THE KEY TO THE GOOD LIFE IS A GREAT PLAN SPRING 2010 ABOUT YOUR PLAN THE RIGHT CARE We want you to get the right care at the right time and at the right place. We don t want you to get too little care or care you don t really need. We also have to make sure that the care you get is covered. We do not reward anyone for saying no to needed care. We are here for you. thank YOU Thank you for being a member of Great Lakes Health Plan. Once again, we are one of the highest-rated Medicaid plans in the nation (according to U.S. News & World Report/NCQA America s Best Health Insurance Plans 2009-10*). We work hard to make our health plan better for you and your family. We listen to you because you are our customer. We want to hear the feedback you give us. We have many friendly and helpful doctors for you to choose from. We want you to get the care you need when you need it, with the providers you want. It is our goal that when people ask you which health plan you prefer, you say: Great Lakes. It s Great Coverage! * U.S. News & World Report/NCQA America s Best Health Insurance Plans 2009-10. America s Best Health Insurance Plans is a trademark of U.S. News & World Report. PRSRT STD U.S. Postage PAID AmeriChoice United Health Group Great Lakes Health Plan 26957 Northwestern Hwy., Ste. 400 Southfield, MI 48033 CALL ONE The first thing to do if you have questions, comments or even a complaint is to call Customer Service at 1-800-903-5253. We will help you. We look forward to being your health plan for years to come! AMC-014-
EMERGENCY CARE SICK DAYS allergies ANDasthma is it an emergency? KNOW THE DIFFERENCE TO GET THE RIGHT CARE AT THE RIGHT PLACE More than one-third of emergency room visits are unnecessary. Do you know when to go to the emergency room and when not to go? An emergency is an illness or injury that starts suddenly. It is very serious. If you don t get help right away, you could die or suffer other harm. Examples of emergencies include: signs of a heart attack or stroke. bleeding that won t stop, a broken bone or a bad burn. trouble breathing or loss of consciousness. you feel you might hurt yourself or others. signs that something is wrong with a pregnancy, like pain or bleeding. In a true medical emergency, you should go right to the nearest hospital emergency room or call 911. Sometimes you have an illness or injury that is not an emergency, but you do need to see a doctor soon. This is called urgent care. It s usually best to see your primary care provider (PCP) for urgent care. 4 STEPS TO FEELING BETTER If you have allergies or asthma, join the club. About 20 million people in the U.S. have asthma. Allergies affect more than 50 million people. Allergies happen when your body overreacts to something. It thinks something you eat, breathe or get on your skin is dangerous. Common causes are pollen, molds, animal dander and certain foods. In some people, allergies lead to asthma attacks. Many allergies can be treated at home. You can avoid some triggers. Over-the-counter medicines can help. See your doctor if your allergies are bad, last a long time or cause asthma symptoms. ALLERGY SYMPTOMS itchy, watery eyes sneezing, or a stuffy or runny nose coughing or wheezing rash, hives or inflamed skin ASTHMA SYMPTOMS wheezing or coughing difficulty breathing tightness in the chest 4TIPS Steps toward controlling your allergies and asthma 1 Find out what your triggers are. 2 Avoid known allergens (things that cause allergies). 3 Pay attention to how you feel. 4 Take your medicine. BREATHE BETTER If you have asthma, GLHP has a program that can help you. Call 1-800-903-5253, ext. 14355, to find out how you can join. Over-the-counter (OTC) allergy medicine is covered by GLHP. You need a prescription from your GLHP doctor. For a list of covered OTC medicines, call Customer Service at 1-800-903-5253 or visit www.glhp.com. 1 OUT OF 4 PEOPLE HAVE ALLERGIES OR ASTHMA. HERE AND NOW Call your GLHP primary care provider (PCP) 24/7 when you need medical care. Your PCP can take care of most conditions. If your PCP can t see you, he or she may tell you to go to an urgent care center instead of the emergency room. 2 HEALTH TALK
BEHAVIORAL HEALTH SEXUAL HEALTH check it out CHLAMYDIA IS EASY TO GET, EASY TO DETECT, EASY TO TREAT out of control WHEN DRINKING IS A DISEASE Alcoholism is a serious disease. It can tear apart your relationships. It can cause you to lose your job. It can get you into trouble with the law. And it can be deadly if not treated. Alcoholism isn t just drinking too much or too often. It is an addiction. Alcoholics need treatment and support to quit. There are four symptoms: CRAVING: You feel a strong need to drink. LOSS OF CONTROL: You can t limit your drinking. PHYSICAL DEPENDENCE: You feel sick if you don t have alcohol. TOLERANCE: You need to drink more to get drunk. GET HELP If you or someone you love suffers from alcoholism, get help. Call 1-800-435-5348 to learn where to get help. Chlamydia can cause serious problems in men and women. It can make women unable to get pregnant. It can also affect newborn babies of infected mothers. Most people with chlamydia have no symptoms. The best way to see if you have it is to get tested. Your doctor can order a urine test to screen you for chlamydia. It is fast, easy and painless. All sexually active women should get tested each year. It s even more important for women under 25. Talk to your doctor about this test. Chlamydia is treated with antibiotics. It s important to take all the medicine. If you don t, the infection may come back. Your partner should also get tested, and treated if necessary. To prevent chlamydia, use a condom every time you have sex. OK FOR OB Annual OB/ GYN checkups are a covered benefit. You can find a provider on our Web site at www.glhp.com. BABY BASICS baby well BE Your child should have at least 10 well-baby visits in the first two years. These checkups make sure your baby is growing and developing well. If your baby has any problems, they can be caught early. Your baby can get the shots and tests he or she needs on time. These visits let you get to know the doctor well. You can get help with your questions and concerns. WHEN TO TAKE YOUR BABY TO THE DOCTOR 3 to 5 days After that, take 1 month your child to 2 months the doctor for a 4 months checkup every 6 months year even if he 9 months or she is not 12 months sick, until your 15 months child turns 21 18 months years old. 24 months 30 months 3 years SPRING 2010 3
ABOUT YOUR PLAN gifts FOR mom REWARD YOURSELF WITH HEALTHY FIRST STEPS Our Healthy First Steps program helps you take care of yourself when you are pregnant. We also reward you for making smart choices about your healthcare. PRENATAL CARE: When you visit your PCP or GLHP OB/ GYN before you are 12 weeks pregnant or within 45 days of joining GLHP, let us know. We will send you a Target gift card. We will also enter your name in our monthly drawing for a $150 MasterCard gift card. POSTPARTUM CARE: When you deliver your baby, you can get another Target gift card. Call your OB doctor s office right after you deliver your baby. Tell them you need to be seen within three to six weeks after you deliver your baby. If you had a cesarean birth, your doctor may want to see you one to two weeks after you had your baby and again in three to six weeks. If you have a postpartum visit on time, call and let us know. We will send you another Target gift card and enter your name in our monthly drawing for a $150 MasterCard gift card. PREGNANT? Call GLHP and let us know. We can tell you about our Healthy First Steps program and how you can reward yourself! We will send out your gift card after all information is verified. extra specialp Great Lakes Personal Care Plus (HMO) is GLHP s Medicare Special Needs Plan. It offers enhanced benefits for people with both Medicare and Medicaid. It includes vision, transportation and other extra benefits. The plan is available in Wayne, Oakland, Macomb and Kalamazoo counties. GET MORE If you qualify and would like to learn how to maximize your benefits at no extra cost, please call 1-888-903-7587. get online Please visit our Web site at www.glhp.com. It has up-to-date information about your healthcare benefits and coverage, such as: A Member Handbook that you can view or print out. The Member Handbook lists services covered by GLHP. It also tells you where you can get help from Michigan Medicaid if a service is not covered by GLHP. A Provider Directory that lists our doctors, hospitals and other health facilities. You can search for a doctor by name, gender, language spoken and city. It includes maps so you can find your way to the doctor s office or hospital. NOT WIRED? You can also call Customer Service at 1-800- 903-5253 and we will send you a Member Handbook or Provider Directory. 4 HEALTH TALK
who TOcall FREE SERVICES ARE JUST A PHONE CALL AWAY HOW TO GET MEDICAL CARE Call your primary care provider (PCP) any time you need medical care. You can call 24 hours a day, seven days a week. Your PCP s name and phone number are on your GLHP ID card. WE LLtake YOUthere If you do not have a ride to get medical care and services, GLHP may provide free transportation. Call four days in advance to set up your ride. If there is a bus service near you, you may be asked to use it unless there is a medical reason that you cannot do so. If you need an urgent ride to your doctor s office or an urgent care center sooner than the four-day advance notice, call us and we will help you. ALL ABOARD Call 1-877-892-3995 directly to ask for a ride. Or, call Customer Service at 1-800-903-5253. WE SPEAK YOUR LANGUAGE Interpretation and translation services are free to GLHP members. GLHP has staff who can speak to you in English, Spanish and Arabic. Call us at 1-800- 903-5253 for translation and interpretation services. GLHP tiene personal que le puede ablar en Español. Llamenos a el 1-800-903-5253., GLHP 1-800-903-5253. HOW TO GET PREGNANCY CARE You do not need to ask your PCP first. Pregnant members may visit any GLHP OB/GYN for pregnancy care. HOW TO GET A WELL-WOMAN EXAM You do not need to ask your PCP first. Starting at age 16, female members need a wellwoman exam every year. The exam may include a Pap smear and chlamydia testing. Older women may get an order for a mammogram. You may see any GLHP OB/GYN or your PCP. HOW TO GET MENTAL HEALTH CARE You do not need to ask your PCP first. If you need mental health care, call 1-800-435-5348. HOW TO GET CHILD AND TEEN CHECKUPS You do not need to ask your PCP first. Children and teens may visit their PCP or any GLHP pediatrician for a well-child checkup every year. For other important preventive care, such as lead testing and immunizations, see your child s PCP. SPRING 2010 5
BABY BASICS PREVENTION GETwhat YOUneed WHY YOU SHOULD SEE YOUR DOCTOR OFTEN unleaded GET YOUR CHILD TESTED FOR LEAD POISONING You hear it in the news all the time. Children s toys and other items are recalled because they have lead in them. Children must be tested for lead poisoning before they turn 1 year old and again before they turn 2 years old. (If your child is over 2 years old and has never had a lead test, have him or her tested right away.) Have your child tested for lead poisoning. It may only take a simple finger stick and one or two drops of blood. This is a free test for GLHP members. You should see your PCP at least one time every year even if you are not sick. WOMEN should have a woman s health visit each year in addition to a general checkup. This visit should include: a chlamydia test for women aged 16 to 25. a Pap smear for sexually active women. an order for a mammogram every one or two years for women aged 40 and older. CHILDREN (infants through teens) need to see their PCP at least once a year. Babies and toddlers need to go more often (see Baby be Well on page 3 for a schedule), but older children need to go, too. They should: be tested for lead poisoning at least twice just before they turn age 1 and again just before they turn age 2. get needed shots on time. have a well-child checkup. PREGNANT WOMEN need to see a doctor or midwife regularly. They should: start prenatal care in the first 12 weeks of pregnancy. see their doctor within 3 to 6 weeks after the baby is born for a postpartum checkup. take their newborn to his or her PCP by the time they are 1 week old. PEOPLE WITH DIABETES need to get an eye exam and diabetic lab tests every year. Talk to your PCP if you have sugar diabetes. MEN need to see their PCP every year for a well-visit. This visit should include a checkup and any tests needed based on your age. IT S FREE These services are all FREE to GLHP members! You can set up a FREE ride to get any of these services. Call 1-877-892-3995 to set up your FREE ride. 6 HEALTH TALK
ABOUT YOUR PLAN HEALTH CONSUMER in touch GLHP wants you and your family to be healthy. We may call you with important health tips and reminders. You may get a call from a GLHP staff person or an automated message. You may get a letter or postcard in the mail. The letter or postcard may be from GLHP or your doctor. You may even see GLHP staff out near your home at a community event or health fair. Talk to your doctor about any health tips or reminders you get. All the services we tell you about are free to GLHP members. plans FOR THE future ADVANCE DIRECTIVES FOR PHYSICAL AND MENTAL HEALTH What would happen if you were unable to make your own healthcare decisions? Do you have written instructions? Have you chosen a family member to decide for you? This is called an advance directive. It s a good idea for anyone to have an advance directive for medical care. If you have a mental illness, you may want an advance directive for mental healthcare, too. There are several ways to make your wishes known in advance. You can give your doctor the name of someone you trust. This is called a durable power of attorney. You can also write your wishes down. This is called a living will. There are forms you can use to make this easy and official. WRITE IT DOWN Ask your doctor for an advance directive form. manage health YOUR LET US HELP WITH CHRONIC CONDITIONS GLHP has FREE programs to help members have healthy pregnancies and manage chronic conditions. DIABETES (HIGH BLOOD SUGAR) facts for you and your family about diabetes information to help you take charge of your health monthly newsletters and free gifts to join, call 1-800-903-5253, ext. 14349 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) a team of health care specialists to help you manage your illness information for you and your doctor advice and help with any medicines you use for your breathing problems to join, call 1-800-903-5253, ext. 14355 HEALTHY FIRST STEPS (PRENATAL AND POSTPARTUM PREGNANCY) a team of health care specialists will help you get timely pregnancy care free gifts when you get timely care during your pregnancy to join this program, call 1-800-903-5253 SPRING 2010 7
YOU AND YOUR DOCTOR YOU LIKE US! Every year, GLHP sends out a survey. It s called a CAHPS survey. We ask members how they like our service. In 2009, you gave us high ratings. Other health plans use the same survey. The results help you compare health plans. You gave us higher member satisfaction scores than any other Medicaid health plan in the state. If you received a survey, thank you for turning it in. This year, if you get a survey in the mail or a phone call asking about the services you got from us or your doctors, please take the time to reply. What you have to say is important. It helps us look for ways to improve. PRESCRIPTION DRUGS FINDINGdoctor right MAKE YOUR PCP YOUR PARTNER IN HEALTH When you joined GLHP, you chose a primary care provider (PCP). Your PCP will provide or coordinate all your healthcare. If you need tests or treatments that your PCP can t provide, he or she will refer you. You should feel comfortable with your PCP. If you are not, contact GLHP to choose a new one. Think about what you want in a PCP. You may prefer a PCP who is male or female. You might want one who speaks your language or shares your culture. You might want one with weekend hours, or one located near public transportation. There are different types of doctors who are PCPs. FAMILY PRACTITIONERS AND GENERAL PRACTITIONERS treat the whole family. They may also provide women s healthcare. INTERNISTS treat adults only. PEDIATRICIANS treat children from birth through the teen years. NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS may provide primary care or work with specialists. your y drug g benefits You can get your prescriptions filled at any GLHP pharmacy. If the medicine is on the list of approved medicines, it s free. You can get a 30-day supply. Most medicines (brand name and generic drugs) are on this list. If the medicine is not on the list, your doctor can ask for permission to prescribe it. If you have trouble getting a prescription filled, ask for details. There may be a solution. Do not leave the pharmacy until you get more information. Do not pay for it yourself. IF IT S NOT COVERED, ask if a similar medicine is covered. The pharmacist can call CVS Caremark at 1-888-233-5517 to find out. Then, ask the pharmacist to call your doctor to find out if the other medicine is OK to substitute. IF PRIOR AUTHORIZATION IS NEEDED, ask the pharmacist to call your doctor. He or she should ask the doctor to send a prior authorization request to CVS Caremark. IF IT S TOO SOON TO FILL, ask when it can be filled. Come back when it s time to fill the prescription. WHAT S YOUR TYPE? To see a list of GLHP providers, see www.glhp.com. Or call 1-800-903-5253 to ask for a directory. 8 HEALTH TALK