I said no.” Per Ladonna’s recommendation, Diane had a variety of blood tests done. It wasn’t long before she started seeing a hematologist. Furthermore, she had to see a liver specialist because the same tests showed an irregularity with her liver enzymes.
If it wasn’t for the professional health care provider coming in and doing the assessment, who knows when I would have found out about the blood disorder. Bill calls her my angel. She circled two numbers and recommended
Meanwhile, while Diane is getting blood tests, her new doctor recommended stopping her cholesterol medication as an attempt to level set her health assessment numbers. There’s also a chance the medication could be affecting her liver. Turns out, Diane has a blood disorder called Thrombocytosis. It’s a disorder in which your body produces too many platelets. Diane’s cardiologist and hematologist believe the disorder was probably the reason behind the stroke and heart attack. “If it wasn’t for the professional health care provider coming in and doing the assessment, who knows when I would have found out about the blood disorder. Bill calls her my angel. She circled two numbers and recommended I get a complete blood count. She saw something she didn’t like and that was it,” Diane said.
I get a complete In July 2021, four months after her heart attack, Diane received a call from Network blood count. She saw At the same time she started taking Health regarding being a part of an inmedication for her blood disorder, she home assessment program. Network Health something she didn’t stopped taking her cholesterol medication. works with an organization that employs like and that was it.” Within weeks, her liver enzyme numbers licensed health professionals to complete returned to normal. the assessments. Members who had recent hospital stays or were on certain medications, - Diane S., What’s Next were asked if they would participate in Network Health a personal health visit. Diane fit the bill Diane is on medication for her blood member on both counts. The assessments offer an disorder and the prognosis is good. As long opportunity for members to discuss their as she keeps taking her medication, doctors health history and have any health-related anticipate no further issues. She finished up her cardiac therapy questions answered. From Network Health’s standpoint, it’s a way to in October and she and Bill have gone to a more plant-based diet, make sure members are doing well and receiving the care they need. reduced their alcohol consumption, they eat out far less than they From Diane’s standpoint as a member, it was a free health exam used to and try to stay as active as possible. “We’re doing stuff and an opportunity to ask questions. Plus, she’d get a gift card as an outside all the time. I’m out in the yard, I’m in my flower field. I love incentive. my flowers. We have a garden in the back. We spend a lot of time in “With everything I have going on, why not?” Diane said. The in-home nurse, Ladonna, was in the process of reviewing 12 | balance • W i n t e r 2 0 21
our pond, just hanging out,” Diane said.
As far as the immediate future, Diane will be stepping down from her full-time position at the Chamber and move into a part-time role.
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This whole summer has been just crazy. Absolutely crazy. Appointment after appointment and test after test. I was afraid Network Health would call and say, ‘We’re done. You have to go somewhere else because we’re not going to do this “Going part-time will free me up to do the things I really want to do, and that’s volunteer.” Diane said. “I enjoy helping people and volunteering my time. I enjoy giving my energy to organizations that help other people.” And she’ll definitely be spending time in her flower field. “This was the first year and it is beautiful. I can’t wait to see what this field will look like next year,” Diane said. As 2021 comes to a close, Diane has had quite a bit of time to look back on the past year. There have been many “what if” moments. What if she hadn’t listened to her body with the heart attacks? What if she would have said no to the third-party assessment or didn’t listen to her recommendations? What if she didn’t change her doctor? What if she hadn’t switched back to Network Health? “This whole summer has been just crazy. Absolutely crazy. Appointment after appointment and test after test. I was afraid Network Health would call and say, ‘We’re done. You have to go somewhere else because we’re not going to do this anymore.’ That’s what I was afraid of. But no. They called to see how I was doing. They called to check in. Network Health made me feel like they really cared. They truly, truly did. I can’t imagine navigating what I’ve gone through with a different insurance company,” Diane said. Obviously, if given the choice, Diane would prefer to have not gone through what she has the last year. But she sees a value in it. “If my story makes a difference in somebody else’s life, encourages people to stand up for themselves and ask questions or to educate themselves, then what I went through was worthwhile,” Diane said. “What we go through in life is what makes us who we are. Staying strong and believing in yourself and fighting forward is important. I have a long life to live yet, and I will live it. I will live it to its fullest.”
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anymore.’ That’s what I was afraid of. But no. They called to see how I was doing. They called to check in. Network Health made me feel like they really cared. They truly, truly did. I can’t imagine navigating what I’ve gone through with a different insurance company.” - Diane Stuckrath, Network Health member
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life. health. wellness.
One-on-One Care Management
By Alice Parks, director of population health management at Network Health
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etwork Health offers care management services to members at no additional cost. Through this program, experienced nurses and social workers, also known as care managers, can support you with the following. • Improving your overall health • Navigating the health care system • Coordinating community resources • Getting needed services in optimal, cost-effective settings If you are eligible and agree to participate, you can be enrolled into the program. When enrolled, a care manager works with you to identify your health care needs, develop goals based on your values and assists you in meeting those goals. If you have complex chronic conditions or illnesses that could lead to high-risk conditions or an increased use of health care services, you may benefit from care management. These conditions or circumstances could include any of the following. • Complex chronic diseases • Catastrophic or rare conditions • Conditions requiring a transplant • Major complications from a surgery or an extended hospital stay • Circumstances where multiple physician specialists are involved in care • Conditions requiring multiple specialty equipment and service needs at home Those who might benefit from care management can be referred by their personal doctor or caregiver, or you can refer yourself. Network Health might also identify you as a candidate for services through claims or utilization processes. Care managers are available by calling 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m. and after hours by appointment.
How Your HMO Plan Works Understanding Your Plan
Is your plan through Network Health a Health Maintenance Organization (HMO) plan? This type of health insurance plan includes a select group of in-network providers that are available to you. As a member of an HMO health plan, you must receive care from these in-network providers. HMO plans don’t cover out-ofnetwork care, except in an emergency.
How to Use Your Network Health HMO Plan
If your Network Health plan is an HMO, you’ll have to choose in-network doctors, hospitals, clinics and specialists for services to be covered under your health plan. If you use an out-of-network facility or provider for health care services, you will be financially responsible for the full cost of the services, unless you receive prior authorization from Network Health.
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Prior Authorization
As a member of Network Health, you can see in-network doctors without a referral (except low-back pain referrals for the State of Wisconsin members). Select services require approval (called prior authorization). If you are referred to an out-of-network doctor for any services (excluding emergency services), you—as the member—must obtain prior authorization from Network Health before the appointment. The purpose of prior authorization is to ensure you are protected from unnecessary care and that the treatment being provided to you is safe and effective. For questions or to obtain a prior authorization, please contact Network Health’s utilization management department at 866-709-0019, Monday–Friday from 8 a.m. to 5 p.m.
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How to Manage Chronic Pain By Karlyn Raddatz, MPA, BSN, RN, manager of care management at Network Health
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hronic pain, or pain lasting for three months or longer, is common among older adults. For this reason, many people don’t talk to their doctor(s) about their pain. By believing pain is expected, or that you must live with it, you may not have important conversations to help you live your best life. Unfortunately, avoiding a conversation about pain with your personal doctor can lead to negative health consequences. People with chronic pain are at greater risk for decreased mobility, increased falls, reduced immunity, decreased concentration, malnutrition, insomnia and depression. It may be time to consider talking to your doctor if your chronic pain affects one or more of the following. • • • • • • • •
Your sleep and ability to rest Your mobility, and you notice you have changed your movement Your mood is depressed or irritable, and connected to how you feel physically Your thoughts largely focus on your pain and worries related to that pain You’re experiencing isolation as a result of your pain Family and/or friends have expressed concern You are using over-the-counter medications, which are not working You are using alcohol to alleviate pain or help you sleep
Discuss Your Pain With Your Personal Doctor Before you meet with your doctor, create a log/diary about your pain including these details. • The severity of your pain—mild, moderate or severe • The location of the pain • When you experience the pain; for example, is it worse in the morning, or after a certain activity • What makes the pain better and what makes it worse When you see your doctor, be clear about how your pain is affecting your quality of life. Your doctor will assess your needs and plan for your care. This may include prescription medications to ease your pain, so if you have concerns about pain medications, let your doctor know. Your doctor may offer these alternative treatments, which may be helpful for reducing chronic pain. • Physical therapy • Acupuncture • Cognitive behavioral therapy • Massage • Electrical nerve stimulation Network Health Care Managers are available to talk about your pain and its impact on your quality of life. You can contact care management by calling 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.
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Where to Get Care I
f you or a loved one becomes hurt or very ill, panic and confusion can make it difficult to know what to do. If you feel you’re experiencing a medical emergency, it’s important to get to the nearest emergency room or call 911. If it’s not an emergency, many times your personal doctor, a virtual visit, an urgent care or walk-in clinic can help at lower cost to you. Below are the differences between primary care, urgent care, virtual care and emergency care. The costs for each type of care are different (log in to your member portal at login.networkhealth.com to view your benefits). This is important to know, because emergency care can be much more costly. If your situation is not an emergency, you can keep your costs down by using other types of care.
Primary Care
This is same-day or routine care for established patients. Areas of primary care include the following. • Annual wellness visits • Coughs and colds • General concerns, visits and physicals • Sore throats • Vaccinations
Virtual Care
Virtual visits, offered through MDLIVE®, are a convenient way to get care for covered health services that include the diagnosis and treatment of medical conditions through electronic means. MDLIVE is an alternative to urgent care visits for non-emergency medical conditions.
Emergency Care
Urgent Care
Urgent care is for an unexpected injury or illness that is not life threatening, but still needs attention quickly so it doesn’t develop into a serious problem. Areas of urgent care include the following. • Allergic reactions • Cuts requiring stitches On average, urgent care • Fever costs $600 less than going • Pink eye to the emergency room. • Sinus infections • Vomiting
• • • •
An emergency is an illness, injury, symptom or condition so serious, that a reasonable person would seek care right away to avoid serious harm. Emergency care conditions include the following.
Chest pain Head or neck injury Sudden numbness in an arm or leg Trouble breathing
Emergency rooms can cost up to seven times more than other care.
The Importance of Exchanging Information M
any medical conditions can be related to, or affected by, other health conditions and/or medications. Communication between patients, providers and health care facilities allows for clear and coordinated treatment. This also lessens the possibility of unwanted medication interactions and additional testing, increases safety and helps control medical costs. Steps you can take to assist in coordinating your health care. • Communicate with your personal doctor. Notify your personal doctor about any other health care provider visits you have, including specialists and behavioral health visits. This will help in providing important health care information and can aid in avoiding duplicate testing. • Keep your doctors up to date on your medications. Being aware of all medications you take helps your personal doctor and other
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providers see the complete picture. Keeping updated lists of all your medications and doses and giving them to your doctor will reduce the chance of medication interactions, helping improve your outcome and safety. • Release of information. When your see a specialist or other care providers in the same health care system as your personal doctor, information is usually shared as allowed by privacy laws. However, if you see a provider outside of your doctor’s system, ask if a signed consent to release information is needed to have information sent to your personal doctor. Open communication and the exchange of information between all providers involved in your care allow you and your personal doctor to develop and follow a complete, safe and successful overall plan of care for your health and well-being.
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Access quality health care – from the comfort of home.
MDLIVE doctors are here to help whenever you need care. • See a doctor on your schedule with ondemand virtual visits 24/7, including nights, weekends and holidays • Board-certified physicians have an average of 15 years’ experience, so you can get accurate, expert care whenever you need it. Pediatricians are also available. • Online doctor visits through MDLIVE are a convenient and affordable alternative to urgent care or a doctor visit, if your personal doctor isn’t available. • Speak to a licensed therapist or psychiatrist seven days a week, from the privacy of home.
MDLIVE physicians can help with more than 80 common conditions, including the following. • Anxiety
• Pink eye
• Allergies
• Rash
• Cold symptoms
• Respiratory issues
• Depression
• Sinus infections
• Fever
• Social isolation
• Flu
• Sore throat
• Headache
• Urinary tract infection
Register today so you’re ready when you need care 877-958-5455
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Meet Sophie, your personal assistant.
Text “NETWORK” to 635483
Copyright © 2020 MDLIVE Inc. All Rights Reserved. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not replace the primary care physician, is not an insurance product and may not be able to substitute for traditional in person care in every case or for every condition. MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit https://www.MDLIVE.com/terms-of-use/. MCR3089 networkhealth.com
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It’s Not Too Late to Get the Flu Shot A
ccording to the Centers for Disease Control and Prevention (CDC), seasonal influenza (flu) viruses are detected year-round in the U.S., but they are most common during the fall and winter months. The flu season generally starts in October and last through March, peaking between December and February. However, each year is different and sometimes the flu season can go into April or May. Which means that although the best time to get your flu shot is before flu season begins, it is not too late to get your flu shot. Getting the flu shot now will protect you for the remaining flu season. Where You Can Get the Flu Shot There are a variety of places you can get a flu shot. • Your doctor’s office • Drive-through flu-shot clinic • At work (employers may have on-site clinics) • Local flu-shot clinic • Retail pharmacy (e.g., Walgreens, Walmart)
How to Protect Yourself Against the Flu While getting the flu shot is the best way to protect yourself against getting the flu, there are other preventive actions you can take. • Avoid close contact with people who are sick. If you are sick, keep your distance from others to protect others from getting sick. • Stay home when you are sick. Avoid going to work, school or running errands to help prevent spreading the flu. • Cover your mouth and nose when coughing or sneezing. • Wash your hands regularly. If soap and water are not available, use an alcohol-based hand. • Avoid touching your eyes nose and mouth. Germs can spread when you touch something that is contaminated with germs and then touches your eyes, nose, or mouth. • Practice good health habits. Get plenty of sleep, be physically active, manage your stress and eat nutritious food. Facts and Information for the 2021-2022 Flu Season from the CDC • The CDC recommends everyone six months and older should get the flu vaccine each year. • All flu vaccines this flu season are quadrivalent (four component), meaning they are designed to protect against four different versions of the flu virus. • A flu vaccine cannot cause flu illness. • Flu vaccines are not designed to protect against the coronavirus. • Flu vaccines and coronavirus vaccines can be given at the same time. • Getting the flu vaccine does not raise your risk of contracting the coronavirus.
How Do Health Plans Make Decisions? By Sarah Dencker, vice president of care services at Network Health
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id you know utilization decisions made about care by Network Health are based on the appropriateness of care and service? Care and service include medical procedures, behavioral health procedures, pharmaceuticals and devices. Decisions are based on written criteria founded on clinical evidence and on the benefits outlined in the various coverage documents. The written criteria are reviewed and approved annually by actively participating practitioners. Criteria are available to providers, practitioners and/or members/participants upon request. Requests for criteria can be submitted via telephone, fax, electronically or by mail. Once the request is received, utilization management associates send the requested criteria to the requestor via fax, electronically or by mail.
and service, and it does not make decisions about hiring, promoting or terminating practitioners or other associates based on the likelihood, or the perceived likelihood, that the practitioner or associate supports, or tends to support, denial of benefits. The medical directors, associates (or designees), care management staff and supervisors of this staff receive no financial incentive to encourage decisions that result in underutilization.
Network Health does not reward practitioners or other individuals conducting a utilization review for denying coverage for care or service. Network Health does not prohibit providers from advocating on behalf of members/participants within the utilization management program.
Callers can leave a message 24 hours a day, seven days a week. All calls are returned promptly. Calls received after business hours are returned the next business day. Members/participants, practitioners and/ or providers may also send inquiries to the care management department through secure email on the provider portal, fax or by mail. You can also fax the utilization or care management department at 920-720-1916.
Network Health does not use incentives to encourage barriers to care
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In addition, treating practitioners may discuss medical necessity denial determinations with the physician review medical director by contacting our utilization management team at 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m. Bilingual language assistance or translation services are also available.
networkhealth.com
COVID-19 After Getting the Vaccine
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s a senior quality program analyst at Network Health, Chad does a lot of behind-the-scenes data crunching. Like many of us, the last couple years Chad has been working from home most of the time, because of the COVID-19 pandemic. This past September, he became more intimately involved with pandemic when he contracted COVID-19, even though he’d been vaccinated.
– Chad’s Story
“I got vaccinated back in April. My whole family—myself, my 16, 18 and 20-year-old children and also my wife, who is a teacher—all got vaccinated. We wanted to get that done so we could kind of get back to some semblance of normal. We felt it was the right thing to do.” In November of 2020, Chad’s brother contracted COVID-19 and had to be hospitalized, which gave Chad’s family an additional reason to get vaccinated. “He’s fine now,” Chad said. “He didn’t have to go on a ventilator, but he was really sick. He had to go on oxygen because his levels were really low.” Once vaccinated, Chad and his family went about life like everyone else. They wore masks when necessary, but for the most part, COVID-19 wasn’t on their minds much. Then, this past September, symptoms showed up. “All of a sudden I started not feeling well and developed a cough. Nothing too bad, though. It was a Thursday. By the time Monday came around, I was not feeling well at all. I was feeling really run down. By four o’clock that afternoon, I was drained. Tuesday was the same. I was really run down.” Chad went to his local pharmacy to get tested. On Wednesday, he was feeling better but lost his sense of smell and his taste was muted. That night he received a call letting him know he tested positive. His taste and smell were back to normal after about a week. Throughout his time having COVID-19, he had a slight cough, which continued for several weeks.
Chad wanted to give himself the best chance of staying healthy throughout the pandemic.
A coworker asked if he was mad he got sick even though he was vaccinated. Chad said, “I’m not mad at all. I could’ve ended up in the hospital like my brother, and I didn’t. I give credit to the vaccine for that, and for not having it as bad as a lot of other people. I never even got a fever.”
I’m almost 50 and probably a little overweight, so I definitely think it helped me, as well as the people around me. I know people who have passed away from COVID. And, I didn’t want to be one of them.
Chad credits the vaccine with the short duration of his illness. He said, “For me, I think the vaccine saved me time from being sick. It wasn’t as bad as it could have been. My perspective was that my brother and I have the same genes, we’re similar. I could have ended up in the hospital or worse. The way I look at it is, it helped me.” Chad continued, “Plus, before knowing I had it, I lived with my family, without masks, for almost five days, and none of them ended up getting it. I think the vaccine is why.”
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Ensuring You Receive the Service You Deserve By Devon Lor, MSN, RN, quality health integration clinical supervisor at Network Health
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t Network Health, we want to ensure you receive the service you need and deserve. If you have concerns, we want to make sure you understand all your options. If you do not agree with Network Health’s decisions about your care or what’s covered, you have the right to file an appeal or grievance. We have a team of appeals and grievance specialists who will personally ensure your concern receives a complete and thorough review.
When do I file a grievance?
You have the right to file a grievance if you do not agree with Network Health’s decisions about your health care. Your written grievance should include your full name, member ID and detailed information about the decision you would like reviewed. You may also include any comments, documents, records or other information you would like Network Health to consider in its review.
Examples of situations appropriate for a grievance include the following. • Network Health will not approve care you believe should be covered. • Network Health is ending coverage on care you still need. • Network Health has denied payment for services or items you have received, and you think they should be covered.
Who may file a grievance?
You or someone you name to act for you (called your representative) may file a grievance. To name your representative, visit networkhealth.com and go to the For Our Members and Employers drop-down menu and select Employer Members (if you get coverage through your employer) or Individual and Family Members (if you buy insurance on your own), and then select Member Resources. Scroll down to the Forms section and click on the Authorized Representative Form link. Complete the form and send it to the address listed on the form. 20 | balance • W i n t e r 2 0 21
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What happens after I file a grievance?
When you file a grievance, you are formally requesting Network Health to review our decision. We will acknowledge your grievance within five business days of receiving it. The Grievance Committee will schedule a hearing to review your case and you will be notified at least seven days prior to that meeting. Before the meeting, you have the right to submit written comments, documents, records and information relevant to your grievance. You may attend the grievance meeting in person or on the phone to present any additional information. After the hearing, the Grievance Committee will address your grievance and provide a written response within 30 calendar days for a pre-service claim or 60 calendar days for a post-service claim.
How are medication grievances handled?
Medication grievances should be submitted in writing and are reviewed by a Network Health pharmacist and Network Health medical director, as needed. The pharmacist communicates with the prescribing provider if additional information is needed or discusses alternative covered medications. Our pharmacists strive to address medication appeals within four hours and have been successful over 90 percent of the time.
Examples of situations appropriate for a grievance include the following. • Network Health will not approve care you believe should be covered. • Network Health is ending coverage on care you still need. • Network Health has denied payment for services or items you have received, and you think they should be covered.
When do I file a complaint?
If you’re dissatisfied with the service or quality provided by your plan or doctor, we can help you work through any issues. You have the right to file a formal complaint about the service you receive from Network Health, our vendors or contracted providers.
These are examples of situations appropriate for a grievance. • • • •
Difficulty getting through on the phone Concerns about the quality of care or services provided Interpersonal aspects of care (for example, rudeness of a provider or staff) Failure to respect your rights
Say What? Pre-service claim is prior approval of a service or procedure Post-service claim is a claim that is processed after the service has been performed
Your Right to Request an Independent Review We work hard to ensure your satisfaction, but it’s important to know you have the right to request that an independent organization examine certain final decisions made by Network Health. Reviews are completed at no cost to you. Decisions eligible for review are those where Network Health determined the requested care or services did not meet our requirements for the following. • Medical necessity (care that is reasonable, necessary or appropriate based on proven clinical standards) • Health care setting • Level of care • Effectiveness • Experimental treatment • Appropriateness • Coverage denial determination based on a pre-existing condition exclusion For more information about the independent review process at Network Health, refer to your certificate of coverage, policy or contact our member experience team at the phone number listed on the back of your member ID card.
networkhealth.com
Network Health is seeking a member from a fully insured plan to join the panel of our weekly Grievance Committee. The committee hears grievances filed by or on behalf of our commercial members. The commitment is two hours weekly, usually from 10 a.m. to noon on Tuesdays. Currently, all meetings are held via webinar. If you are interested, please submit a written statement of interest to the following address.
Network Health Attn: Appeals and Grievance 1570 Midway Place Menasha, WI 54952 W i n t e r 2 0 21
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Network Health Outperforms When It Comes to Quality
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etwork Health provides personalized member experience and collaborate with our excellent provider partners to ensure you receive the right care at the right time and are treated with courtesy and respect.
Our focus on quality is reflected through multiple quality measures, and Network Health rates higher than the national average in many of these areas. The measures below are assessed through the Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey. This is an annual, random survey that you may be asked to complete. Your feedback is valuable to us and helps us determine how we rank compared to the rest of the nation.
Rating of Health Plan
Getting Care Quickly
Getting Needed Care
Customer Service
96.0%
98.1%
90.3%
92.5%
87.2%
91.1%
82.6%
88.1%
67.0%
69.3%
COMMERCIAL CAHPS RATINGS
Treated with Courtesy
The source for data contained in this publication is NCQA CAHPS 2021 results. Any analysis, interpretation or conclusion based on this data is solely that of the authors. NCQA specifically disclaims responsibility for any such analysis, interpretation or conclusion.
Have You Moved Recently? W
e want to make sure you are getting your important documents, such as ID cards or Explanation of Benefits, so be sure to update your address with us if you have moved. To do so, follow the steps below based on your current plan type. Commercial – Let your employer know when you move. After you notify your employer, you may also call our member experience team at the number listed on page three. You may also log in to your member portal at login.networkhealth.com and complete an online email request.
Individual/Marketplace – Call the Marketplace at 800-318-2596 to update your address. They will make sure we get the updated information. Individual/Non-Marketplace – Call our member experience team at the number listed on page three. You may also log in to
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your member portal at login.networkhealth.com and complete an online email request. State of Wisconsin Employees – Let your employer know when you move. After you notify your employer, you may also call our member experience team at the number listed on page three. When you are updating your address, we will need Street Address including apartment or unit number if you have one, City, State, Zip, and County.
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What Is Population Health Management? By Alice Parks, director of population health management at Network Health
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id you know Network Health offers personal wellness, care management and condition management services at no cost to you? Whether you’re dealing with an unexpected medical issue, a complex diagnosis, a chronic disease or just need a little help maintaining your health, we can help you manage your health to increase your sense of well-being and put you in control. Our care management program focuses on assisting people with complex medical and behavioral health needs, which include cancer, end-stage disease and other life-threatening conditions. (See page 14 for more information about our care management services.) The condition management program helps people with asthma, diabetes, heart disease, heart failure and chronic obstructive pulmonary disease (COPD). Our wellness programs focus on quitting smoking, eating healthy, controlling blood pressure and learning about easy ways to exercise. We’ll also help you create a successful transition plan when you’re discharged from the hospital to your home. Your health assessment and/or claims information help us identify you for potential health management services. Your doctor may also refer you or you can refer yourself. Health management begins with a one-on-one conversation between you and one of our health coaches, condition managers or care managers. If you choose to participate, we will help you manage your health conditions and meet your health goals. You may opt out of these programs at any time by calling the member experience number on the back of your member ID card.
After learning more about you and your health concerns, our team can do the following.
• Answer any questions you have • Review your medications and treatment plans • Inform you about the signs that your health condition is worsening and when to act, including when you should contact your health care provider • Work with your health care providers to ensure they are aware of any health changes • Discuss advance care planning • Ensure you and/or your caregivers feel included in your health care decisions • Help you set health care goals and maintain or improve your health • Help you with coordination of care with providers and community services • Provide you with educational resources, specific to your diagnosis • Work with you to meet your goals Learn more about our programs at networkhealth.com/wellness. If you feel you could benefit from wellness, condition or care management support, call 800-826-0940 (TTY 800-947-3529) Monday–Friday from 8 a.m. to 5 p.m. Callers may leave a message 24 hours a day, seven days a week. We’ll call you back at a time convenient to you, morning, afternoon or evening.
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Financial Questions to Ask Your Doctor When Prescribed a New Medication By Emily Tolliver, pharmacy intern at Network Health
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tarting a new medication can come with a lot of uncertainty and you are likely to have questions about the medication, its side effects and how you should take it. These are all important things to consider. In addition to asking questions about how the medication will work, you should also think about the financial impact. For those with pharmacy benefits included in their plan, Network Health provides a list of covered prescription drugs called a formulary. The formulary lists the different cost levels, known as tiers, that medications fall into. Understanding the formulary can help you make cost-effective choices in collaboration with your doctor. To access your health plan’s formulary, visit networkhealth.com/look-up-medications. From there you will select your specific Network Health plan from the drop-down list. Additionally, you can call Network Health’s member experience team at the phone number listed on the back of your ID card with any questions regarding your drug formulary. Being aware of your drug costs and looking for better financial alternatives saves you money on copayments. In addition to checking your health plan’s formulary, there are a few key questions you may want to ask your doctor before starting a new medication.
1.
Are there lifestyle changes I can make before starting this medication?
Many chronic conditions such as high blood pressure, high cholesterol and diabetes, may be impacted by your lifestyle. Making changes, such as increasing exercise and eating a more balanced diet rich in fruits, vegetables and whole grains, may improve your health and potentially eliminate the need for medications. Asking your doctor about lifestyle recommendations may improve your health and save you money by avoiding adding a medication to your treatment plan.
2.
Is there a generic available?
Many medications are available in a brand name and generic form. For example, most people are familiar with Tylenol, the name brand of the drug acetaminophen. Although you can go to the store and buy name brand Tylenol, you can also choose to buy a generic version that is often much cheaper. This idea applies to your prescription medications as well. When your doctor prescribes a name brand medication, make sure to ask if a generic is available, as receiving the generic will end up saving you money.
3.
Is there an alternative medication I could try first?
For most medical conditions, there are multiple medication options available to treat the disease. In some cases, there may be an alternative medication you have not tried yet that is cheaper than the medication your doctor is prescribing. Make sure to consult your drug plan’s formulary and discuss all available treatment options with your doctor to ensure your treatment is effective clinically and financially affordable.
4.
Is there a free trial available?
Some manufacturers of name brand medications, such as Eliquis, provide a coupon card for a free trial of the medication. In some instances, you may be required to provide information to the manufacturer such as your demographic information, contact information or annual income to receive the free trial offer. Once you have the appropriate billing information, you can bring the card to your preferred pharmacy to have them process the coupon for your free trial of the medication.
5.
Is there a prescription assistance program available?
Similar to the free trials offered by manufacturers, some drug companies offer prescription assistance programs to help lower or even cover the entire cost of the medication. These programs often require you and your doctor to fill out an application indicating your need for financial assistance. Some companies may also require additional information such as proof of income and proof of insurance. Once you have filled out the application, it will be sent to the drug manufacturer who will determine if you qualify. In addition to talking about prescription assistance with your provider, you can go to rxassist.org to see if your medication has an assistance program available. At Network Health, we want to make sure you receive the best care possible, and this includes being able to afford your medications. If you are unable to take a medication as prescribed due to financial difficulty, it’s important you talk to your doctor to find a better more affordable option.
In some instances, a generic may not be available for the medication your doctor is prescribing. If this is the case, you may want to ask some of the following questions.
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A Vaccine to Prevent Cancer W
hen you think of vaccines, you probably think of the prevention of acute illnesses, like influenza, pneumonia or COVID-19. The concept of a vaccine used to prevent cancer sounds like science fiction or technology that is in the far distant future. In truth, there is a vaccine available known as Gardasil 9, which helps to prevent cancers of the genitalia, mouth and throat related to Human Papillomavirus (HPV) infection. While adults up to the age of 45 may receive benefit from the vaccine, the intent of the vaccine is to administer it before a person has the chance of being exposed to the virus through sexual activity. In fact, the Centers for Disease Control and Prevention (CDC) recommends routine vaccination starting at age 11 or 12 and as early as nine.
What is HPV?
• HPV is a virus that can cause cancers in both males and females. • Signs and symptoms often do not present with HPV infection, so many people don’t know they even have it. • If infected, our bodies often clear the virus on its own. However, sometimes a person’s body isn’t able to clear the virus, which then put him/her at risk for certain precancers, cancers and other diseases later in life. • Every year there are tens of thousands of new cancer cases caused by HPV. • Having a new sex partner is a risk factor for getting a new HPV infection.
Who should receive the vaccine?
• Both males and females should receive the vaccine. • Children can get the vaccine as young as nine years of age, with CDC’s recommendation that all receive routine vaccination by age 11 or 12. • The CDC recommends vaccination for everyone through age 26, if not previously vaccinated. • Some adults ages 26-45 have the option to get the HPV vaccine, but it may be of less benefit depending on prior HPV exposure in this age range.
Tell me about the vaccine
• The current HPV vaccine that’s available is called Gardasil 9, which protects against nine different types of HPV. • Vaccine can be given at a doctor’s office or a retail pharmacy. • If given before the age of 15, it’s a two-dose series, doses separated by six to 12 months. • If given at age 15 or older, it’s a three-dose series at 0, one to two month mark and six month mark. • Catch-up immunization schedules are available if a dose has been missed.
Clinical Practice Guidelines
Network Health provides clinical practice guidelines to help you and your health care team make decisions regarding appropriate care for specific circumstances. These guidelines are selected after careful consideration by a panel of physicians on Network Health’s Medical Policy Committee. Guidelines are available for conditions that may be medically acute or chronic in nature, such as low back pain, diabetes, tobacco cessation or depression. The guidelines are updated as new ones become available. These evidence-based guidelines are available to both you and your provider on Network Health’s website. To access them, visit networkhealth.com/provider-resources/clinical-practice-guidelines. To view the guidelines for a specific condition, click the condition you are interested in and you will be redirected to a page containing the appropriate information.
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Rewards for Healthy Choices* T
here is a new wellness program available in 2022 for Network Health members who get their insurance through their employer (or their spouse’s employer).* It is available beginning on your health plan’s next renewal date, which for most employers is January 1. Watch for more information about this new program close to your renewal date.
WellnessWays
WellnessWays is a new wellness program offered by Network Health* in partnership with WebMD®. It rewards you for completing activities that support a healthy lifestyle. You can complete a range of activities throughout your plan year to earn gift cards. Some of the wellness activities you can complete for rewards include the following. • Volunteering • CPR/First Aid Certification • Donating blood • Sports league participation • Buying an annual State Park pass • Getting preventive screenings and vaccinations • And more Other resources and tools available through the WellnessWays wellness program include the following. • Wellbeats OnDemand fitness app • Ability to sync tracking devices to track your fitness goals • Access to wellness program materials in one online portal • Wellness challenges • On-site lunch and learns • Coordination of on-site health screenings and other wellness activities You can access your wellness portal anywhere or anytime with the Wellness At Your Side app. This app can be downloaded for free on various smart phone devices and tablets. If you have questions about the WellnessWays program and rewards, please email wellnessways@networkhealth.com.
Wellbeats Fitness Benefit
Included with the WellnessWays program, and with all individual and family Prestige plans, is the Wellbeats fitness benefit. It delivers online, on-demand fitness classes, nutrition demos, recipes, goal-based challenges and fitness assessments anywhere or anytime, at no cost to you. No matter where you are at in your fitness journey, Wellbeats can help you feel happier, healthier and stronger. • 600+ online classes, including yoga • HIIT, strength training, mindfulness, running and more • Easy-to-use navigation and interface • Recommended classes based on personal preferences • Goal-based challenges • Easily track progress and personal statistics *Not all employers have a wellness program through Network Health. WellnessWays and Wellbeats are not available for State of Wisconsin employees.
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Patrick’s Story By Jon Race, strategic marketing and communications coordinator
A
t 5’10”, 194 pounds, Patrick, an information security expert at Network Health, doesn’t strike you as someone who would be at risk of having type 2 diabetes. Nonetheless, he’s a proud graduate of Network Health’s Prevent T2 program.
Prevent T2 program. With support—Kristy, his brothers and sisters and his Prevent T2 family—Patrick was able to get his numbers back to where he would like them, though he would still like to lose five more pounds.
Patrick usually stays in great shape, but he ran into some issues when the COVID-19 pandemic started. “The whole pandemic thing really threw things for a loop,” Patrick said. “I gained a lot of weight. I was the heaviest I had ever been. It was very burdensome. The heavier I got, the worse my numbers got—blood pressure, cholesterol, triglycerides and glucose. They were all bad.”
“I would not have gotten the same results had I not gone through the program. I know it. But I am fortunate in the sense that I can kind of see the future through my family—my brothers and sisters. My oldest brother is 18 years older than I am. He has type 2 diabetes. My second oldest brother is 16 years older and he’s in amazing shape. I can see both sides of things right there. With older brothers and sisters, I can see my own future, so I used that as motivation.”
The weight gain and his family history prompted Patrick to join the Prevent T2 program. That and his co-worker, Kristy, a quality program coordinator at Network Health. After several conversations with her about his concerns, she encouraged him to join the program. “She was like my own, personal health and wellness coach. She was always checking in on me. ‘How are you doing? How are your numbers? Did you run? What have you been eating?’ She provided that accountability aspect. She was always someone I could talk to,” Patrick said. The Prevent T2 diabetes prevention program consists of a one-year series of facilitator-led, group sessions for individuals with prediabetes or a predisposition for developing type 2 diabetes. The program is part of the National Diabetes Prevention Program which is led by the Centers for Disease Control and Prevention (CDC), and has been proven to prevent or delay type 2 diabetes. “Going through the program, Joy [the facilitator] was amazing. It was well organized and very structured. There were guest speakers at each meeting, including Network Health’s CEO, Coreen Dicus-Johnson. She was there the first meeting to welcome us and the last one to thank us. But there were also Network Health doctors, nurses, pharmacists and wellness coordinators. It was all really positive,” said Patrick. From September 2020 through August 2021, Patrick participated in the
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“For me, it was all about prevention and continuing a lifestyle that was positive. I’d definitely recommend the program,” said Patrick.
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I would not have gotten the same results had I not gone through the program. I know it. - Patrick, Prevent T2 program graduate
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Still, is that enough reason to be concerned about type 2 diabetes? Well, Patrick had to consider his family history as well. “I’m the youngest of twelve children,” said Patrick. “My mother was a diabetic. Her mother was a diabetic. All my grandmother’s sisters were diabetic. My oldest brother is a type 2 diabetic. I have two sisters who are type 2. So, it definitely runs in the family.”
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PRESORT STD US POSTAGE PAID PERMIT 1033 GREEN BAY, WI
1570 Midway Pl. Menasha, WI 54952
MAIL ON 12/30/21
Turning 65 Soon? Network Health Has You Covered I
f you or someone you know is turning 65, make sure you check out our Medicare Advantage plans. You will receive the same exceptional one-on-one service you’ve always experienced from Network Health, and we make enrolling in a Medicare plan easy.
As good as Original Medicare is, it will not cover all your health care expenses. Most people who are eligible for Medicare choose to get their benefits through private health insurance companies to help cover costs. With a Network Health Medicare Advantage Plan, you’ll get extra benefits that Original Medicare doesn’t cover. Learn more about Network Health Medicare Advantage Plans by calling 866-755-5233 (TTY 800-947-3529) or visiting networkhealth.com and selecting Shop Insurance Plans, Medicare Plans. You can also check out the Getting Ready for a New Start – Mary’s Story, Part II article on page seven in this edition of Balance. We first visited with Mary back in our 2021 summer issue of Balance, and you’ll learn about her journey through the Medicare process. Visit networkhealth.com/marys-story to read the 2021 summer feature article. *Network Health Medicare Advantage Plans are not available for State of Wisconsin employees.
When am I eligible for Medicare?
3 months before your birthday
There is a seven-month window when you can enroll in Medicare.
Your birthday month
3 months after your birthday
It’s natural to have questions about everything that goes along with Medicare. Our email newsletter, The Next Chapter, helps you navigate the complicated Medicare system. Sign up for the this free newsletter and get answers to commonly asked questions like the following. • Is Medicare better than the insurance plan I’m on? • When can I enroll? • Is my doctor covered? • And many more.
Visit networkhealth.com/medicare/new-to-medicare to subscribe to our free email newsletter.
