a p u b l i c a ti o n o f
W I N T E R
2 0 1 3
doesn’t have to be closed The door
for your child.
Network Health and member Julie Bertram collaborated to open up new possibilities for her son.
l i f e , h e a lt h & w e l l n e s s
from the president
Dear Readers
F
rom Washington, D.C. to northeast Wisconsin, health care reform seems to be in all the headlines and on everyone’s mind. As 2014 draws near, it can be difficult to keep up with the constant changes to the Affordable Care Act (ACA). Luckily, Network Health has been working closely with the Wisconsin Office of the Commissioner of Insurance (OCI) to see how these changes will impact you. Here at Network Health, we’re adapting to provide you Sheila Jenkins opportunities to stay President on your current plan Network Health for as long as possible. Continue to turn to us for health insurance coverage and updates to health care reform information. The close of 2013 also means that the holiday season is in full swing. As you are celebrating the holidays with friends and family this year, consider taking some time to give back to the less fortunate. If interested in volunteering during the holiday season, turn to
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page 14 for ideas on how to get involved. At Network Health, we try to give back during the holidays, too. We’re thankful to be part of the community and that’s why we adopt local families in need. Since 1999, our employees work together to contribute items like coats, snow pants, gloves and other clothing. Some families also request basic items like cleaning supplies, towels and blankets. Of course, we also donate plenty of toys, so local children can have the Christmas they’re hoping for. We really enjoy this opportunity to give back to the community, it’s always rewarding for everyone involved. Besides volunteering, exercising is another good idea for the holiday season. With all the parties, shopping and traveling, it can be easy to lose track of our exercise habits this time of year. Turn to page 12 for simple exercise tips that will fit your budget and schedule. The health insurance industry experienced many changes in 2013, and preparing for health care reform took hard work from everyone here at Network Health, but we’re positioned to offer you the best coverage possible. We will continue to be your partner in health and look forward to serving you in 2014.
S
life 3 Preventive Coverage vs.
Diagnostic Coverage
4
Here to Help
4
How Do Health Plans Make Their Decisions?
4
Your Right to Request an
How the differences can affect your costs Where to turn when you have obstacles keeping you from understanding or following your treatment plan Network Health’s decision-making process
Independent Review
Your right to have certain Network Health decisions independently reviewed
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08
E DITORIAL STAFF President Sheila Jenkins
health 5
Are You at Risk for Chronic Kidney Disease?
6
Good Questions for Your Good Health
Information to help prevent the development of chronic kidney disease Three questions you should ask your health care professional
Chief Administrative Penny Ransom Officer Publications Sam Darcy Coordinator
Brand Experience Darren Brzozowski Manager
E ditorial Board Peggy Huss, Dawn Rady, Deborah Anderson, Renee Corral, Barb Gore, Chuck Rynearson Balance is published quarterly by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals. © 2013 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.
Tell Us What You Think I f you have questions or suggestions or would like to tell us how Network Health improved your life, send us an email at balance@networkhealth.com. You can also write to us at: Network Health Attention: Sam Darcy 1570 Midway Pl. Menasha, WI 54952
7 Healthy Habits During Flu Season
Good habits that can stop the spread of germs and illnesses
FEATURE 8 Network of Support
How a collaboration between Network Health and member Julie Bertram opened up new possibilities for her son
wellness
12 Exercise that Fits Your Schedule and Budget Healthy tools you can use to get fit without spending much time or money
13 A Focus on Quality Health Care 2013 HEDIS/CAHPS report
14 A Holiday Helping Hand
Tips for volunteering this holiday season
15 Instant Access to Your Explanation
of Benefits
Network Health’s electronic Explanation of Benefits, available through networkhealth.com networkhealth.com
life
Information to help you get the most out of your coverage
Preventive Coverage vs. Diagnostic Coverage T
o help you live the healthiest life possible, Network Health offers preventive services at no cost, which could include your annual wellness visit. Your annual wellness visit, which consists of a general review of your health and well-being, is considered preventive, and covered by Network Health at no charge. However, your provider may add an office visit charge, which does not fall under your preventive service coverage, if he or she evaluates and manages a medical condition in addition to your wellness visit. The preventive/wellness visit will still be at no cost to you, but the additional office visit charge will apply to your benefits, and you may need to pay a copayment, deductible or coinsurance. Why is this the case? Providers need to bill your visit based on both the reason you initially scheduled the appointment and what is done during the appointment. If your doctor diagnoses and evaluates a medical condition during your visit, your appointment becomes both a preventive and medical office visit. Any monitoring of a specific medical condition—including medication, lab work and X-rays—is considered diagnostic, and will affect your costs. How can you identify the difference between preventive and diagnostic care? Here is some helpful information.
and copayment) if you receive the services for diagnostic reasons. So, what’s the difference between preventive and diagnostic?
Preventive Care vs. Diagnostic Care Preventive Care
Diagnostic Care
Reason for receiving the service
Prevents future health problems. You receive these services without having any specific symptoms.
You have a specific health issue with known symptoms.
What you pay
You pay nothing.
You pay for the service as a medical claim, meaning your deductible, copayment and coinsurance may apply.
If you are having trouble determining if an upcoming doctor visit would be considered preventive or diagnostic, please call our customer service department at 800-826-0940 or 920-720-1300. A representative will help you with what your costs will be.
What are Preventive Services?
Preventive services help you prevent diseases or medical problems before you show symptoms. It’s care designed to help you stay healthy and keep you from getting sick. These services include screenings (only done in the absence of signs, symptoms or known medical conditions), immunizations, lab tests and other services that help you prevent health problems. You can find a list of the specific preventive services that are covered at no cost to you in your member materials.
When are Preventive Services Covered at No Cost?
When you see a doctor within our network for a preventive service listed in your member materials, Network Health pays 100 percent. However, you may be responsible for certain payments (deductible, coinsurance net workhealth.com
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life { YOUR CARE }
How Do Health Plans Make Their Decisions? D
Here to Help W
e understand there may be religious, financial or cultural obstacles that keep you from following or understanding treatment instructions prescribed by your doctor. These obstacles may include the following. > Beliefs and concerns about your condition and treatment > Perceived barriers you have to meeting treatment requirements > Access, transportation and financial challenges with getting treatment > Cultural, religious and ethnic beliefs These could play into your ability to follow your doctor’s treatment plan. If you experience any of these barriers and need additional support, call our care management department at 920-720-1600 or 800-236-0208. A nurse will assist you with finding ways to work through these challenges.
id you know that utilization decisions made about your care by Network Health are based on the appropriateness of care and service? Care and service include medical procedures, behavioral health procedures, pharmaceuticals and devices. Decisions are based on written criteria founded on sound clinical evidence and on the benefits outlined in your certificate of coverage. Network Health does not reward practitioners—or other individuals conducting utilization review—for denying coverage for care or service. Network Health also does not prohibit providers from advocating on behalf of members within the utilization management program. In addition, the medical director, associates (or designees), care management staff and supervisors of this staff receive no financial incentive to encourage decisions that result in underutilization. If you have questions about the utilization process at Network Health, a utilization management decision or would like a copy of specific utilization criteria, call the care management department Monday through Friday, 8 a.m. to 5 p.m., at 920-720-1600 or 800-236-0208. For questions specific to behavioral health utilization, call 920-720-1340 or 800-555-3616. You can leave a message 24 hours a day, seven days a week.
Your Right to Request an Independent Review
W
e work hard to ensure member satisfaction, but it’s important to know you have the right to have an independent organization examine certain final decisions made by Network Health. Network Health contracts with three nationally-accredited independent review organizations to conduct reviews, and the decisions are binding for both Network Health and the member. Decisions made by Network Health eligible for review are those where we determined 4 | balance • W i n t e r 2 01 3
the requested care or services did not meet our requirements for medical necessity, appropriateness, health-care setting, level of care, effectiveness, experimental treatment, rescission of a policy or a certificate, or coverage denial determination based on pre-existing condition exclusion. Requests for services that are not included in your benefits package are ineligible for independent review (including, but not limited to, benefits limitations and direct exclusions). Typically, you must complete Network
Health’s internal complaint process (called a grievance) before you can start an independent review. However, you do not need to complete the process if you need immediate medical treatment and a delay could jeopardize your life or health, or if we agree with you that it is in everyone’s best interest to proceed with your concern directly to independent review. For more information on the independent review organization process, refer to your certificate of coverage or contact customer service at 800-826-0940 or 920-720-1300. networkhealth.com
health
News and tips to help you maintain a healthy and happy life
Are You at Risk for Chronic Kidney Disease? U nfamiliar with chronic kidney disease? Well, there’s a good chance someone you know either has chronic kidney disease or is at risk for it. According to the National Kidney Foundation, 26 million American adults have chronic kidney disease and millions of others face an increased risk. To prevent chronic kidney disease, you need to first learn about its causes and symptoms. Here’s some information to help you get started.
What is chronic kidney disease?
Chronic kidney disease is a gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, but when chronic kidney disease reaches an advanced stage, a dangerous amount of wastes and fluids can accumulate in your body. If left untreated, chronic kidney disease may lead to possible dialysis and/or a kidney transplant.
What are the symptoms?
In the early stages of chronic kidney failure, you may have few signs or symptoms. Chronic kidney failure may not become apparent until your kidney function is significantly impaired. However, you may notice the following symptoms. > Feeling tired, lack of energy > Trouble concentrating > Poor appetite > Difficulty sleeping > Muscle cramping at night > Swollen feet and ankles > Puffy eyes > Dry, itchy skin > Increased need to urinate, especially at night Symptoms of kidney failure are often caused by other illnesses. Signs and symptoms may not appear until irreversible damage occurs, because your kidneys adapt and compensate for lost functions. S ay W h at ?
Dialysis – A treatment that performs some of the functions done by healthy kidneys. It’s needed when the kidneys can no longer meet the body’s needs. Nephrologist – A doctor specializing in the kidneys. net workhealth.com
What causes chronic kidney disease?
Anyone can get chronic kidney disease. However, diabetes and high blood pressure account for around two-thirds of all cases of chronic kidney disease. To prevent the development of chronic kidney disease, focus on controlling your blood pressure and diabetes. Healthy lifestyle changes, such as losing weight and engaging in regular exercise, can help with prevention. If you have diabetes, careful control of blood sugar prevents kidney disease complication. Try to focus on your diet, exercise and follow your medication guidelines. If you’re at risk for chronic kidney disease, talk to your doctor about precautions you can take. He or she can recommend you for an annual screening and refer to you a nephrologist, if necessary. W i n t e r 2 01 3
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health
Bilingual language assistance or translation services are available for members to discuss utilization management issues. Network Health also offers TTY services for deaf, hard of hearing or speech-impaired members. Members who need these services should call 800-947-3529.
Good Questions for Your Good Health
D
id you know studies show that people who understand health instructions make fewer mistakes when they take their medicine or prepare for a medical procedure? It’s true. Informed patients can even manage a chronic health condition more effectively. Communication with your provider is important. And, many health care professionals recommend Ask Me 3™, a patient education program designed to promote communication and improve health outcomes. The program encourages patients to understand the answers to three questions. 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this? You can ask questions when: > > You see a doctor, nurse or pharmacist. > > You prepare for a medical test or procedure. > > You get your medicine. Make sure to ask these three questions next time you discuss your care with your provider. It can help you be better informed and understand what you need to do to take care of your health.
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networkhealth.com
For a complete list of recent changes to our provider network, go to networkhealth.com/providerchanges.
Healthy Habits During Flu Season G
etting a flu vaccine is always the best way to avoid the flu each year, but adopting good health habits can also stop the spread of germs and illnesses. What everyday actions can you take to avoid illnesses like the flu? According to the Centers for Disease Control and Prevention, these healthy suggestions can help fight harmful germs. Wash your hands often with soap and water. If not available, use an alcohol-based hand rub. Avoid close contact with sick people. Remember, when you are sick you should also keep your distance from others. Stay home when sick for at least 24 hours after your fever goes away without the use of medications. You should only leave your home to get medical care, or if absolutely necessary. Cover your mouth and nose with a tissue when you sneeze or cough. Do not reuse the tissue, immediately throw it in the trash. Avoid touching your eyes, nose and mouth. Germs are most commonly spread by coming into contact with something contaminated and then touching your eyes, nose or mouth. Clean and disinfect surfaces, especially when someone is, or has recently been ill. These surfaces include areas at home, work or school. During the flu season, it’s also important to practice other good health habits like getting plenty of sleep, staying physically active, drinking plenty of fluids and eating a nutritious diet. net workhealth.com
For most people, getting the flu results in a mild illness and they do not need medical care or drugs. However, certain people (young children, elderly persons, pregnant women and people with certain long-term medical conditions) face a higher risk of serious flu-related complications. If you fall into one of these groups and show flu symptoms, contact your health care provider immediately. W i n t e r 2 01 3
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S T O C O V E R Y
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networkhealth.com
NETWORK
Support
OF
When challenges arose for Julie Bertram’s son, she turned to Network Health for help. When you have a child, you expect that your world will change. But what happens when unforeseen circumstances turn that world upside down? For Julie Bertram of Appleton, mother of a child diagnosed with autism, the unexpected suddenly became reality. And like any parent, Julie has done all she can to support her child, including using the resources and help offered through Network Health. > > >
By Sam Darcy
n e t w o r k h e a l t h . c o m
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Photographs by Shane Van Boxtel, Image Studios
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S T O C O V E R Y
“As a parent, you want to do everything you can for your child. Network Health has given us the ability to say we did everything we could. It’s not just a health insurance company, it supports the life of my family.” As Julie’s middle child, Thomas, began to grow and develop, she noticed differences between him and his older brother. Thomas didn’t play with toys, couldn’t put Lego’s together and didn’t react when a ball was rolled his way. “There was a disconnect and it was difficult to engage him,” Julie said. “He was like a blank canvas, and had little response in multiple environments.” Julie also noticed that Thomas seemed extra sensitive to touch, sounds and bright lights. She wondered how he could seem so detached to interactions, but at the same time be so sensitive to other stimulations. Julie decided that she needed to test Thomas for autism, but didn’t know where to start. She turned to Network Health for direction, and was put in touch with care management manager Rosemary Dvorachek. “When Julie first called in spring of 2010, she sounded overwhelmed,” Rosemary said. “She had questions about the diagnosis, the treatment and the benefits available through Network Health.” Rosemary worked to answer Julie’s questions and reassured her of the developmental needs for Thomas, the insurance benefits offered to her family and the providers and treatment options available. “Rosemary is phenomenal. Her voice is like the light at the end of the tunnel,” Julie said. “It was a stressful time, and her soothing voice helped with my understanding of autism.” Leaning on her experience, Rosemary was able to share her knowledge from working with different autism agencies in the area. She described how each agency operated and helped Julie decide which one would be the best fit for Thomas. With Rosemary’s help, Julie chose Lund Van Dyke Autism and Behavior Specialists to have Thomas tested. In April 2012, Thomas was officially diagnosed as being on the autism spectrum.
Looking for local autism resources? Visit the Autism Society of Wisconsin at www.asw4autism.org to find a local chapter near you. 10 | balance • W i n t e r 2 01 3
S ay W h at ?
Autism – A range of brain disorders that causes social interactions, communication difficulties and certain patterns of behavior.
“When Thomas was diagnosed it was a mix of emotions,” Julie said. “It’s comforting that you have an answer to what’s going on with your son, but it’s not the answer you’re hoping for.” With the diagnosis, Julie felt that she had hopped on a merrygo-round that went faster every day. She now had the direction she needed to seek care for Thomas, but she also needed to educate herself to choose the best support for her child and her family. Julie found a tremendous amount of resources available in northeast Wisconsin, including a team of therapists to help Thomas with challenges in his life. Soon, Thomas received 40 hours of inhome therapy every week. As Thomas became old enough for preschool, Julie began to wonder about the best way to transition him into the school environment. She felt Thomas would benefit from a traditional preschool program, surrounding him with peers that would serve as role models for him as he developed his skills. Thomas was able to balance his in-home therapy with preschool, as classes were three days a week and only lasted a half of a day. But as Thomas prepared for kindergarten, Julie wondered how he could go to school five full days a week and still have time to work with his therapists. Wanting Thomas to return to St. Pius X for kindergarten, Julie met with the principal and guidance counselor to see if it could still be a good fit. The school officials suggested that Thomas’ networkhealth.com
autism staff attend school with him on a daily basis. Julie knew that Thomas needed one-on-one guidance for certain portions of the school day, but she wondered whether or not Network Health would authorize Thomas’ support team to attend school with him. Julie contacted Rosemary and explained her situation. Once again, she found putting Thomas’ needs first was Rosemary’s main objective. “Rosemary always stressed meeting Thomas’ needs and that’s every parent’s dream. That’s like Ed McMahon at your doorstep,” Julie said. “Had Rosemary not been able to get approval, I never would have been able to send Thomas to this school.” Today, Julie says Thomas is Lund Van Dyke’s first client, and the first child at St. Pius X to have his autism staff present throughout the entire school day. “We are so elated and grateful that Thomas can go to school with his brothers,” Julie said. “It’s huge for Thomas that they can all walk into the same building together.” Julie credits Network Health for keeping her family together and minimizing the challenges for Thomas. From the time Thomas received his diagnosis to today, Rosemary and Network Health have been there to offer her family support. “When you get the diagnosis, you feel like the rug has been pulled out from under your feet, and then Rosemary answers and enlightens net workhealth.com
and enables. It puts the rug back under you,” Julie said. “The support from Network Health is what energizes me to support my child and be the mom that he needs me to be.” For Rosemary, it has been gratifying to see Thomas and the Bertram family become more confident with the autism diagnosis. She knows that for families like the Bertrams, making herself available via telephone, email or in person makes all the difference. “Julie knows she can come to me anytime with questions,” Rosemary said. “This is especially important with autism since treatment can last a lifetime and will bring about dramatic individual and family changes.” According to Julie, the goals of raising a child don’t change with autism. She tries to do everything she can to provide a better life for her child, just like any other parent. “As a parent, you want to do everything you can for your child,” Julie said. “Network Health has given us the ability to say we did everything we could. It’s not just a health insurance company, it supports the life of my family.” For Julie, it’s never been about adjusting circumstances for Thomas, but helping him reach his full potential. “He has a lot of abilities. I never want to change the world for Thomas. I want to support Thomas so he can understand the world.” W i n t e r 2 01 3
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wellness
Tools to empower your personal health
Exercise that Fits Your Schedule and Budget
M
ost people don’t like working out, but almost everyone likes the benefits that come with it. It’s great to see the numbers on the scale drop or hear friends ask, “Have you lost weight?” Unfortunately, as the great Vince Lombardi explained, “The only place success comes before work is in the dictionary.” While you can’t avoid the hard work, you can avoid the gym. With the few healthy tools described below, you can get fit without spending a lot of time or money. Pedometer Harvard Health Publications reports pedometer users walked at least 2,000 more steps each day than nonusers. When the weather is cooperating, head outdoors for a walk or jog. And to help you stay motivated, set a goal for yourself. Then, wear your pedometer to measure your progress toward that goal. Yoga mat If you’d prefer to stay home, try yoga or Pilates. These workouts can help you burn calories while minimizing the risk of injury. If you’ve never done yoga or Pilates before, follow along with a video. You can find many free videos online or check out the On Demand channels from your cable TV provider. They may offer several free choices as well. If you don’t already have a yoga mat, you could pick one up from any major retailer for under $20. Jump rope (or jumping jacks) You probably loved it when you were a kid, so why not give it another shot? Depending on the intensity, you can burn up to 700 calories an hour—making jumping rope one of the most effective exercises on the list. Basic jump ropes are inexpensive and easy to find, but if you’d prefer to skip the expense all together, you could always do jumping jacks instead. Just ten minutes of jumping jacks will burn around 95 calories (depending on your weight and height). Hand weights A set of hand weights or dumbbells can be a big help in strengthening your shoulders, upper back and arms. And if you don’t already have a set, you don’t have to run out and buy them. Consider using a milk
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Have a smartphone? Then you also have access to helpful apps like Pedometer FREE or Map My Walk. Both apps can measure how far you’ve walked and how many calories you’ve burned. jug—you can fill it with rice, dried beans or water. But, tape the opening to make sure it’s securely closed before doing your arm curls. Fitness Plan or Calendar This may be the most important fitness tool on the list. To keep your motivation up, write down your goal and record your daily or weekly progress. A lot of research supports you’re more likely to achieve your goal if it is written down. It may also be helpful to schedule your workouts. If you already keep a daily planner, add your workouts to the week ahead. Or, an ordinary notebook will work just fine too. networkhealth.com
A Focus on Quality Health Care
N
etwork Health evaluates the quality of care and services provided using two nationally-recognized tests, the Healthcare Effectiveness and Data Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®). Each test scores our services in a different way. HEDIS measures preventive care and our care for chronic diseases. CAHPS evaluates customer satisfaction with services provided by customer service, claims and physicians. Both tables show Network Health’s excellent rankings on both state and national levels.
How We’re Doing
2013 Reporting Year Network Health HMO (Commercial) HEDIS Results (Percentages reflect the number of members who used the offered services and had results within the reported level.) Category Studied Cervical Cancer Screening Colorectal Cancer Screening Childhood Immunization Status Combo 5 (includes DTaP, IPV, MMR, HiB, Hepatitis B, ChickenPox, Rotavirus, Pneumovax, Hepatitis A, Influenza) Adolescent Immunization – Tdap/Td
Network Health HMO Results – National Ranking
84.8%
Ranks 9th
77.4%
Ranks 10th
Wisconsin Health Plans Average Results
National Average Results
76.9%
74.6%
67.3%
59.7%
63.2%
Ranks 6th
95.0%
Ranks 22nd
50.8%
34.2%
84.7%
74.7%
76.7%
64.1%
53.0%
95.3%
92.4%
88.7%
61.3%
45.0%
40.5%
90.9%
86.5%
83.6%
Comprehensive Diabetes Care – LDL Screening less than 100 mg/dL
61.6%
54.4%
45.5%
Cholesterol Management for Patients with Cardiovascular Conditions – LDL-C Tested
93.7%
88.1%
86.1%
77.8%
68.7%
55.5%
Comprehensive Diabetes Care – HbA1c Level less than 7% Comprehensive Diabetes Care – LDL Screening Done
Cholesterol Management for Patients with Cardiovascular Conditions – LDL Level less than 100 mg/dL –
Category/Measure
Network Health HMO Results – National Ranking
Wisconsin Health Plans Average Results
National Average Results
How often did you get an appointment to see a specialist as soon as you needed?
91.6%
86.4%
84.8%
How often was it easy to get the care, tests, or treatment you needed?
94.6%
92.7%
90.9%
How often did your health plan handle your claims quickly?
93.8%
86.9%
86.9%
How often did your health plan handle your claims correctly?
94.8%
90.4%
89.9%
Ranks 14th
Ranks 31st
Ranks 21st
Ranks 32nd
Ranks 19th Ranks 13th Ranks 16th
Ranks 1st Ranks 23rd
Ranks 14th Ranks 18th
Ranks 6th
based on the data is solely that of the authors, and NCQA specifically disclaims any responsibility or any such analysis, interpretation, or conclusion. Quality Compass is a trademark of NCQA.
75.1%
Comprehensive Diabetes Care – HbA1c Tested
(Percentages reflect the number of members who gave positive reviews.)
The source for the data reported above is Quality Compass© and is used with the permission of the
83.0%
Comprehensive Diabetes Care – Eye Exam Performed
2013 Reporting Year Network Health HMO (Commercial) CAHPS Results
National Committee for Quality Assurance (NCQA). Any analysis, interpretation, or conclusion
91.1%
Prenatal and Postpartum Care – Postpartum Care
How You Rate Us
Quality Program information Each year, Network Health’s Quality Improvement (QI) Department updates its QI program structure to include the following. > A written description of the QI program > Behavioral health care, specifically addressed in the program description > Patient safety, specifically addressed in the program description > The structure of the QI program being accountable to the board of directors > A designated physician who has substantial involvement in the QI program > A designated behavioral health care practitioner who is involved in the behavioral health care aspects of the QI program > A QI committee that oversees the function of the organization > The specific role, structure and function of the QI committee and other committees, including frequency, are addressed in the program description > An annual quality work plan including progress toward accomplishing goals > A description of resources the organization devotes to the QI program For more information about Network Health’s Quality Improvement Program, please call 920-720-1229, or toll free at 800-826-0940, ext. 01299. W i n t e r 2 01 3
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wellness Network Health’s Self-Management Workshops For more information or to sign up for a workshop, call us at 920-720-1655 or 800-769-3186, extension 01655. Or, visit us at networkhealth.com/workshops. Click Learn More for details about each workshop, and you’ll also find a link to where you can find dates and times for each workshop.
A Holiday Helping Hand
T
he holiday season is a time for families, gift-giving and making memories. Between going to parties, buying presents and decorating, it’s easy to forget that the holidays can make some people realize how much they don’t have. If you want to make a difference in your community this holiday season, volunteering won’t cost you a dime, and can improve someone’s life. Here are some ways you can give back this year.
Community Service
It doesn’t take any special skills or experience to donate your time. Most places, like a soup kitchen or homeless shelter, will provide on-site training. All you really need to do is show up. If volunteering as a family, community service programs present a great opportunity to start a new family tradition and can set a great example for your children. 14 | balance • W i n t e r 2 01 3
?
did you know
To find local volunteering opportunities near you, visit Volunteer Wisconsin at volunteerwisconsin.org. You can use this website to find your local volunteer center and opportunities in your community.
Donate
If you can’t find the time to volunteer in your community, you can still help out others in your area by simply donating your unwanted items. Gather up your old clothes, kitchen supplies and any other items needlessly filling up your closets or basement and donate them to a good cause. Think of it as spring cleaning in December. You can also purchase new items, such as toys, coats or any holiday gift to go to a family or child in need. Your simple gift could make someone’s holiday.
Living Well with Chronic Conditions Designed specifically for anyone with a chronic condition, such as arthritis, high blood pressure, heart disease, chronic pain or anxiety, this workshop teaches self-management skills and develops a step-by-step plan to achieve specific goals. The six-week class meets once a week for two and a half hours. Healthy Living with Diabetes For any adult living with type 2 diabetes, this workshop is designed to help you better manage your diabetes. Classes cover topics like healthy eating choices and habits, the benefits of exercise, other techniques for dealing with symptoms and how to work with health care providers. This six-week workshop meets once a week for two and a half hours. Stepping On A program for older adults who may have fallen, have a fear of falling or are at risk of falling. This program empowers older adults to step outside of their homes with the confidence to improve their quality of life. This seven-week workshop meets once a week for two hours.
Get Involved at Work
During the holidays, many companies focus on community outreach. If your company has a program in place, make this the year you participate. A little generosity on your part can go a long way to brighten someone’s holiday season. If your company does not have a holiday outreach program, consider starting one. Something as simple as a toy or clothing drive can make a difference. You might also be able to get your company to donate directly to your cause. networkhealth.com
Instant Access to Your Explanation of Benefits S
ometimes mistaken for a bill, an Explanation of Benefits (EOB) is what we send you to explain the medical treatments or services we paid for on your behalf. Your EOB lists services provided, amount the hospital or provider billed and the payment made by Network Health. We issue an EOB after every claim we process, whether or not any payment is due on your part. Traditionally, you receive your EOB through the mail, but Network Health now offers electronic EOBs available through your My Account. By accessing your EOB through My Account, you will get instant access to your information instead of waiting at least a week for your EOB to arrive through the mail. By using your My Account to view your EOB, you can also access the following. > Claims history > Benefits > Authorizations net workhealth.com
A complete list of all past EOBs Email address to contact our customer service department Go to networkhealth.com/eob for detailed directions on accessing your electronic EOB, or follow these three steps. 1. Go to networkhealth.com and click on Member Sign In. > >
2. Log into My Account by entering your User ID and password. 3. Click on Claims in the My Health Plan section. Click view to the left of the specific EOB you would like to review. We invite you to take advantage of our electronic EOBs. It’s another way we’re trying to make health insurance easier for you.
New ID Cards Coming in February
I
HMO
XYZ COMPANY
Group #:
Member #: 000000000
Member Name: JANE SMITH
n February 2014, all Network Health members will receive new ID cards, even if you receive new cards in January. Why? We are changing our vendor (for MRIs, ultrasounds, etc.) to Med Solutions Inc. This means you will be assigned a Med Solutions reference number that will need to go on the back of your ID card.
networkhealth.com
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1570 Midway Pl. Menasha, WI 54952
MAILED ON 12/27/13
Feel lIKe YOU NeeD A traNSlatOr?
CUt thrOUgh the CONFUsION At NetwOrkHealtH.COM. Shopping for health insurance is no walk in the park. Between health care reform and industry jargon, it’s easy to find yourself in a state of confusion. Fortunately, there’s networkealth.com for information that’s easy to understand. On our website, we’ll walk you through all of our plan options to help you find the perfect plan. You’ll also find tools like our insurance translator, a doctor search and news on health care reform updates. at Network Health, we realize that health insurance is not always easy to navigate. let us guide you. networkhealth.com
800-826-0940
HMO plans underwritten by Network Health Plan. POS plans underwritten by Network Health Insurance Corporation, or Network Health Insurance Corporation and Network Health Plan. Self-funded HMO and POS plans administered by Network Health Plan. Sal-174-01-6/13