AETNA BETTER HEALTH OF MISSOURI A MO HealthNet Managed Care Health Plan Member Newsletter Vol. 3 2016 Remember, plan ahead when you use your transportation benefit * Getting a ride Follow these simple tips when you need a ride to your medical appointments: Call Transportation at 1-800-688-3752 at least three days ahead to schedule your ride. Be ready to be picked up at your home one hour before your appointment time. After your appointment, call Transportation right away to be picked up. Your driver will get there as soon as possible, but know that you could wait for up to an hour. Take something with you to read while you wait. Make sure you have your medications with you if you need them. Caution: If it is snowing or raining, expect that the wait could be longer. Your driver will do his or her best to pick up everyone who calls as soon as possible. But there may be many people needing a ride. Knowing ahead of time that you will need to wait a while will help you to plan ahead. Sometimes waiting for a ride can seem like forever. That s why we want you to know what to expect, and how you can plan for it. If eligible, you may also use mileage reimbursement or we may send you public transportation tickets. * Most members have this benefit. Ask Member Services if you are not sure.
Get to know your PCP PCP stands for Primary Care Provider. This is the doctor, clinic, or physician s assistant that you see regularly for most of your care. You can think of your PCP as your medical home. Having a medical home helps makes certain that you get the right medical care when you need it. It s important that you are cared for by someone you know and by someone who knows you. You should receive most, if not all, of your health care at your medical home. Your PCP helps keep you healthy by: Teaching you how to stay healthy Providing treatment before a health problem becomes serious Keeping your immunizations up-to-date Providing care when you are sick Your PCP is there for you, 24 hours a day, 7 days a week. This includes holidays and weekends. If the office is closed, call the PCP s after-hours number. You can expect a callback from a staff member as soon as possible. You can find your PCP s phone number on your Aetna Better Health Member ID card. Find a Provider at www.aetnabetterhealth.com/mo or Call Member Services at 1-800-566-6444
Decisions about your health care When Aetna Better Health makes decisions about what health care option may be right for you, we consider many factors. We make decisions: Based on your current coverage How right the care and services are for you Without rewarding practitioners or other staff for denying care you requested Without giving financial incentives to our employees or providers to reduce which services you get You can get information on physician incentive plans anytime. You just need to call Member Services. Is it time for a flu shot? Flu season is right around the corner. Now is the time you should be thinking about getting your annual flu shot. If you wait until the flu season actually gets here to get your flu shot, you may not be protected in time. You can get your flu shot at no cost to you Aetna Better Health, your MO HealthNet Managed Care health plan, covers flu shots for all members older than 6 months. You can get your flu shot at your local public health department or from your PCP. You may also get a flu shot at participating pharmacy clinics. Member Services will mail you a hard copy of the provider directory if you request it. We can customize your directory for you too if you call us.
Making Decisions about Your Own Healthcare Aetna Better Health of Missouri helps with a member s transition to other care when needed. This support can occur when your benefits end or during transition from pediatric care to adult care. Members in Care Management For members in care management, we will assist you with seeking medical services and/or community resources if your benefits end and you are no longer eligible to participate in our health plan. For members not in care management, you can get assistance changing to other care if your benefits end by contacting Member Services at 1-800-566-6444 and asking to speak with a care manager or social worker. Transition from Adolescent to Adult Aetna Better Health is also reaching out to adolescent members as you approach eighteen years old by mailing you an adolescent transition flyer that provides helpful tips on what you can do to prepare to change from pediatric care to adult care. In addition, these flyers, available in English and Spanish, can be obtained by calling Member Services. The flyer includes information on how a member can: Decide if you are ready to manage your own healthcare Learn how your health insurance plan works Ask your doctor about when to change doctors if he/she doesn t take care of adults Find out about your health history from your doctor and your family Start to keep your own health records Make a list of all the things you do to keep yourself healthy Plan your first visit to a new doctor under the adult care system Call Member Services if you have any questions about the care available to you. Keep your info current so you stay covered It s very important that Aetna Better Health has your current address and phone number. We want to make sure you get all of your mail from Aetna Better Health and MO HealthNet. You may lose your coverage if you don t get important mail about your eligibility. To update your address and phone number, just call 1-855-373-4636. Or, you can visit the Missouri Department of Social Services website at www.dss.mo.gov. Here you can access the FSD Program Enrollment System online to let them know when your address changes. Did you know? Aetna Better Health has a 24/7 Nurse Help Line just for members. Our highly trained nurses can answer any medical question. Call us any time at the number on the back of your member ID card.
Filing grievances and appeals If you re not happy with the service you ve received or how you were treated, you may file a grievance. You can also file an appeal if you re not happy with a decision we ve made. This may be something like denying or stopping care to you or a family member, or denying payment. To file a grievance or an appeal, call Member Services at 1-800-566-6444. You can also call us if you re not sure what to do. We will help you understand your rights. Aetna Better Health of Missouri Members May Be Eligible for More Services Though you already get services from Aetna Better Health of Missouri, you may be able to get more behavioral health services than those provided by your health plan. Here are a few examples: MO HealthNet members may be able to get substance use disorder treatment from a Comprehensive Substance Treatment and Rehabilitation (CSTAR) program. This could include individual and group counseling, family therapy, and residential support which means you stay at the place where you get care. Check the Internet at https://dmh.mo. gov/ada/help.html or call (800) 575-7480 to find places that have CSTAR programs. MO HealthNet members may qualify for Applied Behavioral Analysis (ABA), an in-home treatment for Autism. You can receive help finding an ABA provider by calling MO HealthNet s PSU at 1-800 392-2161. Residential placement for children and teenagers is not available from Aetna Better Health of Missouri as part of members MO HealthNet benefits. However, your child or teen may be assessed at your local Community Mental Health Center for services to address serious behavioral health problems. For more information visit https://dmh.mo.gov/mentalillness/helpinfo/adminagents.html. Member rights & responsibilities As an Aetna Better Health member, you have certain rights and duties. You can get a complete copy of your rights and responsibilities at any time. Here s how: Call Member Services at 1-800-566-6444 Go to www.aetnabetterhealth.com/mo Look in your Member Handbook Direct access to women s health services Did you know Aetna Better Health, your MO HealthNet Managed Care health plan, provides many health screenings at no cost to you? These include breast cancer screenings, cervical cancer screenings, and chlamydia/std screenings. You can get these routine and preventive services from women s health specialists without referral or pre-authorization from Aetna Better Health.
Quality care for you comes first. Making sure our members get quality and timely care is very important. In fact, we have a Quality Management Department committed to ensuring quality for our members. Did you know? The goal of the Aetna Better Health Quality Management (QM) Program is to keep improving our service to you. We do this in many ways. We track and review problems and answer any concerns you may have. We check the credentials of all providers before they can be included in our network. Need an advance health care directive? You have the right to accept or refuse any medical care. A time may come when you are too sick to talk to your PCP, family, or friends. You may not be able to tell anyone what health care you want. The law allows adults to do two things before this happens. You can make an advance directive. This allows you to: Leave written directions about your medical treatment decisions Name someone you trust to decide your care for you If you want a family member or friend to make decisions about your care for you when you cannot, you must ask the person first. You will need to have this person sign the directive with you. To get more information about an Advance Health Care Directive, call Member Services or look on page 25 of your Member Handbook. We help members get regular health checkups and preventive shots. Examples are yearly physicals, eye exams, dental exams, mammograms, pap smears and flu shots. We make sure members can reach doctors by phone, and get a timely appointment. We also make sure you have a choice of doctors located near your home. We track things like how many of our members need to be readmitted after discharge. We also look at how many members have problems after surgery or a procedure. We make sure we answer your calls quickly and pay claims correctly and on time. We check and monitor our services to ensure our members language, cultural and ethnic needs are met. If you have any questions about our QM Program, please visit our Quality Matters page at www.aetnabetterhealth.com/mo or call Member Services at 1-800-566-6444.
Controlling your Diabetes Nephropathy Diabetic nephropathy is damage to your kidneys due to diabetes. The kidneys have many tiny blood vessels. The blood vessels filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. The kidneys are not able to do the job as well when this happens. There are no symptoms in the early stages so it s important to have your diabetic provider regularly check you for nephropathy. Screening Your diabetic provider can check you by using tests that see if you have protein (albumin or microalbumin) in the urine. Finding out if you have protein in the urine is important. It will help to prevent further damage to the kidneys. Treatment We need your help! Keeping your blood glucose and blood pressure in control will help. Diabetic kidney disease can be prevented by keeping blood sugar in your target range. Talk to your doctor about what your target blood sugar range should be. A mild rise in blood pressure can make nephropathy worse. Losing weight and getting regular exercise can help lower your blood pressure. Eating less salt and staying away from alcohol and tobacco can help too. Medicines may be used to lower blood pressure. Not everyone with diabetes has kidney problems. The better a person keeps diabetes and blood pressure under control, the lower the chance of getting nephropathy. Sources: American Diabetes Association, Web MD Aetna Better Health of Missouri will be mailing a survey soon to ask members about their experiences with behavioral health (BH) services. In the next few weeks you may receive a survey in the mail asking you or a parent/guardian about the BH care you received. By answering the questions, you will help our health plan serve you even better. Parents/guardians will likely get a follow up telephone call if no reply to their child s paper survey. We hope you take the time to answer the survey questions. It is important to us to find out how to improve your BH care. And, what you have to say will be kept private. If you choose not to complete the survey your choice will not affect the benefits or services you get. Thanks in advance for your help!
This is general health information and should not replace the advice or care you get from your provider. Always ask your provider about your own health care needs. AETNA BETTER HEALTH OF MISSOURI 10 South Broadway Suite 1200 St. Louis, MO 63102 Esta es información general de salud y no debe reemplazar el asesoramiento o la atención que usted recibe de su proveedor. Siempre consúltele a este sobre sus necesidades de atención médica. MO-16-09-20 AET17026-11/10/16 Important toll-free numbers In this issue: Use your transportation Know your PCP / Questions Time for a flu shot? Filing grievances & appeals Member Services 1-800-566-6444 Transportation 1-800-688-3752 Transportation Fax 1-888-513-1610 Behavioral Health 1-800-566-6444 24-Hour Nurse Line 1-800-475-1142 CMPCN 24-Hour Nurse Line 1-888-670-7264 (Children's Mercy Pediatric CARE Network) Family Support Division (FSD) Information Center 1-855-373-4636 Child Abuse/Neglect Missouri Hotline 1-800-392-3738 24-Hour Parent Support Line 1-888-281-3000 Missouri School Violence Hotline 1-866-748-7047 Poison Control Center 1-800-222-1222 Child Support General Information 1-800-859-7999 Food Stamp Hunger Line 1-800-392-1261 MO HealthNet Participant Services 1-800-392-2161 Smoking Cessation 1-800-QUITNOW TTY/TDD 711 or 1-800-735-2966 To receive a translated copy of this document, call Member Services at 1-800-566-6444. Para recibir una copia traducida de este documento, llame al servicio para miembros al 1-800-566-6444.