L I F E , H E A LT H & W E L L N E S S
A P U B L I C AT I O N O F
FA L L 2 0 2 0
Living a Life of Challenges, Friendship and Faith Member Laurie Perez talks about the special relationship she has with her care manager.
Due to the coronavirus outbreak, we are not offering special event tickets or hosting in-person events at this time. Our priority is ensuring you stay safe and healthy. For Network Health’s latest information about the coronavirus, please visit networkhealth.com/coronavirus.
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FEATURE 10 Living a Life of Challenges, Friendship and Faith 14 The Service You Deserve 15 NetworkPrime (MSA) Plan
24 Preparing for Joint Replacement Surgery 26 How to Read Your Monthly Explanation of Benefits (EOB) BACK COVER Experience Network Health Member Events
16 Partners in Care and Quality
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16 Do You Get Too Much Mail? 17 How to Improve Your Quality of Care 17 Customer Service is Now Member Experience
3 Letter from the President and CEO 4 Evaluating New Technologies 4 Emmi® – An Interactive Experience 4 Do You Love Network Health as Much as We Love You? 5 Keep Yourself Safe from Medicare Fraud 6 October is Breast Cancer Awareness Month
18 Coping With Stress and the Coronavirus 19 Know Your Member Rights and Responsibilities 20 Pantry Challenge Eating Well With What's on Hand 22 Using Technology in a Changing World 23 The Importance of Your Annual Flu Shot
8 The People Behind the Voices
EDITORIAL STAFF President and CEO Chief Administrative Officer Strategic Marketing and Communications Manager Strategic Marketing and Communications Coordinator Visual Design Lead
Coreen Dicus-Johnson Penny Ransom Romi Norton Becky Pashouwer Debra Sutton
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ASK NETWORK HEALTH If you have questions about anything you read in this issue of Concierge, call the member experience team at 800-378-5234 (TTY 800-947-3529) Monday–Friday, 8 a.m. to 8 p.m. You can also learn more at networkhealth.com. Concierge is a biannual publication of Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals. © 2020 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.
For accommodations of persons with special needs at meetings call 800-378-5234 (800-947-3529). Y0108_2952-01a-0820_C 2 | C ONCIERGE
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life. health. wellness.
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
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life. health. wellness.
Evaluating New Technologies
How We Decide to Add or Change Benefits
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etwork 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?
W
hen 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. 4 | C ONCIERGE
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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 Protect your Medicare card by keeping it in a safe place and treating it like a credit card
DON’T Don’t accept any medical supplies you didn’t order
Don’t give your Social Security number, Medicare number, Read each Explanation of Benefits carefully and make sure all financial information, Network Health member ID number or services listed are services you received credit card information to someone you don’t know Use a calendar to keep track of your health care appointments
Don’t share personal financial information on social media websites (like Facebook) or through email
Ask questions about your medical care and understand how Don’t sign blank insurance forms services are billed Watch your credit card and bank statements for any improper Don’t accept money or gifts for free medical care billing or fraudulent activity 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.
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October is Breast Cancer Awareness to Month Remember Schedule Your By Jennifer Footit-Tank, RN, CCP, quality care coordinator at Network Health
Mammogram
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or 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. 6 | C ONCIERGE
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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 is guaranteed 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
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life. 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
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etwork 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
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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,
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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.
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COVER STORY
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Living a Life of Challenges
Friendships and
Faith
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etwork 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 networkhealth.com
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COVER STORY
Ann, Network Health Care Manager, wears a mask to protect herself and Laurie while they meet. 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.
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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 networkhealth.com
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.
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.
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During the Medicare Annual Enrollment period for 2019,
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. Ann P., Network Health care manager
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Medicare and Medicaid. Her plan benefits include a care manager to provide health care support and to help her navigate her benefits.
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 The pair spend a lot of time talking about Laurie’s Network better, and I missed Ann,” Laurie said. “The other insurance Health plan benefits and how she can access and use company didn’t have someone who called and checked in them. “A big part of what we talk about is how Laurie can on me. They were supposed to send a nurse and they never maximize her benefits. We want to help her live her best life did,” she continued. Laurie wasn’t sure how to start the in any way possible,” said Ann. process and switch back to her Network Health plan, but she knew she could count on Ann to guide her through it. One of the services that sets Network Health apart from larger insurance companies is the relationship between care Laurie had one stipulation about returning to Network managers and their members. Ann said, “I’ve met Laurie on Health. “I told them the only way I’d come back is if I got a few occasions, when she had a health issue that warranted 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. I wanted to go back to
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Network Health. The vision benefit was better, and I missed Ann. Laurie Perez, Network Health member
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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.” C ONCIERGE | 13
life. health. wellness.
The Service You Deserve A
t 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
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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
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NetworkPrime (MSA)
High-Deductible Health Plan This is a Medicare Advantage plan which covers your hospital and medical care (known as Medicare Parts A and B). Once you’ve paid a certain amount for health care (called the deductible), the plan begins paying for the Medicare-covered services you receive.
Medical Savings Account This is a special savings account used for health care costs. Once a year, Medicare deposits money into your account, and you can use this money to pay for health care before you meet the deductible.
NetworkPrime has a $5,100 deductible and a $0 monthly premium.
Medicare deposits $1,500 into this account once a year.
BENEFIT
NetworkPrime
Premium
$0
Deductible
$5,100 Based on your plan effective date, your deductible will be prorated.
Annual deposit from Medicare
Medicare will deposit $1,500 into your account prorated based on when you enroll. If you disenroll for any reason during 2021, you’ll be asked to pay back a prorated amount based on the date you disenroll.
Services like hospital stays, doctor All Medicare covered services are billed at the Medicare-approved amount until you reach the visits and emergency room visits deductible. You pay nothing after you reach your deductible.
EXTRAS Benefits that Travel with You
Are you always on the go? Then, NetworkPrime may be the plan for you. No matter where you are in the United States, you have access to quality doctors, hospitals and facilities. With NetworkPrime, there is no such thing as a network. Any doctor or hospital that accepts Medicare beneficiaries should also accept your NetworkPrime coverage. networkhealth.com
$
Ignite Wellness Program
You can earn up to $180 in rewards for completing three activities during the plan year that are essential to your health and wellness. 1. Receive $100 for your annual wellness visit. 2. Receive $50 for your routine labs. (You will have to send a copy of your lab paperwork to Network Health.) 3. Receive $30 for your flu shot. C ONCIERGE | 15
life. health. wellness.
Partners in Care and Quality By Nancy Weber, BSN, MPA, RN, clinical integration program manager at Network Health
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etwork 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. 16 | C ONCIERGE
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How to Improve Your Quality of Care By Nancy Weber, BSN, MPA, RN, clinical integration program manager at Network Health
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ou 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.
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life. health. wellness.
Coping With Stress By: Katie Meiers RN, BSN, BA - supervisor of care management at Network Health
T
he 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.
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
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 18 | C ONCIERGE
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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.
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life. health. wellness.
Pantry EAT WELL WITH WHAT’S ON HAND Challenge By Joy Manning at SilverSneakers®
H
ome 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. purchased on impulse, that don’t fit into your current STEP 1 – THE INVENTORY healthy eating plan. Taking a clear look at what you have in your cabinets and freezer is half the battle, according Now’s the time to trash spoiled items. And those to Lorencz. “I like to separate everything into unopened boxes of cookies and cake mixes? “This is the categories—produce, proteins, starches and perfect opportunity to give back by donating to a local condiments,” she says. food bank,” says Lorencz. 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
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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.
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“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.
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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.
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life. health. wellness.
Using Technology in a Changing World D
uring 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. download the app on your smartphone or tablet. Once you • Zoom • Skype create this account, you can choose to Host a Meeting • Google Hangouts • Apple FaceTime with one or more people, or you can be invited to join a To people who use technology all the time, using these meeting a loved one is hosting. tools may not seem difficult. But, for someone who doesn’t use technology often—or at all—trying one of Google Hangouts these may be confusing. Read on to learn more about how If you use Gmail for your email, you may already to access and use this technology. have access to Google Hangouts. When you’re in your Gmail, check the lower right corner for the icon that looks Zoom like quotation marks. Click this to open Google Hangouts. If you have a computer, open a web browser and In the left column, you can search for people to message visit zoom.us. From here you can create an account or or call. log in to an existing account. Once you have an account, Note – Anyone you connect with on Google Hangouts you can select Host a Meeting and invite one person or multiple people. Or, your family and friends can send you must also have a Google or Gmail account. an invitation to join a meeting they’re hosting.
FaceTime
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.
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.
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.
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.
Skype
Similar to Zoom, you can create a Skype account on your computer by visiting skype.com, or you can
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Note – You’ll need the phone number or email address of the person you want to contact.
networkhealth.com
Importance
The of Your Annual Flu Shot By Rita Hanson, MD, medical director at Network Health
D
uring 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.
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.
Count of Deaths/Hospitalizations
People cannot get the flu from the flu shot*. However, it 180000 160000 140000 120000 100000 80000 60000 40000 20000 0
Hospitalizations
Deaths
Nobody Receives the Flu Shot Half of Populace Receives the Flu Shot 95% of Populace Receives the Flu Shot
Chart created using CDC figures, and U.S. population of 330,000,000. The 50% immunization rate save an estimated 22,000 lives and 45,000 hospital stays, while another 28,000 lives and 60,000 hospitalizations could be saved
https://www.my-emmi.com/SelfReg/NHPMFLU networkhealth.com
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life. health. wellness.
Joint Replacement Surgery Preparing for
Allison Pahnke, RN, care manager at Network Health 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
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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.
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 challenging the 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. *Not included with Network PlatinumSelect or NetworkPrime networkhealth.com
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life. health. wellness.
How to Read Your Monthly Explanation of Benefits (EOB)
T
he 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
Totals for this month (for claims processed from February 01, 2020 to February 29, 2020) Totals for 2020 (all claims processed through February 29, 2020)
5
Amount providers have billed the plan
1 6
$212.00 $1,158.96
Total cost (amount the plan has approved)
Your share
$72.05
3
$60.81
4
$10.00
$525.00
8
$389.48
9
$135.52
2 7
Plan’s share
..............................................................
YEARLY LIMIT - this limit gives you financial protection (this section may vary depending on your plan) YEARLY LIMIT - thisyou limit gives financial protection costs, This limit tells the most will haveyou to pay in “out-of-pocket” As of February 29, 2020, (for the plan year 2020), you have had
10
copays, and coinsurance for medical hospital services covered by the This limit tells the most you will haveand to pay in “out-of-pocket” costs, plan. 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 youishave to your pay, but it does not put a limit onIthow This yearly limit called “out-of-pocket maximum.” putsmuch a limit care you can get. 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, for routine dental, home medical monitoring, Your out-of-pocket spending non-Medicare covered expenses such as meals programs and other non-covered services willmedical not count toward routine hearing, hearing aids, routine dental, home monitoring, your yearly out-of-pocket This means: meals programs and other maximum. 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 out of your pocket forinall services except Oncestop youpaying have reached limit out-of-pocket costs, non-covered services. you stop paying out of pocket for all services except non-covered services. You keep getting your covered medical and hospital services usual, your and the plan will pay and the full cost You keepasgetting covered medical hospital for the rest of the year. Your out-of-pocket spending services as usual, and the plan will pay the full cost for areyear. not covered by Medicarespending does not for services the rest that of the Your out-of-pocket count towardthat your maximum. for services areout-of-pocket not covered by Medicare does not count toward your out-of-pocket maximum.
$121.69 in out-of-pocket costs count $4,500.00 As of February 29, 2020, (for thethat plan yeartoward 2020), your you have had out-of-pocket maximum for covered services. $121.69 in out-of-pocket costs that count toward your $4,500.00 out-of-pocket maximum for covered services.
10
11
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 get from all providers + out of In 2020, you $4,500.00 is the most you (in-network will have to providers pay for covered network providers combined). 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 that count your $4,500.00 combined Asout-of-pocket of February 29,costs 2020, (for plantoward year 2020), you have had $121.69 out-of-pocket maximum forcount covered services. in out-of-pocket costs that 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. 26 | C ONCIERGE
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12
Details for claims processed in February 2020 14
13 Provider: EXAMPLE PROVIDER Claim Number: 20001E00001 In-network provider 15 OFFICE/OUTPATIENT VISIT EST 99213
Date of Service
16
17
01/17/2020
Amount the provider billed the plan
18
Total cost (amount the plan approved)
$212.00
19
$72.05
Your share
Plan’s share
20
21
$60.81
$10.00
You pay a $10.00
22
23
copayment for services from an In-network provider.
The total amount providers billed the plan for
Names the provider submitting the claim for
1 services received during the month
13 services received
2 The total amount the plan approved to pay for
14 A number generated to identify the claim
the services received during the month
3
The total amount the plan paid your provider (your savings) for the month
amount you owe for services received for 4 The the month
5 The year the service was received 6
The total amount providers have billed for the plan year indicated
if this provider is in-network or 15 Describes out-of-network
16 A brief description of the service received 17 The date the service was provided 18 The total amount the provider billed for the service 19 The total amount the plan approved*
7 The total amount the plan approved to pay for
20 The amount the plan paid your provider
total amount the plan paid your provider 8 The (your savings) so far this year
21 The amount you’ll pay for this service
services received so far this year
The total amount you’ve paid for services
9 received this year
10 The amount you have spent toward your
$0.00
(your savings)
22 A code the provider uses to indicate the reason for service
23 Explains why you owe this amount
maximum out-of-pocket costs
11 Your maximum out-of-pocket costs for the plan year 12
Indicates the month when claims were processed for the services listed (Network Health receives claims from your provider)
*The plan’s share and your share may not always equal the total cost. You are not responsible for the difference.
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PRESORT STD US POSTAGE PAID PERMIT 1033 GREEN BAY, WI
1570 Midway Pl. Menasha, WI 54952
MSA
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 this issue of Concierge, because we will reference page 15 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 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.
Online Virtual Events Event Date
Time
Plans to Review
Wednesday, October 7
8:30 a.m.
NetworkPrime Medical Savings Account (MSA) plan
Wednesday, October 14
10:30 a.m NetworkPrime Medical Savings Account (MSA) plan