MyHealth Volume 6, Issue 1 2007 How to Use Your Health Plan Welcome to Anthem Blue Cross and Blue Shield. We are happy to have you as a member of the Hoosier Healthwise program. It s our job to make health care easier for you. Let s get started together. These basics will help you get the most out of your benefits. Keep your Hoosier Healthwise ID card and your Anthem ID card with you at all times. Show them every time you need health care services. You should receive a letter telling you who you chose as a primary medical provider (PMP). Once you get your letter, set up an initial health exam with your PMP right away. The first meeting with your PMP is important. It is a time to get to know each other, and talk about your health, any concerns you may have, and your medical history. He or she can tell you if you should have any vaccines or tests to prevent problems. Call your doctor s office for a first visit. Don t wait until you get sick. Turn a Sick Visit into a Well Visit Next time you take your child or teen to the PMP for a minor illness, ask the doctor for a well-visit checkup at the same time! If you and the doctor have the time, this is a great way to get wellvisit care done and make sure your loved one has the vaccines, tests, and checks needed for his or her age. Look inside to read more about checkups. n If you have an emergency, get help right away. Call 911 or go to the nearest emergency room for medical care. You do not need an OK from us for emergency care. You will be covered for emergency services in the United States. Call your PMP if you have an urgent medical problem that is not an emergency. Good examples might be a chest cough or fever. Your doctor s office staff will help you make an appointment for care. If you need a ride to and from medical visits, just call us. If you are not sure what to do for a health problem, you can call MedCall, the 24-hour nurse help line. The toll-free phone number is (866) 800-8789. If you have hearing loss, you may call the MedCall TTY line at (800) 368-4424. Again, we welcome you to Anthem and look forward to caring for you and your family. n Dear Member: Your health is important to all of us at Anthem. My name is Dr. Karen Amstutz. As a doctor, I want to make sure you know what your Hoosier Healthwise program covers. Did you know your program covers important preventive care like annual checkups for children and any exams adults need? Read on in this newsletter to find out more. Plus, you ll find stories about how your plan works and a few key areas we, as a health plan, focus on such as privacy, and your rights as a member. In order to do the best job we can as your health plan, we track the services you get so we know how to improve. This is called, quality improvement. We check to see if members like you or your children are getting the vaccines and exams needed. We also track how well we take care of members with ongoing illnesses such as diabetes and asthma. And, of course, if you are pregnant, we want to make sure you get the prenatal care you need and learn as much as you can about having a baby. We re glad you re part of our Anthem family. We re in this together. Let us help! Sincerely, Karen S. Amstutz, MD Medical Director State Sponsored Business
Missing Doctor Appointments? 4 excuses and how to get past them Admit it sometimes you get so busy that you forget about your doctor s appointment. Or maybe you avoid going to the doctor because you are uneasy about a test or a health concern. Keeping your doctor s appointment is one of the best ways to stay healthy. Here are a few solutions to help you deal with some common excuses for missing a doctor visit. Excuse 1: I forgot. Write your appointment on a calendar. You also can put a note on your refrigerator, phone, or front door to remind you, especially if the visit is weeks away. Excuse 2: I m afraid. Take a friend or family member with you for support. When found early, many conditions can be treated better. And knowing will give you peace of mind. Talk honestly about your fears with your doctor. Remember, your doctor is your friend. He or she is there to help you deal with your fears. Excuse 3: I feel fine. See the doctor for regular checkups or well visits. It s the best way to help prevent sickness and find problems early. If you have recovered from an illness, you may think you can skip your follow-up. Don t do it! It is important to keep your appointment so your doctor can check on you. When something doesn t seem right with our bodies we usually know it. Tell someone you trust when you feel something is wrong but you can t figure out what it is. That person can be your buddy to help make sure you go to the doctor. Diabetics Focus on Your Eye Care If you have diabetes, you need to get a dilated retinal eye (DRE) exam once a year. As part of the eye exam, you get drops in your eyes to enlarge the pupils so that a special eye doctor (ophthalmologist or optometrist) can see the inside of your eyes. This test is simple and it can save your eyesight! Diabetics can get a serious eye disease. It can even lead to blindness. You could have it and not know it. The DRE exam will show if you have it. If you detect this disease at an early stage, it can be treated and you have a better chance of keeping your eyesight. For a list of these special eye doctors in your area or if you need help setting up a DRE exam, call us at (800) 319-0662. If you haven t had a DRE exam in the last 12 months, schedule your exam now! n Excuse 4: I don t have a way to get there. Ask a friend or family member who drives to help you get there. If no one is available, call the Customer Care Center phone number on your Anthem ID card or on the back of this newsletter. We will help you get a ride or find a new doctor closer to you. There are lots of reasons people miss doctor visits. But, there are many more reasons to keep them. If you cannot keep your appointment, please call your doctor to cancel. If you keep missing your appointments, and don t call to cancel, some doctors will refuse to see you. n Some doctors offices will call ahead to remind you. Ask them to do this when you make the appointment. If your doctor s office does not call ahead, ask someone to remind you a few days before your appointment. 2
Notice of Privacy Practices Si no habla inglés, podemos traducir esta información a su idioma sin cargo alguno. Llame al número telefónico que figura en el reverso de su tarjeta de identificación (ID card). Know your rights This notice tells you who can see your health information with your OK and who can see it without your OK. It also tells what rights you have to see and manage your information. Your health and financial information are personal and private. The law says that we must protect this information of our current and former members. We get information about you from the Office of Medicaid Policy and Planning and the Office of Children s Health Insurance Program after you become eligible and enroll in our health plan. We also get medical information from your doctors, clinics, labs, and hospitals so we can approve and pay for your health care. Federal law says that we must give you this notice to help you understand what our legal duties are and how we will protect your verbal, written, and electronic health information using these methods: Physical (files) Technical (passwords) Procedural (policies to make sure your records stay safe) When is it OK for us to use and share your health information? We can use and share your information without your OK in some cases. Here are some examples: For your medical treatment: To help doctors, hospitals, and others get you the care you need For payment: To share information with the doctors, clinics, and others who bill us for your care When we agree to pay for medical care or services before you get them For health care operations: To help with audits, fraud and abuse programs, planning, and day-to-day work To review our programs and try to make them better For public health reasons: To help public health officials stop the spread of disease or prevent an injury To others acting for you: If you tell us it is OK, we can share your health information with your family or a person chosen by you who helps with, or pays for, your health care If you cannot speak for yourself and it is best for you, we can share your medical information with someone who helps with, or pays for, your health care Other uses allowed or required by law: To help the police and other people who enforce the law To obey laws about reporting abuse and neglect To help the court when asked to do so To respond to legal documents To give information to health oversight agencies for actions such as audits or exams To help coroners, medical examiners, or funeral directors find out your name and cause of death To help when you have asked to give your body parts to science To use for research To prevent or lessen a serious threat to health and safety To help government officials for special government functions To give information to workers compensation for a work-related illness or injury We will get an OK from you in writing before we use or share your health information for reasons not listed in this notice. You may tell us in writing that you want to take back your OK to share information. We can t take back what we used or shared when we had your OK, but we will stop using or sharing your information in the future. What are your rights? You can ask to look at your health information and get a copy of it. Keep in mind that we do not have a complete medical record about you. If you want a copy of your complete medical record, you should ask your doctor or health clinic. If you think that something is missing from, or wrong in your health record that we have, you can ask us to make changes. You can ask us not to share your information in some instances. However, we do not have to agree to your request. You can ask us to mail health information to an address that is different from your usual address or to send the information to you in another way. We can do this for you if sending to your usual address may put you in danger. You can ask us to give you a list of the times (after April 14, 2003) that we have shared your health information with someone else. This will not include the times we have shared your information for the purposes of treatment, payment, health care operations, or certain other purposes. You can ask for a paper copy of this notice at any time, even if you asked for a notice by e-mail. What are our responsibilities? By law, we must keep your health information private except as listed in this notice. We must give you this notice that explains our legal duties about privacy. We must follow what we have told you in this notice. 3
We must agree, when you make reasonable requests and you are in danger, to send your health information to a different address or to send it in a way other than regular mail. We must tell you if we cannot agree when you ask us to limit how your information is shared. If state laws are more strict than the rules in this notice, we will follow those laws. What if you have a complaint? If you think that we have not kept our promise to protect your health information, you may complain to us or to the Department of Health and Human Services. Nothing bad will happen to you if you complain. Contact information If you have questions, complaints about our privacy rules, or want to apply your rights, please call us at (866) 408-6131. We are here to help. If you still feel that we have not protected your privacy, you also may file a complaint with the Office for Civil Rights in the U.S. Department of Health and Human Services. We reserve the right to change this notice and the way we protect your health information. If that happens, we will tell you about the changes in a newsletter. We also will post them on our website at www.anthem.com. As we told you in our Health Insurance Portability and Accountability Act (HIPAA) notice, 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 nonpublic personal information (PI) as described in this notice. Your PI tells us who you are and is often gathered in an insurance matter. We may use your PI to make judgments about your: - Health - Money - Character - Habits - Hobbies - Reputation - Career - Credit We may collect PI about you from other persons or groups such as: - Doctors - Hospitals - Other carriers We may share PI with persons or groups outside of our company without your OK in some cases. We will contact you if we take part in an action that would require us to give you a chance to opt out. 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 action. You have the right to access and correct your PI. We take safety measures to protect the PI we have about you. You can ask for a state notice that is more detailed. Please call the phone number printed on your ID card. n What to Ask Your Pharmacist Checklist Are you a smart pharmacy shopper? You are if you ask the right questions and get answers. The more you know, the less chance you ll have a problem with a drug. Here are a few key questions to ask each time you go to the pharmacy: What is the name of the medicine and what does it do? Is there a generic version for this medicine? How and when do I take it? What if I miss a dose? Do I need to take this drug with food or water? 4 How long should I take it? What are the possible side effects? What should I do for side effects? Will the drug work safely with other medicines I take? What foods, drinks, or activities should be avoided while on this drug? Be sure to ask the pharmacist if you have other questions. Try to go to the same pharmacy each time so the pharmacist has a record of all the drugs you take. n
Get Your Child or Teen a Yearly Checkup Did you know that the doctor needs to see children and teens when they are well? We call these Well-Child and Well-Adolescent visits. These are the special doctor visits where your child or teen gets: A physical exam of his or her body Height, weight, and body mass index (BMI) measured Blood pressure checked Developmental checks to see if your child can do things other kids the same age can do such as walk or talk Review of how your teen performs at school and relates to peers Vision, hearing, and other tests that might be needed Vaccines to prevent illnesses like polio, measles, or hepatitis Why Are Well Visits Important? It may be hard for you to make time for these visits, but there are many reasons to do it: This is a good time to ask your child s doctor questions. Well visits are the best time to talk about your child s health or your teen s changing body. You can catch and treat health problems like hearing loss or poor vision that could affect your child or teen s ability to learn. Skipping a checkup could result in your child or teen missing a vaccine he or she needs. By getting vaccines at the right times, you give your child the best chance at good health. Your child can t start school without having all needed vaccines. Most daycare providers and elementary schools require proof of current vaccines before kids can attend. Infants and very young children need checkups more often because their bodies are growing fast and changing quickly. However, all children need at least one checkup a year until they are 21 years of age. If you aren t sure when your child or teen s next well visit should be, call your child s doctor. To make it easier for you, see if you can schedule a well visit after school, after work, or on a Saturday. Some doctors will work with you and your schedule. You can also find online our list of all the checkups, tests, and vaccines your child needs. We call this list the Preventive Health Care Guidelines. To view this list, go to www.anthem.com. n CLICK to It! Knowledge at Your Fingertips Our website is a great place to go for information. There are helpful links so you can learn about your health plan. You can find out about your rights, free exams you need, what phone number to call for help, how to find a doctor, and what programs we offer that can help you. Give it a try! Just go to www.anthem.com. Member Rights and Responsibilities We want you to know what your rights and your responsibilities are as a member of our health plan. To read them, go to www.anthem.com. Select Members. Then choose the state Indiana and click on the orange Enter button. Choose State Sponsored Plans Indiana Hoosier Healthwise (Medicaid and SCHIP). Scroll down and click Member Rights and Responsibilities. You can also find a written copy of your rights and responsibilities in your Member Handbook. Utilization Management (UM) We have sets of rules for determining what health treatments are covered under your plan. They are called Clinical UM Guidelines. You can find these online. Go to www.anthem.com. Select Members. Then choose Indiana. Click on the orange Enter button. Select State Sponsored Plans Indiana Hoosier Healthwise (Medicaid and SCHIP). Scroll down and choose Hoosier Healthwise Clinical Utilization Management (UM) Guidelines. Call to Learn More If you have any questions, or would like a current copy of your rights and responsibilities, call us at (866) 408-6131. If you have hearing loss, call the TTY line at (866) 408-7188. n What If You Don t Have a Computer? Don t worry. There are many places to go to use a computer. Visit your local library. Most have computers you can use for free. Ask a friend or family member. Someone you know may have one you can use. Go to a copy center. Many places have computers that are open to the public. You may have to pay a small fee to use one. n 5
Anthem Blue Cross and Blue Shield P.O. Box 6144 Indianapolis, IN 46206-6144 STANDARD PRESORTED U.S. POSTAGE PAID PERMIT #555 SAN DIEGO, CA This newsletter is designed to give you health education information, not medical advice. Always talk to your doctor about your medical treatment. If You Want to Reach Us by Phone: Customer Care Center (866) 408-6131 TTY Line (866) 408-7188 MedCall 24-Hour Nurse Help Line (866) 800-8789 MedCall TTY (800) 368-4424 www.anthem.com Si necesita este material traducido, llame al número telefónico que aparece en su tarjeta de identificación. In Indiana, Anthem Insurance Companies, Inc., dba Anthem Blue Cross and Blue Shield, is an independent licensee of the Blue Cross and Blue Shield Association. Registered marks Blue Cross and Blue Shield Association. 0107 IN0013519 6/07 How Medical Decisions Are Made We always want you to have the care you need. Your doctor works with you to decide what care is best. Your doctor may have to ask us for our OK of a certain health care service. You should know: We make decisions based on the care you need. We do not provide doctors any incentive to deny you care. We do not provide doctors any incentive to give you less care than you need. You can learn more about this. To reach our Utilization Management department, call the Customer Care Center. If you call after hours or on a weekend, you can leave a message and someone will call you back during business hours. The Customer Care Center phone number is (866) 408-6131. The TTY line is (866) 408-7188. n