2014: Issue 1 - Passport Health Plan

myhealthmylife
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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.
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We are proud to have you as a member and we hope you
enjoy this issue of MyHealthMyLife!
Until next time,
Your Friends at Passport
2
Visit us online at www.passporthealthplan.com
Find Us in The Community
Our staff travels all around the state attending community events. You can
find us at health fairs, back to school events, county festivals and much more!
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.
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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
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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.
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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