Gateway to Health Gateway to Health A Newsletter for Gateway Health Medicaid Members
November 2013 THIS ISSUE 2 Schedule Your Flu Shot Today Electronic Health Information
Don’t delay, schedule your flu shot today! While the temperatures are dropping outside, this year’s flu season will soon be in high gear. Have you had your flu shot yet? If not, it’s time to schedule one. The influenza vaccine is recommended for people age six months and older. Gateway HealthSM does cover flu shots for you, and you don’t always have to go to a doctor’s office to get one. Gateway Health offers free flu vaccines at many large pharmacy and retail chains. (Continues on next page)
What You Need to Know About Electronic Health Information If you visit the doctor or a pharmacy, chances are you have seen a computer at work, pulling up your medical history or last prescription refill. You are about to see even more of this, as government rules are requiring hospitals and providers to be up-to-date with electronic medical records.
3 What You Can Do to Prevent Cervical Cancer
4 Asthma Control 5 STDs and Domestic Abuse Trained Care Managers Benefit You
6 & 7 Notice of Privacy Practices 8 Protect from Billing Fraud Rights and Responsibilities What’s that Doctor Called?
9 Text to Better Diabetes Health Complex Case Management
10 COPD Doesn’t Have to Rule Your Life
11 Mom Matters Update Stress Management and Health Reconsiderations and Grievances
(Continues on next page)
Did you know? Gateway Health also offers four Medicare Special Needs Plans, Gateway Health Medicare AssuredSM for individuals who qualify for both Medicare and Medicaid! These plans include Chronic Care Special Needs Plans (C-SNPs) for those with the following conditions: diabetes, cardiovascular disorder or chronic heart failure. You may be eligible for Medicare at age 65 or under age 65 with certain disabilities. Once you become eligible for Medicare, call 1-877-GATEWAY (1-877-428-3929) to learn more about your Medicare enrollment options, or visit us online at MedicareAssured.com.
12 Healthy Holiday Recipe Gateway Makes It Easier to Quit Smoking
13 Mammogram Rewards Program 14 Important Phone Numbers
Scan code with your smart phone to learn more about Gateway HealthSM.
Don’t delay, schedule your flu shot today! (Continues from page 1) If you do go to your doctor’s office for your flu shot, ask if it’s time for any routine screenings or tests, like those that check for high cholesterol or cancer. It may be time for other vaccinations. Yes, adults need them as well – vaccinations are not just for kids. People over the age of 65 or those with chronic conditions may be more susceptible to flu-related complications such as pneumonia. Who shouldn’t get the flu vaccine? Those younger than six months or who have egg allergies should first check with their doctor prior to scheduling an appointment. In the meantime, practice good health habits during cold and flu season. Use tissues when coughing
People over the age of 65 or those with chronic conditions may be more susceptible or sneezing, use hand sanitizer and wash your hands often to stop the spread of germs. Most of all, try and avoid others who may be sick. Be sure to call Member Services at 1-800-392-1147 (TTD/TTY users, call 711), 8:00 a.m. to 8:00 p.m., Monday through Friday to find out where you can get one close to where you live.
to flu-related complications such as pneumonia
What You Need to Know About Electronic Health Information (Continues from page 1) What exactly are Electronic Medical and Electronic Health Records? Electronic Medical Records (EMR) are digital versions of the paper charts. An EMR contains the medical and treatment history of patients. EMRs have advantages over paper records. For example, EMRs allow doctors to see, enter, retrieve and store personal health information all in one computer, compared to being stored in multiple filing cabinets. Electronic Health Records (EHR) does all of the things that Electronic Medical Records do, and more. For example, the EHR is a complete patient report that includes data from other doctors, insurance information, hospital admission and discharge data, as well as test and/or lab results. This information moves with you if you move or change primary care physicians.
Will my information be safe? Yes. Many EMR systems now have security codes to keep your medical records safe. The information can only be accessed with a password. This keeps your information safe and secure. The industry refers to this as Protected Health Information (PHI). It also protects hospitals and providers from computer-generated attacks. If there is ever a breach in your PHI information, you will be notified by your hospital or provider as required by law. Therefore, it is in your doctor’s best interest to keep your PHI secure. What are the benefits to using electronic medical records? The benefits of moving to electronic records are clear. Just like using smart phones, tablets and web-enabled devices for personal use, you may soon be using these devices to make appointments, check on a claim status, or participate in November (2) 2013
a patient satisfaction survey. The benefits of EMR can also help: ■■ Improve patient care
■■ Improve both speed and
accuracy of medical tests
■■ Improve cost savings by
eliminating preventable or repeat tests
With complete information, doctors are able to make medical decisions more quickly and accurately. This allows them to spend less time on paperwork and more time taking care of you. To find out more about EMR, including a list of common health care technology terms, visit Gateway’s health literacy website at www.GatewayHELPS.com.
What You Can Do About Cancer: Get Screened For It Prevent it! The Human PapillomaVirus (HPV) has been shown to cause thousands of cases of cervical cancer. But you can prevent it. Get vaccinated, or get the young people you love vaccinated against HPV.
Who should get vaccinated against HPV? HPV vaccines are recommended for 11- or 12-year-old girls and boys. Older teenage girls and women, up to age 26, can also get the vaccine if they did not receive all three doses of the vaccine when they were younger. Older teenage boys and men, up to age 21, can also get vaccinated if they did not receive all three doses of the vaccine when they were younger.
Why is it important to vaccine children when they are young? It’s important to vaccinate kids against HPV long before they have any first sexual contact. This way they have time to develop protection from the vaccine. Eleven and 12 year olds also have the best immune response to the vaccine. That’s why doctors recommend this vaccine for preteen girls and boys.
Are you 21 to 30 years old? Get a PAP smear at least once every three years!
November(3) (2)2013 2013 November
Are you 30 to 64 years old? Get a PAP smear every three years. And, get tested for HPV every five years.
Not sure if you should be screened? Talk to your healthcare provider.
Asthma Control -- Am I damaging my lungs? How do I know when my asthma is out of control? Your asthma may be uncontrolled if: ■■ You have coughing, wheezing, trouble breathing or chest tightness more than twice a week or,
■■ You wake up more than twice a month because of trouble breathing.
What should I do if my asthma is out of control? Take your asthma medicines as ■■ your doctor ordered.
■■ Call your doctor to discuss
your symptoms. You may need a change in your asthma medicine.
What medicines are used for asthma? A rescue inhaler should be ■■
used as needed for quick relief. This type of medicine relaxes the muscles around the airways so that you can breathe more easily. Examples of rescue inhalers are albuterol HFA (Accuneb and Ventolin) and Maxair autohaler.
■■ A long-term control medicine
should be used every day. This medicine helps decrease the swelling in your airways. It can help to prevent asthma attacks and long-term complications. Examples are inhalers such as Flovent Diskus or HFA, Advair Diskus or HFA, Pulmicort Respules, Symbicort, Asmanex and Dulera. There is also a pill called Singulair.
Why do I need to use a long-term control medicine every day when my rescue inhaler seems to work just fine? When your asthma is not ■■
controlled, your airways swell just like your skin does after it’s been cut. You can’t see the swelling in your airways like you can on your skin, but the swelling is still there and it causes you to have breathing problems. When you take your rescue inhaler that helps your breathing for a while, but then the symptoms keep coming back. Why? Because a rescue inhaler helps to relax the muscles around your airways, but it doesn’t do anything to help reduce the swelling.
So take control of your asthma. Use your long-term control medicine every day to help decrease the swelling in your airways. When you treat the swelling, things like pollen, cold air and exercise are less likely to bother you. Then you can be more active and not have to worry about having an asthma attack.
When you use your long-term control medicine every day, pollen, cold air and exercise are less likely to bother you
November (4) 2013
Gateway
What complications can occur if I decide not to use my long-term control medicine every day? You may experience a severe ■■
asthma attack, and it could even be life threatening. Think about when you have been cut. Your skin may have developed a scar. Well, if your asthma is uncontrolled, you can also get scarring of your airways. The difference is that a scar on your skin may not cause a problem, but scarring of your airways can cause permanent lung damage! So, it is very important to take your longterm control medicine every day. It can help prevent asthma symptoms now as well as complications in the future.
STDs and Domestic Abuse Women are more at risk for sexual and physical abuse than men. The Centers for Disease Control and Prevention say that women who are victims of these types of abuse are more likely to have a sexually transmitted disease (STD). HIV/AIDS is one example of an STD. Other STDs can increase the risk of HIV/AIDS. And STDs can cause health issues whether or not a person has HIV/AIDS. Sexual abuse can happen between partners of the same sex or between partners of the opposite sex. Giving a person an STD on purpose is a form of abuse. The abuse may be ongoing if a partner: ■■Will not get treated for an STD ■■Will not use a condom ■■Forces or pressures a partner into sex when there is an STD ■■Blames the other partner for cheating and causing the STD Women risk ongoing health problems from having an STD. These may include: ■■Pelvic Inflammatory Disease (PID) ■■Problems getting pregnant ■■Problems while pregnant ■■Damage to reproductive organs ■■Passing the STD to a baby during pregnancy or birth
y to Health
Regular health check-ups can find an STD. To get help for an STD, see a family or health clinic doctor right away. It is legal in this state for a person to get medicine for their partner to also treat the
STD. A patient can ask their doctor to provide this service in a way that does not put the patient at risk for more abuse. To find the domestic abuse program in Pennsylvania nearest to you, visit http://pcadv.org and click on Find Help or use the Find Help map on the homepage. To reach the National Domestic Violence Hotline, call 1-800-799SAFE (TTY: 1-800-787-3224). To reach the National Teen Dating Violence Hotline, call 1-866331-9474 or text “loveis” to 22522 (TTY: 1-866-331-8453). For more information on HIV and AIDS counseling and testing, call the Pennsylvania Department of Health AIDS Factline at 1-800662-6080 or go to http://www. portal.state.pa.us/portal/server.pt/ community/hiv___aids/14241/ hiv_anonymous_counseling_and_ testing_sites/557955
November (5) 2013
Trained Care Managers Benefit You Gateway HealthSM Care Management Department has a team of care managers who are trained nurses and social workers who can help you better understand and cope with your illness or the illness of your child. This is a service that is available to all members at no cost. A Care Manager will ask you many questions to help determine what they can do to help you. These questions are meant to help the Care Manager guide you to help make the best decisions about your health. A Care Manager will help you work with your doctors, pharmacy and community agencies to keep you healthy. If you have questions about medicine or a disease, they can provide you with education. They can also find help in your local area, such as food banks, help with utility bills, support groups and transportation if you need it. If you think you may benefit from the help of a Care Manager, please call the Care Management Department at 1-800-642-3550. Care Managers are available Monday through Friday from 8:30 a.m. to 4:30 p.m.
If you have questions about medicine or a disease, they can provide you with education
GATEWAY HEALTHSM Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL AND FINANCIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Gateway HealthSM (“Gateway”) is required to protect the privacy of your personal medical and non-public personal (financial) information. Also, Gateway is required to give you this notice about how Gateway uses or gives out (“discloses”) medical and personal (“non-public”) information held by Gateway. This protection extends to all forms of communication (oral, written, and electronic) of this information. We are also required to notify you if you are affected by a breach of unsecured information.
Gateway will use and give your medical information:
■■To you or someone who
acts for you (your personal representative), ■■To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected, and when required by law. ■■To meet your medical needs, to pay for your healthcare and to operate the Gateway benefit program, for example: ■■To give information to help the doctors or other health care providers who care for you. ■■To make sure you and other Gateway members get quality health care, to provide member services to you, or to resolve any complaints you have. ■■To pay or deny your claims or to share payments and payment information with your other insurer(s). ■■To our contracted vendors who
perform various functions on our behalf or to provide certain types of services (such as member service support and pharmacy benefit management).
Gateway may also use or give your medical information:
■■To state and federal agencies that
have the legal right to receive such data, ■■For public health activities (such as reporting disease outbreaks), ■■For government health care oversight activities (such as fraud investigations), ■■For judicial and administrative proceedings (such as in response to a court order), ■■For law enforcement purposes (such as providing limited information to locate a missing person), ■■For research studies that meet all privacy law requirements (such as research related to the prevention of disease or disability), ■■To avoid a serious and likely threat to health or safety, ■■To contact you about new or changed benefits, ■■To contact you for appointment reminders or for disease management programs and alternative treatments that may interest you, ■■To create a collection of information that can no longer be traced back to you, ■■To Plan sponsors of group health plans when applicable to permit the plan to perform administrative functions, November (6) 2013
■■To coroners, medical examiners,
funeral directors and organ donations, ■■To your school when proof of immunization is required by law, ■■To others involved in your healthcare (if you are not present or able to agree to these disclosures of your PHI, we may use our professional judgment to determine whether the disclosure is in your best interest), ■■For underwriting purposes if needed, however, we are prohibited from using or disclosing your genetic information for these purposes. Gateway must have your written permission (an “authorization”) to use or give out your medical information for any purpose that is not listed in this notice. You may take back (“revoke”) your written permission at any time, except if Gateway already took action based on your permission. Some examples of when we need your permission to use or give out your information are: ■■For marketing purposes, ■■If we intend to sell your protected health information (PHI), ■■For use of psychotherapy notes, except if: ■■Your doctor is using them to help in your treatment, ■■Your doctor is using them for his own training purposes, or ■■If your psychotherapy notes are required by law.
GATEWAY HEALTHSM Notice of Privacy Practices
(Continued from previous page)
THIS NOTICE DESCRIBES HOW MEDICAL AND FINANCIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
You have the right to: Ask for your medical information by writing to Gateway or by calling Gateway to request a form for this purpose. ■■Ask Gateway to change your medical information if you can show that it is wrong or that information is missing by writing to Gateway or by calling Gateway to request a form for this purpose. If Gateway disagrees, you may have a statement of your disagreement added to your personal medical information. ■■Get a list of who received your medical information within a sixyear period by writing to Gateway or by calling Gateway to request a form for this purpose. You must tell Gateway the dates for which you are requesting the list. The list will not cover information given out before April 14, 2003, information that was given to you or your personal representative, or information given for healthcare payments, for Gateway operations or for law enforcement needs. ■■Ask Gateway to communicate with you in a different manner or at a different place (for example, by sending materials to a P.O. box instead of your home address), by writing to Gateway or by calling Gateway to request a form for this purpose. Gateway must have written reason(s) for your requests and may not be able to honor your request. ■■Ask Gateway to limit the way your personal medical information is used or given to others, by writing to Gateway or by calling Gateway to request a form for this purpose. Please note that Gateway may not be able to do what you request.
■■Call or write to Gateway to ask
for a separate paper copy or e-mail copy of this Notice.
What is the non-public information that Gateway collects about you?
■■It is personal information but is
non-medical, for example, the information you completed on your enrollment application that identifies who you are and how you can be contacted. ■■Also, it is information collected for a request for services by you or your doctor. ■■Also, it is information collected to answer a question or concern from you.
Can anyone receive your non-public information?
■■Gateway does not give out your
non-public information, except if required or permitted by law. ■■Gateway does not give out your non-public information to anyone unrelated to providing your care under the health plan unless you or your representative gives permission.
How does Gateway protect your non-public information?
■■Gateway does not make your nonpublic information available to anyone other than those necessary to provide medical or health plan services to you.
November (7) 2013
■■You have the right to give or
withhold permission for other uses or disclosures of this information, except as required by law. If you believe Gateway has violated your privacy rights as stated in this notice, you may file a complaint at the following address: Privacy Officer Gateway HealthSM Regulatory, Compliance and Legal Affairs Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222
Filing a complaint will not affect your benefits. You may also file a complaint with the Secretary of the Department of Health and Human Services. For more information on filing a complaint or your rights stated in this notice, you may call Gateway’s Member Services Department at 1-800-392-1147 for Medicaid (TTY/ TDD users: 711). Gateway is required to follow the terms in this privacy notice. Gateway has the right to change the way your medical information is used and given out. If Gateway makes any changes they will be posted on our website, and you will be notified within sixty (60) days of the change. The initial privacy practices were effective April 14, 2003. These privacy practices have been revised as of September 23, 2013.
Protect Yourself from Billing Fraud Gateway HealthSM works with our members, providers and other governmental agencies to protect you and the Medicaid programs from fraud. Medicaid fraud occurs when you or Gateway HealthSM is billed for services you never received. A fraud scheme can be carried out by individuals, companies or groups of individuals. If you suspect billing fraud, you can call: 1. Your healthcare provider to be sure the billing is correct, or 2. Gateway HealthSM Fraud and Compliance Hotline 1-800-685-5235, or 3. The Department of Public Welfare Medical Assistance Provider Compliance Hotline at 1-866-DPW-TIPS (1-800-379-8477).
Medicaid fraud occurs when you or Gateway HealthSM is billed for services you never received
When you receive healthcare services, you receive an Explanation of Benefits (EOB) from Gateway HealthSM. This EOB shows what services or supplies were charged and how much Gateway HealthSM paid. Please check the EOB for mistakes, and make sure the services or supplies that you received are correct. If you see a charge on your EOB that you feel may be wrong, call your healthcare provider and ask about it. The bill may be correct, and the person you speak to may help you to better understand the services or supplies you received. If you aren’t satisfied with the provider’s response, call the Gateway HealthSM Fraud and Compliance hotline at 1-800-685-5235. All calls to this line are investigated and callers may remain anonymous.
Member Rights & Responsibilities All Gateway HealthSM members have certain “rights” concerning their care and treatment. They also have specific “responsibilities” as a member. Your Member Rights and Responsibilities can be found in your Gateway Health member handbook and also on Gateway’s website at www. gatewayhealthplan.com. Click on “I am already a Medical Assistance (Medicaid) member”, then click on “Review Member Handbook” on the left-hand side and then “Member Rights” at the bottom of the listing on the left. If you have any questions concerning this or would like a paper copy, please call the Member Services Department at 1-800-392-1147 between 8:00 a.m. and 8:00 p.m., 7 days a week. (TTY members, phone 711).
What’s that doctor called? It can be very confusing to remember which type of doctor helps which part of the body. In order to assist, Gateway would like to provide a list of the most common doctors for you to reference.
1. A foot doctor – Podiatrist 2. A diabetes doctor – Endocrinologist 3. A skin doctor – Dermatologist 4. A colon doctor – Gastroenterologist 5. A bone doctor – Orthopedic Surgeon 6. A ear, nose, and throat doctor – Otolaryngologist If you have any questions, or need a list of providers who accept Gateway HealthSM, please call Member Services at 1-800-392-1147, 8 a.m. to 8 p.m., 7 days a week. (TTY members, phone 711)
November (8) 2013
Diabetes Support Program Through Texting Complex Case Management
Are you or someone you know living with Type 2 diabetes? Gateway HealthSM now provides Care4life*– a personal diabetes support program that comes right to your phone. Care4life will help you learn healthy habits and better manage your diabetes. Care4life sends personal text messages to help you: • Set reminders for medications and appointments • Record and track blood glucose readings • Learn healthy recipes and nutrition tips • Track weight and exercise goals You set your own reminders and control how many text messages you receive and when you receive them. 95% of users would recommend Care4life to a friend. One user said, “With Care4life, I never felt alone!”
Online:
• Go to www.care4life.com • Click “Sign Up Now” • Fill out the simple form and
Gateway HealthSM provides a Complex Case Management program for eligible members.
enter your sign-up code: gateway • Spanish speaking members must enroll online.
By Text:
• Text the word JOIN to the
number 300400 • Reply to the text message you receive with your: first name, zip code • Reply to the next text message you receive with your sign-up code: gateway Care4life is provided to you for free. Standard text message and data rates may apply. If you do not have an unlimited text messaging plan, your cell phone company may charge you for these texts. You can cancel at any time.
Your information is safe.
Sign up today. It’s easy.
Care4life is private and secure. Information is not shared with any third parties. This program will never ask you for financial or personally identifying information through your cell phone.
Sign up for Care4life today Text STOP to Stop and HELP for Help at any time. Standard message and data rates may apply. Terms at www.care4life.com/terms. November (9) 2013
A Care Manager can help you to better understand your health condition and benefits, and can also help to coordinate your health care services by talking with your doctor. A Care Manager can tell you about community organizations and resources that may meet your needs. Eligible members may include: ■■Members with multiple medical conditions ■■Members with a complex medical history ■■Members who need assistance to become more self-reliant in managing their health care To contact Care Management, Pennsylvania Medicaid Members please call 1-800-642-3550, Option 1 and then Option 2. (TTY users should call 711). Participation in this program is voluntary. Gateway will review the request for enrollment and make the final decision for inclusion in the program.
COPD Doesn’t Have to Rule Your Life Tips to Help You Take Charge of Your Health What is the issue? Smoking
Medicines
Flu or Pneumonia
Why is it a problem?
How can I take charge of my COPD?
Some people think it is too late to quit smoking because they already have lung disease. That’s not true! If you quit smoking, you can slow down the rate of lung damage. Your doctor may order one or more breathing medicines. It is important to take your medicine as prescribed. Medicines can help improve your breathing. They can also help to keep you out of the hospital.
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Chronic lung disease increases your risk of getting a flu or pneumonia. If you get sick, it can cause your breathing to worsen and it can cause more damage to your lungs. So it’s important to try and avoid getting sick.
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Many people do not realize that exercise can • help their breathing. It can also improve your energy, mood and sleep. It’s important to start exercising slowly though. Otherwise you • may become discouraged and stop. Anxiety/Depression It is common to have anxiety and depression • when you feel out of breath. It’s important that you don’t suffer in silence because these problems can make your breathing worse. Lack of exercise
• Sleep problems
Oxygen
It is common to have trouble sleeping and that can make you feel more tired during the day. Some people also have sleep apnea. Sleep apnea can increase your risk of heart problems and hospitalizations. So it is important to get treatment.
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Some people need oxygen, but they are embarrassed to use it or they don’t like being attached to a machine. There is an upside to using oxygen. It can help you to breathe better and be more active. It may even help you live longer.
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November (10) 2013
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Call the PA Quit Line at 1-800-7848669. Talk to your doctor about medicines and classes to help you quit smoking. Do not stop taking your medicines on your own. If you have any concerns or problems using your inhaler, talk to your pharmacist or doctor. If you are discharged from the hospital, get all of your medicines filled as soon as you go home. This can help prevent another hospital visit. Don’t forget to get your flu and pneumonia shot. You can get your flu shot at your doctor’s office or at many large pharmacies. Check with your pharmacy to see if they accept Gateway. Talk to your doctor about a pulmonary rehabilitation program or a home exercise program. Ask your doctor to show you how to do purse lip breathing. Tell your doctor about your concerns. Treatment options include counseling, support groups, medicines, and stress management and relaxation techniques. Consider purchasing a relaxation CD to help you learn how to relax. Discuss your sleep problem with your doctor. Tell your doctor if you have daytime sleepiness, snoring or wake up choking and gasping. These are signs of sleep apnea and you may need a sleep study. Think about the benefits of using your oxygen and remember to use it exactly as your doctor prescribed. Talk to your doctor or home health company about your concerns.
MOM Matters® Update Balancing Lifestyle for Good Health and Wellness Did you know Gateway HealthSM has a program for pregnant women? It is part of the Gateway To Lifestyle ManagementSM Programs. MOM Matters® gives expectant and new mothers education and support about how to have a healthy pregnancy as well as care for their newborn. Do you know someone who may be helped by such a program? Help is just a phone call away. Our care managers can teach women the signs of preterm labor, make referrals to community services and even arrange for a nurse to visit the mother’s home before or after the baby is born.
Stress Management and Health At some point in life, everyone experiences stress. What many people don’t know, however, is that excessive stress can contribute to many types of health problems. Heart disease, asthma, diabetes, ulcers, obesity and depression are just a few of the health conditions that may be complicated by stress. Stress is not just a feeling. When you are under stress your heart rate increases, breathing becomes more rapid, and the bloodstream is flooded with hormones.
If you would like more information about the MOM Matters® Program, call 1-800-6423550, Option 2. The care managers are available Monday through Friday between 8:30 a.m. and 4:30 p.m. by phone.
Reconsiderations and Grievances Gateway HealthSM wants you to be happy with the services you receive from us and the services you receive from our participating doctors. If you are not satisfied with the medical care or services you received, Gateway would like to know. An easy way to tell Gateway is by filing a grievance. You can do this by calling Gateway at 1-800-685-5209. A Gateway staff person will help you file a grievance by asking you: the date of service, the name of the doctor or person you are complaining about, the type of service, and a brief summary about your concerns. You could also send Gateway a letter with a summary of your concerns. If you are unhappy with a decision Gateway made to deny, reduce, or change an item or service you or your doctor requested, you can ask Gateway to review our decision again by filing a Reconsideration. You can file a Reconsideration by calling Gateway Member Services at 1-800-392-1147, Monday through Friday, 8:00 a.m. to 8:00 p.m. (TTY members phone 711). A Gateway staff person will help you file your Reconsideration by asking you: the type of service or item being denied, the name of your doctor, and a brief summary about why you feel Gateway should reconsider our decision. You could also send Gateway a letter asking us to reconsider our decision. Be sure to include the information listed above and any documents that may help Gateway in our review of your Reconsideration. The address to send your complaint or grievance is: Gateway Health Attention Member Appeals Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222
November (11) 2013
The good news is that stress can be effectively managed. Regular exercise, eating a well-balanced diet, learning how to relax, avoiding drugs and alcohol, and setting limits with others are common ways to balance the effects of stress on your health. When stress becomes overwhelming many people often seek professional help with a therapist or a psychiatrist. If you feel you are having a difficult time managing stress, be sure to talk to your doctor about your treatment options. Gateway HealthSM case managers are also available to provide guidance by calling 1-800-642-3550, Monday through Friday, 8:30 a.m. to 4:30 p.m. (TTY members, phone 711).
Healthy Holiday Recipe Gingersnap-Banana Frozen Yogurt
Stir chopped gingersnaps or graham crackers, sliced bananas and toasted nuts into softened vanilla frozen yogurt for a quick, crowdpleasing dessert. Ingredients 2 cups vanilla frozen yogurt, softened 6 gingersnap cookies or graham crackers, chopped 2 bananas, sliced Âź cup of your favorite nut variety Preparation Layer equal portions of frozen yogurt, chopped gingersnaps, bananas and nuts of your choice into 4 small dessert cups or glasses. Freeze until the yogurt is firm, at least 10 minutes. Makes: 4 servings, Prep time: 10 minutes, Total time: 20 minutes Nutrition Per serving: 287 calories; 12 g fat (4 g sat , 4 g mono); 15 mg cholesterol; 42 g carbohydrates; 5 g protein; 2 g fiber; 81 mg sodium; 249 mg potassium. Carbohydrate servings: 3 *Recipe is from Eating Well
November (12) 2013
Gateway Makes it Easier to Help You Quit Smoking
The PA Free Quitline is now offering up to 8 weeks of free nicotine patches and free cessation counseling to smokers in Pennsylvania. Smokers who are ready to quit should call: 1-800-QUIT-NOW. Smokers who use quit aids, like nicotine patches and counseling, are twice as likely to quit for good. Since 2010, the Quitline has helped more than 15,000 Pennsylvanians make a quit attempt. Up to one-third of these participants were smoke-free 6 months after receiving Quitline Services. Current smokers who are 18 years old of age or older and who live in Pennsylvania are eligible. Other restrictions may apply. Encourage smokers you know to quit with help and quit for good. Additional information is also available at DPW’s website at http:// www.portal.state.pa.us/portal/server. pt/community/smoke_free/14315/ tobacco_prevention_and_control_ programs_home/557661
Remember, the Great American Smokeout is November 21
Mammogram Rewards Mammogram RewardsProgram Program Want to Want to earn earn aa reward? reward?Follow Followthese thesesteps! steps! 1. Be an eligible Gateway HealthSM Medicaid member on the day of your mammogram appointment. 2. Get your mammogram before December 31, 2013. No script or physician’s order is needed. 3. Call Gateway within 72 hours after your mammogram: ■■Medicaid members call 1-800-642-3550, oprime 6 para español. TTY/TDD users 711. ■■Tell the representative where and when you received your mammogram. ■■Tell the representative which one reward you wish to have mailed to you. ■■Make sure Gateway has your correct mailing address. The Gateway representative will call the location where you got your mammogram. The representative will verify your appointment. Your reward will be sent to you in about two to three weeks.
Choose one of these four rewards: Relax Gift Set Be good to yourself!
Make-Up/ Accessory Box Get styled!
SPF 15 lip balm, 1 oz. hand sanitizer, 1 oz. hand lotion, and 1 oz. stress relief lotion menthol scented
Four zipper, clear pockets for storing make-up or jewelry
Mini Travel Bag Organizer Small bag perfect for all your travel documents. One main, zipper compartment with four outside pockets and a back velcro pocket
Keep food fresh on the go. Flat bottom to store frozen entrees and lunch containers; front slash pocket; heat sealed interior, and 6-can capacity
November (13) 2013
Cooler Tote
The information in this notice is available in other languages and formats by calling Gateway Health Plan® at 1‐800‐392‐1147/Toll‐free TTY 711. La información en este aviso está disponible en otros idiomas y formatos llamando a Gateway Health Plan® al 1‐800‐392‐1147/Número gratuito TTY 711.
Four Gateway Center Thông tin trong thông báo này có thể được dịch sang ngôn ngữ khác hay cung cấp dưới các hình thức khác theo yêu cầu. Xin gọi Gateway Health Plan® theo số 1‐800‐392‐1147/Miễn phí TTY 711. Данное уведомление можно получить на других языках и в других форматах, позвонив в план Gateway Health Plan® по номеру 1‐800‐392‐1147 или по номеру 711 бесплатной линии TTY. 444 Liberty Avenue, Suite 2100 如需要本通知的其他语言和格式的版本，请致电 Gateway Health Plan®：1‐800‐392‐1147/ 免费电话 TTY 711。 Pittsburgh, PA 15222-1222 B&támank~¬gesck¶ICUndMNwgenH KWmanCaPasa nigCaTMrg'ep§geTot edayTUrs&BæeTA Gateway Health Plan® tamelx²tecj«f 1-800-392-1147/TTY 711.
MOVING? If you are moving or changing your telephone number, please notify Member Services at 1-800-392-1147.
For more information or paper copies of forms or other information, call the area listed below to speak with our staff. More current information may be included on Gateway’s website, GatewayHealthPlan.com, which is available 24/7. Information on Disease Management, Special Needs Areas, and Member Rights and Responsibilities can also be accessed on our website. The information in this notice is available in other languages and formats by calling Gateway Health Plan® at 1‐800‐392‐1147/Toll‐free TTY 711. La información en este aviso está disponible en otros idiomas y formatos llamando a Gateway Health Plan® al 1‐800‐392‐1147/Número gratuito TTY 711. Thông tin trong thông báo này có thể được dịch sang ngôn ngữ khác hay cung cấp dưới các hình thức khác theo yêu cầu. Xin gọi Gateway Health Plan® theo số 1‐800‐392‐1147/Miễn phí TTY 711. Данное уведомление можно получить на других языках и в других форматах, позвонив в план Gateway Health Plan® по номеру 1‐800‐392‐1147 или по номеру 711 бесплатной линии TTY. 如需要本通知的其他语言和格式的版本，请致电 Gateway Health Plan®：1‐800‐392‐1147/ 免费电话 TTY 711。
B&támank~¬gesck¶ICUndMNwgenH KWmanCaPasa nigCaTMrg'ep§geTot edayTUrs&BæeTA Gateway Health Plan® tamelx²tecj«f 1-800-392-1147/TTY 711.
Important Phone Numbers
(ALL PHONE NUMBERS ARE TOLL-FREE)
GATEWAY RESOURCES
MEDICAID NUMBERS
Member Services
1-800-392-1147
Pharmacy Member Services
1-800-392-1147
Preventive Health
1-800-642-3550, Option 4
Outreach Staff
1-800-642-3550, Option 4
Community Development Dept.
412-255-7138
Gateway to Lifestyle ManagementSM:
1-800-642-3550
Mom Matters® Program
Option 2
Cardiac Program
Option 3
Asthma Program
Option 3
Diabetes Program
Option 3
Spanish Speaking Members
Option 6
Special Needs
1-800-642-3550 Option 1
Fraud and Abuse
1-800-685-5235
OUTSIDE RESOURCES
Quitline (Stop Smoking) 1-800-QUIT-NOW
1-800-784-8669
National Domestic Violence Hotline
1-800-799-7233
ATT Operator for Deaf Members (PA Relay/TTY) Center for Disease Control Nat’l AIDS Hotline
711 1-800-232-4636
GATEWAY TO HEALTH is published as a service for the members of Gateway HealthSM Information comes from a wide range of medical experts and other medical resources. If you have concerns or questions about specific content, please contact Gateway HealthSM. Models may be used in photos and illustrations. Four Gateway Center, 444 Liberty Ave., Suite 2100, Pittsburgh, PA 15222-1222 Telephone 1-800-392-1147, GatewayHealthPlan.com Copyright © 2013 Gateway HealthSM 50%
Cert no. SW-COC-002281
November (14) 2013
(11/2013)