2022 Concierge

LIFE,

The Best Day of My Second Life

Larry and Becky recount how their daughter Brooke saved Larry's life.

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. We're available every day, 8 a.m. to 8 p.m. October 1 - March 31

Concierge is an annual publication of Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals. © 2022 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.

In the past, Concierge has been a biannual publication, sent to over 65,000 Network Health members in the summer and winter of each year. Our desire to leave behind a greener footprint, along with the acknowledgement of how much of a role the online world plays in our members’ lives, has prompted us to take Concierge in a slightly new direction. Starting with this 2022 issue, we are reducing the page count, producing it once a year and making more content available to you online.

As you’ll see in this issue, we’ll focus on providing you with informative content and great feature stories about our members. Additional content and articles are available on networkhealth.com; our blog, Grow In the Know; and through social media. We’re looking forward to the change and continuing to help you make the most of your Network Health plan and your health and wellness journey.

If you’d like to go paperless and receive Network Health communications via email, select your communication preferences through your member portal at login.networkhealth.com. Log in (or create an account if you haven’t yet), click your name in the upper right corner and select Change My Communication Preferences. From there, choose email for any or all the available categories.

EDITORIAL

Why an MA-Only Plan?

By: Nichole Sprinkle, supervisor of Medicare and individual sales at Network Health

Network Health has two new Medicare Advantage (MA) plan offerings for 2023. Network Health Armor (PPO) and Network Health Medicare Bravo (PPO) plans have $0 premiums like many of Network Health’s other Medicare Advantage plans do. However, both plans have one major difference from other $0 premium plans. These plans will not include Part D prescription drug coverage and are often referred to as MA-only Plans.

If you currently have or are eligible to enroll in creditable prescription drug coverage from another source, like the Department of Veterans Affairs (VA), CHAMPVA, Tricare® or Wisconsin SeniorCare®, these plans are a great option for you.

We have you covered, no matter where you live within our service area. The Network Health Armor plan is available in our northeast Wisconsin service area and the Network Health Medicare Bravo plan is available in our southeast Wisconsin service area.

The MA-only, $0 premium, Network Health Armor and Network Health Medicare Bravo plans offer additional benefits that you may not get with other plans. These two plans include 100 percent unlimited in-network preventive, comprehensive and diagnostic dental coverage, over-the-counter coverage, vision coverage and a SilverSneakers® gym membership. See the enclosed plan comparison grid to see what's the right plan for you.

Is an Ambulatory Surgery Center the Right Choice for You?

By Sarah Dencker, vice president of care services at Network Health

Ambulatory surgery centers (ASCs) have changed the outpatient experience for a lot of people in the U.S. By providing patients a convenient alternative to hospital-based outpatient procedures, ASCs have given people more control over their health care.

What is an ASC?

ASCs are modern health care facilities focused on providing same-day surgical care, including diagnostic and preventive procedures. This means that patients treated at an ASC do not require admission to a hospital following their procedure. Sometimes referred to as outpatient surgery centers or sameday surgery centers, ASCs do not offer emergency services and usually do not offer overnight stays.

Why choose an ASC?

ASCs and hospital outpatient departments (HOPDs) may offer identical services, but they can vary greatly in cost.

ASCs offer many of the same surgical procedures as HOPDs— joint replacement, rotator cuff repair and knee arthroscopy, as well as other services, like MRIs and injections. However, ASCs generally offer these at a significantly lower cost than HOPDs. In fact, outpatient joint replacements performed in an ASC may cost as much as 40 percent less than those performed in a hospital. Other procedures, such as rotator cuff repair and knee arthroscopy, may cost over 50 percent less.

Lower cost sharing is another potential benefit of using an ASC. Check your plan benefits to see if your copayments would be less if you were to choose an ASC for a procedure. You can also call our member experience team with questions. You can find the number on the back of your member ID card.

It is important for members to understand that the quality of health care provided by surgery centers is equal to, if not higher than, the quality of health care offered by hospitals. Keep in mind that the surgeons have the same credentials to operate in both hospitals and outpatient surgery centers. Because ASCs specialize in the procedures they perform, they

can concentrate on patient safety and the patient experience. ASCs also have an excellent record of safety and quality outcomes for patients. The difference in price can be attributed to how outpatient surgery centers are structured and their ability to see more patients in a shorter timeframe.

What types of procedures can be done at an ASC?

Many procedures can be safely done at an ASC. Here are some of the most common.

• Cataract surgery

• EGDs

• Colonoscopies

• Pain injections

• Knee ar throscopies (scope)

• Total knee and hip ar throplasties (replacement)

• Carpal tunnel surgery

• MRIs

•

Injections

How can you tell the difference between an ASC and an HOPD?

A hospital outpatient department is owned by, and typically attached to, a hospital. An ASC, however, is considered a standalone facility.

Ultimately, the choice is up to you whether you want to use an ASC or an HOPD for a procedure. It is important to inform yourself of all the options before you make the decision that’s best for you. Check your benefit plan, consult with doctors or call Network Health’s member experience team 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. to get your questions answered. Find out what’s best for you.

You’re Invited to Be a Part of Network Health’s Advisory Council

Network Health is looking for members who are interested in joining the Medicare Advisory Council and the NetworkCares Advisory Council in 2023.

The Medicare Advisory Council meets biannually with a team of Network Health employees to review and provide feedback on our programs, services, insurance plan benefits, marketing materials and much more. If you are interested in joining us for this opportunity, please email cx@networkhealth.com

By: Anne Rappert, customer experience coordinator at Network Health

The NetworkCares Advisory Council provides feedback on ways to improve access to covered services, coordination of services and health equity for underserved populations. If you're a NetworkCares member and you're interested in joining, call your care manager directly or call 866-709-0019 and ask to speak with a NetworkCares care manager.

Your feedback will help us improve services in 2023 and beyond.

Do You Love Your Network Health Medicare Advantage Plan?

If you love the high-quality service and support you receive from Network Health, share your excitement with your friends and family and get them that same service in 2023.

Our Medicare member referral program continues and is very popular amongst our current members. We have you to thank for that. Our referral program allows you to earn gift cards for sharing Network Health with your friends and family. You can earn up to four $15 gift cards for a variety of stores each year.

Simply have your friends or family members call our Wisconsin-based sales advisors at 844-850-5284 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. From October 1–March 31, they’re available every day from 8 a.m. to 8 p.m. When you refer someone to Network Health, you’ll receive a phone call from a Network Health employee to determine which gift card you want.

*Licensed agents who are appointed with Network Health are not eligible for these gift cards

The people you refer must meet these criteria.*

Medicare Parts A and B

in our service area Are not already enrolled in a Network Health plan

The best day of my second life

By Julie Heinzel Photography by Beth DesJardin, Trove Photography

Early this year, Larry and Becky were looking forward to their daughter’s wedding in May, after two years of planning and anticipation. This was a truly wonderful and exciting time for their family. Larry’s suit was selected and there were just a few last-minute preparations to take care of. Reflecting on how the months leading up to the wedding would unfold, they discovered that they had so much more to be thankful for than uniting their daughter, Brooke, and her soon-to-be husband, Andrew.

Larry and Becky are active people and had always stayed on top of their health, seeing their personal doctors regularly and a specialist if needed. Their overall well-being is a top priority, and they feel that Network Health made it easy for them to schedule appointments, take care of claims or file for reimbursements.

“We started this insurance when we retired in 2020 and we’ve always loved it. We loved it from the get-go,” Becky explained. Being diagnosed as diabetic at age 39, Larry took charge of his health by jogging early on. At age 50, he switched to walking and biking. He walked five to six miles every day, no matter the weather, and Becky joined him most days. They enjoy walking the trails near their home in Menasha or on the treadmill in the basement.

When Larry visited his doctor in January, they discovered a heart condition that he was likely born with. Since he had no identifiable symptoms, and their family already had a busy couple of months ahead of them, they agreed to meet in June to check his heart again and reevaluate his options.

Their daughter, Brooke, lives in Austin, Texas and came home in April to tie up last-minute needs with her parents for the wedding. She planned to work remotely for the week while she was home in Wisconsin.

On the morning of April 13, Brooke began her morning and caught up with her dad as she returned from a walk. Larry indicated that he was about to go for a brisk walk of his own and headed downstairs to the treadmill. Becky stayed on the main level of the home and was relaxing with the television while Brooke began her workday.

She was on a work call when she heard a commotion. Her mom was yelling but she did not initially think much of it. Brooke

describes her mom as someone who enjoys being goofy and likes to joke around. She assumed her parents were being silly with each other. She became more alarmed as she realized the yelling sounded more like screaming. Brooke excused herself from the call to check on them. She found Larry on his back near the foot of the treadmill, non-responsive and Becky was over the top of him, screaming and shaking him.

Brooke still had her phone in her hand and dialed 911 immediately after assessing the situation. She directed her mom to start CPR. Larry had passed out from a diabetic low before, so it was initially unclear what the cause of the emergency was. Becky was in shock and continued to shake and yell at Larry, trying to rouse him. Brooke took CPR training a few times but never had to put it into practice. She jumped into action and quickly took over from her distressed mom. She performed chest compressions while on speaker with 911 dispatch for seven minutes until the paramedics arrived to relieve her. During the time Brooke was performing CPR, Larry took a few gasping breaths but did not open his eyes.

“He could not have fallen more perfectly for people to work on him,” Becky explained. The paramedics assessed Larry and began life-saving actions, preparing to use an AED. At that point, Brooke took her mom upstairs to call her brother Luke. Larry was eventually resuscitated but was confused and agitated as they transported him on the stretcher and to the ambulance. Part of his confusion stemmed from the pain he was experiencing. He likely suffered a concussion from hitting his head on his way to the floor.

For the first few days in the hospital, he remained disoriented. Becky, Brooke and Luke did their best to recount the events to him and keep him up to date on family news, but he remained confused and did not remember that he owned a treadmill, that Brooke was planning her wedding or where he was and why he was there. Complicating the situation more, Larry tested positive for COVID, so four hours after Larry arrived in the emergency room that first day, they all had to make the difficult trip back home. For the next ten days, the family was not able to see him while he was recovering in isolation, but they got creative and found ways to connect with Larry to support him, so he did not feel alone. They each took turns talking through the door or on the phone, waving through the window in the ICU and texting.

e. health. wellness.

Five days after arriving at the hospital, on April 18, Larry had open heart surgery, a double bypass and a valve replacement. The nurses and hospital staff were very informative and gave great updates to the family on the day of surgery since they were not able to be present for Larry. Two days before he was discharged on April 25, the family was finally able to physically visit with him in the hospital as he recovered. Proudly, Larry stated, “Brooke saved my life, the doctor just did the surgery.”

On the day he was discharged, hospital staff discussed what to expect and how to help Larry at home with medications, nutrition, bathing and his restrictions. Becky felt overwhelmed and worried about managing his blood pressure, blood sugar, temperature, exercise milestones and monitoring how he should or should not feel each day.

“We were well-trained, they were very open and patient with our questions,” Becky remembered. “They covered everything from front to back.” She felt lucky to have the foundation of her whole family and medical staff, but the additional support they received from Network Health eased her mind even more.

Once they were home, their Network Health Case Manager called, summarized who she was and what she was available for, gave her contact information and offered the family several options of services they may want to take advantage of, including topics for Becky. Rehab was one of the services Larry enjoyed most. “We are all affected, I’m not the only patient. She [Becky] needed the rehab mentally as much as I needed it physically,” Larry said.

The case manager continued to check in with the family to see how they were doing. “She was worried about all of us too, not just Larry as the patient. They made it very accessible for all of us to mentally get through this. We had all these different pieces of the pie and they helped to put it all together for us. If she couldn’t answer the question, she had the contacts to find the answers for us,” Becky beamed.

Brooke shared that her mom never once worried about paperwork, claims or how they were going to pay for it all. She said her parents have always raved about their insurance and that through this process, they felt taken care of, so much so that they only had Larry’s well-being and healing to focus on. Once Becky felt settled at home, she logged into the Network

Health portal to look at their claims. She marveled that they were already showing up and processing. She thought “this is fast.” Every couple of days she would look again, and they would be paid. Their previous experiences with insurance involved a multitude of mailed paperwork. Becky lit up as she described their Network Health experience, "We got one paper to verify the incident. Everything else was easy-peasy. I knew we would owe something but there were no surprises. I would go every couple of days to check and I would see ‘you owe zero, you owe zero.’ The claims have been flawless, no questions, no extra paperwork.”

Becky, Brooke, Luke and Andrew were free to focus on time with Larry, his health journey and the upcoming wedding. They were not bogged down with extra worries.

“The best day of my second life was Brooke’s wedding,” Larry explained. He had to get a new suit and take breaks occasionally, but he was determined. With tears, he proudly walked his daughter down the aisle on May 21, and when they reached Andrew, he put Brooke’s hand on his chest, his heart. “He was remarkable,” Becky smiled, "And if she hadn’t been here, randomly from Texas, in the house, with me, this wouldn’t be happening.”

At the reception, Larry delivered a speech to the room full of their loved ones, all of whom knew their family’s journey. Emotionally, he said, “You know you find the love of your life, then you bring kids into the world… and then my daughter, on April 13th, my daughter brought me back into the world.”

Mary is another member who loves Network Health. Enjoy her story on our blog, networkhealth.com/mary

Becky and Larry enjoying Brooke and Andrew's wedding day

Network Health in the Community

Being local allows us to focus on our mission to create healthy and strong Wisconsin communities. At Network Health, we believe in healthy living and have many ways that we connect with you in your community and online. Check out these upcoming events.

Upcoming Events

Appleton Downtown Farmers Market appletondowntown.org/ downtown-appleton-farm-market/

• October 8 • October 22

Virtual Experience Network Health Member Events networkhealth.com/experience

• October 11 – NEWI • October 12 – NEWI

• October 12 – SEWI • October 13 – SEWI

Museum of Wisconsin Art – Programs sponsored by Network Health wisconsinart.org/art-classes-nearme/#events_carousel

• October 5 - Art + Wellness Event

• October 19 – SPARK! Autumn Celebration

• November 2 – Art + Wellness Event

• November 16 – SPARK!

• December 7 – Art + Wellness Event

• December 21 – SPARK!

Connect with Network Health Engagement Event www.facebook.com/networkhealthwi

• October 27

Network Health New Member Virtual Welcome Events networkhealth.com/medicare/events

• November 15

Museum of Wisconsin Art Community Day with Network Health wisconsinart.org/events/second-saturday/ • November 12

Hunger Task Force Food Drive

1 Brewers Way, Milwaukee, WI 53214

• November 18

America’s Black Holocaust Museum Community Day with Network Health 401 W North Ave, Milwaukee, WI 53212

• January 13, 2023

Visit the Network Health Wisconsin Facebook page for more event information facebook.com/networkhealthwi

Multi-Language Inserts

By: Angie Keenan, compliance officer at Network Health

They’re back. Multi-language inserts will be provided in 2023 with specific plan information. What is the multi-language insert?

The multi-language insert contains a statement on how to access free interpreter and translator services. The statement is translated in the top 15 languages in the United States and is required with specific plan materials. English, Spanish, French, Hmong, German, Korean, Russian, Arabic and Polish languages are just a few examples of languages contained within the multi-language insert. You will begin to see this insert included with information such as your Explanation of Benefits, Evidence of Coverage, Annual Notice of Change and Summary of Benefits.

Why are you getting this? The Centers for Medicare & Medicaid Services (CMS) provides regulatory oversight for Medicare Advantage plans, like Network Health, and requires this insert be included with specific plan materials to ensure you are aware of the availability of these services. The insert must be sent with specific materials regardless of whether you previously received the insert in another mailing.

It’s important to CMS and to Network Health that you are fully informed when making decisions about your plan and to make communications easy to access.

Rating of the Drug Plan

By: Anna Peterson Sanders, PharmD, BCGP, Medicare pharmacist at Network Health

At Network Health, we pride ourselves on giving members with prescription coverage a fantastic drug plan. With access to many medications, preferred retail pharmacies and our very own in-house pharmacists, we bring you a local, hometown approach with a focus on customer service. We are a cut above the rest.

Did you know…

1. Our open formulary covers almost 96 percent of Part D drugs. In comparison, our bigger competitors cover between 55-60 percent of drugs. We want to ensure our members have access to a variety of treatment options and are not burdened by a lack of coverage on their drug plan.

2. Consistency is our goal. We are very conservative on our approach to changes to the drug plan, always bringing into consideration impact and cost to you. This helps to keep us consistent each year and offer our members the lowest-cost products available.

3. You have access to over 35,000 preferred pharmacies, including most of our local, independent pharmacies. Other insurance plans often come with pharmacy restrictions, but we allow you to receive a 90-day supply of medications either through a retail store or mail order and we do not mandate mail order use. It is important to us that our members can easily obtain their medications without the additional burden of restricting pharmacy options.

4. You have direct access to a Network Health pharmacist. Whether it be through phone or email, you are be able to speak with a pharmacist here at Network Health. Our pharmacists come from diverse career backgrounds, allowing us to provide you with expertise and knowledge in a variety of areas. They are the experts of our drug formulary, which is helpful for navigating treatment options that may come at a lower cost. Last year alone, our pharmacists were able to save our members over $500,000.

5. Our phar macists also provide medication reviews, free of charge, and tackle questions from medication costs and alternatives to drug interactions to financial assistance. Our pharmacists are here to help arm you with the information you need to make an informed decision. If you receive a letter in the mail regarding this program, call our pharmacists directly at 920-720-1287 or email pharmacist@networkhealth.com to ensure you are getting the most out of your Network Health prescription benefit.

Pick Your Perks Reimbursement

By: Steven Pfaller, specialty contract manager at Network Health

At Network Health, we take your feedback in all forms to heart to improve our processes and create a positive experience. We’ve noticed an increase in the popularity of and feedback on the Pick Your Perks benefit and would like to offer some simple suggestions to make it easier for members with that benefit to use it and get their reimbursement faster.

• Documentation, such as an itemized receipt, must be submitted for reimbursement within 120 days of the date of service or item's purchase. This is an important change to make note of for 2023.

• The most common reason a reimbursement request isn’t approved is because an itemized receipt did not contain all the details required. The receipt must show the specific item purchased, the date of service and the amount paid. Submitting only a credit card payment receipt does not show the detail that is required.

• If you request reimbursement for a massage, a referral from your doctor is required for the service, as well as an itemized receipt from the massage therapist which details the date of service and the amount paid.

• Personal training sessions also require an itemized receipt for each session showing the date of service and proof of attendance for each session.

When you are ready to submit a receipt for reimbursement, please keep in mind that not all items or procedures are eligible for Pick Your Perks. The list below highlights common over-the-counter items that are not covered under the Pick Your Perks benefit and are not eligible for reimbursement. Please save this chart for easy reference for future reimbursements.

Health and wellness or prevention information

Exchange of Information

By: Mary Zamost, quality care coordinator at Network Health

Many medical conditions can be related to other conditions or their treatments. Effective coordination of care depends upon clear and timely communication among patients, providers and facilities. Keeping an open line of communication helps to make the best decisions on treatments, decreases the potential for unwanted medication interactions and avoids test duplications, which increases your safety and helps to control cost.

Giving your doctor the full picture is the best way you can help.

• Discuss other provider visits. You two are a team. The best way to make your team stronger is by letting your personal doctor know about any visits you have with other providers, such as specialists and behavioral health providers. When your doctor has the full picture, they will be better equipped to help you.

• Keep up to date on your medications and doses. Providing your doctor with information on all the medications you take is another way of giving your doctor the full picture. This helps you avoid potential medication interactions and duplicative testing, leading to improved outcomes.

• Sign a release if you visit providers outside of the organization. When your personal doctor refers you to a specialist, outcomes are usually shared back to your personal doctor, as allowed by privacy laws. However, if you choose to seek services outside of your personal doctor’s organization, ask whether a release needs to be signed so that the information can be shared back to your personal doctor.

Open communication and exchange of information allows you and your personal doctor to develop a complete and more successful plan of care. Think of them as your copilot, helping to navigate to a healthier you.