source When you see HIL at the end of a story, just call 1-800-999-1658. Then, enter the four-digit code to hear recorded health messages from our Health Information Library. A guide to your health plan Fourth Quarter 2008 Things to Know Mental Health Crisis Services You re not alone The Tennessee Mental Health Crisis Information Line is 1-800-809-9957. You can call 24 hours a day, every day. This line is always open to anyone who is in crisis. When you call, you will speak with the closest crisis team. They can help you arrange to see someone right away. Someone is always on hand to answer questions and locate crisis services. Most mental health services are covered under TennCare. Substance abuse services for adults are limited. The lifetime maximum substance abuse benefit is:» Ten days in detox» $30,000 in treatment. Methadone clinic services are not available for adults. If you have any questions, call Customer Service at 1-800-263-5479. Enter to win a $100 gift card! See page 7. Do you need a flu shot? A blanket and a bowl of soup might make you feel better if you get the flu. But not getting the flu in the first place is better medicine. So ask your doctor if you or others in your family should get a flu shot. It s one of the best ways to stay healthy. The shot is free for TennCare members. Flu shots can be especially important for some people, such as: Children 6 months to 18 years Adults 50 and older Those with health problems, such as heart disease or asthma Women who will be pregnant during flu season. And you might need a shot if you spend time with others who are at high risk. Sometimes there may not be enough flu vaccine for everyone, so check with your doctor to see if you should get a shot. Some people should not get a shot, such as babies less than 6 months old. There is also a flu vaccine that comes in a nose spray instead of a shot. It can be given to most healthy people ages 2 to 49. Source: Centers for Disease Control and Prevention Para información acerca de TennCare en español, llame al 1-866-311-4290.
children s health Don t let frost bite During warm fall days, it may seem like winter and its harsh coldness are far away. But it is important to be prepared and to keep some safety tips in mind. Protect yourself and children from frostbite. When outdoors, wear warm clothing, such as hats, gloves and jackets. Avoid staying outside FREE GIFT Checkups for preteens Why older kids still need checkups Your child is almost a teen. Even so, he or she needs regular checkups. Checkups are important for older kids, too. Even kids who are healthy and strong. Why checkups are needed The preteen checkup is for 11- and 12-year-olds. This is a good time to make sure your child is healthy. It s also important to check that your preteen has had these shots: Chickenpox Hepatitis B MMR (measles, mumps, rubella) Flu. These vaccines can help prevent serious diseases. Your child may have already had these shots at a unprotected for long periods. At the first signs of skin redness or pain, get out of the cold and protect any exposed skin. Watch for skin that has turned white or grayish and feels firm, waxy or numb. Seek immediate medical attention if you have any of these symptoms. To learn more, call 1-800-CDC-INFO (1-800-232-4636). HIL 4922 Keep your hands warm this winter with a free pair of stretch knit gloves. Just call 1-800-231-4890 and request your gloves. But hurry. Supplies are limited. younger age. But this is a good time to make sure your preteen is up-to-date. The good news is that these checkups and shots are free through the TENNderCare Program for TennCare kids up to age 21. There are also some vaccines just for 11- and 12-year-olds. During this time, kids start middle school or may go to camps more. This can raise their risk for getting different diseases. MCV4. This vaccine can help Checkups are important even when kids are healthy. protect your child from a serious infection called meningitis. It can cause serious health problems, such as hearing loss. Meningitis can also cause death. Tdap booster. This vaccine protects against tetanus, whooping cough and diphtheria. Whooping cough is very contagious. HPV vaccine (for girls). HPV stands for human papillomavirus. This shot helps protect against the virus that can cause cervical cancer. If your preteen hasn t seen the doctor in a while, schedule a checkup soon. Source: Centers for Disease Control and Prevention To learn more about kids health, go to the American Academy of Pediatrics Web site at www.aap.org. 2
wellness Are you eligible for a free Weight Watchers class? Many medical problems can result from obesity. Some of these problems include heart disease, type 2 diabetes, asthma and depression. But there s help! If you are overweight and you have a body mass index (BMI) of 25 or more, or if you have a doctor s referral, you may be eligible for a free, 12-week Weight Watchers class. How do you determine your BMI? It s a math formula that measures the ratio of weight to height. A BMI of 30 or more is considered obese. Ask your primary care provider what your BMI is. TennCare will even provide a free ride to the class if you need one. The program is not open to pregnant women or people diagnosed with eating disorders. A doctor s referral is required for anyone between the ages of 10 to 17. To see if you qualify, call 1-800-651-6000. Or call TennCareSelect Customer Service to find out if there is a participating Weight Watchers near you. Weight Watchers is an independent company serving BlueCare and TennCareSelect members. HIL 4719, 4728, 4667 Did you know? TennCare will pay for: An emergency ambulance ride to the emergency room A nonemergency ambulance ride when your doctor, caseworker or social worker Check for chlamydia Are you a sexually active woman younger than 26? You may have a sexually transmitted disease (STD) and not even know it. TennCare will pay for testing for STDs, including chlamydia. Chlamydia is one of the most common STDs. It is a bacterial infection that you can get during vaginal, oral or anal sexual contact with an infected partner. In about 70 percent of people infected, there are no symptoms. But it can still cause serious problems. The infection, if severe, can prevent a woman from having a baby. Or it can cause newborn babies of infected mothers to be born with infections. It can also cause painful urination and yellowish discharge from the vagina or penis. If you do have chlamydia, it can be treated with antibiotics. To learn more, talk to your doctor. HIL 9572 schedules the ride Preventive care that helps keep you well and catches health problems early. This care includes health education about birth control. You do not pay any copay. 3
member news Your safety comes first TennCare s the safety of its members seriously. That s why 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 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 given by a registered nurse or a licensed practical nurse who is not an immediate relative. However, if an intermediate or skilled nursing facility can give the required care at a lower cost than private-duty nursing, the member has two options: 1. Get services from a nursing facility 2. 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. Minorities have greater health risks In Tennessee, African-Americans make up the minority group with the highest death rate for most diseases. Protect yourself by knowing the risks, staying active and watching your weight. Making strides in quality The safety and quality of care and service that you get as a TennCareSelect member is important to you and to us. That s why we have a Quality Improvement Program (QIP). Every year we evaluate the program for: The quality of care our members receive The suitability of care our members receive The ease of getting care. The QIP program targets certain chronic conditions by providing member education to improve the rates of: Breast and cervical cancer screenings Well-child checkups Immunizations Care before and after giving birth Diabetes management. Our QIP is approved by well-known outside quality groups such as: The National Committee for Quality Assurance (NCQA) URAC The External Quality Review Organization (EQRO) for the Bureau of TennCare. For more news about our QIP, call 1-423-535-6221. 4
You have rights Fair 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. 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 1-800-263-5479 Mental health care, call 1-800-325-7864 Dental care, call 1-888-233-5935. Medical appeals. If you are unhappy with a decision to deny a medical service, you can appeal or ask for another answer. You can also appeal if: TennCare stops or changes your health care your health You have to wait too long to get health care You have health care bills you think TennCare should pay for but didn t. You have 30 days to appeal after you find out there is a problem. You can appeal by: Using the Medical Appeal Form in your TennCareSelect Member Handbook Writing to: TennCare Solutions P.O. Box 593 Nashville, TN 37202-0593 Calling TennCare Solutions at 1-800-878-3192. more rights To see a list of the rights and duties of TennCareSelect members, visit vshptn.com. Or call TennCareSelect Customer Service. How to get help to stop tobacco use Quitting smoking is one of the most important things you can do to protect the health of your unborn baby. The Tennessee Tobacco QuitLine is available to help. Call 1-800-QUIT-NOW, or 1-800-784-8669. The service 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 make a plan to kick tobacco use for good and provide tips to stay on track. The QuitLine is available Monday through Friday from 8 a.m. to 11 p.m., Saturday from 9 a.m. to 6 p.m., and Sunday from 11 a.m. to 5 p.m., Eastern time. Counseling is available in both Spanish and English. QuitLine services for people who are deaf and hard of hearing are available by calling 1-877-559-3816. For more information on quitting tobacco use and the Tennessee Tobacco QuitLine, visit the Web site health.state.tn.us/tobaccoquitline.htm. HIL 3361, 3362 ask your doctor Your doctor may also give you advice on how to stop smoking. Just ask. 5
Doral Dental ** care What is preventive dentistry? Preventive dentistry means a healthy smile for your child. You should begin regular dental visits when your child s first tooth comes in. You will learn how to protect your child s dental health. The earlier your child begins visiting the dentist, the better you will be able to prevent dental disease and help your child be cavity-free. Preventive dentistry for children includes: Seeing the dentist every six months Brushing Flossing Fluoride Sealants Proper diet Parent involvement. Dentists have known for a long time that having a healthy mouth helps your child have a healthy body. Children with healthy mouths: Chew more easily Learn to speak clearly Have better general health Have confidence in their appearance. Children on TennCare have TENNderCare (EPSDT) dental services until they reach the age of 21. These services include regular six-month checkups at no charge, fluoride treatments and sealants. If you have TennCare, call Doral Customer Service at 1-888-233-5935 or visit the Web site doralusa.com for: Help finding a dentist Questions about your TennCare dental benefits Help with interpretation and translation Help with a ride to the dentist. HIL 3852, 3856 Health clinic doctors must be in network Community health clinics are a convenient way to get care. Your primary care provider (PCP) may work at a clinic. Even if your PCP does not work at a clinic, you may use a clinic for some medically necessary services. This includes well-woman exams. The clinic doctor must be in the TennCareSelect network. You can call Customer Service to check if a doctor is in the TennCareSelect network. The phone number is on the back of your TennCareSelect member ID card. Find a PCP online, a health clinic doctor and other network providers. The listing is updated nightly. Go to vshptn.com. 6
Tape to close source BUSINESS REPLY MAIL FIRST-CLASS MAIL PERMIT NO. 483 CHATTANOOGA TN POSTAGE WILL BE PAID BY ADDRESSEE NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES GOVERNMENT PROGRAMS COMMUNICATIONS 3E 801 PINE STREET CHATTANOOGA TN 37402-9837 Fold Fold Enter to win and tell us what you think Get your name in a drawing for a $100 Wal-Mart gift card*. Let us know what you think about your TennCareSelect newsletter. It s easy. Just answer the questions to the right. Cut off this page, fold it along the lines that are marked and tape it shut so that the 801 Pine St. address is showing. Drop it in the mail. You do not need a stamp. You do not have to fill this out if you don t want to. This does not affect your benefits in any way. *No TennCare funds have been used for this gift card. Thank you for your time and input. We look forward to serving you in the future. 1. When you get your TennCareSelect newsletter, do you most often: Read it yourself Have someone read it to you Throw it away without reading Give it to someone else 2. Are the articles easy to understand? Yes No Sometimes 3. Does the newsletter keep you informed with health tips that you can use? Always Sometimes Never 4. Are the articles interesting? Yes No Sometimes What kind of articles would be interesting to you? 5. Does the newsletter keep you informed about how to use your TennCare benefits? Yes No Sometimes 6. Have you ever visited the TennCareSelect Web site at vshptn.com? Yes No Fold Fold Name Address 7
numbers to know Talk to a nurse* anytime day or night. 1-800-262-2873 TennCareSelect Customer Service Call about your physical health care; your health plan; help for free interpretation and translation services; or to ask for TENNderCare information in formats for members who are blind or deaf, cannot read, or do not speak English. M F, 8 a.m. to 6 p.m. Eastern time (ET). Calls received after normal business hours will be forwarded to voice mail. 1-800-263-5479 TDD/TTY (only for members with impaired hearing): 1-800-226-1958 Premier Behavioral Systems of Tennessee, LLC** Call about your mental health care, your alcohol and drug abuse treatment, or a ride to your behavioral health visit. 1-800-325-7864 Doral Dental Customer Service** Call about dental (teeth) care for children under age 21. M F, 8 a.m. to 6 p.m. ET 1-888-233-5935 Note: This newsletter is not meant to the place of your doctor s advice. This document is classified as public information. *A service of an independent company serving TennCareSelect members. **An independent company serving TennCareSelect members. A government agency. Family Assistance Service Center (TennCare hotline) Call about: Applying for TennCare Appeals to get or keep TennCare TennCare premiums and copays Change of address or income Programs like food stamps or Families First. M F, 9 a.m. to 5:30 p.m. ET English: 1-866-311-4287 Nashville: 743-2000 Spanish: 1-866-311-4290 TDD/TTY (only for members with impaired hearing): 1-800-772-7647 Report possible fraud Call to report TennCare fraud or abuse. TennCare: 1-800-433-3982 Medicaid: 1-800-433-5454 TennCareSelect: 1-800-496-9600 Dental: 1-888-233-5935 Transportation* If you need a ride to see your doctor, to get medical care, to go home after a hospital discharge or to go to the pharmacy to get prescription medicine, call toll-free 1-866-473-7565. 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 arranged. In case of bad weather, a ride will be provided only if the place you are going is open. If you need a ride to mental health or substance abuse care, call 1-800-325-7864. source 801 Pine St. Chattanooga, TN 37402-2555 vshptn.com Volunteer State Health Plan, Inc. (VSHP), and BlueCross BlueShield of Tennessee, Inc. (BCBST), are independent licensees of the BlueCross BlueShield Association. VSHP is a licensed HMO affiliate of BCBST. No one is treated in a different way because of race, color, birthplace, language, sex, age, religion or disability. Do you think you ve been treated unfairly? Do you have more questions? Do you need more help? You can make a free call to the Family Assistance Service Center at 1-866-311-4287. In Nashville, call 743-2000. Copyright 2008 Coffey Communications, Inc. WHN22481p Presorted Standard U.S. Postage PAID St. Cloud, MN Permit No. 2260 T