Caring for Hawai i Caring for Family: A Message from Monette Bringas

Transcription

1 HAWAI I 2015 ISSUE III Caring for Hawai i Caring for Family: A Message from Monette Bringas Aloha! Living with a chronic condition can be a challenge. But you don t have to face it alone. If you re ready to make changes, Ohana s disease management nurses can help. The service is free. It can help you deal with the following health conditions: Diabetes Asthma Coronary Artery Disease Depression Smoking Cessation Your disease management nurses offer coaching and training at no cost to you. They will work with you and your primary care provider (PCP). The nurses want to make sure you understand what you can do to improve your health. They will mail you sheets with health tips. They will help you get needed services or equipment. They can even refer you to social services in your area. To join this program, you or your PCP can call us toll-free at We re here to help you take charge of your health! Be on the lookout! Our pharmacy processing information is changing for Look for your new member ID card. Always show it when you pick up your medications starting on January 1, Monette Bringas, RN, MSN, Service Coordination and Disease Management Manager Numbers to Know We re just a phone call (or click) away! Call Customer Service toll-free: TTY Monday Friday, 7:45 a.m. to 4:30 p.m. Hawai i Standard Time Or visit: Toll-free Nurse Advice Line: hours a day/7 days a week OH Q3 Member Newsletter HI5CADNEW66916E_0515

2 Manage Stress This Holiday Season (and All Year Long) The holidays can be a wonderful time of year. It s a chance to spend time with family and friends. There are get-togethers and traditions. Yet sometimes it can all be too much. That s when stress appears. Yes, along with all the fun, stress is common. However, the holidays don t need to take a toll on your health. Keep from trying to do too much. It s easy to get overwhelmed with family demands. Also avoid spending too much money, another source of holiday stress. Here are some good ideas for dealing with stress at the holidays and all year long: Take care of yourself. Eat sensibly and get the rest you need. Take a break from the rush to quiet your mind. Exercise also reduces stress. Avoid alcohol or drugs. In the long run, they create more stress. Find support. Share your feelings with someone you trust. Connect socially. Have fun with family and friends. Source: Centers for Disease Control and Prevention, and Keep Your Member ID Card Handy Your member ID card is very important. Think of it as your key to getting health care services. That s why you ll want to keep it with you at all times. Give it to your PCP when you get care. It also has useful details about your health plan. It shows the name and phone number of your PCP. Please keep your card up to date. Call Customer Service if you move or have other changes. This number is on your member ID card. Click or Call for the Latest Drug Coverage Updates Want to find the latest about the drugs we cover? Be sure to stop by our website. You ll find our Preferred Drug List (PDL). You can learn about any drug or coverage changes. Just go to You can also call us for updates at the number listed on the cover of this newsletter. 2 Member Newsletter

3 The Care You Need While You re Pregnant Moms-to-be need special care. Prenatal care is the health care you get while you re pregnant. See your health care provider as soon as you think you re pregnant. Most experts suggest you see your health care provider: Once each month for the first 6 months Every two weeks in the 7th and 8th months Every week in the 9th month But be sure to follow your provider s advice. He or she may need to see you more often. What will happen at prenatal visits? Your provider will check to see how you and your baby are doing. Each visit may be different. But your provider may do the following: Ask about your health history Ask about your family s health history Give you a complete physical exam Calculate your due date Answer your questions Check your baby s growth Check your baby s heart rate Don t miss any of your prenatal visits. They are all important! Don t forget to follow up after your baby is born Your baby is counting on you to take care of yourself, too! You ll need your follow-up checkup. This is also called your postpartum visit. This should come sometime before your baby is 6 weeks old. This visit is very important. It lets your provider see how you re healing and how you re feeling. At this visit, talk with your health care provider about things like: Any breastfeeding concerns if you are nursing Family planning such as birth control, future pregnancies and timing between babies Parenting classes or issues Sleeping Crying or feeling down Exercise Sexual activity Your next visit This visit is a good time to ask any questions you may have. Your provider can share tips to help both you and your baby. Ohana s got you covered! We have a network of providers to give you the care you need. It includes PCPs, hospitals and other providers. We cover maternity services such as: prenatal care prenatal laboratory screening tests diagnostic tests prenatal vitamins postpartum care and more To learn more, see your Member Handbook. Or call the Customer Service number on the cover of this newsletter. Sources: U.S. Department of Health and Human Services, publications/our-publications/fact-sheet/ prenatal-care.cfm#f Member Newsletter 3

4 Tools to Help You Track Diabetes Managing diabetes is easier when you remember your ABCs. These ABCs were written by the American Diabetes Association. They help people with diabetes keep track of three important factors: A stands for your A1C or your glucose average The A1C is a blood test to measure the sugar levels in your blood. The target number is below 7. You should have your blood tested at least twice a year. B stands for blood pressure Your blood pressure should be below 130/80. Your PCP should check it at every visit. They may also ask you to monitor your blood pressure at home. C stands for cholesterol Cholesterol is something that is in all humans. It is a waxy, fat-like substance. It travels throughout the body in the blood. There is bad cholesterol called LDL. There is also good cholesterol called HDL. The LDL can build up and clog blood vessels. But the HDL can help the body remove the LDL. Your bad cholesterol (LDL) level should be less than 100. Have it checked out at least once a year. Eye Exams Too! Did you know that diabetes can also cause eye problems? Eye disease from diabetes is sometimes called retinopathy. And it can lead to loss of sight. But finding and treating eye problems early can help. That s why eye exams are so important. Get a full eye exam every year. Tell your eye care provider about any eye problems you may have. Be sure to say you have diabetes. Also check your coverage. Your eye exams may be covered as a medical benefit. Source: Centers for Disease Control and Prevention, home/index.html Handbook Highlights: Transportation Some members may get transportation to and from medical appointments. Here are 3 steps for using this benefit: 1. Schedule a ride by calling Logisticare toll-free. The number is Customer Service can also help. 2. Call at least 2 business days (48 hours) before your appointment. You can schedule a ride up to 30 days before your appointment. 3. Be ready at least 15 minutes before your pickup time. To learn more, check your Member Handbook in the Covered Services section under Transportation Services. Call right away to cancel or reschedule a ride. Call at least one hour before your pickup time. This helps give better service to everyone. 4 Member Newsletter

5 Eat Smart, Stay Active, Be Healthy Smart eating plays a key role in good health. So does exercise. They help you keep a healthy weight and get needed nutrition. Ideas for a Smart Diet Eat plenty of fruits and vegetables Drink plenty of water and limit sugary drinks like sodas Eat smaller portions Limit sugar and fats like candy and fast food to once every 1 2 weeks Choose lean meats, fish and beans for protein Stay Active Children should get at least 60 minutes of brisk exercise daily like walking or playing sports Adults should get two and a half hours of moderate aerobic activity like walking each week Good vs. Bad Fats Fats are also part of a healthy diet. But fats are high in calories. Limiting the fats you eat can help you lose weight and be healthier. You should also know that some fats are better for your body than others. The guide below can help you sort the good fats from the bad ones. Unsaturated fats are heart-healthy. Most of the fat you eat should be unsaturated. Examples of foods with unsaturated fats include: fish; corn, soybean, canola and sunflower oils; nuts; peanuts, peanut butter and peanut oil; seeds; and avocados. Saturated fats and trans fats increase your risk of heart disease. Foods with saturated fats include: meat (especially beef, pork, bacon, sausage, and canned and deli meats); dairy products like whole milk, cheese, butter, cream and ice cream; lard; and many packaged baked goods like cakes, cookies and doughnuts. Examples of trans fats include microwave popcorn; frozen foods like pizza rolls, pies and breakfast sandwiches; and cake, biscuit and cookie mixes. Sources: Adapted from Health Bulletin # 76, Good Fats/Bad Fats How to Know the Difference, New York City Department of Health and Mental Hygiene. What Are the Types of Fat?, retrieved from Centers for Disease Control and Prevention, Tips for Parents Ideas to Help Children Maintain a Healthy Weight, children/index.html, and How Much Physical Activity Do Adults Need? guidelines/adults.html Did You Know? Communication between you and your PCP is a key part of health care. Share your concerns. And remember that it s OK to ask your PCP questions to help you understand what your choices are. Being informed can help you make better decisions about your health. The more you know, the easier it will be to make the decision that is best for you. Member Newsletter 5

6 How to handle a health crisis big or small Your PCP is trained to manage all your health care. See your PCP if: you re not having a medical emergency or you don t have an urgent need for care Go to an urgent care center for illnesses or injuries that need care right away, but where your health is not in serious danger. Some symptoms that can be treated at urgent care include: Fever without rash Minor trauma such as a common sprain Painful urination Persistent diarrhea Severe sore throat Vomiting Tip: To find the nearest urgent care facility, visit our website at Or you can call Customer Service at the number on the cover of this newsletter. If you need emergency care, call 911. Call an ambulance if you do not have 911 services in your area. Emergency services do not need prior authorization. Go to the nearest hospital emergency room (ER) right away. Some things that may require emergency care include: Persistent chest pain Persistent shortness of breath or wheezing Severe pain, particularly in the abdomen or starting halfway down the back Severe heart palpitations Intestinal bleeding Loss of vision Head and eye injuries Broken bones or dislocated joints Serious harm to yourself or others due to an alcohol or drug abuse A threat to the health or safety of a pregnant woman or her unborn child When you get to the ER, you will need to show your Ohana ID card. Let your PCP know as soon as you can that you are in the hospital and if you got ER care. The ER doctor will decide if your visit is an emergency. If it s not, you may choose to stay, but you must pay for the care. Post-Stabilization Services It s important to get care until your condition is stable. We ll pay for care you get after your ER care. This is called post-stabilization care. This care must be done to maintain, improve or solve your medical condition. Out-of-Area Emergency Care What should you do if you have an emergency while traveling within the United States? Go to a hospital. Show your ID card. Call your PCP as soon as you can. Ask the hospital staff to call us toll-free at And remember, you can speak to a nurse 24/7 about any concerns you may have about your health care. Call Ohana s Nurse Advice Line at Source: Scripps, news_items/4231-should-you-go-to-theemergency-room-or-urgent-care 6 Member Newsletter

7 About Benefits and Services Here are some things about your plan you should keep in mind: Women s Visits You can use in-network women s health specialists for routine and preventive health care service. Also, you can see an OB/GYN for one women s health visit each year without approval. Second Opinions If you want another take on your health, call your PCP. He or she will ask you to choose an Ohana Health Plan provider in your service area. You may also choose one outside the plan s network. Out-of-Network Services If we can t provide a necessary and covered service to you in-network, we will cover it out-of-network. We ll do this for as long as we can t provide the service in-network. We will also work out payment with the out-of-network provider. The cost to you will be no more than if the service was done in-network. Notice of Privacy Practices The law says we must protect your health information. Our Notice of Privacy Practices states how we may use this data. It also tells you how you may use your rights to: Access your health information Control your health information You can see our Notice of Privacy Practices at default/privacylegal or by looking in your Member Handbook. You may also ask us for a copy. To do this, call Customer Service toll-free at We re here for you Monday Friday, 7:45 a.m. to 4:30 p.m. HST. TTY users, call If we change our privacy policies, we will post an update on our website. We will also mail a notice of the changes to you when the law says we must. Fair Treatment Our providers must offer you the same office hours as they do to those with other insurance. Always talk with your provider(s) about the care that is right for you. This material does not replace your PCP s advice. It is based on third party sources. We are presenting it for your information only. It does not imply that these are benefits covered by Ohana. Also, Ohana does not guarantee any health results. You should review your plan or call Customer Service to find out if a service is covered. Call 911 or your doctor right away in a health emergency. Member Newsletter 7

8 949 Kamokila Blvd., 3rd Floor Suite 350 Kapolei, HI HI029963_CAD_NEW_ENG State Approved WellCare 2015 HI_05_ This document has important information from Ohana Health Plan. You can request this written document to be provided to you only in Ilocano, Vietnamese, Chinese (Traditional) and Korean. If you need it in another language you can request to have it read to you in any language. There is no charge. We also offer large print, braille, sign language and audio. Call us toll-free at (TTY/TDD: ). Daytoy a dokumento ket naglaon iti napateg nga impormasyon manipud iti Ohana Health Plan. Mabalinyo a kiddawen a maisurat daytoy a dokumento iti Ilocano. Awan ti bayadanyo. Mabalinyo a kiddawen a maibasa daytoy kadakayo. Idiaya mi pay ti dadakkel a letra, braille, senyas a pagsasao ken audio. Tawagandakami iti awanbayadna nga (TTY/TDD: ). OH Language Block State Approved