Florida 2015 ISSUE II How Care Management Can Help You Got a question or concern about your health? Care Management helps members with special needs. It pairs a member with a care manager. The care manager is a nurse. He or she can help the member with issues. These include: Complex medical needs; Solid organ and tissue transplants; Children with special health care needs; and Lead poisoning. We re here to help you! Call us at 1-866-334-7927. Ask for the Care Management Department. You may be eligible to receive this service at no cost to you. Disease Management Program Disease Management is similar to Care Management. The program supports members with health problems. These may include, but are not limited to: Asthma; Diabetes; Hypertension; Heart disease; and HIV/AIDS. Do you have any of these conditions? Are you interested in this program? Please call Customer Service. You can get educational materials. In some cases, you may get coaching from a registered nurse.
The Care You Need While You re Pregnant Moms-to-be and their babies need to be healthy. Prenatal care is the special health care you get while you re pregnant. See your health care provider as soon as you think you are pregnant. Most experts say you should see your health care provider: Once a month for the first six months; Every two weeks in months seven and eight; and, Every week in month nine. Everyone is different. Your provider may need to see you more often. Follow his or her advice and take your prenatal vitamins. At prenatal visits, your provider will check to see how you and your baby are doing. He or she may: Ask about your health and pregnancy history; Ask about your family s health history; Give you a complete physical exam; Figure out your due date; Answer your questions; Check your baby s growth; Check your baby s heart rate; and Educate you about you and your baby. See your provider early and often. This may help you have a healthier baby. Don t miss any of your prenatal visits. They are all important! It is also important to keep healthy habits even after you deliver. Follow up with your provider after your baby is born. Your first postpartum visit should be between 21 and 56 days after you give birth. Do you have concerns or questions about the health of you and your baby? The Nurse Advice Line is there for you. Talk with a nurse 24/7 at no cost to you. The toll-free number is 1-800-919-8807 (TTY 711). Source: U.S. Department of Health and Human Services, Prenatal Care Fact Sheet, retrieved from www.womenshealth.gov/publications/our-publications/fact-sheet/ prenatal-care.html Are you pregnant? Are you younger than age 20? You may be eligible for doula services. What s a doula? A doula is like a labor coach. She ll work with you before, during and after your birth. To learn more, call our Care Management team by calling Customer Service. The number is on the back page. 2 Member Newsletter
Take Control of Your Asthma and Breathe Easier Asthma is a chronic lung disease. It s a long-term issue. It causes the airways in the lungs to become sore and swollen. When the airways react to irritants like dust or smoke, they get narrower. That can make breathing difficult. You Can Control Asthma There are two main medicines to help control asthma. The first is long-term control medicine. It will stop symptoms and control asthma. It may take a few weeks before you notice it s helping. The second is for quick relief. An inhaler is an example of this type. It relaxes and opens the airways. This can help control asthma attacks. These attacks block airways. This makes breathing difficult. You can also control your asthma by avoiding the things that cause your attacks. These are called triggers. Common triggers include: Tobacco smoke; Dust mites; Outdoor pollution; Cockroach allergens; Mice droppings; Pets; Mold; and Added activity like running or playing sports. Manage Your Asthma With a Good Action Plan A good asthma action plan can help. It can lessen your symptoms and prevent attacks. Asthma changes over time. So your plan may need updates. Work with your health care provider on an asthma action plan that s right for you. Our Nurse Advice Line can give tips on how to better manage your asthma. To speak to a nurse 24/7, call 1-800-919-8807 (TTY 711). Sources: Centers for Disease Control and Prevention, Learn How to Control Your Asthma, retrieved from www.cdc.gov/asthma/faqs.htm National Heart, Lung, and Blood Institute, What Is Asthma? retrieved from www.nhlbi.nih.gov/health/health-topics/topics/asthma Member Newsletter 3
Start Your Tobacco-Free Life With a Successful Quit Day Have you decided to finally quit tobacco? If so, congratulations! Cigarettes, pipes, hookahs and smokeless tobacco are all bad for you. Quitting is one of the best things you can do for your health. Now you can focus on that first step your Quit Day. This is the day you begin a tobacco-free life. Here are some tips for getting through your Quit Day. They come from www.smokefree.gov. Reach Out for Support Use a support program. Call 1-800-QUIT-NOW (1-800-784-8669) to learn more. Are you using medications like gums or patches to help you? Use them as directed. Our Disease Management Department can help. Get educational materials and advice on how to quit. Call Customer Service. The number is on the back page. Ask for the Disease Management Department. Do you miss having a cigarette in your hand? Hold something else. Try a pencil. Have a craving? Try chewing on gum, hard candies, toothpicks, or carrot or celery sticks. Drink plenty of water or fruit juice. But avoid drinks that may be triggers. This could be alcohol or coffee. Source: Steps to Take on Your Quit Day, retrieved from www.smokefree.gov The Health Benefits of Quitting Heart and circulation improve 1MINUTE 10YEARS 3-6MONTHS Easier to breathe Cancer risk cut in half Stroke, heart attack and lung disease risks drop 1YEAR Keep Busy Stay as busy as possible on your Quit Day. Go to a movie or take long walks. Spend time in places where smoking isn t allowed. Source: Centers for Disease Control and Prevention, Health Effects of Cigarette Smoking, retrieved from www.cdc.gov 4 Member Newsletter
Staywell in the Community: Quality All-Star Maritza Zeno Shares Her Story At Staywell, we know our members have unique needs. And we want to address them all. That s why we use a team approach to care. We involve members, their families and their primary care physicians. We also work with community groups and government programs. Together, we deliver health care seamlessly. Here is an example from Quality All-Star Maritza Zeno. She s a social service specialist. Recently, she helped a family get financial support. This helped them manage a severe illness. A member s newborn son was diagnosed with Kawasaki disease. This condition causes inflammation in the arteries. It is usually treatable. But in this case, it had damaged arteries around the boy s heart. The mother had applied for special federal benefits twice. She had been denied both times. My job is to help members apply for this type of government benefit. I contacted the Social Security Administration. I asked The member s mom was very appreciative. She sent me a thank-you email with a picture of her son attached. to get the case reopened. They told me what they told the mother. We would need to send an appeal for a hearing. I then asked to speak with the operations manager. I was able to get the case reopened. The case was approved. The member s mom was very appreciative. She sent me a thank-you email with a picture of her son attached. Dealing with health care and social services can be challenging. We can help. Call Customer Service. The number is on the back page. You may be eligible to get this service at no cost. Always talk with your doctor(s) about the care that is right for you. This material does not replace your doctor s advice. It is based on third party sources. We are presenting it for your information only. It does not imply that these are benefits covered by Staywell. Also, Staywell does not guarantee any health results. You should review your plan or call Customer Service to find out if a service is covered. Call 911 or your doctor right away in a health emergency. Member Newsletter 5
Staywell s Commitment to Quality Quality is one of our most important goals. We want to make sure you are getting the right care for your health. In 2014, the Staywell Quality Program did many things to improve the quality of your health care. The program: Responded to reported quality concerns; Encouraged you to go to well visits, including mammograms, eye exams for those with diabetes, immunizations and more; Met your language, cultural and ethnic needs; Made sure you can reach doctors by phone, get a timely appointment and find a doctor near your home; Made sure we answered your calls quickly; and Ensured that claims were paid accurately. Here are some of our goals for 2015: We will continue to measure the quality of the care and services you receive. We will continue working with you and your doctor(s). Together, we can meet your health care needs. We can also coordinate your health care. This improves the quality of service. We will continue to ask if you are satisfied. This helps us make sure you are pleased with us and your doctors. We will ask what your doctor(s) think of our service. We ll use that feedback to improve. We will continue to review and update our guidelines. This will help us keep a safe and healthy environment for your care. Want to receive a copy of our Quality Improvement Program description? Call Customer Service. The number is on the back page. 6 Member Newsletter
FREE Over-the-Counter Items Get up to $300 in FREE over-the-counter items each year per household! That s $25 each month. Choose from diapers, pain relievers, vitamins and more. It s easy to get your items. Just follow these steps: 1. Choose what you and your family need. 2. Call Customer Service with your order. The toll-free phone number is 1-866-334-7927 (TTY 1-877-247-6272). 3. Or visit our website at www.florida.wellcare.com. Log in to the member portal. Place your order. That s it! Your order will be mailed to your home. It is no charge to you. For more information, call Customer Service. Go Mobile with the New Staywell Mobile App! Now Staywell members can keep up with their health benefits on the go! Download the Staywell mobile app to your smartphone or tablet. It can help you find doctors, dentists, hospitals, urgent care facilities and more. You can view email, fax your ID card and get reminders to make appointments with your doctor. And it keeps your personal health information private. You can access it anytime, anywhere. Download the app at your device s app store. Please note: Features of the Staywell mobile app apply to you alone. They are designed for your program. Not all of the features outlined here may be available to you. Availability varies from person to person. It may change with your changing health needs. This app is offered in English only. Visit florida.wellcare.com for information in Spanish. Get the Latest Drug Coverage Updates Want to find the latest about the drugs we cover? Stop by our website. You ll find our Preferred Drug List (PDL). You can learn about recent additions and removals. You ll also find changes to any drug requirements or coverage limits. Just go to florida.wellcare.com. You can also call us for updates. Our number is on the back page. Member Newsletter 7
P.O. Box 31387 Tampa, FL 33631-3387 PRSRT STD U.S. Postage Paid Wellcare Health Plans FL028536_CAD_NEW_ENG State Approval 04062015 WellCare 2015 FL_12_14 64085 Important Information This information is available for free in other languages. Please contact our Customer Service number at 1-866-334-7927 (TTY 1-877-247-6272) Monday Friday, 8 a.m. 8 p.m. Esta información está disponible gratis en otros idiomas. Por favor comuníquese con nuestro Servicio al Cliente al 1-866-334-7927 (TTY 1-877-247-6272) de lunes a viernes, de 8 a.m. a 8 p.m. Important managed care plan information Información importante del plan de cuidado administrado Address correction requested Solicitud de corrección de dirección Numbers to Know We re just a phone call (or click) away! Call Customer Service: 1-866-334-7927 TTY 1-877-247-6272 Monday Friday, 8 a.m. 8 p.m. Or visit florida.wellcare.com Nurse Advice Line: 1-800-919-8807 (TTY 711) 24 hours a day/7 days a week 10867MA