My Health 2010 Kids Need Checkups and Screenings When you think of checkups, are shots the first thing that comes to mind? While kids do need checkups to get their shots, there are other important tests kids need at checkups. For example, at age 3 your child should have a vision and hearing test. Doctors also check how kids develop as they grow. Your child needs these checkups, or well visits. How often? The American Academy of Pediatrics says to get well-child visits at these ages: Birth 3 to 5 days By 1 month 2 months 4 months 6 months 9 months 12 months 15 months 18 months 24 months 30 months Ages 3 to 21 years: at least one well visit per year The good news is that we pay for well visits for children. To schedule one, call your child s primary care provider, or PCP. Be sure to ask if your child has had all needed shots and vaccines. Sources: American Academy of Pediatrics Periodicity Schedule, www.aap.org; Bright Futures (2008) Text4Baby If you are about to have a baby or are a new mom, there s a lot to do for your child. You can get free health reminders during your pregnancy and your child s first year of life texted right to your phone. These messages help you remember important checkups. You also can get health tips for you and your baby. To be part of this program for moms-to-be and new moms, just enroll. It s easy. Simply text the word BABY to 511411 (or BEBE in Spanish). After enrolling, please text the word PLUS to 511411 to let them know you are an Anthem HealthKeepers Plus member. Program for Pregnant Members Expecting a baby? Did you know you could be part of our Future Moms prenatal program? This program does not cost anything for Anthem HealthKeepers Plus members. It explains more about pregnancy, childbirth, infant care and breastfeeding. You ll learn how often to see the doctor during and after your pregnancy. For example, doctor visits after your baby is born are just as important as prenatal visits while you are pregnant. Call 1-800-828-5891 to enroll today! VA Presorted Standard U.S. Postage PAID Platteville, WI Permit No. 7 ANTHEM HEALTHKEEPERS PLUS BY HEALTHKEEPERS, INC. 277 BENDIX ROAD SUITE 100 VIRGINIA BEACH VA 23452-1361 My Health 1
You Get More Benefits Thank you for being an Anthem HealthKeepers Plus member. We want to let you know about some improvements in your benefits. Mental Health We have removed limits for inpatient hospital days and outpatient visits for mental health or substance abuse treatments. But the inpatient days or outpatient visits must be medically needed. Babies Born to FAMIS MOMS Members Newborns of FAMIS MOMS members are now eligible for coverage during their birth month and the next two months. If you are a FAMIS MOMS member, please call Member Services toll-free at 1-800-901-0020 when your baby is born in order to get this coverage. You must also call the FAMIS Central Processing Unit at 1-866-873-2647 to continue coverage for your baby. Copays for FAMIS Members Maternity Services FAMIS members will no longer have copays for maternity-related services or well-child visits. Extra Benefits for Members Anthem HealthKeepers Plus members who are pregnant now have coverage for treatment of tobacco abuse, including stop-smoking counseling services and drugs, with no copay. Early Intervention Services You still have early intervention services (a program for young children with developmental delays) available to you, but they are no longer provided by your plan. Instead, these services are now provided by the Department of Medical Assistance Services (DMAS). If you would like a Provider Directory or have questions about these benefit changes, call toll-free 1-800-901-0020. If you have speech or hearing loss, call the TTY line at 1-757-326-5185 (Tidewater area) or 1-800-247-9843 (outside Tidewater area). You also can find a provider on our website at www.anthem.com. Checkups Count See Our Poster Contest Winners ADHD? Don t Forget the Follow-Up Doctor Visit Has your child just been prescribed a drug for attentiondeficit/hyperactivity disorder (ADHD) or attention-deficit disorder? If so, you need to follow up with a visit to your child s doctor within 30 days of when your child started taking the drug. It s important for the doctor to make sure the drug is working the way it should. If your child just resumed taking a drug for ADHD, you also should schedule a doctor visit within 30 days of when your child started taking the drug again. Going to this doctor visit is crucial because some drugs don t work right away. Your child s doctor may need to try dierent drug types and amounts. Also, some drugs can have strong side eects that aect appetite, mood or sleep. To keep your child safe, check in with your doctor once your child has been taking the drug for a few days. We want to thank the members who sent in posters for our Checkups Count contest. We applaud these winners of our poster contest they really know why Checkups Count! Ages 5 to 7: Walter E., age 7 Ages 11 to 13: Sheyla M., age 13 Ages 8 to 10: Darwin L., age 8 2 My Health
Worried About Your Child s Weight? Knowing Body Mass Index (BMI) Can Help! One step you can take to help watch your child s weight is to have his or her BMI measured. You can ask the doctor or nurse to check your child s BMI during your child s next checkup. BMI is one way that doctors can get an idea about how much body fat your child has. It s a number that measures how your child s weight compares to his or her height. The higher a BMI is, the higher the amount of fat in the body. Checking BMI is simple. The doctor or nurse weighs your child and measures his or her height. Then he or she marks those two numbers on your child s growth chart. That way he or she can find your child s BMI on the chart. It helps your doctor know if your child is growing at a healthy rate. So the next time you get a checkup for your child, ask your child s PCP to check your child s BMI too. Be Part of the Alliance for a Healthier Generation Pilot This year we are part of an Alliance pilot program to help children make healthier lifestyle choices. If your child is an Anthem HealthKeepers Plus member, ask your child s PCP for your child s body mass index (BMI) during the next well-child visit. It s simple, easy and painless. If your child has a BMI above the 85th percentile, he or she may be able to be part of this program. It includes four no-cost visits with a dietitian to help teach your child about healthy food and physical activity choices and four well visits with your child s PCP or other professional. To be part of the program, ask your child s PCP to check your child s BMI. The Dangers of Lead for Young Children Lead poisoning happens when you get too much lead in the bloodstream. We all have some lead in our blood. Too much lead can be harmful to the organs and brain. Lead is invisible and has no smell. You can find it in paint and plastic. It s banned in U.S. house paint now but was used on houses until 1978. Lead poisoning is a great concern for children under age 6, because they grow so fast and tend to touch everything and put things into their mouths. This can be a problem if the items have lead or lead dust on them. There are often no obvious signs of lead poisoning. It s important for all children to get a blood-lead test at age 1 (12 months) and again at age 2 (24 months). Your child s PCP can make sure your child gets a blood-lead test on schedule. What You Can Do To help prevent lead poisoning: Keep kids away from peeling paint on surfaces. Pay attention to the painted toys you buy; choose those with lead-free labels. Only buy cookware, plates, cups and silverware with lead-free labels. Don t give your child candies from other countries. Use only cold water for making baby formula, drinking or cooking, as hot water is more likely to have higher lead levels. Cover peeling paint with contact paper or duct tape or block o the areas. Wash kids hands and toys often. Wet-mop floors and wet-wipe windows every two to three weeks. Windowsills can have a lot of lead dust. Keep kids from playing in soil. There is often lead in the soil around a home. Talk to your state or local health department if you are worried about paint and dust in your home. Source: Centers for Disease Control and Prevention, www.cdc.gov/nceh/lead/tips.htm My Health 3
What You Can Request Anthem HealthKeepers Plus members can ask for and get certain information, including: Names, addresses and telephone numbers of network providers and the languages they speak besides English. Names of providers not accepting new patients. (The information will include PCPs, specialists and hospitals in your service area.) Any limits to your freedom of choice among network providers. Information on how to make a complaint or appeal and how to ask for a fair hearing. Benefits oered under the program in enough detail to make sure that you understand your covered benefits. How to get benefits, including getting your health plan s OK. How to get benefits, such as family planning services, from out-of-network providers. How to learn the limits to those benefits. How to get care in emergencies or when your doctor s oice is closed. How to learn about any limits on what we pay for. The policy on referrals for specialty care and for other benefits not given by your PCP. Our guidelines for provider care. This information is available to Anthem HealthKeepers Plus members on an annual basis. Looking for a Provider or Hospital? You can search for Anthem HealthKeepers Plus providers and hospitals (in English or Spanish) through the Find a Doctor tool at www.anthem.com. The online provider directory enables you to find a doctor, health professional or facility. Look for Find a Doctor on the right side of the www.anthem.com home page. If you do not have Internet access, please call Member Services at the number on your member ID card. A representative will search the website for you using the criteria you provide and mail, e-mail or fax a copy of the results to you. Care Management Can Help Our care managers, registered nurses and other qualified health professionals are here to help when you have a serious medical condition or unexpected medical event. This voluntary and confidential program teams you, your family and your doctors with a care manager who provides telephone support at your convenience and at no additional cost to you. The care manager will work with you for your identified needs which can include benefit information and what you would like to know about managing your condition. For more information or for self-referral, call us toll-free at 1-800-901-0020. 4 My Health
Do You Have Diabetes? Make Testing Part of Your Game Plan Having diabetes means more than keeping track of what you eat and getting plenty of exercise. It also means you need special checkups and tests. When your blood sugar is high, it can lead to serious problems. You can develop kidney disease, eye issues, high blood pressure, heart trouble or worse problems. Getting diabetes tests and keeping your numbers at goal can help lower your risk of serious problems. Check to see if you ve had these tests. Ask your PCP or specialist about them. Take this chart with you to the doctor s oice. With the right planning, you come out a winner! Test/Activity/ Checkup What It Is and How Often You Need It What Result Do You Want? A1C Blood test to measure blood sugar levels in the last three months At least twice a year A1C below 7% Cholesterol screening A test to check: LDL cholesterol (bad cholesterol) HDL cholesterol (good cholesterol) Triglycerides Once a year LDL below 100 mg/dl HDL (male) above 40 mg/dl HDL (female) above 50 mg/dl Triglycerides below 150 mg/dl Micro-albumin Dilated retinal eye exam Foot exam Urine test to tell how well your kidneys are working Once a year Check for eye damage or disease from diabetes Once a year Check feet for problems from diabetes At least once a year Less than 30 ug/mg No sign of disease No foot problems Get Yearly Eye Exams if You Have Diabetes Caring for your eyes is important, especially when you have diabetes. That s because diabetes can damage blood vessels throughout the body, including vessels in the eye s retina. This eye damage from high blood sugar is called retinopathy. It s one of the most common problems from diabetes. It can cause vision loss and lead to blindness. Blood pressure Weight and body mass index (BMI) Test blood pressure using a cu around your arm Every doctor visit BMI is calculated based on your weight and height Every doctor visit Blood pressure below 130/80 BMI 25 or less To take care of your eyes if you have diabetes, schedule a dilated retinal eye exam with an ophthalmologist or optometrist every year. This eye exam is not the same as a routine eye exam. With a dilated eye exam, the doctor uses special eye drops to dilate the pupils of your eyes. Then the doctor looks through a scope to see the blood vessels in the back of each eye (the retina). He or she can find out if you are having signs of eye disease before it has a chance to get worse. Dental checkup Look for dental problems Twice a year No dental problems To get a dilated eye exam, you don t have to ask for an OK before seeing the eye doctor if you have diabetes. Your PCP can send you straight to the eye doctor. Flu vaccine Pneumonia vaccine Depression screening Shot or nasal spray Every year Shot At least once in a lifetime Talk to your doctor if you have: Little interest or joy in doing things Feelings of sadness or hopelessness Prevent flu Prevent pneumonia Feel better about yourself, which can help you manage your diabetes When you see an eye doctor, it is important to explain that you have diabetes. After you have your eye exam, ask the provider to send a copy of the results to your PCP or specialist. Your PCP needs to know about any changes in your eyes. He or she can change your treatment plan if needed to help prevent more damage. You and your eyes are worth it! Sources: American Diabetes Association; National Diabetes Information Clearinghouse, www.diabetes.niddk.nih.gov/dm/pubs/complications_eyes/index.htm Sources: American Diabetes Association, Executive Summary: Standards of Medical Care in Diabetes 2010 ; Centers for Disease Control and Prevention, www.cdc.gov; National Diabetes Fact Sheet, www.cdc.gov/diabetes My Health 5
Information at Your Fingertips Anytime, day or night, you can find information on our website. Looking for information about how your health plan works, and not sure where to find answers? Log on to the following areas of www.anthem.com to access valuable information. First select State Sponsored. Then select Virginia where you see Select a state. Click the orange Enter button. This takes you to the main member page. From there, you can learn a lot more about your plan. Benefits Info You can properly access health care benefits for dierent types of services including primary and specialty care, behavioral health, and hospital services or when out of the plan s service area. At the main member page, select Anthem HealthKeepers Plus Member Handbooks/ Evidence of Coverage (EOC). Then select the handbook for your plan. The handbook includes: A list of what s covered and not covered in your plan, even things that need prior approval. What is not covered by Anthem HealthKeepers Plus but is covered by Medicaid. What you have to pay for services, if anything. What happens if you go out of the service area. What happens if you use a provider not in the Anthem HealthKeepers Plus network. How to learn about providers in the Anthem HealthKeepers Plus network. How to see your PCP and get care. How to get specialty care and use the hospital. What an emergency is. How to get care in an emergency, after hours or out of the service area. How to submit a claim for covered services. How to make a complaint or grievance. How to learn about advance directives (living wills). How we make decisions about what medical technology will be covered. If you have questions or would like a paper copy of the handbook, call 1-800-901-0020. If you have hearing or speech loss, call the TTY line at 1-757-326-5185 (Tidewater area) or 1-800-247-9843 (outside Tidewater area). Quality Improvement Find out about our Quality Improvement Programs to continuously monitor and evaluate aspects of your health care experiences and how we use that information to improve the quality of our benefits and services. At the www.anthem.com home page, select Anthem Dierence. Select drop down button, Commitment to Quality and Safety. Under Quality and Safety choose Learn More >. Here you can view the 2010 Quality Improvement Program overview. Customer Care You always can: Obtain emergency care and 911 services. Obtain care after normal oice hours. File a claim for covered services. Voice a complaint or appeal a decision, including the right to independent external appeal. Get familiar with your role as a member by reading your Member Rights and Responsibilities statement. It explains how you, your provider and your health plan cooperate to ensure the delivery of quality health care benefits. Utilization Management Commitment to Our Members Utilization management (UM) is a review process that helps determine the medical necessity of certain outpatient care, inpatient stays or procedures. Our decisions are based upon standards of appropriate care drawn from medical policies, nationally recognized clinical guidelines and the applicable terms of your health benefits contract. We do not reward or oer incentives to our associates, consultants or others for denying care or service. For more information about the UM process, call us toll-free at 1-800-533-1120 weekdays (except holidays) from 8 a.m. to 5 p.m. At other times, you may leave a confidential voice mail, and our sta will return your call on the next business day during the hours above unless other arrangements are made. Supporting Coordination of Your Care Timely exchange of information between your physicians and specialists is very important. It promotes coordination of care, helps to reduce out-of-pocket costs and duplication of services, and helps ensure improved outcomes for you. You are key in your treatment, and being involved in the coordination process is essential to your receiving optimal care. What you can do: Share the names of each of your providers with all physicians who are providing your care. Make sure that you tell your physicians when you are taking medications from more than one doctor, when you are hospitalized and when you see a specialist. Sign a consent form for release of medical records to ensure your information can be shared by dierent providers. 6 My Health To read your rights, follow the steps at the beginning of this article to go to the member main page. Then select Member Rights and Responsibilities. You also can find this in your Member Handbook/Evidence of Coverage. Remember, when each of your providers knows about all aspects of your treatment, they can better care for you and your ongoing needs.
New Anthem HealthKeepers Plus Members: Get an Initial Health Exam An Initial Health Exam is your first visit with your PCP or your child s PCP. You should get it right away. Why? It helps your PCP: Learn about you and your health before you get sick. Look at past or ongoing health issues. Go over the drugs you take to make sure they work. Tell you what checkups, shots or tests you need. Study your family s medical history. Call your PCP for an exam today! If you need help making that first health exam appointment, call us at 1-800-901-0020. If you have hearing or speech loss, call the TTY line at 1-757-326-5185 (Tidewater area) or 1-800-247-9843 (outside Tidewater area). HIPAA Notice of Privacy Practices Reminder The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law governing the privacy of individually identifiable health information. We are required by HIPAA to notify you of the availability of our Notice of Privacy Practices. The notice describes our privacy practices, legal duties and your rights concerning your Protected Health Information. We must follow the privacy practices described in the notice while it is in eect. (It will remain in eect unless and until we publish and issue a new notice.) You may obtain a copy of our Notice of Privacy Practices on our website at www.anthem.com on the main member page by selecting Notice of Privacy Practices or you may contact Member Services using the contact information on your identification card. State Notice of Privacy Practices As we indicate in our HIPAA Notice of Privacy Practices, we must follow state laws that are more strict than the federal HIPAA privacy law. This notice explains your rights and our legal duties under state law. Your Personal Information We may collect, use and share your nonpublic personal information (PI) as described in this notice. PI is information that identifies a person and is often gathered in an insurance matter. PI could also be used to make judgments about your health, habits and hobbies. We may collect PI about you from other persons or entities such as doctors, hospitals, or other carriers. We may share PI with persons or entities outside of our company without your OK in some cases. If we take part in an activity that would require us to give you a chance to opt-out of that activity, we will contact you. We will tell you how you can let us know that you do not want us to use or share your PI for a given activity. You have the right to access and correct your PI. We take reasonable safety measures to protect the PI we have about you. A more detailed state notice is available upon request. Please call the phone number printed on your ID card. Source: This Notice is provided by the following company: HealthKeepers, Inc. Let s Talk About Health Care Reform There s a lot of buzz about health care and the new laws. Everyone wants to know, What does this mean for me? We have set up a site and open forum at www.healthychat.com. Anyone can go there. On the site, you can find answers to common questions about health benefits and the impact of health care reform. You can ask us questions and we ll get back to you within one business day. We ll share news as the law goes into eect. Plus, as your needs and questions change, so will the site. New content is posted on an ongoing basis. My Health 7
Tests and Checkups that Matter Don t let illness sneak up on you. Paying attention to your health, even when you feel fine, can make staying well easier. We have a chart that lists the checkups, tests and shots needed for all age groups, from child to adult. This chart is called Preventive Health Care Guidelines. To get any of the checkups, tests or shots in this chart, just call your PCP and schedule a visit. You can view the guidelines online at www.anthem.com. Choose State Sponsored. Then pick Virginia where you see Select a state. Click the orange Enter button. Scroll down and click Preventive Health Care Guidelines. You also can call us toll-free at 1-800-901-0020 for a paper copy. New Treatments and Procedures We strive to stay informed about medical advances, and when appropriate, we create or update policies to address new medications, devices and procedures. Teams of health care professionals periodically evaluate our medical, behavioral health and pharmaceutical policies. Also, we consult the following resources when making policy decisions: Peer-reviewed, professional medical publications and journals Policies and procedures of government agencies Study results showing the impact of new technology on long-term health The opinions of physicians, specialists and other health care consultants How to Get Language Assistance HealthKeepers, Inc. is committed to communicating with our members about their health plan regardless of their language. We employ Spanish-speaking sta and also have an interpretation service for use by all of our Member Services call centers for Spanish or other non-english languages. Simply call the Member Services phone number on your ID card, and a representative will be able to assist you. You also can request translation of written materials about your benefits by calling Member Services. If you want to reach us: Toll-free Member Services... 1-800-901-0020 24/7 NurseLine...1-800-382-9625 Anthem HealthKeepers Plus TTY Line... 1-757-326-5185 (Tidewater area) 1-800-247-9843 (Outside Tidewater area) Website...www.anthem.com 8 My Health The information in this newsletter is meant to educate. It is not meant as medical advice. Please check with your doctor for any advice about your health. Your health plan may not cover some types of care. Check your Anthem HealthKeepers Plus Member Handbook for details about what benefits your health plan covers and what it does not cover. We can translate this at no cost. Call the Member Services number on your member ID card. Podemos traducir esto gratuitamente. Llame al número de servicio de atención al cliente que aparece en su tarjeta de identificación (ID card). With the exception of www.anthem.com and www.healthychat.com, the websites referred to in this newsletter are websites of independent entities and not ailiated with HealthKeepers, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 2010 WPT25977c 0509 VA0015025 12/10