Is it the Flu or is it a Cold?

Transcription

1 IN THIS ISSUE: Know Your Rights and Responsibilities pg. 3 Fa l l Changes for Medicare Members pg. 4 Surviving the Holidays pg. 6 Is it the Flu or is it a Cold? It s that time of year again. It starts out as a small tickle in the nose or throat, but soon your whole body aches, your head throbs, and you start to cough. You re sick. Is it just a cold, or is it the flu? A cold and the flu have some of the same symptoms, but the flu is usually worse with more intense symptoms. Flu The flu is caused by a virus. Flu symptoms can include body aches, fever, feeling very tired or weak, and sometimes a dry cough, and can last up to two weeks. Treatment If you think you have the flu, get plenty of rest, and drink lots of fluids. You can take some over-the-counter medications to help you feel better. See your doctor as soon as you can if your fever lasts more than 3 to 4 days or if symptoms get worse. Cold A cold is usually milder than the flu. Symptoms include a stuffy or runny nose, sneezing, coughing and a scratchy throat, and can last for about a week. Protect Yourself Here are a few things you can do to keep healthy during cold and flu season: Wash your hands often. Keep your hands away from your face. Cover your nose and mouth when you sneeze and cough (using a tissue or hanky is best). Get lots of rest. Boost your immune system by eating a healthy diet filled with fruits and vegetables. Ask your doctor about getting a flu shot. Treatment As with the flu, the best way to treat a cold is with lots of fluids and rest. Cough drops, over-the-counter sore throat sprays, and medications such as Tylenol and Motrin can help you feel better. See your doctor if cold symptoms last longer than two weeks or do not get better.

2 Elaine Batchlor, MD Ask the Doc: Common Questions & Answers About Breast and Cervical Screenings! What is a mammogram? A mammogram is a test used to look for cancer in a woman s breasts. Mammograms can show small lumps or growths that cannot be seen or felt. Early detection is the best way to survive breast cancer. Who should have one? New guidelines say most women should have their first test at age 50 and then every 1 to 2 years after that. Women who have symptoms of breast cancer (such as a lump), or those with a personal or family history of breast cancer might need to have a mammogram sooner or more often. How long does it take? Screening mammograms take about 15 minutes. You stand in front of a special X-ray machine and one at a time your breasts are placed between two plastic plates that press your breast flat. Two pictures are taken of each breast one from the side and one from above. Diagnostic mammograms take longer because more pictures of the breast are taken. What about monthly breast self-exams (BSE)? The best way to find breast cancer is to have a mammogram along with a breast exam done by a doctor. Checking one s own breasts for lumps or other changes is called breast selfexam or BSE. A BSE should not take the place of routine clinical exams and mammograms. What is cervical cancer? Cervical cancer is cancer of the cervix - the lower, narrow part of the uterus (womb). When you get cancer of the cervix, the cells split and grow out of control. These extra cells form a tumor. Although most cases of cervical cancer are caused by the human papillomavirus (HPV), most women with HPV will never develop cervical cancer. HPV is a virus that is passed from person to person, most often during sex. You are more likely to get cervical cancer if you smoke, have HIV or reduced immunity. 2 MEMBER NEWS FALL 2010 How can I help prevent cervical cancer? Here are some things you can do to help protect yourself against HPV infection and cervical cancer: Get vaccinated. Two vaccines (Cervarix and Gardasil) can protect girls and young women against the types of HPV that cause most cervical cancers. Cervarix and Gardasil are licensed, safe, and effective for females 9 to 26 years of age. For more information on these two vaccines, talk to your doctor. Get tested. Get regular Pap tests and pelvic exams. Your doctor can find and treat abnormal cells before they turn into cancer. Use a condom. Both men and women can get HPV. Protect yourself with a condom every time you have vaginal, anal or oral sex. What is a Pap test? The Pap test (sometimes called a Pap smear) looks at cells taken from the cervix. A Pap test can find cancer or abnormal cells that may lead to cancer. It can also find other things, such as an infection. How often should I get a Pap test? Women should start getting Pap tests by age 21, and then every 1 to 3 years after that as recommended by their doctor. Talk to your doctor about when to begin testing, how often you should be tested, and when you can stop. Nurse Advice Line Numbers Anthem Blue Cross Care1st Health Plan Community Health Plan Kaiser Permanente

3 Know Your Rights and Responsibilities As a member of L.A. Care, you have the right to Respectful and courteous treatment. You have the right to be treated with respect, dignity and courtesy from your health plan s providers and staff. You have the right to be free from retaliation or force of any kind when making decisions about your care. Privacy and confidentiality. You have the right to have a private relationship with your provider and to have your medical record kept confidential. You also have the right to receive a copy of, amend, and request corrections to your medical record. If you are a minor, you have the right to certain services that do not need your parent s okay. Choice and involvement in your care. You have the right to receive information about your health plan, its services, its doctors and other providers. You have the right to choose your Primary Care Physician (doctor) from the doctors and clinics listed in your health plan s provider directory. You also have the right to get appointments within a reasonable amount of time. You have the right to talk with your doctor about any care your doctor provides or recommends, discuss all treatment options, and participate in making decisions about your care. You have the right to a second opinion. You have the right to talk candidly to your doctor about appropriate or medically necessary treatment options for your condition, regardless of the cost or what your benefits are. You have a right to information about treatment regardless of the cost or what your benefits are. You have the right to say no to treatment. You have the right to decide in advance how you want to be cared for in case you have a life-threatening illness or injury. Voice your concerns. You have the right to complain about L.A. Care, the health plans and providers we work with, or the care you get without fear of losing your benefits. L.A. Care will help you with the process. If you don t agree with a decision, you have the right to appeal, which is to ask for a review of the decision. You have the right to disenroll from your health plan whenever you want. As a Medi Cal member, you have the right to request a State Fair Hearing. Service outside of your health plan s provider network. You have the right to receive emergency or urgent services as well as family planning and sexually transmitted disease services outside of your health plan s network. You have the right to receive emergency treatment whenever and wherever you need it. Service and information in your language. You have the right to request an interpreter at no charge and not use a family member or a friend to translate for you. You have the right to get the Member Handbook and other information in another language or format. Know your rights. You have the right to receive information about your rights and responsibilities. You have the right to make recommendations about these rights and responsibilities. As a member of L.A. Care, you have the responsibility to Act courteously and respectfully. You are responsible for treating your doctor and all providers and staff with courtesy and respect. You are responsible for being on time for your visits or calling your doctor s office at least 24 hours before the visit to cancel or reschedule. Give up-to-date, accurate and complete information. You are responsible for giving correct information and as much information as you can to all of your providers and L.A. Care. You are responsible for getting regular checkups and telling your doctor about health problems before they become serious. Follow your doctor s advice and take part in your care. You are responsible for talking over your health care needs with your doctor, developing and agreeing on goals, doing your best to understand your health problems, and following the treatment plans and instructions you both agree on. Use the Emergency Room only in an emergency. You are responsible for using the emergency room in cases of an emergency or as directed by your doctor. Report wrongdoing. You are responsible for reporting health care fraud or wrongdoing to L.A. Care. You can do this without giving your name by calling the L.A. Care Compliance Helpline toll-free at FALL 2010 MEMBER NEWS 3

4 Important Phone Numbers Medi-Cal Members Anthem Blue Cross Care1st Health Plan Community Health Plan Kaiser Permanente Medicare Advantage HMO SNP, Healthy Families Program, and Healthy Kids Members L.A. Care Compliance Helpline L.A. Care Family Resource Centers Inglewood Lynwood Visit us online Find a doctor, hospital or pharmacy Find out about your benefits Learn about health topics Register for L.A. Care events These are just some of the things you can find on our Web site. Take a minute to visit today! Open Enrollment Dates and Changes for Medicare Members In the past, the Centers for Medicare & Medicaid Services (CMS) would let Medicare members join or switch health plans between November 15 and December 31, and to make one more change between January 1 and March 31. This has changed. Open enrollment will still be from November 15 to December 31, Members can no longer change plans during the first three months of the new year, However, members with Medi-Cal and Medicare can make changes at any time. If you have questions about your enrollment, please contact L.A. Care Member Services at is a Medicare Advantage organization with a Medicare contract. Avoid Being a Victim of Elder Abuse If you think you or an elderly person/senior you know is being harmed or abused, there are steps you can take to get help. Watch for the following that may be signs of elder abuse: Cashing personal checks or taking money from an elderly person/ senior s bank account without their permission Telling an elderly person/senior that they have won a prize and must pay money or give personal information to get it Fake charities asking for money from the elderly Investment fraud (like trying to sell a person land or something to make money) Charging the elderly person/senior for health care they didn t receive Overcharging or double-billing for medical care or services Financial activity such as an ATM withdrawal by someone other than the elderly person If you suspect elder/senior abuse, tell someone you trust, like a doctor, a friend or a family member. You can also call the Elder Abuse Helpline: or Eldercare Locator: MEMBER NEWS FALL 2010

5 Managing Care Transitions for L.A. Care s Medicare Advantage HMO SNP Members A care transition happens when a patient moves from one care setting to another. Examples of care transitions include going from the emergency room to the intensive care unit, or from a hospital to a nursing home. Things can go wrong when there is more than one site of care. This is why L.A. Care s care team takes steps to keep Medicare Advantage HMO SNP members safe when being moved to a new care site. As a Medicare Advantage HMO SNP member going through a care transition, you will get a call from your L.A. Care care team. The team will work with you and your doctor to arrange your care. This information will only be shared with your doctors to help them meet your health care needs. The team will help you: Identify your health care and social needs Understand your doctor s care plan Get information on what you can do to stay healthy Get needed items such as medicines and equipment L.A. Care s care team is here to help you manage your care if there is ever a change in your health status or care setting. If you have questions please call L.A. Care Member Services at and ask to speak to a nurse care manager. Members Visit the Family Resource Centers! Do you have questions about your benefits? The L.A. Care Family Resource Centers in Lynwood and Inglewood have member service reps that can assist you with related issues, such as: Verifying your eligibility Changing your primary care physician Updating your address or phone number Re-determinations Getting an ID card You do not have to make an appointment. Are you a new member to L.A. Care? Stop by and attend a new member orientation. These are held the last Wednesday of the month. Call the center for specific dates and times. If you attend an orientation, you will get a welcome kit with a $10 Target GiftCard. Can you read this? L.A. Care Family Resource Centers: Inglewood 3111 W. Century Blvd., Suite 100 Inglewood, CA Toll free: Lynwood 3180 E. Imperial Highway Lynwood, CA Toll free: You don t have to strain your eyes to read your member materials. Call L.A. Care and ask for materials in large print. We also offer materials in Braille and on audio cassette or CD. If you speak another language, you can call and ask for someone who speaks your language to interpret for you when talking with health care staff or your doctor. American Sign Language interpreters are also available to you at no cost. To get what you need in large print, Braille, on cassette or CD, or for an interpreter, call L.A. Care at or TTY FALL FALL MEMBER NEWS 5

6 Surviving the Holidays Tis the season for joy, cheer and gift giving! For many it is also the season for overeating, lots of stress and the holiday blues. Here are some tips to help you make it through: 1. Start a walking program. Exercise is one of the best ways to burn off stress, get time to yourself, and lift your mood. 2. Don t go to a party on an empty stomach. Have a small, healthy snack before you leave your house. 3. Drink lots of fluids. A good rule to follow is to drink eight 8-oz glasses a day. Your best choices are water, 1% milk, unsweetened beverages or tea without added sugar. 4. Get enough sleep. A good night s rest will leave you feeling great, help you make smarter food choices, lower your stress level, and lift your mood. QUICK TIP: Take a FREE healthy cooking class at one of L.A. Care s Family Resource Centers. Learn about your Notice of Privacy Practices L.A. Care s Notice of Privacy Practices lets you know how your medical information may be used, how we protect your information, and how you can access this information. You can get a copy of this notice by calling the Privacy Officer at You can also find it on our website at A Guide to Giving Your Child a Great Start L.A. Care has a new booklet for parents of young children titled A Guide to Giving Your Child a Great Start. This booklet helps parents with issues such as meal time, bedtime, and toilet training. For a copy of this or other health material, talk to your doctor or call L.A. Care. All materials come in other languages, audio, large print and Braille upon request. Also, as a member of you can get FREE health information and classes. If you want to learn more about a health topic such as weight loss, asthma, or heart health, ask your doctor for free handouts. Healthy Teeth, Great Smile. Do not let cavities and tooth decay get in the way of your child s smile. Here are some tips on how to keep your child s teeth healthy: Start early clean your baby s teeth and gums with a clean cloth once or twice a day. Do not put your baby to bed with a bottle at night or at nap time. Do not let your child walk around with a bottle or drink for long periods. If your baby uses a pacifier, do not dip it in anything sweet like sugar or honey. Teach your child to drink from a cup at the age of one year. Take your child to a dentist regularly beginning at the age of one. Check with your doctor about fluoride use and fluoride varnish. Fluoride can help prevent tooth decay. Why wait? Start today and keep your child s teeth healthy. What to do if you have a problem or complaint You are important to us. When you have a problem with your health care, call Member Services. We will work with you to find a solution to your concern. Member Services can help you resolve your problem or help you file a complaint (also called a grievance) or make an appeal against a decision made that you may not agree with. You can call Member Services at , 24 hours a day, 7 days a week (including holidays). Or send your request in writing to: Attn: Grievance and Appeals Unit P.O. Box Los Angeles, CA To learn more, please see your Evidence of Coverage we sent to you. You may also visit our website at 6 MEMBER NEWS FALL 2010

7 Learn About Your Coverage When you first join L.A. Care, and then every year after, you will get a package of important information about your health care coverage. Please read it and call us if you have any questions. You can visit our improved Web site at for the information listed below and more: Basic information What benefits and services are covered What benefits and services are not covered How your health plan makes decisions about when new treatments will become benefits What care you can and cannot get when you are out of Los Angeles County or the L.A. Care network How to access care when you are out of Los Angeles County How to change or get care from your primary care physician (PCP) How to get information about doctors How to get a referral for special care or to go to the hospital What to do when you need care right away or when the office is closed What to do when you have an emergency Co-payments and other charges How to get prescriptions filled and other pharmacy program information What to do if you get a bill Special programs Programs to improve care and services for our members Programs for people with a disease, like diabetes or asthma How decisions are made about your care How our doctors and staff make decisions about your care based only on need and benefits. We do not encourage doctors to provide less care than you need and doctors are not paid to deny care. How to reach us if you want to know more about how decisions are made about your care How to appeal a decision about your care Member issues Your rights and responsibilities as a health plan member How to complain when you are unhappy What to do if you are disenrolled from your plan How L.A. Care protects and uses your personal health information How to get help if you speak a different language If you would like paper copies, please call us at Don t be a victim! Stop healthcare fraud. Here s how: Remember to always keep your ID card with you. Show your ID card whenever you: Have a doctor s visit Go to the hospital Need emergency services Pick up a prescription If you lose or damage your ID card, call L.A. Care at Do not let anyone else use your ID card. That is considered fraud. Don t give out your medical information to anyone but your doctor, clinic or hospital. Don t let others get free medical services or equipment by using your medical ID card. Don t sign your name to a blank form. Do guard your medical ID card and information as you would your wallet. Do be cautious of anyone who asks to use your medical ID card. Do ask for a copy of any forms you sign. If you think healthcare fraud has occurred, or believe you are a victim, report it! Call the Compliance Helpline at FALL 2010 MEMBER NEWS 7