L I F E , H E A LT H & W E L L N E S S
SPRING 2018
Deer and Ticks and Bears-Oh My A tick bite sets off a chain reaction for a local member.
PAGE 6
Understanding the American Heart Association’s New Blood Pressure Guidelines
PAGE 11
Special Tear-Out Section Preventive Health Checklist
PAGE 20
Ways to Save on Your Health Care Costs
A PUBLICATION OF
Exclusive Reduced Rates for Network Health Medicare Advantage Plan Members For ticket information, visit NetworkHealthMedicare.com/offers. Fox Cities Performing Arts Center - Appleton, Wisconsin RENT – May 13 at 1 p.m. Tickets on sale now. Offer expires May 6, 2018. Subject to availability. Marcus Center - Milwaukee, Wisconsin A GENTLEMAN’S GUIDE – May 5 at 2 p.m. and May 6 at 1 p.m. and 6:30 p.m. Priority Seating - Tickets on sale now. Offer expires May 4, 2018.
AN AMERICAN IN PARIS – June 30 at 2 p.m. and July 1 at 1 p.m. and 6:30 p.m. Priority Seating - Tickets on sale now. Offer expires June 29, 2018.
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3 Letter From President and CEO 4 Knowledge at Your Fingertips
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4 Six Tips To Understanding Your Monthly Premium Invoice
TEAR-OUT SECTION 11 Preventive Health Checklist
5 What’s New at NetworkHealthMedicare.com 14 Medication Therapy Management 5 How to Read Your Explanation of Benefits 15 Opioid Awareness 6 Know Your Numbers FEATURE Understanding the American Heart 16 Deer and Ticks and Bears–Oh My Association’s New Blood Pressure Guidelines 20 Top 5 Ways to Save on Your Health Care Costs 7 Discover Fitness to Control Symptoms and Improve Health 22 Getting to Know Ascension Wisconsin 8 Better Bones, Better Health 23 Is It More Than a Cold or the Flu? 9 Conquering Diabetes and Living Well 23 Breast Cancer Screening More Important Than Ever 10 How Does Network Health Make Decisions? BACK COVER Watch Your Mail – Your New Medicare ID Card is Coming Soon Y0108_1550-01-0318 Accepted 04072018
EDITORIAL STAFF President and CEO Coreen Dicus-Johnson Chief Administrative Officer Penny Ransom Marketing Coordinator Romi Norton Lead Designer Debra Sutton
ASK NETWORK HEALTH If you have questions about anything you read in this issue of Concierge, call customer service at 800-378-5234 (TTY 800-947-3529) Monday–Friday, 8 a.m. to 8 p.m. You can also learn more at NetworkHealthMedicare.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. © 2018 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.
Network Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. If you, or someone you’re helping, has questions about Network Health, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 800-378-5234 (TTY 800-947-3529). Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Network Health, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 800-378-5234 (TTY 800-947-3529). Hmong: Yog koj, los yog tej tus neeg uas koj pab ntawd, muaj lus nug txog Network Health, koj muaj cai kom lawv muab cov ntshiab lus qhia uas tau muab sau ua koj hom lus pub dawb rau koj. Yog koj xav nrog ib tug neeg txhais lus tham, hu rau 800-378-5234 (TTY 800-947-3529). 2 | C oncierge
NetworkHealthMedicare.com
life. health. wellness.
Letter from the President and CEO
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or more than 35 years, Network Health has received recognition for providing exceptional service. Recently wait times in our customer service call center have not met our usual standards, and we have not delivered on our promise to you. Please accept my apology if a recent interaction you had with us fell short of your expectations. I often say you can tell how good an organization is by how they handle the bumps along the way. Our “bump” at the beginning of the year was getting double the number of calls we typically receive. We acted swiftly by adding 10 representatives to our call center staff and formed an action team charged with improving wait times and service levels. We are steadily making our way back to delivering a high-quality experience. I am incredibly proud of the way our team responded. Taking care of you is our highest priority. We will continue to work hard to fulfill our mission—to enhance the life, health and wellness of the people we serve. Sincerely,
Coreen Dicus-Johnson President and Chief Executive Officer
NetworkHealthMedicare.com
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life. health. wellness.
Knowledge at Your Fingertips
E
mmi® is a series of free, animated, interactive online programs that walk you through important information about a health topic, condition or procedure. Maybe your personal doctor clearly explained what you need to know during your last office visit, and after you left the clinic, some of those details got a little fuzzy. Emmi programs can help answer your questions and make you feel more at ease about your health condition. The most important member of your health care team is you, so it’s essential you have the information you need. Even if you feel confident about managing your health, visit GoEmmi.com to verify you’re on the right track and learn some new helpful tips. Using Emmi is easy. Watch for the icon above throughout this edition of Concierge, to know what article topics are covered by Emmi. By visiting the links provided, or viewing Concierge online, you can interactively experience a variety of health topics. Watch them on your computer, smartphone or tablet as many times as you like.
6 Tips to Understanding Your Monthly Premium Invoice
I
f you’re new to a Network Health Medicare Advantage Plan or have switched plans recently, the tips below should help answer any questions you might have about your monthly premium invoice.
1. If you’re on a $0 premium plan, have paid your premium in advance or if you don’t owe anything, you won’t receive an invoice. 2. If you have selected to have your premium payments automatically deducted from your bank account, you won’t receive an invoice. 3. If you have chosen to have your premium payments made by a recurring credit card or through Social Security Administration (SSA) deductions, you won’t receive an invoice. 4. You will only receive an invoice if you have a balance due. 5. If you purchased our optional dental supplemental benefit, you will receive one bill for the total amount owed. 6. Remember to include the bottom portion of your bill if you are mailing in payment. The coupon is needed for payment to be properly applied to your account. If you send in multiple payments at one time, please ensure that each payment coupon is completely filled out so payment is applied appropriately. 4 | C oncierge
NetworkHealthMedicare.com
What’s New at NetworkHealthMedicare.com?
I
f you haven’t visited our website or your secure member portal recently, you should take a peek. We’ve been working hard to enhance your online experience with the following updates.
Online learnings are now available at NetworkHealthMedicare.com in Member’s Corner Online learnings are designed to provide information and guide you on the following topics. Healthy weight maintenance and understanding body composition Tobacco and alcohol use Exercising throughout the seasons Nutrition lifestyle options Emotional health View your claims, Explanation of Benefits and Evidence of Coverage directly from your secure member portal Simply log in to your account by selecting Member Sign In at NetworkHealthMedicare.com, then select the My Claims button to view your claims in detail. View the status and details on your authorizations This includes viewing the requesting provider and start date of an authorization, along with the status and if it’s been approved. If the status says “pending,” that means a decision hasn’t been determined yet. Update or verify your personal doctor, also referred to as your primary care practitioner Choosing one doctor to coordinate all of your care is one of the most important things you can do for your health.
More enhancements are coming to the portal throughout the year, so visit often.
How to Read Your Explanation of Benefits When you use your Network Health Medicare Advantage Plan, you’ll receive an Explanation of Benefits (EOB). This statement explains the services you received, the costs and the amounts covered by Network Health. It is not a bill. Here’s a quick guide on how to read your EOB. The doctor you saw. Explanation of Benefits This is not a bill. Servicing Provider: Dr. Quinn Dates of Service
Total Charges
Claim Number: 12345 Plan: Network PlatinumSelect Plan Disallow Amount Paid
Patient Responsibility
Copay Co-Insurance Non-Covered 9/21/2017 228.00 20.00 0.00 0.00 Description of Service: OFFICE/OUTPATIENT VISIT EST 99214
Date you saw your doctor.
Total amount your doctor billed.
This is your share of the doctor bill.
10/18/17
35.80
Don’t worry about this amount. No one owes this amount.
172.20 This is what Network Health paid your doctor.
Remarks 45 This is an explanation code. It’s explained on the last page of your EOB.
Important Note—Do not send payment when you get an Explanation of Benefits in the mail. It is not a bill. The doctor or facility where you received treatment will bill you directly for any amounts you owe. NetworkHealthMedicare.com
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life. health. wellness.
Understanding the American Heart Association’s New Blood Pressure Guidelines
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he American Heart Association recently released new standards for healthy blood pressure readings. These new guidelines encourage better control early on to help avoid more serious health conditions down the road. As a result, many Americans will be told they are considered at risk for high blood pressure. Doctors may recommend preventive treatment such as lifestyle changes to avoid damage to blood vessels caused by elevated blood pressure. BLOOD PRESSURE CATEGORY
DIASTOLIC mm Hg (lower number)
SYSTOLIC mm Hg (upper number)
NORMAL
LESS THAN 120
and
LESS THAN 80
ELEVATED
120 – 129
and
LESS THAN 80
HIGH BLOOD PRESSURE (Hypertension) Stage 1
130 – 139
or
80 – 89
HIGH BLOOD PRESSURE (Hypertension) Stage 2
140 OR HIGHER
or
90 OR HIGHER
HIGHER THAN 180
and/ or
HIGHER THAN 120
HYPERTENSION CRISIS (Consult your doctor immediately)
Normal: Your blood pressure is within optimal range. Continue heart-healthy habits such as following a balanced diet and exercising regularly. Elevated: You may develop high blood pressure unless steps are taken to control it. Hypertension Stage 1: Your doctor is likely to prescribe lifestyle changes and may consider blood pressure medication, depending on your risk of heart disease. Hypertension Stage 2: Your doctor is likely to prescribe a combination of blood pressure medications along with lifestyle changes. 6 | C oncierge
Hypertension Crisis: If your blood pressure readings suddenly exceed 180/120, wait five minutes and test again. Contact your personal doctor immediately if your readings stay unusually high.
Call 911 if you experience symptoms such as chest pain, shortness of breath, back pain, numbness/weakness, vision changes or difficulty speaking. NetworkHealthMedicare.com
Try these healthy habits to control blood pressure Eat a balanced, low-salt diet Exercise regularly Quit smoking
Limit your alcohol intake Manage your stress level Take medications as prescribed
Remember, managing blood pressure is a lifelong commitment that can lower the risk of heart attack, stroke, heart failure, kidney damage, vision loss and sexual dysfunction. It is important to be aware of your readings and risk factors, and adopt healthy lifestyle habits to manage your health and prevent serious conditions from developing. Although heart disease is still the leading cause of death in the United States and around the world, death rates have decreased significantly, thanks in part to earlier and better treatment of high blood pressure. Link to AHA information: http://bit.ly/2FCMpId
Visit www.goemmi.com/NHPMHTN for free, interactive programs on blood pressure.
Discover Fitness to Control Symptoms and Improve Health
A
regular exercise program packs some powerful benefits. Many people avoid exercising because of arthritis, back pain, balance issues or other conditions. But the right exercises can actually help improve and manage these conditions and others. Finding a routine that fits your needs and abilities—and that you enjoy—is the first step to better health.
Most fitness centers have certified, specially trained instructors who can help you discover the exercise classes, equipment and movements that work best for you. Most participants in the SilverSneakers® fitness program report an increase or improvement in flexibility (67 percent), strength (80 percent) and aerobics (86 percent). Exercise can help you be more independent, comfortable and active. Sources The Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/ART-20045206 American Heart Association, http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/ Understand-Your-Risk-for-High-Blood-Pressure_UCM_002052_Article.jsp#.Wjqs7mfrspF Arthritis Foundation, http://www.arthritis.org/living-with-arthritis/exercise/benefits/exercise-knee-osteoarthritis.php https://uhs.berkeley.edu/sites/default/files/LowBackPain.pdf Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. © 2018. All rights reserved. NetworkHealthMedicare.com
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Better Bones, Better Health T
here is never a great time for a slip or fall, but when you’re on a cruise vacation with your family, it’s especially inconvenient.
Network Health’s Medical Director, Dr. Rita Hanson, had been enjoying a beautiful day at the beach on the Jamaican coast when she decided to go for a dip in the ocean to cool off. On her way into the water, a rogue wave knocked her over. She made hard contact with a rock shelf just underneath the water’s edge. Luckily, she was able to break her fall by stretching out her left hand to protect herself.
Pictured is Dr. Rita Hanson
It wasn’t long after the fall that Dr. Hanson noticed swelling and pain in her left wrist. Back on the cruise ship, she visited the infirmary for a bandage, wrapped it, and tried to move on and enjoy the rest of the trip. Dr. Hanson had been traveling with her grandchildren and she was determined not to let the injury slow her down.
About a week later, the injury was still plaguing her. Dr. Hanson made the trip to see an orthopedic surgeon. She learned she had a small fracture (broken bone) in her wrist and would need to spend the next five weeks wearing a cast. Looking at the bright side, Dr. Hanson was just happy she would have use of her thumb and she’d be cast-free by Christmas. Even if her granddaughter didn’t like the cast, it was still a much better alternative than surgery. Because of her fracture, Dr. Hanson had a bone density test done. Thankfully, the test showed that she did not have osteoporosis. As she suspected, her bones were strong and healthy. Otherwise, the injury would have been much more severe after such a hard fall and likely would have required surgery. To help minimize the effects of falls and fractures, it’s important to focus on bone health. All women ages 65 or over should get a bone density test. It is also recommended for younger women or men that have an abovenormal chance of fracture (such as a history of smoking, family members with osteoporosis or breaking a bone between ages 35-65). There are several other important steps you can take to protect your health. Dr. Hanson offers these tips and advice. 88 || C Concierge oncierge
Focus on healthy lifestyle habits – Limiting alcohol, staying away from tobacco products and exercising are important for protecting bone density. Weightlifting is especially helpful. Get plenty of calcium and vitamin D – For your body to absorb the calcium in foods like milk, cheese or yogurt, you will need to also get your daily dose of vitamin D. Foods like salmon, or other fatty fish varieties, are a good source of vitamin D. Know your family history – You may not have heard your family members talk about osteoporosis, but there are signs you can look for. When people break bones in their 40s or 50s, it may be a sign of osteoporosis. Another indication is a ‘dowager’s hump’ (a rounding of the upper spine). Talk to your doctor about medication – Sometimes a healthy lifestyle and calcium intake just aren’t enough. There are new medications to stop bone density loss. There is a pill available that you only need to take once a month. And, if you are opposed to taking a pill, there are also single IV treatments that are effective for the entire year. Talk to your doctor and discuss what would be best for you. Prevent falls – Most falls occur in your own home. One of the best ways to avoid fractures is to remove items that might cause slips. It’s a good idea to limit rugs, wear nonslip shoes, make sure you have grab bar railings installed in bathrooms and use lights with motion sensors. For more great information on bone health, check out Dr. Hanson’s video at http://bit.ly/2GE2f6P. NetworkHealthMedicare.com NetworkHealthMedicare.com
Conquering Diabetes and Living Well T
he Centers for Disease Control and Prevention estimates that almost 10 percent of the U.S. population has diabetes.
Living healthy with diabetes includes regular evaluation with your personal doctor —including an annual A1c blood test, annual dilated eye exam, monitoring kidney function, controlling blood pressure and monitoring the effectiveness of medication. Living well with diabetes requires following some basic guidelines you and your personal doctor can tailor to your specific needs. EAT RIGHT Eat smaller portions, consume less fat and limit foods that are high in sugar and saturated fats. Eat more fiber and whole grains, and a variety of fruits and vegetables. BE ACTIVE Experts recommend moderate to intense physical activity for at least 30 minutes, five or more days per week. You don’t have to be an athletic superstar. Start slow and work your way up. Always consult with your personal doctor before starting an exercise program. BE PREPARED Always have an emergency plan that includes the following. A list of your health problems A list of current medications and dosages A list of known allergies The name and number of your personal doctor Emergency contact information
If diet and exercise aren’t enough, there are several medications to help treat diabetes and keep your blood sugar within range. These medications only work if they are taken every day, exactly as your doctor says to take them. Even missing a couple doses can lead to significant changes in your blood sugar. If blood sugar levels are left untreated, it can lead to potentially serious outcomes such as heart problems, infections and amputations. Always take your diabetes medications every day and closely monitor your blood sugar levels. Visit page 14 to see if you are eligible to participate in our medication therapy management program.
Remember to stay hydrated and keep a source of sugar with you at all times, such as glucagon. If you have any further questions or would like additional help managing your diabetes, call our care management coordinators at 800-236-0208 (TTY 800-947-3529), Monday–Friday, from 8 a.m. to 5 p.m. or email us at qi@networkhealth.com.
WHAT’S THAT? GLUCAGON is a medicine that is different from insulin. It is used to treat severe low blood sugar. Glucagon works by telling your body to release sugar into the bloodstream to bring the blood sugar level back up. Source: https://www.lillyglucagon.com NetworkHealthMedicare.com
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Visit www.goemmi.com/ NHPMDIABETES for free, interactive programs on diabetes.
How Does Network Health Make Decisions?
Care and service include medical procedures, behavioral health procedures, pharmaceuticals and devices.
N
etwork Health makes decisions on the appropriateness of care and service through a process called utilization management. Decisions are based on written criteria established from clinical evidence and the benefits outlined in your Evidence of Coverage document. The written criteria are reviewed and approved annually by actively participating practitioners. Criteria can be made available to you upon request. Requests for criteria can be submitted several ways, as noted below. Network Health does not reward practitioners, or other individuals conducting utilization review, for denying coverage for care or service. Nor does Network Health prohibit providers from advocating on behalf of members within the utilization management program. Network Health does not use incentives to encourage barriers to care and service, and does not make decisions about hiring, promoting or terminating practitioners or other associates based on the likelihood, or the perceived likelihood, that the practitioner or associate supports, or tends to support, denial of benefits. The medical directors, associates (or designees), care management staff and supervisors of this staff receive no financial incentive to encourage decisions that result in underutilization of care. In addition, treating practitioners may discuss medical necessity denial determinations with the physician review medical director by contacting us.
Contact Information Phone: 866-709-0019 (TTY 800-947-3529)
Callers have the option to leave a message 24 hours a day, seven days a week. Messages are retrieved at 8 a.m., Monday–Friday and periodically during the business day. All calls are returned promptly. Calls received after business hours are returned the next business day.
Fax: 920-720-1916
Mailing Address
Network Health 1570 Midway Pl. Menasha, WI 54952
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NetworkHealthMedicare.com
Access to Network Health Care Management Coordinators and Services Network Health assures access to medical and behavioral health care management coordinators for you, your personal doctor and provider office staff seeking information about our case or utilization management programs. If you have questions about our programs, please contact care management at 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.
Preventive Health Checklist I
t can be tough to keep all the recommended preventive care and screenings straight, but they are crucial for early detection and treatment.
Take this checklist to your next doctor’s appointment and review with your doctor to schedule any necessary screenings. Costs and coverage for these services vary depending on the plan you are enrolled in. Refer to your Evidence of Coverage for plan-specific information. NetworkPrime (MSA) members will pay nothing for Medicare-covered services after the deductible is met. If you have any questions about your coverage for these preventive screenings, contact a health care concierge at 800-378-5234 (TTY 800-947-3529) before you schedule your appointment. COVERED PREVENTIVE SERVICE FREQUENCY One-time visit within the Welcome to Medicare visit first 12 months of having TIP - Ask your doctor’s office to schedule your “Welcome to Medicare” Medicare Part B preventive visit when you make this appointment.
APPOINTMENT SCREENING SCHEDULED COMPLETE
OR Every 12 months (once you’ve had Part B for longer than 12 months)
Every 12 months
Annual wellness visit Must be at least 12 months after your “Welcome to Medicare” preventive visit. TIP - You are able to have lab screenings for early detection of diabetes, high cholesterol or blood disorders. As part of your wellness visit OR your routine physical, you can have a fasting blood sugar, lipid panel and/or complete blood count that are included in the cost. Note: These screening labs are intended to assist in early detection of new health conditions and are not part of routine monitoring of existing health conditions. Annual routine physical exam To be covered, this exam must include preventive medicine evaluation and management, including an age and gender appropriate history, examination and counseling/anticipatory guidance/risk factor reduction interventions. TIP - You are able to have lab screening for early detection of diabetes, high cholesterol or blood disorders. As part of your wellness visit OR your routine physical, you can have a fasting blood sugar, lipid panel and/or complete blood count that are included in the cost. Note: These screening labs are intended to assist in early detection of new health conditions and are not part of routine monitoring of existing health conditions.
NetworkHealthMedicare.com
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COVERED FREQUENCY One-time ultrasound Every 12 months
Every 12 months Every 12 months Every 24 months Every 12 months Every five years Every 24 months Every 24 months Every 12 months
PREVENTIVE SERVICE Abdominal aortic aneurysm screening Recommended for people at risk, as determined by your doctor. Alcohol misuse counseling One alcohol misuse screening for adults who misuse alcohol but are not alcohol dependent. Up to four counseling sessions per year for people who screen positive for alcohol misuse. Annual flu shot recommended in the fall or winter. Blood pressure screening If medically necessary, these may occur more frequently. Bone mass measurement If medically necessary, these may occur more frequently. Cardiovascular disease Behavioral therapy in a primary care setting only. Cardiovascular screenings This screening includes blood tests for the detection of cardiovascular disease. Cervical and vaginal cancer screening For those at high risk, one Pap is test recommended every 12 months. Clinical breast exam Recommended for women age 40 and older.
Every 12 months
Depression screening Provided in a primary care setting only. Diabetes screening Based on results, you may be eligible for up to two screenings every 12 months. Digital rectal exam Recommended for people age 50 and older. Dilated eye exam
Every 12 months
Drug level blood test
Every 12 months
Fasting blood glucose Based on the results, Medicare may cover up to two screenings per year. Glaucoma screening Recommended for people who are at a high risk of getting glaucoma. Hemoglobin A1c test
Every 12 months Every 12 months
Every 12 months Every 12 months One-time vaccination (three shot series) One-time screening Every 12 months 12 | C oncierge
APPOINTMENT SCREENING SCHEDULED COMPLETE
Date of last screening
Date of last screening Date of last screening Date of last screening
Hepatitis B vaccine Recommended for people who are at intermediate or high risk of contracting Hepatitis B. Hepatitis C screening Recommended for those at high risk and those born between 1945 and 1965. HIV screening Recommended for people at risk of contracting HIV. NetworkHealthMedicare.com
COVERED FREQUENCY Every 12 months
PREVENTIVE SERVICE
Every 12 months
LDL (cholesterol) screening
APPOINTMENT SCREENING SCHEDULED COMPLETE
Kidney and liver function tests
Every 12 months
Lung cancer screening Recommended for those 55-77 at risk due to being a current smoker or having quit within the last 15 years. Every 12 months Mammogram Recommended for women age 40 and older. Varies Medical nutrition therapy Three hours of counseling are offered during the first year of medical nutrition therapy services. After the first year, two hours are offered each year for people with diabetes and/or kidney disease but not on dialysis when ordered by their doctor. Varies Obesity screening and counseling Intensive counseling for people with a body mass index (BMI) of 30 or more received in a primary care setting. One-time vaccination Pneumonia vaccine Most people only need this vaccine once in their lifetime, unless advised by a doctor. Pneumonia booster vaccines must be administered at least one year from the initial vaccine. Every 12 months Prostate specific antigen (PSA) test Recommended for people age 50 and older. Every 12 months Sexually transmitted infections (STI) screening and counseling Recommended for people at risk for chlamydia, gonorrhea, syphilis and Hepatitis B. Two counseling sessions may be covered each year for adults at increased risk of STI. Ask your doctor. It is Spirometry test recommended to confirm Provided for diagnosis of and for those with Chronic Obstructive Pulmonary Disease (COPD). the diagnosis and then as medically necessary. Eight times within 12 Tobacco cessation counseling If you have signs or symptoms of tobacco-related disease, you may be months responsible for additional costs. COLORECTAL CANCER SCREENINGS Every 10 years Colonoscopy Recommended for people age 50 and older. For people at high risk, a colonoscopy or barium enema is recommended every 24 months. Every 12 months Fecal occult blood test Recommended for people age 50 and older. Every four years Flexible sigmoidoscopy or barium enema Recommended for people age 50 and older. For people at high risk, a colonoscopy or barium enema is recommended every 24 months. Every three years Multi-target stool DNA test Recommended for people age 50-85 with no symptoms of colorectal disease who are not at increased risk. NetworkHealthMedicare.com
APPOINTMENT SCREENING SCHEDULED COMPLETE Date of last screening
Date of last screening
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life. health. wellness.
MEDICATION therapy
Management
As a Network Health Medicare Advantage member, you may be eligible to participate in our medication therapy management (MTM) program, at no cost to you.
How does this benefit me? The MTM program gives you the opportunity to speak one-on-one with a pharmacist about your medication therapy. The meeting centers on you, your prescription medications and any over-the-counter medications. You will be able to discuss side effects, adherence tips and medication cost savings.
How long will the meeting take? While it varies from person-to-person, the average call takes about 20 minutes.
I’m interested, what’s next?
Good reasons to say “yes” to an MTM call. 1. Get answers to questions related to your medication costs. 2. Find out why it’s important to take your medication exactly as prescribed. 3. Learn how to manage side effects. 4. Learn about brand name drugs vs. generics.
Eligible members are automatically enrolled in the MTM program and will receive the following. An introductory letter telling you how to get started. An offer to participate in a comprehensive medication review each year. This review will help you get the best results from your medicines, from the comfort of your home. A follow-up letter that outlines the review and suggested next steps. This is a great tool to share with your personal doctor and other health care providers.
How do I know if I am eligible? Eligible members must meet the following the criteria. 1. You must have at least three of the following long-term (chronic) medical conditions: asthma, chronic heart failure, chronic obstructive pulmonary disease (COPD), depression, diabetes, end stage renal disease, high blood fat levels, high blood pressure or osteoporosis. 2. You must take seven or more daily medicines covered by Medicare Part D. 3. Your Part D covered medications must cost more than the CMS specified annual cost threshold. For 2018, that amount is $3,967.
What if I don’t meet the criteria? If you don’t meet the eligibility requirements but are still interested in reviewing your medications, call a health care concierge at 800-378-5234 (TTY 800-947-3529), Monday–Friday, 8 a.m. to 8 p.m. to schedule time to speak with a pharmacist. As a Network Health Medicare member, the service will still remain cost-free. 14 | C oncierge
NetworkHealthMedicare.com
OPIOID AWARENESS O
pioid abuse is a growing problem in Wisconsin. Opioids are narcotic medications used to treat mild to severe pain. You might think this is just an issue for drug users and abusers. The fact is any of us could fall victim to a dependency on opioids.
Are any of the following medications in your home?
oxycodone morphine fentanyl methadone
hydrocodone codeine hydromorphone tramadol
These prescription painkillers are some of the most commonly used opioids. If you have been prescribed opioids, use them only until pain is manageable with non-narcotic pain relievers. Keep opioid medications locked up and dispose of unused medications when they are no longer needed. Resist the urge to save them “just in case.” Dispose of the drugs properly. Flushing drugs or washing them down the drain can contaminate our water supply. Check the medication label for disposal instructions or look for drug take-back programs in your area.
VISIT THE DOSE OF REALITY WEBSITE TO LEARN MORE
General information and dangers – http://doseofrealitywi.gov/get-the-facts/dangers/ Safely dispose of unwanted drugs – http://doseofrealitywi.gov/drug-takeback/
DANGERS OF MIXING OPIOIDS WITH OTHER MEDICATIONS
Benzodiazepines, sometimes called “benzos”, are a common group of medications that work on your body’s central nervous system to treat conditions such as panic attacks and trouble falling asleep. Taking benzos with opioid pain medications or alcohol can cause a number of negative outcomes. Opioids, benzodiazepines and alcohol can all slow down or stop signals from your brain to your body. When these signals are stopped, you may experience drowsiness, slurred speech and trouble breathing. It is important to only take your pain and anxiety medications exactly as prescribed by your doctor and to avoid alcohol. Taking more medication than necessary can be very dangerous and potentially lead to serious side effects and even death.
COMMONLY USED BENZOS lorazepam (Ativan) clonazepam (Klonopin)
diazepam (Valium) alprazolam (Xanax)
WHAT’S THAT? OPIOIDS BENZODIAZEPINES Narcotic medications used to treat A common group of medications that work on your body’s central nervous system to treat mild to severe pain conditions such as panic attacks and trouble falling asleep NetworkHealthMedicare.com
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COVER STORY
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NetworkHealthMedicare.com
Deer Ticks Bears–Oh My and
and
G
eorge Shubat has always loved the great outdoors. He and his wife Bonnie grew up on farms in the northwoods Ashland area before moving to Greenville 45 years ago. The farmland is still part of their family today and makes for excellent hunting, a favorite pastime for George who serves as a guide for bear hunters in the area.
By Romi Norton, Photography by Beth DesJardin, Trove Photography NetworkHealthMedicare.com
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COVER STORY
“A
buddy of mine retired up there and started this guide service. He needed people to help him out,” George said. “The season is in September in Wisconsin. There are about 30 stands. We take people out to the stand and go back at dark and get them.”
anaplasmosis, a disease caused by bacteria and transmitted to humans by the bite of an infected tick. Soon after, they received the new test results indicating George had indeed been bitten by a tick and contracted anaplasmosis.
In September of 2015, during a warm spell, George was wearing shorts while out in the woods. He fell down, cut his leg and believes that’s when he was bit by a tick. “I’m guessing that’s how I got bit. I’ll never know, we never found the tick. It just bites you, it doesn’t have to stick to you,” George said.
“This wasn’t Lyme disease. It’s totally different. It goes in your blood. He had severe sepsis,” Bonnie said. Anaplasmosis is a serious illness that requires immediate medical attention. If it isn’t treated appropriately, it can result in death. While the Shubats were glad George’s condition was identified, the relief was short lived. The medication George needed to treat his illness caused him to start hemorrhaging.
“I didn’t feel good most of the month of October. I went to my doctor and we thought I had the flu,” he says. Bonnie explained, “He had heart issues. He was always tired.” In late October, with George still not feeling well, they decided to go back to the doctor. Since they were in Ashland at the time, they went to the local hospital. “I just didn’t feel right and knew something was wrong,” said George. Bonnie continues solemnly, “When we took him to the Ashland hospital, they said if I would have waited one more day, he wouldn’t have been here.” George was transferred to Duluth, MN, where he spent three weeks in the intensive care unit. Having a Network Health Medicare Advantage Plan made it easy to continue to get the care he needed when and where he needed it. “In Duluth, they tested George for tick bites and the test came back negative. But the doctor surmised that (a tick) was it, because he was so sick. They gave him all different kinds of antibodies to fight it and that wasn’t doing a thing,” Bonnie said. “They almost lost me a couple times,” George added. George was started on a drug for
For Bonnie, the uncertainty was the most challenging part. George’s recovery wasn’t always a consistent improvement. Some days the news they received was good. Other days, they were surprised to learn of a setback. “We were always afraid to open the curtain, because we never knew,” she remembers. The tick bite had set off a chain reaction. “At one point, he couldn’t talk and was mumbling, so I thought he had a stroke. The next day, they did some testing with a neurologist. At the time, he was in really bad shape,” said Bonnie. Fortunately, the doctors ruled out a stroke but determined George had kidney failure. Once George stabilized, the Shubats started looking for a rehabilitation center for George to recover and receive dialysis for his kidney failure. They wanted to be near home so they went to Brewster Village in Appleton. Being bedridden for so long took a toll on George’s body. At Brewster Village, George was able to get the physical therapy and exercise he needed, in addition to the dialysis. Finally, George was on the road to recovery. After six weeks of dialysis, the Shubats received a phone call announcing that George didn’t have to take dialysis anymore. “That was the best Christmas present ever,” said Bonnie.
WHAT’S THAT? SEPSIS is a potentially life-threatening complication of an infection. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail. Source: mayoclinic.org. 18 | C oncierge
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It has been over two years since the tick bite and there are no long-term effects. Today, George and Bonnie continue to remain very active. Each week they visit the YMCA, where Bonnie enjoys the pool. George keeps busy building in his garage workshop and Bonnie gathers with her friends to play dominoes. And yes, George continues to guide bear hunters in the northwoods. When asked what they would like readers to learn from their story, Bonnie says “You have to have friends and family. I had good support because of my friends. Somebody called me every day.”
This wasn’t Lyme disease. It’s totally different. It goes in your blood. He had severe sepsis.” -Bonnie Shubat
George adds with a laugh, “Do not wear shorts in the woods.”
Tick Bite Prevention
According to the Centers for Disease Control and Prevention, the greatest risk of being bitten by a tick exists in the spring, summer and fall. However, adult ticks may be out searching for a host any time winter temperatures are above freezing. • Avoid direct contact with ticks by avoiding wooded and brush areas with high grass and leaf litter. • Walk in the center of trails. • Use repellent that contains 20 percent or more DEETP, picaridin or IR3535 on exposed skin for protection that lasts several hours. (Always follow product instructions.) Although easily treated with antibiotics, these diseases can be difficult for physicians to diagnose. Early recognition and treatment of the infection decreases the risk of serious complications.
Common Symptoms of Tick-Related Illnesses • Fever and chills • Headaches, fatigue, joint pain and muscle aches • Distinctive rash, often referred to as a circular rash or a “bulls eye” Source cdc.gov. NetworkHealthMedicare.com
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life. health. wellness.
See In-Network Doctors
Top 5 Ways to $ave on Your Health Care Costs A
s health care costs continue to rise, making informed decisions about how and where you get care and services can dramatically impact how much you end up paying. Knowing how to get the most out of your health plan is essential. Don’t be afraid to ask your doctor about the cost of care to keep you better informed.
Here are some of the biggest ways you can save on your overall costs. Know When to Use Urgent Care
1. See In-Network Doctors Make sure to use in-network providers that are part of your plan. Though your plan may have out-of-network coverage, you may pay more for services provided out-of-network depending on your plan. View your Evidence of Coverage for information on in-network and out-of-network costs for your specific plan.
Take Advantage of Virtual Visits
Look for Surgery Centers
Ask About Generics 20 | C oncierge
You can always search for the most up-to-date in-network providers at NetworkHealthMedicare.com. Click Find a Doctor. The providers listed have a contract with Network Health and they’ve agreed to provide members care at a discounted price. Out-ofnetwork providers not listed are not part of your plan and they don’t have a contract with Network Health. In addition, take advantage of annual visits, screenings and preventive care using in-network doctors. Doing so can help diagnose conditions early before they become a bigger, more expensive problem. NetworkPrime (MSA) members may select any doctor or hospital that accepts Medicare.
2. Know When to Use Urgent Care Urgent care and emergency care are not the same. When your situation is not an emergency, you can significantly save on costs by going to an urgent care facility instead of the emergency room. On the following page are some important differences and examples that can help you decide where to get care.
NetworkHealthMedicare.com
Urgent Care
Emergency
Urgent care is for an unexpected injury or illness that is not life threatening, but still needs attention quickly so you don’t develop a serious problem.
An emergency is an illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.
Examples may include, but are not limited to, the following. • Most broken bones On average, • Minor cuts urgent care can cost • Sprains • Most drug reactions than going to • Non-severe bleeding the ER • Minor burns
Examples may include, but are not limited to, the following. • • • •
$600 LESS
Shortness of breath Persistent chest pain Loss of vision Traumatic injuries
If you have an emergency, call 911 or go to the closest emergency facility.
ER costs can range anywhere from
$600 up to $6,000
You can find the closest in-network urgent care facility at NetworkHealthMedicare.com. Select Find a Doctor. Click Find a Facility.
“
3. Take Advantage of Virtual Visits
You have access to virtual visits through MDLIVE®. Virtual visits are a convenient way to get care for covered medical and behavioral health services by phone, secure video or the MDLIVE App. With your Network Health Medicare Advantage plan, a virtual visit for medical services is available at no cost to you. Virtual visits are a quick and easy way to get care for non-emergent issues. The average wait time is less than 10 minutes, and you can use virtual visits 24/7. Virtual visit providers can also send e-prescriptions to your local pharmacy, if needed. Activate MDLIVE now (so it’s ready when you need it) by signing in to your member account at NetworkHealthMedicare.com/MyAccount and clicking MDLIVE Virtual Visits.
Types of care treated with virtual visits
NetworkHealthMedicare.com
• Acne • Allergies • Cold and flu • Constipation • Cough • Diarrhea
• Ear problems • Fever • Headache • Insect bites • Pink eye • Rash
• Sore throat • Nausea and vomiting • Respiratory problems • Urinary problems or UTI
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life. health. wellness. Top 5 Ways to $ave on Your Health Care Costs continued 4. Look for Surgery Centers Outpatient Surgery
40-50%
If you’re going to be having surgery, consider going to a surgery center instead of a hospital. Generally, outpatient surgery costs can be 40 to 50 percent less expensive at a surgery center.
LESS EXPENSIVE In addition, another medical service that can be less expensive
at a surgery center
outside of a hospital is an MRI scan. If you need an MRI scan, consider facilities like Smart Choice MRI for high quality scans at a fraction of the typical price.
5. Ask About Generics If you’re prescribed a brand name medication, ask your doctor or pharmacist if there’s a generic alternative available. Doing so can have a big impact on your overall cost for the drug.
Generic Drug Cost
80-85% LOWER
According to the U.S. Food and Drug Administration, the cost of a generic drug is 80 to 85 percent lower, on average, than the cost of a brand name drug. And, generic drugs use the exact same active ingredients, work the same and have the same benefits as a brand name.
Getting to Know Ascension Wisconsin B y now, you may have noticed some new signs in the area. Affinity Health System, Ministry Health Care, Wheaton Franciscan Healthcare and Columbia St. Mary’s are rebranding as Ascension Wisconsin. What does this mean to you, our member? The same access to the high-quality doctors and hospitals you’ve come to know and trust, supported by the largest not-for-profit health system in the U.S. Ascension is also the world’s largest Catholic health system. Ascension Wisconsin is composed of 24 hospitals and hundreds of related health care facilities stretching from Racine to Eagle River. Network Health is co-owned by Froedtert Health and Ministry Health Care, a part of Ascension Wisconsin.
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Is It More Than a Cold or the Flu? C
hronic obstructive pulmonary disease, or COPD, is a disease that affects your lungs making it hard to breathe. During cold and flu season, it can sometimes be difficult to tell the difference between a cold, the flu or a COPD flare-up. If you have COPD, a cold may make it worse. If you are coughing up dark mucus, you may have a bacterial infection. It’s a good idea to contact your personal doctor to find out if you need to be seen. If you notice you are short of breath even at rest, have a fever or chills, it is important to be seen by your personal doctor right away. Learn how to better manage, or even improve, your chronic lung condition by enrolling in Network Health’s condition management program. We can help you with a customized COPD action plan outlining when it is necessary to go to the doctor. To find out more, call 866-709-0019 (TTY 800-947-3529), Monday–Friday, 8 a.m. to 5 p.m.
Remember to get your annual flu vaccine. It is the best way to help prevent the flu. Avoid close contact with anyone who is sick and wash your hands frequently with soap and water. Thank you for getting your flu shot.
Visit www.goemmi.com/NHPMCOPD for free, interactive programs on COPD.
Breast Cancer Screening – More Important Than Ever R
egular breast cancer screenings are important to help detect cancer in its early stages, since many women have no symptoms. Unfortunately, as you age, your risk of developing breast cancer increases. Almost half of all invasive breast cancers and breast cancer deaths occur among women 65 and older.1 A mammogram is recommended every one to two years, depending on your risk level. Talk to your personal doctor about breast cancer screenings and your risk level at your next annual wellness visit. 1 United States Preventative Services Task Force
NetworkHealthMedicare.com
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1570 Midway Pl. Menasha, WI 54952 Health and Wellness or Prevention Information
Watch Your Mail – Your New Medicare ID Card is Coming Soon
B
y now, you’ve heard some buzz around the new Medicare card and new Medicare number. It is important to understand what it means to you. Take a look at these frequently asked questions.
Q: Why is Medicare changing the cards and my number? A: Medicare is removing Social Security Numbers from Medicare cards to help protect your identity. Your Medicare benefits will not change.
Destroy
Q: When will the new cards be issued? A: Medicare will mail new Medicare cards between April 2018 and April 2019. Your card may arrive at a different time than your friend’s or neighbor’s. Q: What should I do with my old Medicare card when I receive my new one? A: Continue to carry your Network Health member ID card as usual. You should destroy your old Medicare card and store the new card in a safe place. Q: What is the best way to destroy my old Medicare card? A: It is best to destroy all identifiable information from your card. Cut up your name and Medicare number in multiple pieces. Keep cutting so that this information is unreadable. When you throw it away, place different pieces in the trash on different collection days.
( ( ( ( Network PlatinumPlus (PPO)
Keep
( (
This is your 2018 medical card.
Member ( JOHN Q PUBLIC
( Member ID
( 123456789 Health Plan (80840) ( Group 2001899
PC 00
Copays PCP Specialist
Network In Out $10 $10 $40 $40
Part B Pharmacy Claims Rx BIN: 003858 RxPCN: A4 RxGrp: NHPA H5215_001
(
IMPORTANT: ( Beware of anyone who contacts ( you about your new Medicare You will never Service: 800-378-5234 (TTY card. 800-947-3529) ( Customer Prior Authorization: 866-709-0019 be asked to give personal or private information Pharmacy Customer Service: 800-316-3107 (TTY 800-899-2114) ( Use Only: 800-922-1557 ( Pharmacist 24–Hour Nurse Advice: 888-879-8960 (TTY 888-833-4271)and card. to receive your new Medicare number ( For Providers You will not( be contacted byNetworkHealthMedicare.com Medicare by phone. Network Health MA Plans 120 ( P.O. Boxyour You will receive card by mail. Menasha, WI 54952 ( Payer ID: 77076 ( Provider Customer Service Line: 855-580-9935
Medicare limiting charges apply.
(
More information is available at www.cms.gov/newcard, then click Health & Drug plans. Out-of-network/non-contracted providers are under no obligation to treat Network Health Medicare Advantage Plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Network Health Medicare Advantage plans include MSA and PPO plans with a Medicare contract. NetworkCares is a PPO SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in Network Health Medicare Advantage Plans depends on contract renewal. The benefit information provided is ( Limitations, copayments and restrictions may a brief summary, not a complete description of benefits. For more information, contact the plan. apply. Benefits, premium and/or copayments/coinsurance may change January 1 of each year.( The formulary, pharmacy (network and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premium. 1550-01-0318