A parent s guide to checkups and screenings

Transcription

1 Volume A parent s guide to checkups and screenings When your child is born, it s amazing. You take care of your baby. You also make sure he or she gets shots and checkups for a great start in life. You re the best person to look out for your baby s health. That means making sure that your child gets all the checkups (also called well visits) needed to become a healthy adult. It s not just about getting shots Doctors also check how kids develop as they grow. Your child should get well visits at these ages: Birth 3 to 5 days By 1 month 2 months 4 months 6 months 9 months 12 months 15 months 18 months 24 months 30 months Ages 3 to 21: at least one well visit per year Why well visits matter New babies are immune to some diseases. That lasts only between one month and a year after birth. Without well visits and shots, your child s body may not be strong enough to fight certain diseases, like whooping cough. Germs are passed from person to person. So getting your child a well visit and shots also helps protect those who come in contact with your child. Good news: we cover shots and well visits To set up a well visit, call your child s primary care provider (PCP). A PCP is a provider who is your child s main doctor. Before you see your child s PCP, make notes about what you want to talk to the doctor about. And don t be afraid to ask questions during your visit. Source: American Academy of Pediatrics website: Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) (2008): aap.org Pick an easy date to remember checkups It s hard to remember when to get yearly well visits for your child or yourself. To make it a bit easier, schedule the visit on a key date in your life. You might use a birthday or holiday. Think of it this way: good health is the best gift you can give to anyone. BlueChoice HealthPlan Medicaid P.O. Box Columbia, SC Presorted Standard U.S. Postage PAID Platteville, WI Permit No. 7 SC

2 What all mothers, daughters and sisters need Women s health tests and checkups for you Finding cancer early is the best way to treat it and beat it. And the simplest and most effective way to find cancer before it starts can be a test, depending on the type. Some breast and cervical cells may grow faster than other cells. This cell activity can become a mass of cells. This is called a tumor. Not all tumors are cancerous. Some are not cancerous (called benign). However, cancerous cells can spread and cause other problems in your body. Here are three steps every woman should take: Know your risk factors (the things that put you at greater risk for cancer). Change things you can control (lifestyle factors, like what you eat and do). Get regular women s health tests (see Tests ). Breast cancer screenings Tests Risk factors Lifestyle factors Breast self-exam Women 19 and over: every month Exam by physician Women under 40: every 2 to 3 years Women 40 and over: every year Mammogram Women 40 and over: every year Women at higher risk: talk with your doctor Cervical cancer screenings Gender being a woman Aging as you age your chance of breast cancer increases. Most breast cancer is found in women over 60. Genetic risk factors (e.g., inherited changes to the BRCA1 and BRCA2 genes) Family and personal history of cancer Race and ethnicity Dense breast tissue and certain benign breast conditions Having children at an older age Never having children Using oral contraceptives (birth control) Hormone therapy use for many years Drinking high amounts of alcohol Being overweight and having a lack of physical activity Tests Risk factors Lifestyle factors Pap test: women within 3 years of sexual activity or age 21, whichever comes first Women ages 19 to 39: every year Women ages 30 to 69: every 2 to 3 years for women with 3 normal Pap tests in a row Women ages 70 and older: with 3 or more normal tests in a row and no abnormal tests in the last 10 years, women may stop having this screening exam HPV infection Immunosuppression (such as HIV that causes AIDS) Chlamydia infection Birth control use for 5 or more years Multiple full-term pregnancies (3 or more) First pregnancy at a young age (under 17) Poverty Chemical exposure to DES (a drug prescribed to pregnant women from the 1940s to 1970s) Family history of cervical cancer Smoking Diet low in fruits and vegetables Source: American Cancer Society website: cancer.org Speak to a nurse 24/7 Sometimes you re miles from the doctor s office. Or your child gets a high fever late at night. What should you do? You can reach a registered nurse at any time. You can call from anywhere in the U.S. It s free. Just call MedCall at Add this number to your cell phone contacts. If you have hearing or speech loss, call Nurses have been carefully trained. And they can help you figure out the care you need. A nurse on the phone can help answer questions like: should you go to the emergency room? Or can treatment wait until you get to your PCP? If you have a true emergency, always call 911 first. Or go to the nearest emergency room right away. A true emergency comes on suddenly with severe symptoms. If it s not an emergency, call your PCP or MedCall. One easy call can help you make the right choice of where to go and how to get the care you need. Speak another language? Habla otro idioma? Let us interpret We can help you no matter what language you speak. Just call us at Or call MedCall at Ask for someone to interpret in your language. You can also ask for items to be read to you in your language. An interpreter will read them over the phone. Just call If you have hearing or speech loss, you can call the TTY line at or the MedCall TTY line at Podemos traducir esto gratuitamente. Llame al número de servicio de atención al cliente que aparece en su tarjeta de identificación (ID card). 2 My Health

3 Diabetes shouldn t keep you from getting in the game! If you have diabetes, stay on top of your health care game. How? Get the tests you need. Your PCP and health care team are your partners. They ll help you manage your condition. They will also support your efforts to care for your diabetes. They can help you avoid the problems that can come with poorly controlled diabetes. These tests are very important. Many can be done during a single office visit with your doctor or a quick visit to an in-network lab. Test How often Goal A1C blood test At least twice per year Less than 7 Low-density lipoprotein (LDL) (cholesterol) Kidney function urine test At least once a year Less than 100 At least once a year Blood pressure At every doctor s visit Less than 130/80 Dilated retinal (eye) exam Every year Your health team will also teach you how to care for yourself on a daily basis. You ll learn how to: Inspect and care for your feet to prevent infections from blisters and scrapes. Get moving. Physical activity can help you stay at a healthy weight and help keep your blood sugar down. Eat healthy. You can get advice from a registered dietitian. With your health care team, you can be a winner and improve your health and your life. Get in the game talk to your doctor today! Sources: American Diabetes Association website: diabetes.org; Executive Summary: Standards of Medical Care in Diabetes 2010, Diabetes Care, January 2010 Medicines that help control diabetes If you have diabetes, take all the medicines (drugs) the way your doctor tells you to. Your PCP or doctor might prescribe drugs to help: Control blood sugar. Control blood pressure. Lower your risk of heart disease. Prevent kidney problems. Talk to your doctor about what drugs will work to help your diabetes. Know your rights We want you to know what your rights and responsibilities are as a member of our health plan. To read about your rights, visit Choose Members. Select Benefits & Services, and then click on Member Handbook. Scroll to Part 15: Your Health Care Rights and Responsibilities. New treatments and procedures We work to stay aware of medical progress. So we make policies to check new drugs, tools and treatments. Health care experts look at medical, behavioral health and drug policies on a regular basis. To make decisions about what medical technology will be covered, we check with: Medical journals. Government policies. Doctors and health experts. The latest medical studies. You can find more about this in your EOC/ Member Handbook. You also can find your rights and responsibilities listed in your paper copy of the Evidence of Coverage (EOC)/Member Handbook, or call us at to ask for a paper copy. A baby s healthy future starts with Future Moms Expecting a baby? Future Moms is our free program to answer your questions and support you during your pregnancy and delivery. You work one-on-one with a nurse coach. There s no cost to be a part of Future Moms. It s strictly private, and you ll get: Reminders to help you schedule prenatal exams and visits after the baby is born. A toll-free phone number you can call 24/7 to speak with a nurse. Materials to help you prepare for the unexpected, plus information about infant care and home safety. Referrals to prenatal education classes in your area. Access to a breastfeeding support line. If you re expecting a baby, call Future Moms at Be sure to sign up within your first three months of pregnancy or as soon as you can. It s the best way to help make sure you stay as healthy as you can for you and your baby. My Health 3

4 ADHD drugs: what you should know Does your child have attention-deficit/ hyperactivity disorder (ADHD)? Most children who take drugs prescribed by a doctor for ADHD find that the right dose helps them greatly. And they have only mild side effects. To find out what dose is right, your child s doctor may have to change the dose. Your child might also need to try different drugs. To be safe when using ADHD drugs: The child must take the drug exactly as it is prescribed. When a child first starts on an ADHD drug, parents should set up an office visit within the first month with the doctor who prescribed the drug. This helps make sure the drug is working well. Watch how your child first responds to the drug. Ask his or her teacher too. The best dose of each drug is not decided by a child s size or weight alone. So reports from parents and teachers help the doctor make sure that the child gets the right dose. Track how your child is doing using the drug over a period of time. There are checklists and rating scales that can help you do this. Ask the doctor about how to get them. See the doctor who prescribed the drug at least two more times within the next nine months. It helps make sure the drug works right. These two visits could happen during well visits. What to expect As children grow, the dose is expected to change. So see the doctor for well visits. Use this time to talk about any ADHD drug your child takes. Tell the child s doctor if your child is taking other medicines. Include those sold over the counter, vitamins or supplements. Watch how well your child does in school, at home and overall. Call the doctor who prescribed the drug if you have any concerns. Source: American Academy of Child and Adolescent Psychiatry website: Practice Parameters for the Assessment and Treatment of Children and Adolescents with ADHD (2007): aacap.org Need extra help? The Care Management program can help. Care managers are registered nurses or other health care experts. They re here to help when you have a serious health condition or unexpected medical event. This program comes at no cost to you. You, your family and your doctors work with a care manager. He or she will give you phone support at a time that works best for you. This program is private and voluntary. It gives you extra help when you need it most. To be part of it, you can self-refer. Or your caregiver can refer you. The care manager will: Work with you to help you manage your condition. Answer questions about your benefits. Help you figure out what care you need. To learn more or be part of the program, call us toll free at We also can help members with hearing or speech loss. Call the TTY line at New to the plan? Get an initial health exam Pharyngitis is just the medical term for a sore throat. You might hear your doctor use it when you have a cold or strep throat. Pharyngitis is usually easy to treat. A virus, not bacteria, causes most cases of it. In order to treat it, your PCP needs to know what type you have. You should call the PCP if you think you or a family member may have it. The PCP will want to run a simple strep test to see if it comes from bacteria. If it does, he or she may prescribe antibiotics. Ever heard of pharyngitis? Sometimes pharyngitis becomes dangerous. Call 911 or a doctor right away if you also have: Trouble breathing or swallowing. A stiff neck. A fever over 104 degrees. A very dry mouth or no tears with crying. Purple or dark red spots on your skin. Sources: American Academy of Otolaryngology Head and Neck Surgery website: entnet.org; American Medical Association website: ama-assn.org Your or your child s first exam with the PCP is called an initial health exam. It s very important. You should get it right away. Why? It helps your PCP: Learn about you and your health before you get sick. Look at past or ongoing health issues. Go over the drugs you re taking to make sure they re working. Tell you what checkups, shots or tests you need. Study your family s medical history. Call your PCP for an exam today! 4 My Health

5 Could you have asthma? Take action so you can breathe easier! Do you or someone in your family: Wheeze sometimes? Feel chest tightness? Have an early morning or bedtime cough? Seem out of breath when it s not expected? These may be signs of asthma, a long-term lung disease. If you have asthma, you have it all of the time even when you do not have symptoms. If you learn what to do and get help from your PCP or doctor, you can help make your asthma attacks a thing of the past. How to manage asthma You can take control with three key steps: Know what things make your asthma worse and avoid those triggers. Triggers are different for different people. Common triggers include: Smoke (including tobacco and secondhand smoke) Air pollution Dust mites Cockroaches and their droppings Furry pets Mold See your PCP or doctor. Take prescribed drugs in the right way at the right time. Be sure you take prescriptions exactly as your doctor tells you to. Create an action plan with your PCP or doctor to control your asthma. This plan should be reviewed when you see your PCP to make sure it stays up-to-date. Go to asthma/asthma_actplan.pdf for a sample action plan. Look on the back for a list of possible asthma triggers and ways to avoid them. Take control of your asthma. You ll find you can breathe a little easier and enjoy life! Sources: Centers for Disease Control and Prevention website: CDC.gov; National Heart, Lung, and Blood Institute website: Asthma Action Plan (April 2007): Checkups for all ages Don t let illness sneak up on you. We have a chart that lists the checkups, shots and tests you need at all ages. The chart is called Preventive Health Care Guidelines. To see the chart, just go to Choose Members. Click on Benefits & Services. Click on Preventive Health Care Guidelines. Anytime, day or night, you can find information on our website. Just visit You can learn: About your benefits for different services. These could include primary and specialty care, behavioral health and hospital services. How to see your PCP and get care. How to learn about providers in your area. What to do when you are out of the plan s service area. How to get information about getting emergency care and 911 services. How to get care after office hours. How to file a claim for covered services. How to make a complaint or appeal a decision. This includes your right to an external appeal. About your rights and responsibilities as a member. About our Quality Improvement (QI) programs. You can see how we use this information to review and help improve the quality of our benefits and services. Just a click away How to ask for Advance Directives (Living Wills). Information you can ask for and get every year, including a new provider directory. Need information specific to your policy? Register on the member website to: Learn about your copays. You can learn about costs you ll have to share (if any). View your claims. Change your PCP (if it applies to your health plan). Order a new member ID card. Get other information. Or you can refer to your EOC/Member Handbook to find more about the benefits and services covered under your plan. Your handbook also has any benefits that are not covered or are limited. These include benefits that may not be covered if you get services outside your plan s service area. If you need a copy of the information on the Web or in your EOC/Member Handbook, call us at the number on your member ID card. Rx 101: know what the doctor prescribed! When your doctor prescribes a certain drug, be sure to find out what you need to know before you leave the doctor s office. Ask what the common side effects are with the drug. Repeat back to the doctor what you were told about the medicine. This includes what it s for and when and how to take it. That way you know you understood what the doctor told you. When you see the doctor, bring along all medicines you take. Be sure to include any you buy over the counter (even those for weight loss, cold or cough). Be sure to list vitamins, herbs or homemade remedies too. If you are afraid of a medicine or of getting hooked on it, talk with your doctor. Call the doctor if you think you are having side effects or want to stop taking a prescribed medicine. My Health 5

6 Your pharmacy benefits program There are tools to help you manage your prescriptions online. At our website, you can: View and search the drug list (called Preferred Drug List). Learn about generic drugs. At home with your PCP When you first become a member, get to know your PCP. This is the main doctor you see for care. It can be a pediatrician, family doctor, OB/GYN or even someone at a clinic. Think of this doctor and his or her office like a second home. It s your home for medical care. So treat your PCP like your personal doctor. You can see the PCP for care or a well visit. Some drugs require that you get an OK ahead of time. There also may be other limits or things required when a drug is prescribed and filled, like a certain quality, age limit, dose allowed and more. This helps ensure safe, correct use. If a drug has a limit, it is noted on the Preferred Drug List. The drug must be approved by your plan before filling the prescription. For more on our pharmacy benefits, visit Choose Resources. Click on Preferred Drug List (PDL).You may also ask for a paper copy by fax or mail. Or you can call the Customer Care Center at If you have hearing or speech loss, please call the TTY line at So why see your PCP? Here are three good reasons: It s a one-stop shop. Instead of having to figure out where you need to go for a problem, start with your PCP. This way you may only have to make one stop. You get to know and trust a provider. When you find a place or even a doctor you like and see him or her regularly, you build trust. That can lead to you and your doctor working together to get you the best care. You get personalized care. If you have an allergy, does your doctor know it? Does he or she know if you have a family history of disease? The more the doctor knows, the better-informed the doctor will be. Then he or she can make decisions that are best for you and cover your basic needs. Remember, if you see a doctor who is not your PCP without an OK from us, the visit may not be covered. It depends on what you see the doctor for. This is in your EOC/Member Handbook. So be sure to read it or call us if you have a question. Also, you can change your PCP at any time for any reason. See your PCP before you go to another doctor. It s the best way to get the care you need. Notice of Privacy Practices Looking for a provider or hospital? Anyone can search for doctors, hospitals and other health care providers in English and Spanish. Go to Choose Members. Click Provider Directory. If you don t have Internet access, call us at the number on your member ID card. A staff member will search the Web for you using the criteria you provide. He or she will then read, mail or fax a hard copy of the results to you. We care about your privacy. Our Notice of Privacy Practices tells you how we keep your information private. It also tells you what rights you have to see and manage your information. To learn about your privacy rights, follow these steps: Go to Choose Members. Click on Privacy at the bottom left side of the page. Click on Notice of Privacy Practices. 6 My Health

7 How to resolve your concerns If we decide a treatment or service is not covered under your plan, you can use the appeals process to help get your concern solved. Please note that some of these steps must occur within a certain time frame. You can find details about the appeals process for your plan at You can also find details in your EOC/Member Handbook. Or call us at the number on your member ID card. Follow these key steps: Step 1: Call the Customer Care Center. We ll do our best to resolve your concern fairly and quickly during this first call. Step 2: If you re not happy with the first response to your concern, you can file an appeal. We ll tell you how. We ll also tell you about any steps you must take within a certain time frame. Step 3: If step 2 does not resolve your concern, you may be able to appeal further. If your plan has a second level of appeal, we ll tell you about any specific state rules. We ll tell you if there are other steps you can take. Step 4: In some cases, if benefits are denied at the final internal appeal level, you may have the right to get an independent external review. Your personal information How to get a paper copy of notices If you have any questions, or if you would like a current paper copy of the notices in this newsletter, call You also can ask for a new EOC/Member Handbook. If you have hearing or speech loss, call the TTY line at We may collect, use and share nonpublic personal information (PI) as described in this notice. Your PI tells us who you are and is often gathered in an insurance matter. We may use your PI to make judgments about your health, habits and hobbies. We may collect PI about you from other persons or groups such as doctors, hospitals or other carriers. We may share PI with persons or groups outside of our company without your OK in some cases. We will contact you if we take part in an action that would require us to give you a chance to opt out. We will tell you how you can let us know that you do not want us to use or share your PI for a given action. You have the right to access and correct your PI. We take safety measures to protect the PI we have about you. What Utilization Management (UM) is and how it affects you UM is a part of the process to give a prior OK to care. It s in your handbook. UM is a process that helps decide if certain services are covered. This means that both BlueChoice HealthPlan Medicaid of South Carolina and your PCP or specialist agree that the service is medically needed. Coverage decisions are based on: Medical policies. Nationally recognized clinical guidelines. Your health benefits. You should know that: We make decisions based on care and services you need and benefits you have. We do not reward doctors, providers or decision-makers who work with us for not approving requested care or services. We do not provide financial incentives for those who make UM decisions to encourage those that result in less care given. To learn more about the UM process, call us toll free weekdays except holidays from 8 a.m. to 5 p.m. at If you speak another language, we can interpret in your language, too. When you call, just ask for an interpreter in your language. If you call before or after hours, you can leave a private message. A member of our staff will return your call on the next business day during the hours above. Or you can request a different time. Any staff member who calls you about a UM issue will give you his or her name. He or she will also give his or her title and the name of the company. If you have hearing or speech loss and want to reach UM, you can call the TTY line at My Health 7

8 Share for better care When you see a specialist or go to the emergency room, are you telling your PCP? Make sure your PCP and specialists all know about all the care you get. This helps the doctors so you don t have to go through the same tests twice. And that saves time and money. It helps to make sure you have the best outcome for your health concern. You play a big role in making sure you get the right care for any problems you have. Test toddlers for lead poisoning Lead is found in paint from homes built before After 1978, the use of lead paint was banned in the United States. Lead also is found in plastic. It s even found in painted toys from some countries that haven t banned lead in paint. And it can poison a young child without anyone even knowing it. Lead poisoning happens when you get too much lead in the blood. Lead is invisible and has no smell. But it can hurt the body s organs, even the brain. Children under age 6 tend to put things into their mouths. This can be a problem if the items have lead or lead dust on them. What you can do All children need to get a blood-lead test at age 1 (12 months) and again at age 2 (24 months). And the tests are free. Your child s PCP can make sure your child gets a blood-lead test on schedule. If you have a 1-year-old or a toddler, ask your PCP for this free test. If your child is older than 24 months and has never been tested for lead, ask your child s PCP right away for a test. Source: Centers for Disease Control and Prevention website: CDC.gov If you get a phone call, take our quick health survey You may get a call from us in the next few weeks asking you to take a quick telephone health survey. If so, please do. The survey will help us find out more about your health needs. It helps us figure out if we have programs, community resources or tools to match your needs. Most questions you can answer with yes or no. And everything you say will stay private. Be sure to: Share the names of each of your health care providers with all of the doctors who give you care. Tell your doctors when you are prescribed medicine from more than one doctor. Also share if you are hospitalized or see a specialist. Sign a consent form for the release of medical records so your records can be shared by different doctors and providers. Remember to share for better care. Teens: x-ams 4 u to ace Health exams are not just for young kids. Preteens, teens and college students all need checkups and the vaccines that are part of those yearly exams. Some vaccines that younger children get can wear off. So older kids need booster shots (extra doses) of those vaccines to stay protected. There also are certain vaccines made just for preteens and teens. The PCP can tell you which vaccines are right for your older child. Call your teen s PCP to schedule a yearly checkup for your teen. It s his or her best way to ace life s exams. Source: American Academy of Pediatrics website: aap.org If you want to reach us by phone: Customer Care Center TTY Line MedCall MedCall TTY Care Management Healthy Connections Choices The information in this newsletter is meant to educate. It is not meant as medical advice. Please check with your doctor for any advice about your health. Your health plan may not cover some types of care. Check your EOC/ Member Handbook for details about what benefits your health plan covers and what it does not cover. We can translate this at no cost. Call the customer service number on your member ID card. Podemos traducir esto gratuitamente. Llame al número de servicio de atención al cliente que aparece en su tarjeta de identificación (ID card). With the exception of the websites referred to in this newsletter are websites of independent entities and not affiliated with BlueChoice HealthPlan Medicaid of South Carolina. Copies of any type of member information are made available (at no cost) upon request for translation, Braille, large print or audio format. Just call We also can answer questions about your plan. If you have hearing or speech loss, call the TTY line at BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. BlueChoice, BlueCross, BlueShield and the Cross and Shield symbols are registered marks of the Blue Cross and Blue Shield Association. Medicaid managed care administered by WellPoint Partnership Plan, LLC, an independent company. MedCall is a registered mark of WellPoint, Inc WPT27108c SCMENBCH 1111