Amerigroup Community Care MakeHealth Happen Antibiotics kill Bacteria strep throat sinus infections some types of pneumonia NOT viruses common cold the flu The Truth About Antibiotic Use When you feel sick, you want to feel better fast. Taking antibiotics may seem like the quickest way to get well. But they are not the answer for every illness. In fact, using antibiotics at the wrong times can actually be harmful. The Risk Most illnesses are caused by two kinds of germs: bacteria or viruses. Antibiotics kill bacteria, not viruses. Using antibiotics when they are not needed causes some bacteria to become resistant to the antibiotic. These resistant bacteria are stronger and harder to kill. Bacteria cause strep throat, sinus infections and some types of pneumonia. Viruses cause the common cold and the flu. Using Antibiotics for a Virus WILL NOT: n Cure the infection n Help you feel better n Keep others from catching your illness What Can You Do? Here are some simple rules that can help you use antibiotics wisely: n Trust your health care provider to decide if you need antibiotics or not n Do not take antibiotics prescribed for a previous illness or prescribed for someone else n If you are prescribed antibiotics, be sure to take all of the medicine To learn more, talk to your health care provider or visit www.cdc.gov/getsmart. Quarter 3, 2012 Inside this issue: Diabetes Care from Head to Toe Member Services TennCare 1-800-600-4441 CHOICES 1-866-840-4991 TTY 1-800-855-2880 TTY Español 1-800-855-2884 Amerigroup On Call 1-866-864-2544 1-866-864-2545 (Español)
The Being a Benefits of CHOICES Member There are many benefits to being a TennCare CHOICES in Long-Term Care member. Whether you or a loved one needs care in a full-time nursing facility or a little extra help in a home-based setting, we ve got you covered. Here is a listing of our benefits and services: Benefits and Services Nursing Facility Care Community-Based Residential Alternative Adult Critical Care Home Assisted Living Care Facility Home and Community Based Services (HCBS) Companion Care Personal Care Attendant Care Homemaker Home-Delivered Meals Personal Emergency Response System (PERS) Adult Day Care In-Home Respite Care In-Patient Respite Care Assistive Technology Minor Home Modification Pest Control TennCare CHOICES in Long-Term Care, or CHOICES for short, is TennCare s program for long-term care services. Long-term care services include care in a nursing home. Long-term care also includes care in your own home or in the community. This type of care may keep you from having to go to a nursing home for as long as possible. If you think you need long-term care services, you can call Amerigroup at 1-866-840-4991. A Real CHOICES Success Story Vicki, Dorothy and Karen When Ms. Dorothy Harper entered a nursing facility, there were no signs she would ever be able to live on her own again. But despite her many health issues, the CHOICES program made it possible. Now, Ms. Harper receives daily visits from a caregiver in her home to help with personal needs, meals and medication reminders. Through CHOICES, she was given money to buy things she needed for her new home. Two days a week, Ms. Harper visits an adult day center through her CHOICES benefit. There she enjoys being in the pool and taking part in other activities. To learn more about how you or a loved one may benefit from the CHOICES in Long-term Care program, please call 1-866-840-4991 (TTY 1-800-855-2880).
Diabetes Care from Head to Toe Did you know diabetes can affect your body from head to toe? When diabetes isn t managed well, it can hurt your eyes, heart, blood vessels, kidneys, nerves and feet. Seeing your health care provider for regular checkups and screenings is one good way to help protect your overall health. Amerigroup has a care management program. If you have diabetes, a care manager can work with you by phone to help you set goals and create a care plan. You ll learn to take small steps toward better health and to get past the things that may be getting in your way. Your care manager can help you: n Set up a doctor s appointment n Identify health goals and create a care plan n Obtain and use a glucometer for testing your blood sugar n Find information about diabetes education programs in your area n Arrange for transportation or other special needs n Learn about diabetes People with diabetes are at risk for diabetic retinopathy, which can lead to loss of vision. Since there are no symptoms in its early stages, seeing an eye doctor once a year for a dilated retinal eye exam is the best way to help protect your sight. Kidneys Eyes Over time, having blood sugar that s too high can damage your kidneys and other organs. Checking your blood sugar at home often should be part of your diabetes care plan. It is also important to go for an HbA1c test every six months. This test shows your average blood sugar level over the past two to three months. Feet Heart Having diabetes also puts you at higher risk for heart disease. If you have diabetes, be sure to have your blood pressure checked at each health care visit and your cholesterol checked at least once a year. Nerve damage and poor circulation can lead to infections or make it harder for foot injuries to heal. Be sure to have your health care provider check your feet for sores at every visit. And see a podiatrist or foot doctor for a thorough foot exam at least once a year. To find out more about our diabetes care management program or to speak with a care manager, please call us at 1-888-830-4300 (TTY 1-800-855-2880).
Hospital to Home:Getting the Right Care If you or a loved one were ever in the hospital for a behavioral health condition, you know how stressful it can be. It may have involved a major change in your home life or support system. Here are three important reasons to go for follow-up care within the first week of discharge from the hospital: 1 Staying out of the hospital. Studies show those who see a behavioral health specialist soon after leaving the hospital are far less likely to have to go back. 2 3 Finding a medication that works. By going for a follow-up visit within the first week of discharge, your health care provider can help make sure your medication is working well and address any side effects you may be having. Fitting in again. Depending on how long you were away from family or friends, coming home may be hard at first. You may feel like you don t fit in right away. Talking with a trained behavioral health specialist can help you and your loved ones readjust. Taking Care of Baby Me and Amerigroup has a special program for pregnant women called Taking Care of Baby and Me. You do not have to enroll. As soon as we learn you are pregnant, we ll send you the program information in the mail. Through the program, you will: n Have the chance to receive free gifts for going to doctors visits during and after your pregnancy Do you still have concerns about getting follow-up care? Read the statements below and put a check in the box next to all that apply: I feel better and do not think I need to go for a follow-up visit. I do not have a behavioral health specialist who has worked with me before. I do not have a way to get to the appointment. I am embarrassed about having a mental health diagnosis. Whether you checked one of the above or all, we can help. Amerigroup case managers are here for you during this transitional time. A case manager can assist you with scheduling or rescheduling your discharge appointments and linking you to additional services, if needed. Don t be afraid to ask for help. Please remember now or in the future a case manager is here to offer you support. Please call us at 1-800-600-4441 (TTY 1-800-855-2880). n Learn about how to have a healthy pregnancy n Receive a self-care book and other brochures to help you through your pregnancy We screen all of our pregnant members for high risk. Those at high risk will be referred to an Obstetrics (OB) case manager at Amerigroup. An OB case manager will work with you one-on-one over the phone. We can also help you with things like scheduling doctors visits or arranging for a ride. To find out more about the program or to let us know you are pregnant, please call Member Services at 1-800-600-4441 (TTY 1-800-855-2880).
We care about your health and the health of your baby. We know you do too. One of the most important things you can do during your pregnancy is to go for regular prenatal checkups. Prenatal checkups are the care you receive from a doctor while you are pregnant. These checkups can help catch problems early and help you avoid giving birth too soon. AreYou Pregnant? At most prenatal visits, you can expect your health care provider to: n Check your blood pressure and weight n Check the baby s heart rate n Measure your abdomen to check your baby s growth???? You may also have some routine tests done throughout your pregnancy. These tests check for things like anemia, gestational diabetes and harmful infections. Use the chart below to help you keep track of your health care during and after your pregnancy. Fill in the date of your next scheduled visit. Then, check the box when it is complete. Weeks of Pregnancy 4 through 28 28 through 36 36 through birth Postpartum Checkup (3-6 weeks after birth) Note: This is the number of checkups recommended for a routine pregnancy. Women with high-risk pregnancies may need to go for prenatal visits more often. It is also important to go for a postpartum checkup between 3 to 6 weeks after you give birth. This is about how long it takes for your body to heal. Once your baby is born, Amerigroup will cover TENNderCARE services. TENNderCARE is a program that provides free checkups for eligible children younger than 21 years of age. When you have your baby, ask to speak to the social worker at the hospital. The social worker where you have your baby will help you get your new baby enrolled for TENNderCARE services.
Utilization Management Notice Amerigroup follows the standards set forth by the National Committee for Quality Assurance (NCQA). All Utilization Management (UM) decisions are based solely on a member s medical needs and available benefits. Amerigroup policies do not encourage the under use of services through its UM decision process. Practitioners and others involved in UM decisions do not receive any type of reward for denial of care or coverage. Our Notice of Privacy Practices This type of notice explains how medical information about you may be used and disclosed by Amerigroup Community Care. It also tells you how to access this information. The notice follows the privacy regulations set by the Health Insurance Portability and Accountability Act (HIPAA). If you would like a copy of our Notice of Privacy Practices, please call Member Services. We do not allow unfair treatment in TennCare. No one is treated in a different way because of race, color, birthplace, religion, language, sex, age or disability. Do you think you ve been treated unfairly? Do you have more questions or need more help? If you think you ve been treated unfairly, call the Family Assistance Service Center for free at 1-866-311-4287. In Nashville, call 743-2000. Need help in another language? You can call Amerigroup Community Care for language assistance at 1-800-600-4441 (TennCare), 1-866-840-4991 (CHOICES) or the numbers below. Interpretation and translation services are free to TennCare members. Foreign Language Lines call if you need help and need to speak with someone in one of these languages: Do you need help with this information? Is it because you have a health, mental health or learning problem, or a disability? Or do you need help in another language? If so, you have a right to get help; and we can help you. Call Amerigroup Community Care at 1-800-600-4441 (TennCare) or 1-866-840-4991 (CHOICES) for more information. Do you have a mental illness and need help with this information? The TennCare Advocacy Line can help you. Call them for free at 1-800-758-1638 (TTY 1-877-779-3103). If you have a hearing or speech problem, you can call us on a TTY/TDD machine. Our TTY/TDD number is 1-800-855-2880. Habla español y necesita ayuda con esta carta? Llámenos gratis al 1-800-600-4441 (TennCare) o 1-866-840-4991 (CHOICES). To report fraud or abuse to the Office of Inspector General (OIG), you can call toll free 1-800-433-3982. Or go online to www.state.tn.us/ tenncare and click on Report Fraud. To report provider fraud or patient abuse to the Tennessee Bureau of Investigation s Medicaid Fraud Control Unit, call toll free 1-800-433-5454. Amerigroup Community Care P.O. Box 62509 Virginia Beach, VA 23466-2509 www.myamerigroup.com/tn
Amerigroup is a culturally diverse company. We welcome all eligible individuals into our health care programs, regardless of health status. If you have questions or concerns, please call 1-800-600-4441 (TennCare) or 1-866-840-4991 (CHOICES) (TTY 1-800-855-2880) and ask for extension 34925. Or visit www.myamerigroup.com. If you don t have a way to get to your health care visits, you may be able to get a ride. You can get help with a ride: Only for your TennCare services and Only if you don t have any other way to get there If you are a child under the age of 21, you can have someone ride with you. If you need help with a ride, you can call 1-866-680-0633. Amerigroup Community Care has a Quality Management/Quality Improvement (QM/QI) program that defines and guides our processes, including how we look at patient safety. We listen to your comments and look at claims data to help us determine where we need to make improvements. If you would like information about the data we collect related to performance, our efforts to improve patient safety or any other information about our QM program, please write us at: Amerigroup Community Care 22 Century Blvd, Suite 310 Nashville, TN 37214 Do you need help with this information? Is it because you have a health, mental health or learning problem, or a disability? Or do you need help in another language? If so, you have a right to get help; and we can help you. Call Amerigroup Community Care at 1-800-600-4441 (TennCare) or 1-866-840-4991 (CHOICES) for more information. Do you have a mental illness and need help with this information? The TennCare Advocacy Line can help you. Call them for free at 1-800-758-1638. If you have a hearing or speech problem, you can call us on a TTY/TDD machine. Our TTY/TDD number is 1-800-855-2880. Habla español y necesita ayuda con esta carta? Llámenos gratis al 1-800-600-4441 (TennCare) o 1-866-840-4991 (CHOICES). We do not allow unfair treatment in TennCare. No one is treated in a different way because of race, color, birthplace, religion, language, sex, age or disability. Do you think you ve been treated unfairly? Do you have more questions or need more help? If you think you ve been treated unfairly, call the Family Assistance Service Center for free at 1-866-311-4287. In Nashville, call 743-2000. Need help in another language? You can call Amerigroup Community Care for language assistance at 1-800-600-4441 (TennCare), 1-866-840-4991 (CHOICES) or the numbers below. Interpretation and translation services are free to TennCare members. If you want to know more about a doctor or hospital, such as professional qualifications, please call Amerigroup Member Services at 1-800-600-4441 (TennCare) or 1-866-840-4991 (CHOICES) (TTY 1-800-855-2880). You have a right to file a complaint about Amerigroup or your care. If your complaint is about either physical health care or behavioral health care, you can call Amerigroup at 1-800-600-4441 (TennCare) or 1-866-840-4991 (CHOICES). Or write to us at: Amerigroup Community Care 22 Century Blvd, Suite 310 Nashville, TN 37214
www.myamerigroup.com/tn PRSRT STD U.S. Postage PAID Amerigroup P.O. Box 62509 Virginia Beach, VA 23466-2509 www.myamerigroup.com/tn 7630-TN Make Health Happen is published by Amerigroup to give information. It is not a way to give personal medical advice. Get medical advice directly from your physician. 2012. All rights reserved. Printed in the USA. TENNderCARE at a Glance TENNderCARE is a program that provides free checkups for eligible children younger than 21 years of age. Every child and teen needs regular health checkups, even if they seem healthy. TENNderCARE also pays for all medically necessary care to treat problems found at the checkup. What happens at a wellness checkup? n Health history n Physical exam n Lab tests (as needed) n Immunizations n Vision/hearing screening n Developmental/behavioral screening (as needed) n Advice on how to help keep your child healthy It s easy for your child to get a wellness checkup. Just call your child s doctor and schedule a visit today. If you need help with a ride, you can call 1-866-680-0633. TN HP-C-0637-12 05.12