Way. 3rd Quarter bluecare.bcbst.com

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1 Way 3rd Quarter 2014 BlueCare A newsletter for BlueCare members bluecare.bcbst.com Your membership includes our FREE Population Health CareSmart Program. The program provides important health information and support to you at no cost. Population Health services are provided whether you are well, have an ongoing health problem or have a serious health episode. Please call for more information. Or see our website at: bluecare.bcbst.com/ Health-Programs/Population- Health/index.html. MAKE SURE YOUR MAIL FOLLOWS YOU Make sure TennCare SM has your correct mailing address. If you don t, you could miss important mail about your health plan and benefits. If you re going to move or if you ve moved, call the Tennessee Health Connection at Help for Tennessee families includes links to state services, information and more Healthiertn.com Let s work together toward a healthier you and a healthier Tennessee. KID S The state requires vaccinations for youngsters in child care or school. Vaccines are a safe way to protect against measles, mumps, rubella, hepatitis, chickenpox and more. Updating vaccines should be part of regular well-child checkups (see box below). Ask your child s doctor about: The human papillomavirus (HPV) vaccine. Usually given to girls around age 11, it protects against cervical cancer and certain other cancers. Vaccines needed before seventh grade. The tetanusdiphtheria-pertussis (Tdap) booster is required. Some children also need the varicella (chickenpox) vaccine. Vaccines for college students. They may need meningitis, measles, mumps, chickenpox, rubella and hepatitis B vaccines. To find more information about vaccines: Tennessee Department of Health - tn.us/ceds/required.htm (includes a list of vaccines required in Tennessee) Centers for Disease Control and Prevention - Habla español y necesita ayuda con este boletín? Llámenos gratis al Is it time for a well-child checkup? Remember these important things about well-child checkups, also called TENNderCare checkups: TENNderCare checkups are free for TennCare kids up to age 21 Infants/ toddlers should have 12 checkups before their 3rd birthdays Beginning at age 3, children should receive TENNderCare well-child checkups every year until they turn 21 Each TENNderCare checkup includes any recommended shots and lab tests your child might need You can get a free ride to the doctor s office, if you need one To learn more about TENNderCare visits, or to schedule a ride to the doctor s office, call Customer Service at

2 Law Forbids Unfair Treatment State and federal laws do not allow unfair treatment in TennCare. No one is treated in a different way because of race, beliefs, language, birthplace, disability, religion, sex, color or age. AGING & SPECIAL NEEDS You have the right to file a complaint if you think you are not getting fair treatment. By law, no one can get back at you for filing a complaint. To complain about: Health care, call / Mental health care, call Dental care, call Find the Unfair Treatment Complaint form online at bluecare.bcbst. com/forms/member-handbooks/ Unfair_Treatment_Complaint_BlueCare- Member_Handbook.pdf. La Ley Prohíbe el Tratamiento Injusto Las leyes estetales y federales no permiten el trato injusto en TennCare. Nadie recibe un trato diferente debido a su raza, creencias, idioma, lugar de nacimiento, discapacidad, religión, sexo, color de la piel o edad. Usted tiene el derecho de presentar una queja si piensa que no ha sido tratado de manera imparcial. Por ley, nadie se puede vengar porque usted reclame. Para quejarse acerca de la: Atención médica, llame al / Atención de salud mental, llame al Atención dental, llame al Puede encontrar el formulario de Queja por Trato Injusto en línea al bluecare. bcbst.com/forms/member-handbooks/ Queja_por_trato_injusto_BlueCare- Member_Handbook.pdf. AVOID GOING BACK TO THE HOSPITAL Before you leave the hospital: 1 Get information in writing. Go over lists or instructions with the doctor or nurse. Take notes. Ask them to explain anything you don t understand Find out how to take care of yourself at home. Will you need help? If so, ask for help setting it up. (See Hospital tips for CHOICES Members. ) Ask about the warning signs that mean you should call the doctor or for emergency help. Get a current medicine list. Talk to the doctor about any new medicines. Discuss all medicines, including vitamins or medicines you buy without a prescription. Ask about programs to help you pay for your medicines. Get phone numbers to call if you have any questions when you get home. Once you are home, make an appointment with your Primary Care Provider (PCP): 1 Tell the office you have been in the hospital. 2 See your PCP within a week of your hospital stay. 3 Take the information you got from the hospital, your medicine list and a written list of questions to the appointment. Source: The Care Transitions Program For Health Information Library messages, call and enter the four-digit codes included at the end of some articles.

3 Hospital Tips for CHOICES Members: To help us schedule your care, call your BlueCare CHOICES Care Coordinator - Before or when you are admitted to the hospital, and When you know you are coming home Need help with transportation from hospital, to drugstore or to your PCP? See the Transportation section on Page 7 of this newsletter. DENTAL A Trip to the Dentist Children and youth on TennCare should have dental checkups every six months at their Dental Home. A Dental Home is the dentist s office where they go regularly. What to Expect at your child s Six-Month Dental Checkup: Visiting the dentist is easy if your child knows what to expect. Your child s appointment starts in the waiting area where you check them in. During a regular checkup, your child will see a dental hygienist and a dentist. The hygienist may make X-rays. X-rays let the dentist look inside parts of their mouth that sometimes can t be seen. X-rays will also show cavities. The hygienist usually cleans and polishes their teeth, while they sit in a large comfy chair. The hygienist may put fluoride on your child s teeth. Fluoride is a mineral that makes teeth strong. When the hygienist is done, the dentist will look at your child s mouth and gums. The dentist may make a treatment plan just for your child. If your child has any cavities or other dental problems, you may need to schedule another visit. Your child s dentist will be happy to see them and help them have a healthy smile. Need help finding a dentist or scheduling an appointment? Call us at or TTY/TDD Or visit our website at Sources: American Academy of Pediatric Dentistry - org/media/policies_guidelines/p_dentalhome.pdf; Simple Steps to Better Dental Health - com/ss/ihtss/r.==/st.31855/t.32270/pr.3.html; American Dental Association - scienceandresearch/pdfs/patient_72.pdf Long-Term Care TennCare CHOICES is TennCare s program for Long-Term Services and Supports (LTSS). Long-term services and supports give you help doing everyday activities that you may no longer be able to do for yourself. You may need this help as you grow older or if you have a disability. To learn more or find out if you qualify, call the Customer Service number on your ID card. Diabetic? Take care of your eyes. Diabetic eye disease can cause vision loss and blindness. There are few warning signs. People with diabetes should have a dilated eye exam every year. These exams can find diabetic eye disease before there is vision loss. If you are a member with diabetes, your health benefits cover this exam. Make an appointment today with an eye specialist (ophthalmologist). Need a ride to this exam? See the Transportation section on page 7. Source: National Eye Institute Long-Term Asthma Control Quick-relief asthma medicines (like albuterol) can help you through asthma attacks. Treating asthma over time may also call for long-term asthma medicines. The long-term medicines may include inhaled corticosteroids and others. Your doctor will decide what s right for you. You should take all medicines as prescribed. Talk to your doctor about all of your asthma symptoms. Make an asthma action plan together. Source: The Mayo Clinic - in-depth/asthma-medications/art AGING & SPECIAL NEEDS Habla español y necesita ayuda con este boletín? Llámenos gratis al

4 IS IT TIME FOR YOUR MAMMOGRAM? A mammogram is an X-ray of the breast. It is used to check for breast cancer and other problems. It can help find a lump that is too small to feel. Finding cancer early can help make it easier to treat. BlueCare covers mammograms: At least one time for women ages 35 to 40 Every two years, or more often if your doctor says it is needed, for women ages 40 to 49 Each year for women who are age 50 and older. WOMEN S For African Americans Breast cancer in African American women often grows faster and is more difficult to treat. If you are aged 40 to 49, talk to your doctor about how often to have mammogram screenings. Mammogram screenings are advised every two years for ages 50 to 74. Mammogram screenings are free with Source: Centers for Disease Control and Prevention - no copay. Talk to your primary care provider about getting a mammogram. Call the Customer Service number on the back of your ID card for help scheduling your appointment and transportation. Health Information Library: HIL Medically Necessary Services Services that are listed as medically necessary mean that you can have those services if your doctor and BlueCare agree that you need them. See your Member Handbook for a full definition of medically necessary. BlueCare providers will give you health care that is medically necessary. Sometimes your doctor may have to get an OK for your health care services, even if he or she says that you need them. This is called a Prior Authorization, or PA. Your doctor may have to tell BlueCare why the health care service is medically necessary for you. BlueCare looks at your medical needs and your covered services when they give an OK. BlueCare providers do NOT get any extra payment from BlueCare or TennCare for giving you less care than you need or for denying you care. Workers for BlueCare do NOT get any extra pay or gifts for saying no to care. If you have questions about what your physical or mental health care services are, you can call BlueCare at If you have problems getting your physical health or mental health care services, see the sections of your Member Handbook called, Help for problems with your health care or TennCare and TennCare Appeals. There is also information available on our website, bluecare.bcbst.com. Know your risk and get tested for Chlamydia If you are sexually active you may be at risk for chlamydia. Chlamydia is a sexually transmitted disease (STD) that can be very serious. It may have mild symptoms or none at all. If not treated, chlamydia can make it hard for you to have a baby. Experts say women aged 25 and younger who are sexually active should have a yearly test for chlamydia. Older women with risk factors should also be tested. 4 Risk factors include having new or multiple sex partners, having sex with someone who has other partners and not using barrier contraceptives, such as condoms. Ask about a chlamydia screening test when you get your yearly well-woman checkup BlueCare will pay for the chlamydia test for women up to age 29 if your doctor recommends it. Source: Centers for Disease Control and Prevention Health Information Library: HIL For Health Information Library messages, call and enter the four-digit codes included at the end of some articles. WOMEN S

5 Pregnant women need prenatal care MATERNITY Regular doctor visits when you re expecting: Improve your chances of having a healthier baby Lower your chances of serious problems during pregnancy FREE and FOR YOU CaringStart Maternity program for pregnant members: Support from obstetric nurses Information and educational materials about before, during and after pregnancy Coordination of services Call CaringStart at , Monday through Friday, 8 a.m. to 6 p.m. Eastern Time. It is a free call. Text4baby will send you FREE text messages every week about having a healthy pregnancy and a healthy baby. Just text the word BABY (or BEBE for Spanish) to the number to get started. Or register online at text4baby.org. Text4baby is an educational program of the National Healthy Mothers, Healthy Babies Coalition, provided by the Voxiva Corporation, an independent company that does not provide BlueCross BlueShield branded products and services. Continuing care for pregnant members If your provider leaves the BlueCare Tennessee Provider Network, you usually have to find a new doctor. This is not the case for many pregnant members. If you are four or more months pregnant, you can stay with the same provider even if he or she leaves our network. You can see that same provider after your baby is born for what s called postpartum care. To find a provider for your pregnancy care, visit bluecare.bcbst.com. Or call the Customer Service number on the back of your ID card. Get free help to stop tobacco use The Tennessee Tobacco QuitLine is free to all Tennessee residents who want to stop smoking or using spit or chew tobacco. Callers are assigned a coach who will give one-on-one help to kick tobacco use for good. Tennessee Tobacco Quitline: QUIT-NOW, or Monday through Friday from 8 a.m. to 11 p.m., Saturday from 9 a.m. to 6 p.m., Sunday from 11 a.m. to 5 p.m., Eastern Time. For the deaf and hard of hearing Counseling is available in both Spanish and English. To learn more visit: health.state.tn.us/ tobaccoquitline.htm Health Information Library: HIL 3361, SAFETY FIRST: private duty nursing TennCare only covers services that are medically necessary. To be medically necessary, a service must be: Ordered by a treating health care provider Required to diagnose or treat the member s condition Safe and effective Not experimental The least costly alternative that is adequate for the member s condition. The best value For example, home health and private duty nursing is a covered benefit when medically necessary and when prescribed by an attending doctor. The treatment and services must be provided by a registered nurse or a licensed practical nurse who is not an immediate relative. However, if an intermediate or skillednursing facility can provide the required care at a lower cost than private-duty nursing, the member has two options: Get services from a nursing facility Have home health care or private-duty nursing up to the amount allowed for facility care. By paying for the effective service that costs the least, TennCare is able to provide more people with health care benefits. And that s good news for everyone. Habla español y necesita ayuda con este boletín? Llámenos gratis al

6 BEHAVIORAL LOWER THE COST OF Y EATING Understanding ADHD All children have trouble sitting still and behaving at times. Kids with attention deficit/hyperactivity disorder (ADHD) have a little more trouble than others. If you think your child has ADHD, look for the following signs. Children with ADHD may: Have a hard time paying attention Not follow directions well Struggle to control their behavior Be easily distracted from schoolwork Forget or lose things Be in constant motion Talk too much Act and talk without thinking Helping Your Child The first step is talking to your child s doctor. Only a doctor can say if your child has ADHD. Doctors have special tests and rules they use to diagnose ADHD. Have a question about ADHD? Want to know more? BlueCare and TennCareSelect members can call Nurseline at You can get answers to health questions 24 hours a day, 7 days a week. Sources: American Academy of Pediatrics - Centers for Disease Control and Prevention - KidsHealth. org (Nemours Foundation) - kidshealth.org; National Institute of Mental Health (National Institutes of Health) - Studies show a strong connection between lower income levels and higher obesity rates, especially for women. The reason seems to be low-cost but high-calorie, processed food. This includes pre-packaged meals, prepared meats and frozen meals. Cooking your own food allows you to control how much fat, salt and sugar you eat. It doesn t have to cost more. Some suggestions to eat well for less: Plan your meals for the whole week. Search for new and easy recipes. Keep your focus on fresh foods that don t break your budget. Summer is a great time to use fruits and vegetables. Make a grocery list. Get everything you need in one trip. Not shopping so often also cuts down on the temptation to spend more. Be prepared. Thaw meat and chop vegetables ahead of time. Make cooking so convenient that you don t rely on fattening, prepared foods to make quick meals. Sources: Web MD - Population Reference Bureau - New BlueCareFitness SM Can Help You Lose Weight The new BlueCareFitness program gives you tools to help you lose weight and improve your health. We offer two program options depending on your fitness goals. BlueCareFitness is for members who want to: Lose weight and keep it off Develop healthy eating habits Increase their physical activity BlueCareFitness Plus SM is for members who: Have more weight to lose Are actively following a weight-loss plan Have a body mass index (BMI) of more than 30 * Weigh less than 500 pounds * Are able to stand for at least five seconds * Take your first step to a healthier weight today. Call us at *Determined during Health Risk Assessment (an exam by a health care professional) 6 +For Health Information Library messages, call and enter the four-digit codes included at the end of some articles.

7 HOW CAN WE HELP YOU? BlueCare Customer Service help with your health plan free help in another language TENNderCare information in formats for members who are deaf or blind help getting treatment for mental health and substance abuse problems information about CHOICES Call Monday - Friday, 8 a.m. - 6 p.m. Eastern Time. If you call after normal business hours, you can leave a voic message For TTY dial 711 and ask for OTHER FREE HELP DentaQuest ** Customer Service Information on dental (teeth) care for people under age 21. Call Monday - Friday, 8 a.m. - 6 p.m. Eastern Time ; TTY/TDD /7 Nurseline * Nurses are on call to answer your health questions 24 hours a day, seven days a week. They can also help you figure out if you should call your doctor, go to the Emergency Room (ER) or treat the problem yourself. Call Apply for TennCare The Health Insurance Marketplace at -- Find a computer to use to apply at your local DHS office Or call toll-free at Apply for CHOICES (TennCare CHOICES in Long-Term Care) Tennessee Health Connection, toll-free, (Mon-Sat, 7 a.m. 7 p.m.) TennCare Appeals Find help to file an appeal for a TennCare service (medical or mental health service, alcohol or drug abuse treatment) TennCare Solutions Unit, toll-free, (Mon-Fri, 8 a.m. 4:30 p.m., Central Time) More TennCare Help Information on TennCare premiums and copays Change your address, family size, job or income Tennessee Health Connection P.O. Box Nashville, TN Toll-free, (Mon-Sat, 7 a.m. 7 p.m.) Fax: Health Information Library *** Taped messages on more than 1,200 health topics Call toll-free , 24 hours a day, 7 days a week. Then, enter the four-digit code found at the end of many of the articles in this newsletter to hear the messages. Transportation **** For a ride to see your doctor To get medical or behavioral care To go home after a hospital discharge To go to the pharmacy to get medicine Call toll-free, 24 hours a day, 365 days a year (East) (West) (Schedule a ride at least three days in advance. If an urgent situation arises and you can t give a three-day notice, a ride can be set up. In case of bad weather, a ride will be given only if the place you are going is open.) Get Help with this Newsletter help if you have a health, mental health, learning problem or disability free help in another language information in audio or Braille format, if needed Call toll-free, Monday - Friday. Each office s hours may be different (BlueCare) (TennCare Partners Advocacy Line) For TTY dial 711 and ask for Report Fraud and Abuse To report fraud or abuse to the Office of Inspector General (OIG) you can call toll-free or go online to tn.us/tenncare and click on Report Fraud. To report provider fraud or patient abuse to the Tennessee Bureau of Investigation s Medicaid Fraud Control Unit (MFCU), call toll-free Habla español y necesita ayuda con esta boletín? Llámenos gratis al WE DO NOT ALLOW UNFAIR TREATMENT IN TENNCARE. No one is treated in a different way because of race, color, birthplace, religion, language, sex, age, or disability. Do you think you ve been treated unfairly? Do you have more questions or need more help? If you think you ve been treated unfairly, call the Tennessee Health Connection for free at Need help in another language? You can call for language assistance. Call Interpretation and translation services are free to TennCare members. Note: This newsletter is not meant to take the place of your doctor s advice. BlueCare Tennessee is an Independent Licensees of the BlueCross BlueShield Association * 24/7 Nurseline offers health advice and support provided by Carewise Health, Inc., an independent company that does not provide BlueCross BlueShield branded products and services. ** DentaQuest is an independent company serving BlueCare and TennCareSelect members. DentaQuest s number and website address are listed for your convenience. DentaQuest does not provide Blue Cross or Blue Shield products or services. *** Health Information Library provides information on health topics and is provided by McKesson, an independent company that does not provide BlueCross BlueShield branded products and services. **** Transportation is provided by Southeastrans, an independent company that does not provide BlueCross BlueShield branded products and services. + A government agency. Habla español y necesita ayuda con este boletín? Llámenos gratis al

8 14BCM1003 (05/14) 1 Cameron Hill Circle Chattanooga, Tennessee bluecare.bcbst.com PRSRT STD U.S. POSTAGE PAID BLUECROSS BLUESHIELD OF TENNESSEE, INC. THE LATEST EDITION OF BlueCare Way IS HERE! Like us on Facebook! Learn more about your benefits and get health and wellness tips. Connect with us today by visiting facebook.com/bluecaretn. bluecare.bcbst.com A newsletter for BlueCare members In This Edition: Vaccines for Back-to-school Page 1 Avoid going back to hospital Page 2 A trip to the dentist Page 3 Is it time for your mammogram Page 4 Free help to stop smoking Page 5 Help to lose weight Page 6 3rd Quarter 2014 BlueCare Way Visit our new website, bluecare.bcbst.com Habla español y necesita ayuda con este boletín? Llámenos gratis al (BlueCare ) o (TennCareSelect).