Concierge Summer 2020

Living a Life of Challenges, Friendship and Faith

Member Laurie Perez talks about the special relationship she has with her care manager.

Letter from the President and CEO

The coronavirus health crisis continues to impact and challenge our daily lives. Please know you can still count on Network Health to provide exceptional support and service—our Hometown AdvantageTM—even if it looks a little different this year. Many of our teams are providing remote support as we continue our mission to create healthy and strong Wisconsin communities.

Because your health and safety are always our top priority, Network Health is doing something we have never done before—we are hosting our member events online this year so that you have the necessary information about our 2021 plans. By providing plan information this way, you will be able to remain safe and enjoy the presentation from the comfort of your home. Please see the back cover for more information about how to register.

In addition to the member events, this issue of Concierge contains a plan brochure with benefit enhancements for our 2021 Medicare Advantage plans. You can use this brochure to follow along during our online member events. We work with our provider-owners, Froedtert Health and Ascension Wisconsin, to create plans with you in mind.

Our feature story is about Laurie, a woman who left Network Health in 2019 for a large insurance company, only to come back four months later. Her time at Network Health had given her high expectations that her new insurance company could not meet. That is what our Hometown Advantage is all about— caring about our members as our neighbors, friends and family.

Thank you for your Network Health membership in 2020. We wish you health and safety throughout your holiday season and into the new year.

Sincerely, Coreen Dicus-Johnson President and Chief Executive Officer

health. wellness.

Evaluating New Technologies How We Decide to Add or Change Benefits

Network Health’s Medical Policy Committee evaluates new technology or new application of existing technologies. The evaluation process considers effectiveness of the technology, its appropriate use and evidence base.

Making decisions about technologies is based on, but not limited to, the following.

• Scientific evidence

• Information from appropriate government regulatory bodies

• Risk/benefit analysis

• Manufacturer information

• Assessments done by agencies specializing in technology assessments

• Opinion of provider experts

The following technology assessments have been completed over the past 12 months.

• ZioXT/ZioPatch - Network Health Medical Directors reviewed and decided Network Health will use the MCG guideline, Patch-Type Cardiac Monitors.

If you have a question about a technology assessment, call our utilization management department at 800-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.

Emmi® An Interactive Experience

Emmi® icons are featured throughout this issue of Concierge.

By visiting the links provided, or viewing Concierge online, you can view interactive videos on a variety of health topics. Each icon takes you to free, animated, online programs provided by Emmi. Watch them on your computer, smartphone or tablet as many times as you like.

Do You Love Network Health as Much as We Love You?

When you recommend Network Health Medicare Advantage Plans, you know your loved ones will have access to the same local, high-quality care you receive. As a Wisconsin-based company, we go above and beyond for our customers, because we know we’re helping our neighbors, friends and family.

This fall, Network Health is launching a referral program to reward you when you recommend us to your friends and family. We are still working on the details, so watch our Facebook page, Network Health Wisconsin, for more information.

Keep Yourself Safe from Medicare Fraud

Medicare fraud costs American taxpayers billions of dollars each year and results in higher medical costs for everyone.

Keep your personal information safe by following these guidelines.

DO DON’T

Protect your Medicare card by keeping it in a safe place and treating it like a credit card

Read each Explanation of Benefits carefully and make sure all services listed are services you received

Use a calendar to keep track of your health care appointments

Don’t accept any medical supplies you didn’t order

Don’t give your Social Security number, Medicare number, financial information, Network Health member ID number or credit card information to someone you don’t know

Don’t share personal financial information on social media websites (like Facebook) or through email

Ask questions about your medical care and understand how services are billed Don’t sign blank insurance forms

Watch your credit card and bank statements for any improper billing or fraudulent activity Don’t accept money or gifts for free medical care Monitor your credit report regularly

Report suspected instances of fraud

What If I’m scammed?

Do not be ashamed or embarrassed about being scammed, because it’s not your fault. Modern scammers are very good at what they do, which means we have to be even more diligent when keeping our personal information private.

If you feel you are the victim of a Medicare scam, we are here to assist you. Call our member experience team or send an email to paymentintegrity@networkhealth.com.

You can also call our Values Line at 800-707-2198 (TTY 800-947-3529) to report and discuss activities or incidents you believe are inappropriate. The hotline is confidential, and you may report concerns anonymously. You can reach the hotline 24 hours a day, seven days a week. Your concerns will be investigated, and proper action will be taken to address the problem.

October is Breast Cancer Awareness Month

By Jennifer Footit-Tank, RN, CCP, quality care coordinator at Network Health

Remember to Schedule Your Mammogram

For the last several months, many of us have put preventive health care needs on hold due to the coronavirus pandemic. Businesses and clinics are now open to schedule annual tests, including a screening mammogram. This screening test is the most reliable way to detect breast cancer early.

What Is a Screening Mammogram?

A screening mammogram is an X-ray that radiologists use to look for signs of breast cancer. The American Cancer Society recommends scheduling screening mammograms annually for women 45 to 54 years old. Women 55 and older can choose to switch to a mammogram every other year. Women between 40 and 44 have the option to start a screening mammogram every year.

Mammograms can be done in several different facilities, including radiology and imaging centers, mammography clinics, hospital radiology departments, mobile vans and some physicians’ offices.

Traditional (2D) vs. Tomosynthesis (3D) Mammogram

A traditional—or two-dimensional (2D)—mammogram is the most common type of screening mammogram. It takes an X-ray picture of the breast to get a single image. Most medical facilities offer 2D mammograms.

A newer type of mammogram called digital breast tomosynthesis—or three-dimensional (3D) mammography—takes several pictures of the breast, which allows the computer to create a threedimensional picture of the breast. The FDA approves 3D mammograms for women who have dense breasts. It’s important to note this option is not available at all breast imaging locations.

If you have questions about which type of mammogram is best for you, ask your personal doctor.

Risks Associated with a Screening Mammogram

Mammograms expose you to small amounts of radiation. The 3D mammogram exposes you to a slightly longer dose of low radiation than the 2D mammogram. These levels are still within the recommended safe range per FDA guidelines and do not pose a health risk.

Either type of mammogram screening may find non-cancerous abnormalities, such as cysts. And, neither type of mammogram isguaranteed to find all types of breast cancer.

Preparing for a Mammogram

• If you’re going to a breast imaging center for the first time, bring a list of the places and dates of mammograms, biopsies or other breast treatments you’ve had before.

• If you’ve had mammograms at another facility, try to bring those images with you or have them sent to the new facility so the radiologist can compare the new images to previous ones.

• Do not use deodorant, powder, lotions or creams on your breasts or under your arms prior to the mammogram because the metallic particles in these products may interfere with the images.

• Discuss any recent changes or breast problems with your doctor before getting the mammogram.

Results

A computer will compile the images for a radiologist to read and compare them to previous mammograms, if possible. A full report of the results will be sent to your personal doctor—he or she can discuss the results with you. It usually takes a week or two to receive your results, but the time may vary.

Breast Cancer Screening During the Coronavirus Pandemic

Take care of yourself and others by following these tips when you go to a medical facility.

• Wear a face mask

• Give yourself a few extra minutes, because you may be screened upon entry

• Practice social distancing while in the waiting room

• Wash your hands or use hand sanitizer as needed

If you have additional questions regarding which mammogram is right for you or how to schedule a mammogram, please contact your personal doctor. If you have questions about what is covered by your Network Health Medicare Advantage Plan, please call the member experience team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. From October 1-March 31 we're here seven days a week.

https://www.my-emmi.com/SelfReg/NHPMMAMMO

health. wellness.

Yvonne, RN oncology care manager at Network Health

The People Behind the Voices

By Jon Race, strategic marketing and communications coordinator at Network Health

Network Health’s Care Management team sets us apart from other insurance providers. Having a care management team isn’t out of the ordinary. But the people who make up the team? That’s what makes Network Health extraordinary.

Our care managers are more than a voice on the phone. They truly care about supporting our members through their difficult diagnoses. This includes providing the following services and more.

• Assessing health status

• Creating care plans and monitoring progress

• Collaborating with providers and community resources

• Providing self-care education

• Answering questions about members’ treatment plans

All the care managers are—or have been at some point—a nurse or social worker. Hospice, ICU, neonatal, oncology, surgical, pediatric, you name it, and someone on the team has the experience. The team’s background also includes case managers, social workers, teachers and more. This collective experience, combined with our Hometown Advantage™, allows Network Health to provide support in ways that go above and beyond your health insurance coverage.

MEET THE CARE MANAGERS

Currently, the Network Health Care Management team is made up of 15 people, with varying backgrounds and experience. Here are a few of the people behind the voices who assist our members during their difficult diagnoses.

Yvonne, RN oncology care manager

12 years at Network Health

I’ve been a nurse for 24 years. I did float nursing for ten years then moved to hospice for a couple more. Making a difference in someone’s life is what being a care manager is all about. I get the honor of talking to some of the most amazing, strong and resilient people. And, I work with a wonderful group of people who all have my back. We’re all striving for the same thing—to connect our members with resources and provide the support they need.

Julie, nurse care manager

1.5 years at Network Health

I’ve been a nurse for five years. Prior to that, I was a teacher for 13 years. When my husband passed away from cancer, I resigned as a teacher and went back to school for nursing. We had so many outstanding nurses who helped with his care, I felt strongly that I needed to give back.

Jodie, RN oncology care manager

7 years at Network Health

I’ve been a nurse for 24 years, many of which I worked in home care. The last five of those years I was a hospice nurse. I love helping our members through challenging times, providing a listening ear when needed. There’s nothing better than knowing you put a smile on someone’s face or hearing the joy in a member’s voice when they tell you their cancer is in remission.

Laurie, RN care manager

8 years at Network Health

I was a nurse for seven years prior to coming to Network Health. I had experience in medical/surgical, urology,

internal medicine and doing patient education on chronic conditions such as diabetes, hypertension and asthma. I love working at Network Health because our whole team strives to do their best for our members.

Kristen, Social work care manager

1 year at Network Health

I’ve been a social worker for 21 years. I earned a master’s in social work and all my work experience has been in some form of case/care management. I enjoy the caring culture at Network Health and I really enjoy helping people meet their goals and getting them connected with resources.

Sheila, RN care manager

5 years at Network Health

I’ve been working in the medical field for the past 20 years in various roles. I’ve done long term care, acute rehab, inpatient hospital-medical/oncology, post anesthesia care and pediatrics. I was also a hospice RN for five years. The best thing about Network Health is knowing our members receive the same care my family does.

Tracy, RN care manager

7 years at Network Health

I worked in acute hospital care for over 17 years. My coworkers make Network Health a great place to work. One of the things I like about my job is I’m able to talk to our members without any time pressures or interruptions. When we are working with a member, we’re allowed to give them the attention they need and deserve.

Living a Life of Challenges Friendships and Faith

Network Health member Laurie Perez has led a full life. She and her late husband, Tomas, lived all over the United States and in Puerto Rico. “We’d go anywhere he was contracted to sing,” she said. “I think we only missed 10 states.” While Tomas was busy with his singing career, Laurie took care of the house and children.

At the height of his career, Tomas was approached by a producer from Paramount Studios about playing Mario Lanza in a film about the singer’s life, but he decided against it. “He said, ‘I don’t want to be famous. That would take me away from you and the kids.' He was a wonderful man,” said Laurie. Tomas sang until two weeks before he passed away in 1995.

Laurie and Tomas were blessed with four children. Their daughter was very young when she had a baby, so they adopted her daughter and raised her as one of their children. One of their children had a heart condition and died during childhood. Their son, Staff Sergeant Tomas Perez, Jr., gave his life for our country in 2010.

Each year—except for 2020, due to the coronavirus—Laurie goes to Camp Serenity at Lake Tomahawk, which is a weekend retreat where survivors of soldiers get together and honor their fallen heroes. She said, “I miss him so much. There is nothing more painful than losing a child you carried and raised.” Through the experience, Laurie has connected with other people who lost a loved one in the military.

By Becky Pashouwer, Photography by Beth DesJardin, Trove Photography

Since her husband passed away, Laurie hasn’t thought about dating anybody else. She said, “I’m waiting until God puts me and my husband back together again.” When her church learned about this, they asked her to speak with women who are newly single or widowed. “Many women, when their husbands leave them or pass away, want another man right away. But it doesn’t have to be like that,” said Laurie. Laurie works with her church to provide strength and comfort to these women.

Laurie is also active with the Salvation Army. She’s part of a group that supports underprivileged seniors in the community. Normally, they go on trips and spend time together regularly. During the coronavirus pandemic, that’s stopped. It's been hard on Laurie, because she misses seeing all her friends. But, the group continues to keep in touch. “I’m calling some people from the group to make sure they’re doing ok. Then I report back to the group leader,” Laurie said. “Some people I talk to every day. And, everyone is always worried about how I’m doing, but I’m fine,” she continued.

Unfortunately, Laurie’s health has given her problems for most her life. “I have a lot of health issues. I’ve had more than 20 operations,” she said. Her most recent surgery was a revision to her knee replacement. She’s had both knees and both shoulders replaced. In addition to that, she lives with rheumatoid arthritis, diverticulitis, scoliosis and plaque buildup in her arteries. She also recently broke her spine.

Despite all the obstacles Laurie has faced in her life, she manages to stay positive. “People will ask me if I’m depressed and I tell them no.’ “I can’t even remember a time I was depressed,” said Laurie. Laurie keeps herself busy by walking on her treadmill, doing puzzles, playing games on her computer and reaching out to the friends she’s met through her community involvement. Laurie said, “Most importantly, I have faith. That’s what keeps me going.”

In 2012, Laurie joined Network Health’s dual-eligible special needs plan (D-SNP), NetworkCares. This plan provides coverage to people who are eligible for both

Ann, Network Health Care Manager, wears a mask to protect herself and Laurie while they meet.

Medicare and Medicaid. Her plan benefits include a care manager to provide health care support and to help her navigate her benefits.

As part of the welcome process, Ann P., nurse care manager with Network Health, called Laurie to introduce herself. During this call, Laurie had a memorable request. “Laurie wanted one of those large orange flags to put on her power mobility unit to alert vehicles she was coming. It had nothing to do with her Network Health plan benefits, but I secured one for her by calling around and asking different companies if they had one available,” said Ann. By following through with this request, Ann earned Laurie’s trust, and since then, the two have developed a wonderful relationship.

“We talk a lot, sometimes a couple times a week, depending on what’s going on with Laurie’s health,” Ann continued, “She knows she can call me any time she gets something in the mail she doesn’t understand.”

The dual-eligible population requires open communication with Medicaid, the Centers for Medicare & Medicaid Services and other social services for which the member is eligible. Care managers ensure members understand how everything works together. “These members receive an overwhelming amount of paperwork from social services programs. We help them put it all together, so they understand how these programs work with their Network Health benefits,” said Ann.

The pair spend a lot of time talking about Laurie’s Network Health plan benefits and how she can access and use them. “A big part of what we talk about is how Laurie can maximize her benefits. We want to help her live her best life in any way possible,” said Ann.

One of the services that sets Network Health apart from larger insurance companies is the relationship between care managers and their members. Ann said, “I’ve met Laurie on a few occasions, when she had a health issue that warranted

I wanted to go back to Network Health. The vision benefit was better, and I missed Ann.

an in-person visit. Because we live in the community, we can do that—see our members when they need us most.”

Ann can provide individualized guidance and care because Laurie keeps Ann well informed about any changes with her health. “Laurie is really good about keeping me in the loop about what’s going on with her, so we can continue to work toward the goals she has set for herself. She’s proactive and participates in everything from home visits to health risk assessments, so we have a very clear view of her health and how we can support her,” said Ann.

During the Medicare Annual Enrollment period for 2019,

Laurie’s friend convinced her to leave her Network Health Medicare Advantage Plan to join a different plan. But it didn’t last long.

After a few months, Laurie reached out to Ann. “I wanted to go back to Network Health. The vision benefit was better, and I missed Ann,” Laurie said. “The other insurance company didn’t have someone who called and checked in on me. They were supposed to send a nurse and they never did,” she continued. Laurie wasn’t sure how to start the process and switch back to her Network Health plan, but she knew she could count on Ann to guide her through it.

Laurie had one stipulation about returning to Network Health. “I told them the only way I’d come back is if I got to work with Ann again,” said Laurie. Once her Network Health plan was back in effect, the two continued where they left off—working together to ensure Laurie’s health goals are met.

Now, everything is back the way it was. Laurie gets the support from Ann she didn’t have with her other insurance company. And, Ann gets the joy of supporting Laurie. “Network Health is the best,” said Laurie. “I’ll be with them until I leave this planet.”

“

Laurie Perez, Network Health member

“

“

Ann P., Network Health care manager

I’ve met Laurie on a few occasions, when she had a health issue that warranted an inperson visit. Because we live in the community, we can do that—see our members when they need us most.

“

The Service You Deserve

At Network Health, we work to ensure you’re receiving the service you need and deserve. If concerns arise, it’s important for you to 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 guide you through the review of your concern.

When do I file an appeal?

You have the right to file an appeal if you do not agree with Network Health’s decisions about your health care. You can call or submit an appeal in writing within 60 calendar days of the date of your determination. Your written appeal should include your full name, member ID and information about what you are appealing. 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 an appeal include the following.

• Network Health did not approve care it should cover

• Network Health is stopping 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 an appeal?

You or someone you name to act for you (called your representative) may file an appeal. A Durable Power of Attorney agreement can work in place of an Appointment of Representative form. You can name a relative, friend, advocate, attorney, doctor or someone else to act for you. To name your representative, visit networkhealth.com, select Medicare Plans, Member Resources and scroll down to the Appointment of Representative form. Simply complete this form and send it to us.

What happens after I file an appeal?

If you appeal, we will review our decision. If payment for any of your claims is still denied after our review, we will automatically forward your Part C appeal to the Medicare

independent review contractor. This process ensures that you receive a new and impartial review of your appeal. If you disagree with the independent review decision, you will be notified of further appeal rights.

How are medication appeals handled?

Medication appeals 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 he/she may discuss alternative covered medications.

When do I file a grievance?

If you’re dissatisfied with the service or quality provided by your plan or doctor, we’re here to work with you through any issues. You have the right to file a grievance (a formal complaint) about how Network Health, our vendors or contracted providers provided services.

Examples of situations appropriate for a grievance include the following.

• Concerns about the quality of care or services provided

• Interpersonal aspects of care (for example, rudeness of a provider or staff)

•

Difficulty getting through on the phone

• Failure to respect your rights

Contact Information

Call: Member Experience Team at 800-378-5234 (TTY 800-947-3529), Monday-Friday from 8 a.m. to 8 p.m. From October 1-March 31 we're here seven days a week. Fax: 920-720-1832

Or, write to the below.

Appointment of Representative Form

Network Health

Attn: Medicare Advantage Plans P.O. Box 120, Menasha, WI 54952

Appeals and Grievances

Network Health Attn: Appeals and Grievances P.O. Box 120, Menasha, WI 54952

Preventing Pneumonia Current Vaccine Recommendations

By Joe Lor, Network Health intern from UW-Madison School of Pharmacy

New recommendation for pneumonia vaccines

The adult pneumonia vaccines which are used to prevent bacterial pneumonia— caused by the bacteria Streptococcus pneumoniae—are Prevnar 13® (PCV13) and Pneumovax 23® (PPSV23). The numbers 13 and 23 refer to the specific strains of bacteria these vaccines protect against.

Recent findings suggest the number of pneumonia cases have been drastically reduced among adults aged 65 and older. This is due to increased pediatric PCV13 vaccination rates. As a result, the Advisory Committee on Immunization Practices (ACIP) recently made changes to their recommendation for the pneumonia vaccine.

The new recommendation for adults age 65 and older is to receive one dose of PPSV23 routinely. PCV13 is no longer recommended as part of a routine, although individuals with certain medical conditions or who are at a higher risk of pneumonia may still receive PCV13. Talk with your personal doctor to determine which vaccine is right for you.

and sanitation measures to ensure individuals who receive these services remain safe during the coronavirus pandemic.

What will it cost?

Your Network Health Medicare Advantage Plan covers Pneumovax 23 for $0. If you and your doctor determine PCV13 is best for you, it is also available for $0. Contact our member experience team for additional information about what is covered by your plan.

In some cases, the flu may cause pneumonia. This is another reason it’s so important to get your flu shot every year. Your personal doctor or pharmacist can help determine which vaccines are right for you.

It’s important to understand pneumonia vaccines will not protect you from pneumonia caused by viruses.

What else can you do to reduce your risk of getting pneumonia?

These suggestions can help you stay healthy during pneumonia and flu season.

• Avoid close contact with individuals who are ill

• Disinfect frequently touched surfaces

• Practice good hand hygiene by washing your hands with warm water and soap

Yes. Health care providers who provide essential services (such as vaccines) have incorporated additional safety

Sources

• Keep your immune system healthy through a combination of regular exercise, a nutritious diet and adequate sleep at night

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices (2019). Morbidity and Mortality Weekly Report. Retrieved from https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6846a5-H.pdf

Did you know getting your annual flu shot also reduces your risk for pneumonia?

Is it safe to receive vaccinations during the coronavirus pandemic?

Risks, Costs and Potential Alternatives to Biologic Medications

By Beth Coopman, PharmD, pharmacist at Network Health

Many of us have seen advertisements for Humira®, Enbrel®, Remicade®, Rituxan®, Cimzia® and Simponi®, which are drugs that fall into the category of biologic medications. While this type of medication isn’t new—vaccines and insulin are considered biologics— there are many newer biologic medications which treat severe inflammation occurring in individuals with certain autoimmune diseases. People with these diseases have a lot of questions about these drugs, and the high price tag that goes along with them.

What are biologic medications?

Biologic medications (or biologics) are made from living cells, so they’re different than non-biologic medications made from chemicals. Biologics are given as an injection into the body.

Because biologics are made from living cells, they have different risks and higher costs than non-biologic medications. Some of the most commonly used biologics target inflammation in conditions like psoriasis, rheumatoid arthritis (RA), Crohn’s disease and ulcerative colitis.

For some patients, these biologics have made a tremendous difference in their health, although that’s not the case for all recipients.

How much do biologics cost?

From 2009 to 2018, the amount spent on biologics nearly doubled, to $45 billion*. Additionally, the amount spent on nonbiologic medications has decreased.

Biologic medications, like Humira, Enbrel and Remicade, cost over

$60,000 per year to treat one person. This means the average cost for a single biologic drug in one year is more than the average income of a person residing in the United States. Using these medications raises health care costs for all members, not just those on biologics.

What are potential alternatives to high-cost biologics?

Non-biologic medications that also target inflammation in conditions like psoriasis, rheumatoid arthritis (RA), Crohn’s disease and ulcerative colitis, cost less than $1,000 per patient, per year. Many of these medications have been used safely for decades.

Biosimilar medications (or biosimilars) are made by competing companies and are kind of like a generic version of a biologic. Biosimilars improve access and reduce costs. Unfortunately, available biosimilars are only slightly less expensive than the original biologic medication. As biosimilar competition increases, costs are expected to substantially decrease.

By using non-biologic medications and future biosimilars, you’re helping to keep health care costs and premiums stable.

What are the risks of biologic medications?

As with any medication, you should discuss the risks of biologics with your personal doctor before starting the medication. Since biologics are injected into the body, injection-site or infusion reactions may occur. Because they weaken the immune system, all biologic medications decrease the body’s ability to fight germs. Additionally, biologics can worsen preexisting conditions like heart failure and multiple sclerosis.

Your doctor should test for certain underlying infections and treat them appropriately before starting a biologic medication. The most common infections are upper respiratory tract infections, sinus infections, bronchitis and

*According to IQVIA, a health care analytics company

urinary tract infections. Less common, but more serious, are tuberculosis, hepatitis B or C and fungal infections. Biologic medications can lose effectiveness over time. Because the drug doesn’t naturally occur in your body, your immune system begins to produce antibodies which make the drug ineffective. Sometimes doctors will delay the start of biologics or switch to different biologics to address antibody formation.

You and your doctor should re-evaluate biologic medications periodically to make sure they’re working most effectively. If your quality of life hasn’t improved, it may be time to discuss a more cost-effective alternative.

If you have any questions pertaining to this article, email the Network Health pharmacists at pharmacists@ networkhealth.com.

*According to IQVIA, a health care analytics company

https://www.my-emmi.com/SelfReg/NHPMBIOTHERAPY

Dispensing Knowledge

Complimentary Medication Review by a Network Health Pharmacist

By Gary Melis, RPh, pharmacist at Network Health

Each year, Medicare encourages health insurance companies to reach out to members that may be eligible for a medication therapy management (MTM) review.

Network Health’s MTM program has an in-house, local health plan pharmacist who reviews both pharmacy and medical claims with you. This service allows our pharmacists to see the bigger picture of your health care needs when offering suggestions to you and your personal doctor.

It is important for you to ask your doctor and pharmacist about any questions or concerns you have regarding your medications. And, as an added benefit of your Network Health Medicare Advantage Plan, you can also speak with a Network Health pharmacist who knows about your medication costs and which medications are covered by your insurance.

The medication review only takes a few minutes and may cover the following.

• Medication cost savings

• Available financial support, such as assistance from the manufacturer

• Providing answers to your questions about how and when to take your medications

Below, you’ll find examples of how members have saved money from MTM reviews.

• Inhaler for chronic obstructive pulmonary disorder went from $84 per month out-of-pocket cost to $8 per month out-of-pocket cost for the member

• Bladder medication for $8 per month out-of-pocket cost, instead of $84 per month out-of-pocket

• Savings of $180 in the coverage gap (also known as the donut hole) when NovoLog insulin was switched to a generic version

• OneTouch® and Accu-Chek® test strips covered for $0 out-of-pocket, versus paying cash at the pharmacy

At Network Health, our goal is to ensure you receive the care and support you need to maintain or improve your health.

If you feel an MTM review may benefit you, reach out to the clinical pharmacist team at 888-665-1246 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.

Partners in Care and Quality

By Nancy Weber, BSN, MPA, RN, clinical integration program manager at Network Health

Network Health has a clinical integration partnership with several provider partners, including our provider owners, Froedtert Health and Ascension Wisconsin. Through this partnership, we share goals to achieve the health outcomes that are important to you.

What is clinical integration?

Clinical integration is a coordinated effort between Network Health and your providers to ensure you receive effective care across all conditions, providers, settings and time. The expected outcome is high-quality care that is safe, efficient, timely, unbiased and patient-focused. Simply put, it means your providers and Network Health have a unique interactive connection to ensure you’re getting the best care possible for your individual needs and conditions.

Why would an insurance company need to know about the care I’m receiving from my provider(s)?

Network Health does more than pay your medical bills. We ensure your health and wellness journey is as streamlined and efficient as possible. As a Wisconsin-based company, our Hometown Advantage™ helps us grow personal relationships with our provider partners and members to deliver services that matter most to you. Being owned by two provider health systems allows us to work together to make your care a top priority in everything we do.

Isn’t my personal doctor responsible for coordinating my care?

It’s true that quality health care starts with your personal doctor. We encourage you to choose a doctor you trust for your routine care needs. He or she will provide guidance if an illness or health concern develops. And, by documenting your symptoms, your doctor gives other providers necessary information to use when additional care is needed.

Your opinions matter

Your opinions about your experiences with doctors, nurses, hospitals and Network Health are extremely important. We take your input seriously and work closely with our provider partners to assure you have satisfying health care experiences. We rely heavily on input from surveys you complete on our behalf and on behalf of your providers.

If you have questions about how Network Health works with your provider, please call the quality health integration team at 800-826-0940 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.

Do You Get Too Much Mail?

Network Health now 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.

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 here, you can choose email for any or all the available categories. Make sure to click Next to save your choices.

How to Improve Your Quality of Care

By Nancy Weber, BSN, MPA, RN, clinical integration program manager at Network Health

You may not directly see our clinical integration partnership when you receive preventive services or care for your conditions. However, Network Health’s partnership with providers is constantly at work behind the scenes to ensure you receive high-quality care.

At Network Health, we strive to achieve positive member experiences. It’s important for us ensure you can do the following.

• Receive coordinated care with your primary care and specialty providers

• Improve or maintain your physical and mental health throughout your life

• Improve bladder control and minimize urinary incontinence

• Reduce risks of falling and sustaining a life changing fracture

• Consistently afford and take medications as prescribed

• Recommend your providers and Network Health to friends and family

What can you do?

• Select a personal doctor who is contracted with Network Health

• Notify Network Health to assure we have the correct doctor in your member profile

• Establish care with your personal doctor

• Set your health and wellness goals

• Share feedback about your care experiences by responding to one of our surveys

At Network Health, we want you to get the care you need, when you need it. We’re grateful for the partnerships we have with our members, provider owners and our local providers who focus on caring for the people who matter most to us—you.

Customer Service is Now Member Experience

Beginning in fall 2020, our customer service team is changing its name to the member experience team. This new name considers your entire journey, which is made up of all the experiences you have when interacting with Network Health.

At Network Health, you’re more than just a customer. We know we are serving our neighbors, friends and family. The member experience team name is about supporting you, our member—the best part of Network Health. This team still provides the same great service you’ve come to expect—assisting with benefits, claims, authorizations, pharmacy and more. Now we’re just doing it with a name that more accurately describes what we do.

Coping With Stress

By: Katie Meiers RN, BSN, BA - supervisor of care management at Network Health

The coronavirus outbreak has been stressful for many people. Fear and anxiety about the pandemic can be overwhelming for some, often causing strong emotions in both adults and children. It is important to realize these feelings are not out of the ordinary. According to the Centers for Disease Control and Prevention (CDC), signs and symptoms of stress during a disease outbreak can include the following.

• Fear and worry about your own health and the health of your loved ones

• Changes in sleep or eating patterns

•

Difficulty sleeping or concentrating

• Worsening of chronic health problems

• Worsening of mental health conditions

• Increased use of alcohol, tobacco or other drugs

Everyone reacts differently How you respond to the coronavirus pandemic greatly depends on your background, personality, the community where you live, your mental makeup and more. In other words, how you react is directly related to everything that makes you, you.

According to the CDC, people who may respond more strongly to the stress of a crisis include the following

• Older people and people with chronic diseases who are at higher risk for severe illness from the coronavirus

• Children and teens

• People who are helping with the response to the coronavirus, like doctors, other health care providers and first responders

• People who have mental health conditions, including problems with substance use

Ways to cope with stress

The CDC recommends several ways to handle and cope with stress.

• Take breaks from watching, reading or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.

• Take care of your body

• Take deep breaths, stretch or meditate

• Try to eat healthy, well-balanced meals

• Exercise regularly

• Get plenty of sleep

• Avoid alcohol and drugs

• Make time to unwind—try to do some activities you enjoy

• Connect with others—talk with people you trust about your concerns and how you are feeling

Take care of your mental health

It is normal to feel stress, worry and anxiety during a crisis such as a pandemic. Being aware of and taking care of your emotional health can help you think clearer and react better to the events going on around you. And, that’s a good thing for you and your family.

Take care of your mind by doing one or more of the following.

• Garden

• Keep your mind active

• Revisit a hobby like knitting, puzzles or painting

• Practice mindfulness

Support your friends and family

It is a good idea to check in with friends and family on a regular basis. Face-to-face communication may not be possible, but virtual communication can help you and your loved ones feel less lonely and isolated. You can stay in touch the following ways.

• Telephone – Share your experiences

• Email – Share photos or what you’re up to

• Snail mail – Write a letter, send a card or a care package

• Text – Set up group chats with friends, family and neighbors

• Video chat – There are numerous free apps and software available to use for one-on-one or group chatting. Join or create a virtual book or movie club

• Social media – Use Facebook, Snapchat or Instagram to share your feelings, stories, jokes or memories with family and friends

• Live streams – Schedule time to watch live streams of faith services or art performances together

• Visit – Visit outside from a safe distance wearing masks

Remember, everyone is different. Every one of your friends and family members—including you—are handling the coronavirus pandemic a little differently. Some are handling it better than others. If you can, reach out and help those in need. If you are struggling, reach out and ask for help. Take comfort in the support of others.

Know Your Member Rights and Responsibilities

Did you know you have rights and responsibilities as a Network Health Medicare Advantage member? To learn more about how we provide you with service that respects your rights, go to networkhealth.com, select Medicare Plans and Member Resources. On this page, you’ll find Member Rights and Responsibilities. You can also call the member experience team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. to request this information. From October 1-March 31 we're here seven days a week.

Pantry Challenge

EAT WELL WITH WHAT’S

ON HAND

By Joy Manning at SilverSneakers®

Home cooking has taken on a new meaning the past few months. Since we can’t pop out to the store and pick up ingredients like we used to, we have good news. Your cupboards and freezer are likely already full of nutritious staples that can lead to some incredibly delicious, good-for-you dishes.

You just need to take stock of what’s on hand. We’ve all stared down a pantry that’s a bit scary—cluttered with bags and boxes of half-used, out-of-date, or forgotten ingredients. According to Kelsey Lorencz, registered dietitian and founder of Simply Nourished Home, this is the perfect time to kick off a 30-day pantry challenge.

WHAT IS A PANTRY CHALLENGE?

During this time, you’ll build your meals out of what you have on hand, putting only meat, eggs, dairy, and fresh fruits and vegetables on your shopping list.

By the end of the challenge, you’ll have a more organized kitchen and a better understanding of how to shop and cook based on what you like to eat. Plus, you’ll likely come up with creative new homemade meals that outlive the challenge. Here’s how to get started.

STEP 1 – THE INVENTORY

Taking a clear look at what you have in your cabinets and freezer is half the battle, according to Lorencz. “I like to separate everything into categories—produce, proteins, starches and condiments,” she says.

As you go, pull all items out of their storage spaces so you see the containers and bags hiding in the back. Often, perfectly good ingredients go bad because you don’t even know they’re there. While you’re at it, this would be the ideal time to clean those shelves and your freezer.

STEP 2 – THE PURGE

Once you see everything you have on hand, you might notice you have some things you don’t really want after all. Perhaps there are items that are long expired or goodies, like packaged cakes or cookies you

purchased on impulse, that don’t fit into your current healthy eating plan.

Now’s the time to trash spoiled items. And those unopened boxes of cookies and cake mixes? “This is the perfect opportunity to give back by donating to a local food bank,” says Lorencz.

STEP 3 – THE RULES

In terms of buying new groceries, depending on your situation, you may be more or less strict with yourself. If you already have frozen foods like fruits, vegetables, and proteins in your freezer, you may not need to buy much to eat well for a month or more.

For most people, though, Lorencz suggests your meals during the challenge should be about three-quarters items you have on hand and one-quarter fresh items.

“Allowing yourself to buy some perishable foods and produce makes it easier to create healthy, balanced meals while using up most of your stored foods, she says.”

STEP 4 – THE CULINARY MAGIC

Even those who don’t think of themselves as creative cooks discover their inner chef during a pantry challenge. Often, you’ll combine things in new and unexpected ways, resulting in a favorite that becomes part of your regular meal routine.

Watch enough cooking shows and you’ll learn these three tips.

• Almost anything can be made into soup

• Almost anything can be rolled into a wrap

• Almost anything can be tossed with pasta

Other times, you may need a little help from the internet. You can try searching for easy meals that are perfect for one person or dinner recipes for two people.

Plus, take advantage of recipe sites with search boxes where you can enter an ingredient to find relevant recipes.

Lorencz is a fan of allrecipes.com and epicurious.com, because they both have an excellent search function. While perusing recipes, don’t get tempted to buy more groceries. Any meal will be just fine if you omit the fresh parsley or use the dried herbs you already have.

STEP 5 – THE LESSONS

Even if you’ve been cooking for many decades, you may learn a lot about how you cook and eat by doing this pantry challenge. Perhaps you discarded so much expired whole wheat pasta you’ve finally permanently deleted it from your shopping list.

On the other hand, maybe now that you realize how simple it is to cook quinoa, it can become a new favorite. Make notes on what you’ve learned and save any new recipes which have come into your rotation.

“Challenging yourself to eat from food that is already available is an excellent way to get creative in the kitchen, reduce food waste and save some serious money in the process,” says Lorencz.

What’s the Difference Between an Annual Wellness Visit and an Annual Physical?

An annual wellness visit is covered by your Network Health Medicare Advantage Plan as a preventive service and is available for $0. However an annual physical is considered a doctor visit where an office visit copayment applies. So, what’s the difference between the two?

These visits are each performed for different reasons. The purpose of the annual wellness visit is for your personal doctor to get a snapshot of your current health. At an annual physical, your doctor determines if you have any physical illnesses or issues.

Below is a breakdown of services your doctor may perform at each of these visits.

Annual Wellness Visit

Measure height, weight, blood pressure and body mass index (BMI)

Review your medical and family history

Annual Physical

Measure height, weight, blood pressure and body mass index (BMI)

Review your medical and family history

Develop/update a list of providers and prescriptionsAssess risk factors for preventable diseases

Look for signs of cognitive impairment

Create a list of risk factors for medical conditions

Help with lifestyle changes, such as quitting smoking

Set up/update a personal preventive plan

Review an annual health risk assessment

Set up schedule for appropriate preventive services

When you call your personal doctor’s office to set up your appointment, make sure you know which type of appointment you’re scheduling, so you don’t have any surprises when you get your Explanation of Benefits. If you ever have questions about how your doctor is coding a specific service, all you have to do is ask.

If you have questions about the difference between an annual wellness visit and an annual physical, you can contact the Network Health Care Management Team at 866-709-0019 (TTY 800-947-3529) Monday–Friday, from 8 a.m. to 5 p.m.

Check vital signs

Perform head, neck, lung, abdominal and neurological exam

Check reflexes

Obtain urine and/or blood samples for lab testing

What’s the Welcome to Medicare visit?

This is a one-time visit with your personal doctor within 12 months of joining Medicare. It costs $0. At this visit, your doctor will perform services similar to the annual wellness visit. The purpose is for your doctor to have a reference point he or she can use at future appointments.

Telehealth Services and

—What Are They?

In the past few months, the use of telehealth services has skyrocketed. Originally developed to help people save time and money, these services can now serve as an alternative to in-person doctor visits, which is great for people who have coronavirus concerns.

Why and when would you use telehealth services?

The two main reasons for using telehealth services are listed below.

1. You have a non-emergency question or illness and your personal doctor is unavailable.

2. You need to see a doctor but have concerns about coronavirus and an in-person visit.

What do telehealth services cost?

To give you access to the care you need, through December 31, 2020, Network Health will cover all services for CMS-approved providers and covered services for a $0 copayment. Telehealth services from out-of-network providers for Health Maintenance Organization (HMO) members will not be covered.

What is MDLIVE?

Network Health partners with MDLIVE to provide telehealth services to our members. Available 24 hours a day, seven days a week, MDLIVE allows members to connect with a board-certified physician for treatment of a wide range of conditions.

MDLIVE providers can help you with more than 50 non-emergency medical, behavioral health and dermatological issues, from colds, anxiety and sinus infections, to acne, psoriasis and more.

As many clinics now offer telehealth visits, you should always check with your personal doctor before using MDLIVE. However, if your personal doctor is not available, online doctor visits through MDLIVE are a convenient and affordable alternative.

How can I sign up for MDLIVE?

Set up your Network Health MDLIVE account in one of four ways. Register for MDLIVE today, so your account is ready when you need it.

Log in to your member portal at login.networkhealth.com and click Virtual Visits to create your username and password.

Once you’ve set up your MDLIVE account, you’ll be able to seamlessly access it from your member portal.

Text NETWORK to 635483 to be walked through step-by-step registration on your phone.

Download the MDLIVE app on your smartphone or tablet. Open the application and follow the instructions to create an account.

Call 877-958-5455 and an MDLIVE customer service representative will walk you through the process of setting up an account.

Using Technology in a Changing World

During the coronavirus pandemic, you’ve probably heard about people using online virtual technology to stay in contact with family and friends from a safe distance. This allows you to see and interact with loved ones while you’re socially distancing. It also works well if your family and friends don’t live close enough to visit on a regular basis. Remember, if you want to use a video feature, your computer, smartphone or tablet needs to have a webcam. Are you ready to join in? You’ll want to use the same technology as your family and friends. If you need help getting started, four common tools are listed below.

• Zoom

• Google Hangouts

• Skype

•

Apple FaceTime

To people who use technology all the time, using these tools may not seem difficult. But, for someone who doesn’t use technology often—or at all—trying one of these may be confusing. Read on to learn more about how to access and use this technology.

Zoom

If you have a computer, open a web browser and visit zoom.us. From here you can create an account or log in to an existing account. Once you have an account, you can select Host a Meeting and invite one person or multiple people. Or, your family and friends can send you an invitation to join a meeting they’re hosting.

If you prefer, you can download the Zoom app through the app store on your smartphone or tablet. You’ll have all the same capabilities as you would online. It’s all about how you prefer to access the tool.

In October 2020, Network Health is using Zoom to host our Experience Network Health Member Events. For more information about the times of the meetings and how to sign up, see the back cover of this issue.

Skype

Similar to Zoom, you can create a Skype account on your computer by visiting skype.com, or you can

download the app on your smartphone or tablet. Once you create this account, you can choose to Host a Meeting with one or more people, or you can be invited to join a meeting a loved one is hosting.

Google Hangouts

If you use Gmail for your email, you may already have access to Google Hangouts. When you’re in your Gmail, check the lower right corner for the icon that looks like quotation marks. Click this to open Google Hangouts. In the left column, you can search for people to message or call.

Note – Anyone you connect with on Google Hangouts must also have a Google or Gmail account.

FaceTime

FaceTime can only be accessed through Apple devices. This means you and the person you’re contacting must both have Apple devices, including a smartphone, tablet or Mac computer.

To use FaceTime, you will have to download the FaceTime app through the Apple app store. Once the app is downloaded, you can set up an account. From here, you can search through your contacts list and reach out to the person you want to call.

Note – You’ll need the phone number or email address of the person you want to contact.

The

of

Annual Flu Shot

By Rita Hanson, MD, medical director at Network Health

During the coronavirus pandemic, it is more important than ever to avoid getting the flu. Thankfully, strategies to prevent the spread of coronavirus also help reduce the spread of flu.

• Avoid close contact with people who are ill

• Cover coughs or sneezes

• When outside your house, wear a mask

• Wash or sanitize your hands often, especially after touching objects frequently touched by others and before getting back into the car

Fortunately, unlike the coronavirus, we have a way to prevent flu and decrease its complications, such as pneumonia or respiratory, heart or kidney injury—the annual flu shot.

Most people 6 months or older should get a flu shot each year, but only about half do. The rest decline either because of concerns about side effects or the belief that it doesn’t work.

People cannot get the flu from the flu shot*. However, it

takes two weeks to develop flu-fighting antibodies after receiving the shot. If flu symptoms occur during that twoweek period, it’s not a result of the shot. It simply means exposure to the flu happened before the antibody response occurred.

This graphic shows the rates of illness and death caused by the flu if the typical half of the population gets the flu shot, versus if no one gets the shot, versus if most people get it, even if effectiveness is low.

While the flu shot is not 100 percent effective, it still saves lives. And, the more people that get the shot, the truer that is.

So, please get a flu shot. It’s recommended that adults 65 or older should consider the high-dose version of the vaccine if available.

*Inhaled flu vaccine can cause a mild case of the flu which can be transmitted to others.

wellness.

Preparing for Joint Replacement Surgery

If you’re planning a joint replacement surgery, you may wonder how to get yourself and your home ready. Preparing ahead of time is important for a successful recovery.

Home Environment Setup

Ask your doctor what you may need to help you recover. Shop for these items before surgery, so you can focus on healing when you arrive home.

1. You may need pharmacy items such as acetaminophen, stool softeners, thermometer, ice packs or assistive equipment such as a walker, shower chair, raised toilet seat, commode or a grab bar.

2. Make sure your bed is firm, low and close to the bathroom. You will want to sleep on the first floor of your home, because stairs may be a challenge for the first few weeks.

3. Set up a space where you will spend most of your time during the first days of your recovery.

4. Take a spin around the house with your walker or crutches to see how you will manage doorways and maneuver in the bathroom. Pick up throw rugs, clutter and remove cords that may create tripping hazards.

5. Stock your fridge, pantry and freezer so you have easy access to food and drinks.

Dial 211 or call your county Aging and Disability Resource Center (ADRC) if you would like access to community support such as meals on wheels, equipment loan closets or ride assistance. You can locate your ADRC at FindMyADRC.org

Prepare Your Body

Surgery is stressful for your body both physically and mentally.

1. Quit or reduce smoking. Your body starts to heal, and your heart and lungs start to work better as soon as you quit. This can also reduce your risk of developing pneumonia and other complications such as a heart attack.

2. Ask your doctor for some simple exercises to help strengthen muscles before surgery. Low impact activities such as swimming, tai chi, chair yoga or even simple stretching can help improve blood flow, mobility and flexibility.

3. Sign up for SilverSneakers® fitness online.* They offer access to hundreds of workouts, nutrition videos and exercise programs you can access from your home computer or phone.

*Not included with Network PlatinumSelect or NetworkPrime

Allison Pahnke, RN, care manager at Network Health

Plan to Have Help

More than ever, people are successfully recovering at home after elective surgery. The first few days can be difficult, so it’s best to have a friend or family member stay with you until you can manage most things on your own.

1. Mobility may be challengingthe first few weeks after surgery. Home health can provide monitoring and support with nurses, physical therapists, occupational therapists and home health aides. Many Network Health Medicare Advantage Plans have little to no copayment for these types of skilled services for the first few weeks after surgery. Review your Evidence of Coverage (EOC) to find out how much these services will cost you.

2. Arrange to have someone who can drive you to your appointments after surgery. You can contact your local ADRC or dial 211 to find ride assistance in your area.

3. Prepare for worst case scenarios and complete the Power of Attorney for Health Care form. Have a discussion with your family about how and where you would like to recover if there are complications.

4. Reach out to your personal doctor for advice and suggestions about preparing and recovering for surgery.

5. We are here to help you on your road to recovery. For more information or assistance with community resources, please contact the Network Health Care Management Department at 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.

Remember to Use Your $200 Benefits Card

Your health is important to us. In response to the coronavirus health crisis, we’re making it easier for you to get the care you need when you need it. In June, Network Health sent you a $200 Benefits Card to use for qualified health care expenses in 2020. If you haven’t had a chance to use it yet, please do so before it expires on December 31, 2020.

The funds are already loaded, and the card is ready for you to use. Make sure to sign the back of the card before using it and select the credit payment option when using your card at retail locations.

As a reminder, you can use your card in any combination of the following ways.

• Pay your office visit copayments

• Pay your prescription drug copayments (if you have drug coverage)

• Purchase necessary over-the-counter items and pay for other Medicare-approved medical expenses

• For more ideas and a list of approved over-the-counter items, visit networkhealth.com/coronavirus-medicare

If you have questions about your card, please reach out to the Network Health Member Experience Team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. From October 1-March 31 we're here seven days a week.

How to Read Your Monthly Explanation of Benefits (EOB)

The EOB is a statement you get in the mail after you’ve been to a doctor or hospital. In May, we began sending one EOB per month, to reduce the amount of paper and mailings sent to you. You’ll only receive an EOB if you had services during the previous month.

In addition, you’ll notice the new EOB is in a different, easy-to-read format. The below example details where you can find all the information.

TOTALS for medical and hospital claims

Amount providers have billed the plan

Total cost (amount the plan has approved) Plan’s shareYour share

Totals for this month (for claims processed from February 01, 2020 to February 29, 2020) $212.00 $72.05 $60.81 $10.00

Totals for 2020 (all claims processed through February 29, 2020) $1,158.96 $525.00 $389.48 $135.52

YEARLY LIMIT - this limit gives you financial protection

YEARLY LIMIT - this limit gives you financial protection

(this section may vary depending on your plan)

This limit tells the most you will have to pay in “out-of-pocket” costs, copays, and coinsurance for medical and hospital services covered by the plan.

This limit tells the most you will have to pay in “out-of-pocket” costs, copays, and coinsurance for medical and hospital services covered by the plan.

This yearly limit is called your “out-of-pocket maximum.” It puts a limit on how much you have to pay, but it does not put a limit on how much care you can get.

This yearly limit is called your “out-of-pocket maximum.” It puts a limit on how much you have to pay, but it does not put a limit on how much care you can get.

Your out-of-pocket spending for non-Medicare covered expenses such as routine hearing, hearing aids, routine dental, home medical monitoring, meals programs and other non-covered services will not count toward your yearly out-of-pocket maximum. This means:

Your out-of-pocket spending for non-Medicare covered expenses such as routine hearing, hearing aids, routine dental, home medical monitoring, meals programs and other non-covered services will not count toward your yearly out-of-pocket maximum. This means:

Once you have reached your limit in out-of-pocket costs, you stop paying out of pocket for all services except non-covered services.

Once you have reached your limit in out-of-pocket costs, you stop paying out of pocket for all services except non-covered services.

You keep getting your covered medical and hospital services as usual, and the plan will pay the full cost for the rest of the year. Your out-of-pocket spending for services that are not covered by Medicare does not count toward your out-of-pocket maximum.

You keep getting your covered medical and hospital services as usual, and the plan will pay the full cost for the rest of the year. Your out-of-pocket spending for services that are not covered by Medicare does not count toward your out-of-pocket maximum.

As of February 29, 2020, (for the plan year 2020), you have had $121.69 in out-of-pocket costs that count toward your $4,500.00 out-of-pocket maximum for covered services.

As of February 29, 2020, (for the plan year 2020), you have had $121.69 in out-of-pocket costs that count toward your $4,500.00 out-of-pocket maximum for covered services.

Combined (in-network + out-of-network) limit

Combined (in-network + out-of-network) limit

In 2020, $4,500.00 is the most you will have to pay for covered services you get from all providers (in-network providers + out of network providers combined).

In 2020, $4,500.00 is the most you will have to pay for covered services you get from all providers (in-network providers + out of network providers combined).

As of February 29, 2020, (for plan year 2020), you have had $121.69 in out-of-pocket costs that count toward your $4,500.00 combined out-of-pocket maximum for covered services.

As of February 29, 2020, (for plan year 2020), you have had $121.69 in out-of-pocket costs that count toward your $4,500.00 combined out-of-pocket maximum for covered services.

If you have questions about how to read your EOB, please contact our member experience team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. From October 1-March 31 we're here seven days a week.

Details for claims processed in February 2020

Date of Service 01/17/2020

Amount the provider billed the plan $212.00

Total cost (amount the plan approved) $72.05

Plan’s share $60.81 23

The total amount providers billed the plan for services received during the month

The total amount the plan approved to pay for the services received during the month

The total amount the plan paid your provider (your savings) for the month

The amount you owe for services received for the month

The year the service was received

The total amount providers have billed for the plan year indicated

The total amount the plan approved to pay for services received so far this year

The total amount the plan paid your provider (your savings) so far this year

The total amount you’ve paid for services received this year

The amount you have spent toward your maximum out-of-pocket costs

Your maximum out-of-pocket costs for the plan year

Indicates the month when claims were processed for the services listed (Network Health receives claims from your provider)

Names the provider submitting the claim for services received

A number generated to identify the claim

Describes if this provider is in-network or out-of-network

A brief description of the service received

The date the service was provided

Your share $10.00

You pay a $10.00 copayment for services from an In-network provider. $0.00

The total amount the provider billed for the service

The total amount the plan approved*

The amount the plan paid your provider (your savings)

The amount you’ll pay for this service

A code the provider uses to indicate the reason for service

Explains why you owe this amount

*The plan’s share and your share may not always equal the total cost. You are not responsible for the difference.

1570 Midway Pl. Menasha, WI 54952

Health and wellness or prevention information

Experience Network Health

You’re invited to learn about your 2021 Network Health Medicare Advantage Plan benefits from the comfort of your home. Keep the Medicare Plan Choices and Benefits booklet you received with this magazine because it will be referenced during these events.

What to Expect from This Year’s Events

• Learn what’s new for 2021 Network Health Medicare Advantage Plans

• Enjoy a presentation explaining your benefits and how to use them

• Get answers to your common Medicare Advantage plan questions

• Find out about the resources available to you

How to Register for an Online Virtual Event

Visit networkhealth.com/experience to see the list of available event times. You can use the link provided to register for the online virtual event that works best for you.

After you register, you’ll receive an email with a link from Zoom to join the event on the scheduled day and time. We recommend joining five minutes early.

What If I Don't Have Access to a Computer?

If you don't have access to a computer to view our presentation, you can still learn about your plan benefits for 2021. Simply call in at one of these times to receive your 2021 plan information.

Northeast Phone Events

Phone Only Event Date Time Plans to Review

Monday, October 1210:30 a.m. Network PlatinumSelect

Tuesday, October 1310:30 a.m. Network PlatinumSelect

Tuesday, October 132 p.m. All northeast Wisconsin plans

Wednesday, October 148:30 a.m. All northeast Wisconsin plans

Southeast Phone Events

Phone Only Event Date Time Plans to Review

Friday, October 98:30 a.m. All southeast Wisconsin plans

Wednesday, October 1410:30 a.m. All southeast Wisconsin plans

When it’s time for the meeting, call 312-626-6799 and enter webinar ID 972 8729 9247 to join. We recommend joining five minutes early. Please note this is not a toll free number, so your standard rates will apply.

PPO, SNP, HMO