myhealthmylife my TM 2014 ISSUE 1 WHAT’S INSIDE 5 Health Numbers Everyone Should Know 9 Get the Most from Your Pharmacy Benefits 10 What to Know About High Blood Pressure 16 Learn the Truth About Your Child's Asthma 18 Welcoming New Members Across Kentucky Here at Passport Health Plan, we are happy to welcome our new members from around Kentucky. Now, we are able to serve people in every county of Kentucky. From the lakes of the west to the rolling hills of the Bluegrass and Appalachian mountains, we proudly serve members across Kentucky! We think we can learn a lot from our new members and we are ready to hear from you. If you are new to Passport, please look through this issue of MyHealthMyLife and send us a note: • Tell us what you’d like to read about in the future. • You might even tell us a neat story about your hometown. – What do you like about your county? – What is your county known for? – What makes your county different from others? As fellow Kentuckians, we want to get to know you and your county! Our hope is to find more ways to help you improve your health and quality of life. IMPOR TA Specia NT: DO NO l T ENLAR to meet care must GE, RE both US be taken DUCE to PS reg OR ulation ensure FIM and POMOVE the FIM s and autom STNE and PO ation com T bar patibili code are STNET bar actual ty standa cod size AN es. They rds. D placed are onl proper y valid as prin ly on the IMPOR TA mail pieted! Specia NT: DO NO ce l T ENLAR to meet care must GE, RE both US be taken DUCE to PS reg OR MO ulation ensure FIM VE the and PO s and FIM autom STNE ation com T barcod and POST NE patibili e ty standaare actual T barcodes. size AN They are rds. D placed onl proper y valid as prin ly on the mail pieted! ce Mail us your note by using the postage-paid envelope inside this newsletter. NO PO STAG NECE E SS IF MA ARY ILED IN UNITE THE D STAT ES BUSIN ESS R FIRST EPLY -CLAS S MAIL PERM POST IT NO AGE WIL . 570 LOUIS L BE PA VILLE ID BY KY ADDR ESSE E MAIL NO PO STAG NECE E SS IF MA ARY ILED IN UNITE THE D STAT ES MARK ETIN SSPO G TEAM BUS51PAIN HEAL ESRTSER -CLAS00 CO S MAIL MM RCEETH LOUI PPL CR L AN POST SVILLPE E RM SINM KYIT NO. 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To find out where we’ll be next, please visit www.passporthealthplan.com: • Click on Members. • Then click on Find Us in The Community. If you see an event close to your home, come on by the Passport table. We love meeting our members! We’ll be there to talk with you, give you information, answer your questions and send you home with one of our giveaways. We are looking forward to seeing you. If you do not use a computer, please call us at 1-800-578-0603. We are happy to give you our schedule of events by phone. Your Friends at Passport are Just a Phone Call Away Our caring Member Services staff is ready to help you get the most from Passport. Call us anytime you have a question. We will get the answers you need or find someone who can help you! 1-800-578-0603 TDD/TTY 1-800-691-5566 Monday – Friday 7:00 am – 7:00 pm EST Read what one member, Anthony*, had to say to one of our Member Services representatives: “I’ve been to 30 states and 6 countries, and ya’ll are the only people that really try to help with your hearts and care. That means the world to me!” Thanks Anthony* for your kind words, you mean the world to all of us here at Passport! *The name has been changed to protect the member’s privacy. Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 3 We want you to know that you have certain rights and responsibilities as a Passport member. You have the right to: Be treated with respect and dignity, and the right to privacy and nondiscrimination, as required by law. Your Rights and Responsibilities Choose a primary care provider (PCP) and request a change to another PCP. 4 Join your providers in making decisions about your health care. You may refuse treatment. Ask questions and receive complete information about your medical condition and treatment options. This may include specialty care. Voice grievances (within 30 days) or file an appeal about Passport decisions that affect you. If you do not agree with Passport’s appeal decision, you may file a state hearing with the Department for Medicaid Services. Receive timely access to care that does not have any communication or physical barriers. Make an advance directive, like a living will. Look at and get a copy of your medical records, as permitted by law. Receive timely referrals and access to medically needed specialty care. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation. Receive information about Passport including your benefits, services, providers, rights and responsibilities. Make suggestions about your rights and responsibilities. Discuss treatment options, regardless of cost or benefit coverage. You have the responsibility to: Learn about your rights. Follow the policies and procedures of the Department for Medicaid Services and Passport. Learn about health services and treatment options. Follow the steps of the Grievance and Appeal Process. Take part in personal health care decisions and practice a healthy lifestyle. Keep appointments with providers and call to cancel appointments when you cannot be there. Provide, to the best of your ability, information that your providers need to give you the best care possible. Follow the orders and plans for care that you have agreed on with your providers. Learn about your health problems and follow the orders and care plans that you and your providers have agreed upon. Tell us if you suspect fraud or abuse of your benefits. This may include the misuse of your member ID card. To report fraud or abuse, please call Passport’s Compliance Hotline at 1-855-512-8500 or the Office of the Inspector General (OIG) at 1-800-372-2970. Visit us online at www.passporthealthplan.com Filing a Grievance or Appeal We hope you are happy with the benefits you are getting. If you are not, we want you to tell us right away. If you file a grievance or an appeal with us, you will not lose your Passport membership or health care benefits. To learn more about grievances and appeals, please see Pages 29 to 33 in your Member Handbook called Your Guide to Passport Health Plan. Want to learn more about your benefits and how to use services? Check out our How-To Guide at www.passporthealthplan.com. Click on Members, then Using Your Benefits and then Your Benefits & How-To Guide. If you do not use a computer, you may call Member Services at 1-800-578-0603 and someone will mail you a copy. What is the NOPP? The Notice of Privacy Practices (NOPP) tells you about your privacy rights and how you can use these rights. The NOPP also tells you how Passport (we) may use and share your health information. We must follow all the rules listed in the NOPP. You may find a copy of our NOPP at www.passporthealthplan.com: • Click on Members • Click on Using Your Benefits • Click on Your Guide to Passport Health Plan • Go to pages 44 to 51 If you would like us to mail you a copy, please call Member Services at 1-800-578-0603. TDD/TTY users may call 1-800-691-5566. Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 5 My OB Doctor Told Me I Have a “High Risk” Pregnancy Your Pregnancy May Be High Risk If You Have... I am 20 years old and my OB doctor told me I have a high risk pregnancy. This sounds really bad. What is this and what does it mean? -Tiffany, Passport Member Dear Tiffany, If your OB doctor sa ys you have a “high risk” pr egnancy, you and your baby m ight need special monitoring or care during pregnancy. Being ca lled high risk may sound scary, but it’s just a way for doctors to make sure you get the right atte ntion during your pregnancy. You r doctors will watch you closel y and look for any early signs of problems. -Your Passport Friends A History of Preterm labor When you go into labor too early. If your baby is born before 37 weeks, it’s called preterm. Chronic High Blood Pressure When you have high blood pressure before you become pregnant. Preeclampsia When you have high blood pressure and protein in your urine during or shortly after pregnancy. Diabetes When you have too much sugar in your blood. Gestational Diabetes When you have diabetes only during pregnancy. Premature Rupture of Membranes (PROM) When your water breaks early. Incompetent Cervix Multiples When your cervix is too weak. This can cause you to miscarry or deliver your baby early. When you are pregnant with more than one baby (twins, triplets). Intrauterine Growth Restriction (IUGR) When your baby’s weight is less than expected. Placenta Previa When the placenta is covering all or part of the cervix (vaginal opening). Substance Abuse Source: March of Dimes 6 What This Means Visit us online at www.passporthealthplan.com When you have a drug or alcohol problem. What happens during a high risk pregnancy? If you are high risk, your OB doctor may send you to see a specialist. You may have more appointments and tests. You may also have to go to the hospital, take medicines, be placed on bed rest or all of these. What are the most important things you can do? The 3 most important things you can do is: 1. Go to all your OB doctor appointments. 2. Eat healthy. 3. Make good lifestyle choices. Making good choices means choosing not to smoke, take drugs or drink alcohol during your pregnancy. Mommy Steps nurses will help you the whole way! Passport members will always have our support during pregnancy. Our Mommy Steps nurses are just a phone call away. Call a Mommy Steps nurse at 1-877-903-0082. They can answer your questions and help you get the care and support you need. If you need to call after hours or on the weekends, you may call our 24-hour Care for You Nurse Advice Line at 1-800-606-9880. Call your OB right away if you have: • Regular contractions - when you feel like your belly is tightening up like a ball. • Cramping that feels like a period. • A low dull backache. • Vaginal bleeding. • Leaking or gushing fluid from the vagina. • A headache that does not go away. • Blurred vision, seeing spots or other vision changes. • Sudden swelling or puffiness in your hands, face or feet. • Chills, fever or a rash. • Less than usual movement from your baby or your baby stops moving. Source: March of Dimes Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 7 What is EPSDT? EPSDT is a special program for children ages 21 years and under. The EPSDT program covers checkups, shots and tests for your children. Your child needs well-child EPSDT checkups at these ages: EPSDT stands for Early and Periodic Screening, Diagnosis and Treatment. 1 month 9 months 24 months 5 years 9 years 2 months 4 months 6 months 12 months 15 months 18 months 30 months 3 years 4 years 6 years 7 years 8 years Every year from age 10 to age 20 EPSDT If you have any questions about EPSDT, please call us at 1-800-578-0603. DG S E NY E S E T R O C H S S DA A L E L L U A D S T GP ME Z L HE K L V Q 8 Seek and Find S X H DV V D T L J I I N V R Y S A J T DG I U N E A H OE T P C L N G P K N N S Q V MX X C C U Z O MR E O Z WL E C Z I T R E S Z E C T N S WL S MS S I S I V R O O A A R T B D I C A T I F J X T N F A R I N G S B MG Q ML MP B A DK MM T T X I B N J T R W L A D R T O U S A WA N R S X B OR E OL S K U P G DE S P R HH U X T R H G E L HS Y R X I R O G L L T A O S A E WI L I E P GUC DA U E T N WE N R A K I Z P T I R R B H T S I Q S N WO T E A D Q C WX WY D N F N E Z B L A HU T HA DO O N B GX R V MHP K G M H S I Z Y E WU H T C ODS P U K C E HC J P OB C NU P Z J UL ON K OHA O QQ G I H F L V M B WP Z H L I Q C R E E NS Y V O E C M T D E X Y DU S U A Y W J B J WT A K D C O MG Visit us online at www.passporthealthplan.com CHECKUPS DENTAL SCREENS DOCTOR VISITS EPSDT HEARING SCREENS LEAD SCREENS MEDICATION NURSELINE NUTRITION PASSPORT PHYSICAL EXAM SHOTS STREP THROAT URGENT CARE VISION SCREENS WASH YOUR HANDS (Look for the answers on page 11!) 5 NUMBER 1 2 3 4 Health Numbers Everyone Should Know YOUR GOAL You can start taking charge of your own health by getting to know 5 health numbers. Commit to knowing these numbers and you will be on your way to a healthier life! If you do not know your numbers, talk to your doctor. QUICK FACTS Blood Pressure • High blood pressure raises your chances of stroke, heart disease and kidney failure. Less than 120/80 • Foods with lots of salt (fast food, packaged meats) can raise your chances of high blood pressure. Total Cholesterol • Too much cholesterol in your blood can buildup on your artery walls and stop blood flow. • Use vegetable oils such as olive and canola oil. Below 200 mg/dL • Limit high fat meats such as corned beef, pastrami, ribs, steak, hot dogs, sausage, bacon and processed meats like bologna. Fasting Blood Sugar • This test measures the sugar in your blood and tells your doctor if you have diabetes. Less than 100 mg/dL Body Mass Index Less than 25 • Choose turkey, chicken without the skin and fish. • Regular exercise can help control your weight and your blood sugar level. Adults need 30 minutes a day and children need 60 minutes every day. • Your BMI number tells you if your overall body weight is healthy for your height. • People who are overweight or obese are at risk for health problems. • To find out your BMI, ask your doctor or visit www.cdc.gov/healthyweight/assessing/BMI/. • Your body uses calories for energy. 5 Your Daily Calorie Needs Everyone is Different • We get calories through what we eat and drink. • We burn calories off with activity. • Eating less and moving more can help you lose weight. • Talk to your doctor or a registered dietician to get your daily calorie needs. Source: heart.org Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 9 Get the Most from Your Pharmacy Benefits Passport wants to help you get the most from your pharmacy benefits. We cover a wide range of prescription and over-the-counter medicines. Our list of covered medicines is called the Preferred Drug List (PDL). How can I find out if a medicine is on the Preferred Drug List (PDL)? You can quickly and easily find a covered medicine by visiting our drug listing at www.passporthealthplan.com. Once you are on our website, click on Find a Medicine. You can even view our online PDL from a computer or a smartphone. If you do not use these tools, just call our Member Services team at 1-800-578-0603. Someone will look up a medicine for you or mail you a copy of the PDL. How much will I pay out-of-pocket for my medicines? 10 $0 As long as you use generic medicines, they will not cost you a thing. Generic medicines work just as well as the brand names. To avoid paying out-of-pocket, always ask for generics. Most of the time you will be able to get a generic medicine and pay $0! $2 If the medicine you need does not come in a generic, ask for a preferred brand name. This means the brand name is on our PDL. You will pay $2. $4 Non-preferred brand names are not on our PDL. You will pay $4 for these medicines. If you need help finding another medicine at a lower cost, please call us at 1-877-903-0082. We want to help you! Visit us online at www.passporthealthplan.com *If you have a copay, the total amount you will pay depends on your income. You will not pay more than 5% of your family income for a 3-month time period. If you have questions about what this means for you, please call us at 1-800-578-0603. Ask Questions ? Take some time to learn about the medicines you are taking and why. If you have any questions, there are people who can help you. You can ask your doctor, your pharmacy or call us here at Passport. Our team is ready to help you, give us a call at 1-877-903-0082. Seek and Find Answers D+ S E N+ E S E T R O C H S S D+ A + E + L + + + S T + + ME + + HE + + + + + + N + + + + + + + + + + I + D + A + + + + + T + + + + + + + + + S + I + R + + + + + + A + + + + + + + + I + C + I + + + + + + + L + + + + + + + V + A + N + + V I S I O N S C R E E N S R + T + G + + + + + U E + + C E + S + S O + I + S + + M+ + A + S P + R + + G + I N+ R R T E + N D+ + + T C + + ON + + C R + + + + T D X + + L E E + A E + + O + + + E + + T R + E E + P N H + + N + D + + + E + + + + O S L T + R T + + + S S + + + N + + + + R P H A U + + C + + + P + + + S + + + U + R S O C + + + A + + U + + + + + + N + O + Y S + I + + + R + K + + + + + + + A + H + + A + S + + + E C + + + + + + T + S + + + + P + Y + + + E + + + + + + + W A N + U + T + R + I + T + I +O + N H+ + P + + HC + + + + + + + + + + + + CHECKUPS DENTAL SCREENS DOCTOR VISITS EPSDT HEARING SCREENS LEAD SCREENS MEDICATION NURSELINE NUTRITION PASSPORT PHYSICAL EXAM SHOTS STREP THROAT URGENT CARE VISION SCREENS WASH YOUR HANDS Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 11 Physical Activity is for Cool Kids More and more of our kids are not at a healthy weight. It may seem like the problem is with how much they are eating. But, eating is only one part of it. Helping your kids get more activity is the other part. And, it is easier than you think! Kids are active all the time without even thinking about it. They run around outside, play kickball at school and dance with their friends. Physical activity is cool! 3 Easy Ways to Help Kids Get More Physical Activity 1 Play Sports! When kids play sports, they can: ✓ Lower their chances of having weight problems or becoming obese. ✓ Lower their body mass index (BMI). Your BMI tells you if you have a healthy weight. Encourage your kids to find a sport they enjoy — basketball, softball, soccer, martial arts, swimming or running. It does not matter what it is, as long as it gets them moving. Source: www.EatRight.org 12 Visit us online at www.passporthealthplan.com Find things to do where the whole family is moving and having fun. ✓ Teach your kids the games you played when you were their age. This might include tag, touch football, wiffle ball or hide and seek. ✓ Have a dance contest in your living room. See who can dance the longest! The person who dances to the most number of songs without stopping is the winner. ✓ Plan activities like biking or hiking. Many kids spend too much time looking at screens (computers, phones, video games, tv and movies) instead of active play. Looking at screens does not involve any movement. Too much screen time is tied to weight gain. ✓ Limit the amount of time your kids look at screens. ✓ If your kids do play video games, find games that use activity like Wii™ Fit or Wii™ Sports. 2 Plan Family Activities! 3 Limit Screen Time! Source: www.EatRight.org Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 13 People who get Type 2 diabetes almost always start out with prediabetes. What is prediabetes? When your blood sugar level is high, but not high enough to have diabetes. Some call it “borderline diabetes” or “a touch of sugar.” How do you know if you have prediabetes? Prediabetes usually has no symptoms. You may have it and not even know it. To find out if you have prediabetes, ask your doctor to check for it, especially if you have risk factors. Risk factors are things that raise your chances of getting diabetes. Having prediabetes is a risk factor. Other risk factors are: • You have a mom, dad, brother or sister with diabetes • You weigh too much 3 Ways to Lower Your Risk for Diabetes! ✓ Stay at a healthy weight (ask your doctor if you need to lose weight) ✓ Stay active and exercise daily* • You are 45 years of age or older ✓ Eat healthy well balanced meals • You had gestational diabetes (diabetes while pregnant) *Check with your doctor before starting any weight loss or exercise program. • You had a baby weighing 9 pounds or more • You do not get enough exercise Need Help? If you have any questions or want help with diabetes, just call us at 1-877-903-0082. We are happy to help you! • You have high blood pressure • You are an American Indian, Alaska Native, African American, Asian American, Hispanic/ Latino or Pacific Islander 14 Source: American Diabetes Association, Centers for Disease Control and Prevention Visit us online at www.passporthealthplan.com Other sore throats, like strep throat, are caused by bacteria. These sore throats must be treated with medicine. How to Treat a Sore Throat and Strep Throat Strep Throat (caused by bacteria) Sore Throat (caused by a virus) • Your PCP will need to test you for strep. If you test positive, your PCP will prescribe antibiotics. • Get lots of rest. • Drink lots of fluids. • Do not take antibiotics*. • Talk to your doctor about over-the-counter medicines like throat lozenges or sprays. *Antibiotics do not cure viral sore throats. They can even do more harm than good. Taking them when you don’t need them can lower your body’s ability to fight bacteria when you really do need antibiotics. • Take any medicines your doctor gives you. • You need antibiotics to cure strep throat. Strep throat can only be diagnosed with a positive strep test. Your PCP cannot diagnose you just by looking at your throat. Ways to Prevent a Sore Throat • Keep your hands clean. Always wash your hands after using the bathroom, before eating and after sneezing or touching dirty things. • Stay away from others who are sick. • Stay away from smoke. • Do not smoke. If you smoke and would like to quit, please call us at 1-877-903-0082. We want to help you! Sore Throat or Strep Throat? Most sore throats are caused by a virus, just like the ones that cause a cold or flu. These sore throats can also be caused by heartburn, allergies or even sinus problems. The good news is that sore throats caused by a virus will go away on their own. Source: http://www.cdc.gov/getsmart/antibiotic-use/URI/sore-throat.html | http://www.cdc.gov/Features/StrepThroat/ Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 15 What to Know About High Blood Pressure You could have high blood pressure and not even know it. To find out if your blood pressure is high, have your doctor check it often. Blood Pressure Checks are Quick and Easy! • Your doctor will tell you how often to have your blood pressure checked. • Your doctor may need to take several readings over time to decide if you have high blood pressure. What’s so bad about having high blood pressure? The longer you have it, the more likely you are to have a heart attack, stroke, heart failure, kidney disease or vision loss. • You can get your blood pressure checked in a doctor’s office, hospital, pharmacy, clinic or at a health fair. Are you an African-American? If you are an African American, you are more likely to have high blood pressure earlier in life. Your average blood pressure may also be higher than others. You cannot change this risk factor, but you can control high blood pressure. Just follow the tips on the next page! 16 Visit us online at www.passporthealthplan.com Things to do for HIGH Blood Pressure ✓ If you are overweight, lose weight. ✓ Eat healthy foods low in saturated fat, trans fat, cholesterol and salt. ✓ Eat a diet packed with fruits, vegetables and low-fat dairy products. ✓ Get some daily exercise*. ✓ Limit alcohol. No more than 1 drink a day for women or 2 drinks a day for men. ✓ If you smoke, stop. Stay away from second-hand smoke. ✓ Listen to your doctor and take your medicine as ordered. *Talk to your doctor before you start an exercise program. Call Us If you have any questions or want more information about high blood pressure, please call us at 1-877-903-0082. We’re here to help you! Source: American Heart Association Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 17 LEARN THE TRUTH about Your Child’s Asthma There are lots of “myths” out there about asthma that are simply not true. If your child has asthma, you need to know the truth! Knowing the truth can help you feel better about managing their asthma. Myth #1 Children can outgrow their asthma. Myth #2 Asthma is contagious. You can catch it from other people. Myth #3 Children with asthma should not exercise. 18 The truth Most children with asthma will have it their whole lives. Children may have fewer asthma attacks as they get older. As they become adults, they may start having more attacks again. The truth Asthma cannot spread from person to person. You either have it or you don’t. The truth Exercise is a healthy choice for most children with asthma! If exercising gives your child asthma symptoms, your child’s doctor can order an emergency inhaler to take 15 minutes before exercise. Visit us online at www.passporthealthplan.com The truth Myth #4 Inhaled steroids used in asthma medicines are harmful. Myth #5 It's better to treat my child’s asthma flare-ups than to give him or her a daily controller medicine. Myth #6 A child with asthma wheezes, but never coughs. Inhaled steroids (corticosteroids) are used to control asthma. They are not the same as illegal steroids used by some athletes. They are more like the steroids found in skin creams. Have your child rinse his or her mouth after steroid use. Please talk with your child’s doctor before making any changes to their medicine. The truth Giving your child a daily controller medicine is the best way to keep his or her asthma controlled. Only treating flare-ups can be harmful. Asthma flare-ups can get worse quickly and cause death. The truth Coughing is a sign of asthma. If your child is always coughing, have him or her checked for asthma. Some children with asthma never wheeze. To learn more about asthma, talk with your child’s asthma doctor or call us at 1-877-903-0082. We want to help you! Sources: http://www.bellaonline.com/site/asthma | www.pamf.org/asthma Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 19 Marketing and Community Engagement Department 5100 Commerce Crossings Dr. Louisville, KY 40229 Helping Kentuckians Live Healthier Lives™ Any information included in this newsletter is not intended to replace medical care or advice from your doctor. Any references to other companies or internet sites are not an endorsement or guarantee of the services, information or products provided. Passport does not take responsibility for anything that may result from the use, misuse, interpretation or application of the information in this newsletter. Passport does not guarantee the availability or quality of care. We are not responsible for any act or omission of any provider. All providers contracted with Passport are independent contractors and not employees or agents of Passport. Get Tested Early for Cervical Cancer Ladies, we know you take care of everyone else. Maybe you're a mom, wife, caretaker or all of these! Whatever role you play, you can only be at your best when you take care of yourself. Start looking out for your own health by getting a Pap test to check for cervical cancer. What causes cervical cancer? Most cervical cancers are caused by the human papillomavirus or “HPV.” HPV is passed from person to person during sex. Most of the time, you will not even know you have it. Girls and women ages 9 to 26 can get an HPV vaccine to help prevent cervical cancer. Get checked! The test you need is called a Pap test. A Pap test checks for HPV or abnormal cells. A Pap test can find problems early before they become cancer. This test could save your life! Women need to start getting tested for cervical cancer at age 21 and sometimes sooner. Talk with your doctor or OB/GYN about how often you need a Pap test. Source: www.cdc.gov/cancer/cervical/basic_info/screening.htm | www.cdc.gov/std/hpv/pap/ Earn rewards! Did you know you can earn a $20 gift card just for getting tested? For more information or to get help scheduling your appointment, just call us at 1-877-903-0082. PASS-13131 APP_3/7/2014
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