Want Healthy Kids? Join the Club! — p. 10
Take care of yourself. Someone’s depending on You. ~Women’s Health Information Inside~
Customer Service Numbers Category
Little Rock Toll-free Number (501) Number
State/Public School Employees
e-mail: email@example.com firstname.lastname@example.org Medi-Pak (Medicare supplement)
Medicare (for beneficiaries only): Part A (hospital benefits) Part B (physician’s benefits)
378-2173 1-800-482-5525 378-2320 1-800-482-5525
UniqueCare, UniqueCare Blue, Blue Select® (individual products) 378-2010 1-800-238-8379 Group Services
Federal Employee Program (FEP)
Medi-Pak HMO (Health Advantage) 954-5200 1-800-354-9904 USAble Administrators
INSIDE THIS ISSUE
Breast Health ............................................ 4-5 Down but not out (depression information) .......... 6 Are you depressed? Find out with
The Wakefield Scale ........................................... 7
Flu & You .................................................. 8-9 Do you want healthy kids? Join the
BlueAnn Club! ............................................ 10-11
Focus on Women’s Health (information about
osteoporosis, menopause and PMS) ...................... 12
Numbers to call for information about obtaining coverage:
Diabetes and You ....................................... 13
Little Rock Toll-free Number (501) Number
How to file a Health Advantage claim ........ 14
Medi-Pak (Medicare supplement)
UniqueCare Blue, Blue Select® (individual products)
Medi-Pak HMO (Health Advantage) 378-6987 1-800-588-5706
Regional Office locations: Central Northeast Northwest South Central Southeast Southwest West Central
Little Rock Jonesboro Fayetteville Hot Springs Pine Bluff Texarkana Fort Smith
Customers who live in these regions may contact the regional offices or call the appropriate toll-free telephone number listed above.
is published four times a year by the Arkansas Blue Cross and Blue Shield Advertising and Communications Division for the company’s members, health care professionals and other persons interested in health care and wellness. Opinions expressed herein do not necessarily reflect the views of Arkansas Blue Cross and Blue Shield or any of its publics.
Health Advantage members, take note! (what you need to know about prescriptions, utilization guidelines and the new Health Management Programs) ...
Leading the Way
(get to know some of Arkansas’ legislators) ....... 16-17
Ageless Heroes honorees ........................... 18 Blue & Your Community ............................. 19 Clearly Blue
(a guide to health insurance terminology) ............... 20
Vice President of Advertising and Communications Patrick O’Sullivan Editor Kelly Whitehorn Designer Gio Bruno Contributors Mark Carter, Damona Fisher, Kathy Luzietti and Greg Russell
4 Breast Three Steps to Breast Health
B reast Cancer is the leading cause of death in women 35-54. Every three minutes, a woman is diagnosed, and every 12 minutes, a woman dies from this disease in this nation. While there is no cure at this time, and there are no prevention techniques or therapies, the best defense is a good offense — to use a wellknown phrase. There are three tried-and-true steps to follow: 1) Monthly breast self-examination (BSE). 2) Annual clinical exam by a physician or nurse practitioner. 3) Annual mammograms starting at age 40. Step 1 in good breast health is to perform a monthly breast self-examination — a commitment women make to themselves and to the ones who love them. Starting at age 20, the monthly exam should be done approximately one week following the start of the menstrual period. For women who have reached menopause, the BSE should be done on the same day each month. It is suggested that women select a day that has meaning, such as a birth date or anniversary date, so that the day is easily remembered. Step 2 includes an annual physical examination by a physician or nurse practitioner. Women do not need to see a gynecologist if their family physicians are including breast and cervical exams in the annual physical. Step 3 is a baseline screening mammogram which should be done sometime before the age of 40. Then, once a woman reaches 40, screening mammograms should be done on an annual basis. Mammography is about 90 percent effective and can detect tiny lumps before they can be felt. If the family physician or gynecologist is not recommending annual mammograms, then once again, it is recommended that women request this test. The sooner a breast health program is begun and consistently followed, the greater the chances of detection, diagnosis, treatment and survival. Know the Facts. I t’s important to know the risks and the facts about breast cancer and you. Did you know... • By the end of the decade, about 1.8 million women and 12,000 men will be diagnosed with invasive breast cancer? • Approximately 44,000 women and 300 men will die of this disease each year? • Breast cancer is the leading cancer among American women and is second only to lung cancer in cancer deaths? (For women ages 35-54, breast cancer is the leading cause of death.) • Breast cancer accounts for 30 percent of all new cancer cases in women? • When breast cancer is confined to the breast, the five-year survival rate is higher than 95 percent?
Breast Cancer Q & A Q. Who is at risk for breast cancer? A. All women are at risk. Women with either a mother, sister or daughter with breast cancer, particularly if it occurred before menopause or in both breasts, are at higher risk. However, only 5 percent to 10 percent of breast cancers are due to heredity. Q. When should breast self-examination be performed? A. Breast self-examination (BSE) should be performed at the same time each month. A good time to examine yourself is just as your menstrual period is ending, when the breasts are least sensitive. Q. What role does diet and nutrition play in reducing one’s breast-cancer risk? A. There is an increasing body of knowledge suggesting that a low-fat, high-fiber diet may play a role in lowering breast-cancer risk. However, there is no conclusive evidence. Q. Will drinking alcohol increase one’s risk for breast cancer? A. Some research studies have shown an association between alcohol consumption and an increased risk of breast cancer. Q. Are women who have fibrocystic changes in their breast at higher risk for breast cancer? A. For the majority of women, fibrocystic changes are not associated with an increased risk of breast cancer. Q. Are women who use birth control pills at an increased risk for breast cancer? A. Most research studies have not found an increased risk of breast cancer in women who use birth control pills. Q. Is obesity a risk factor for breast cancer? A. Obesity itself is not a risk factor. Weight gain is a much greater risk factor, especially if the weight gain occurs after menopause. This information is reprinted from the Susan G. Komen Breast Cancer Foundation’s “Breast Health Basics” literature. For printed copies of this or other information or to schedule a breast education class for a civic, church or business group, please call the Arkansas Affiliate Office at (501) 202-4009.
Know the Risks.
What is your risk of developing breast cancer? By age 60 — 1 in 24 By age 25 — 1 in 19,608 By age 65 — 1 in 17 By age 30 — 1 in 2,525 By age 70 — 1 in 14 By age 35 — 1 in 622 By age 75 — 1 in 11 By age 40 — 1 in 217 By age 80 — 1 in 10 By age 45 — 1 in 93 By age 85 — 1 in 9 By age 50 — 1 in 50 Ever — 1 in 8 By age 55 — 1 in 33 Source: Susan G. Komen Breast Cancer Foundation
veryone feels a little “down in the dumps” now and then. It’s just part of being human. But for some people, major depression is a clinical condition with a huge impact. It is estimated that one out of every eight people needs treatment for depression, but only
Other factors such as gender and age also can play a part. For instance, women are up to twice as likely as men to experience depression. And the age factor is particularly problematic (more than 15 percent of seniors experience depression) because of influences including deteriorating health and
Down but not out
Recognition is the key to beating depression
one-third to one-half of that number actually get help. Sadly, many cases of depression simply aren’t recognized. Often, people are reluctant to admit that they are depressed because of the stigma associated with the disorder. Also, the symptoms of depression aren’t always easy to identify because they can appear to stem from some other physical problem. Major depressive disorders can strike at any age, but generally speaking, they occur most commonly between the ages of 20 and 40. One common misconception is that depression is caused by some mental defect. Psychiatric disorders may make a person more susceptible to depression, but in reality, depression can be triggered by a number of nonpsychiatric factors: major or chronic health problems, the use of certain medications, etc. Illness can be a significant contributor. Overall, it is believed that from 25 percent to 33 percent of people who suffer from chronic illnesses experience depression. One survey found the following rates of depression among patients in several categories of serious illness: • Recent heart attack victims — 45 percent. • Hospitalized cancer patients — 42 percent. • Recent stroke survivors — 40 percent. • Multiple sclerosis victims — 40 percent. • Parkinson’s disease sufferers — 40 percent. • People with diabetes — 33 percent. ... once major depression is recognized, it can almost always be treated successfully ...
cognitive abilities, adverse drug interactions and personal losses (loss of occupation; death of a spouse, relative or friend; etc.). Also, older adults are less likely to believe they are depressed, so they tend to focus on physical complaints that actually might stem from depression (insomnia, weight loss, fatigue, etc.). Because of these and other “atypical” factors associated with aging, seniors may not fit the usual criteria or measurement tools used to determine whether a person is clinically depressed. And the cost of depression is high. The disorder takes an incalculable emotional toll, and the estimated annual monetary impact on the nation is $43 billion in medications, professional care and missed time at school and work. But the news about this condition isn’t all depressing. In fact, once major depression is recognized, it almost always can be treated successfully with medication or psychotherapy — or both. Not everyone responds to the same therapy, but if a person doesn’t respond to the first treatment used, he or she is likely to respond to another approach. Health Advantage recently issued Major Depression Guidelines to its primary care physicians and behavioral health specialists. This information is provided as a resource to assist physicians in identifying the symptoms of depression so they can see that patients get the help they need.
The Wakefield Scale D
etection is the key to successfully dealing with depression. The Wakefield Scale is one easy-to-use screening tool that can help you determine whether you need to contact your primary care physician to discuss possible treatment. Just answer the following 12 questions, circling your response, and add up the circled numbers. If your score is 15 or higher, show the test to your primary care physician. And even if you do not score highly on the test but suspect you are depressed, talk to your doctor. Some people with normal scores on depression questionnaires actually are depressed and can benefit from treatment. And please, if you develop thoughts of harming yourself or others, seek help right away.
A. I feel miserable and sad. (0) (1) (2) (3)
No, not at all No, not much Yes, sometimes Yes, definitely
B. I find it easy to do the things I used to do. (0) (1) (2) (3)
Yes, definitely Yes, sometimes No, not much No, not at all
C. I get very frightened or panicky feelings for apparently no reason at all. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely
D. I have weeping spells, or feel like it. (0) (1) (2) (3)
No, not at all No, not much Yes, sometimes Yes, definitely
E. I still enjoy the things I used to. (0) (1) (2) (3)
Yes, definitely Yes, sometimes No, not much No, not at all
F. I am restless and can’t keep still. (0) (1) (2) (3)
No, not at all No, not much Yes, sometimes Yes, definitely
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G. I get off to sleep easily, without sleeping tablets. (0) (1) (2) (3)
Yes, definitely Yes, sometimes No, not much No, not at all
H.I feel anxious when I go out of the house on my own. (0) (1) (2) (3)
No, not at all No, not much Yes, sometimes Yes, definitely
I. I have lost interest in things. (0) (1) (2) (3)
No, not at all No, not much Yes, sometimes Yes, definitely
J. I get tired for no reason. (0) (1) (2) (3)
No, not at all No, not much Yes, sometimes Yes, definitely
K. I am more irritable than usual. (0) (1) (2) (3)
No, not at all No, not much Yes, sometimes Yes, definitely
L. I wake early and then sleep badly for the rest of the night. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely
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FLU & YOU ¥ FLU & YOU ¥ FLU & YOU ¥
Risk Factors for flu and pneumonia
u andts l f t s Fa ia fac n o d m nt reporte pneu Departme
ths Health e Arkansa monia were the six h the th , 7 9 9 1 pneu • In sans, wit enza and ng Arkan o m a that influ th a than 90 use of de for more g n ti n u leading ca o c c pulation a senior po s. th a e f the d occal percent o pneumoc , s te ta S d ases of ite d 3,000 c in the Un te r a a e m y ti s h e c n ,000 • Ea unts for a of bacteremia, 500 o c c a e s a tis s dise ,000 case ases of oti c 0 5 n , o is li it il g m menin and 7 neumonia p f o s e s a c ). een r infection ath. Betw e d f media (ea o e s urred in icant cau eaths occ is a signif d a 0 z 0 n e ,0 u 0 1 fl 80 ast • In 1987, at le za epidemics, with 1977 and n e r u r cu ing in arate infl deaths oc e th f o seven sep t 90 percen percent to ge 65 and older. ls a ctive in individua rcent effe but only e p 0 8 is ccine pulation, uenza va at-risk po lts e th • The infl in older adu eath d d e z g li n a ti n n o e ti prev nstitu ally. t of non-i tion annu 40 percen a iz n u m e im ceive the receive th atients re p k is r ta of 0 percent coccus. • Only 2 u e ains r pn mo fo e in sistant str c e c -r a g v u r d ised. and mult ave increa -resistant h n li e il ia ic n n o e eum • P coccus pn of strepto
Y ou may be at risk for the flu and/or pneumonia if you are in one of the following categories. Take preventive measures and get your flu and pneumococcal vaccines. People at risk include: • Persons aged 65 or older. • Persons aged 2 to 64 who have chronic illnesses such as cardiovascular disease (including congestive heart failure (CHF), cardiomyopathies and chronic obstructive pulmonary disease (COPD), recurrent bronchitis, emphysema, diabetes mellitus, alcoholism, chronic liver disease, cirrhosis, cystic fibrosis, functional or anatomic asplenia, sickle cell disease and splenectomy. • Smokers. • Persons who are in special environments such as nursing homes or other long-term care facilities. • Persons aged 2 and older who have functional or anatomic asplenia (including sickle cell disease and splenectomy), Hodgkin’s disease, lymphoma, leukemia, multiple myeloma, chronic renal failure and other situations such as organ transplantation, cancer treatments and drug regimens causing immunosuppression and HIV infection. If you are pregnant, contact your health care provider for more information. If you are in one of the above risk categories, you will be receiving a reminder card from Health Advantage encouraging you to get your vaccines. Both vaccines may be taken at the same time at the onset of the flu season (October through midNovember). See your primary care physician with questions or for more information. Information for the articles concerning the flu and pneumonia was obtained from “Prevention and Control of Influenza: Recommendations for the Advisory Committee on Immunization Practices”; “Prevention of Pneumococcal Disease: Recommendation of the Advisory Committee on Immunization Practices”; and the Arkansas Health Department.
FLU & YOU 짜 FLU & YOU 짜 FLU & YOU 짜
What causes pneumonia? P
neumonia can affect anyone at any age. Pneumonia is an inflammation of the lungs caused by an infection. It is a common, serious illness that affects approximately one out of 100 people each year. It is caused by many different types of organisms and may range from a mild to a lifethreatening illness. Pneumonia symptoms include: cough, chills with shaking, fever, fatigue, chest pain, headache, loss of appetite, nausea, vomiting and general discomfort. Additional symptoms that may be associated with this disease include: shortness of breath, excessive sweating, clammy skin, rapid breathing, coughing up blood and abdominal pain. Supportive therapy includes oxygen and respiratory treatments. Most patients will respond to the treatment and improve within two weeks. If you are at high risk (see risk factors on Page 8), it is important that you get vaccinated to prevent the illness and any further complications. The vaccine has a protective efficacy of approximately 60 percent. Most people will need one shot that will immunize them for the rest of their lives. However, some people may need to have another vaccine after five years.
Get your flu sho t
I f you have ever had in fluenza (bette the flu), you r known as know it is no fun. So, to im chances of hav p rove your ing a flu-free fall and winte preventive m r, take easures and ge t your flu sho The flu is a v t. iral infection that causes fe of the respirat ver, headache, ory tract muscle aches weakness. It and is spread from person to per inhaling infect son by ed droplets fr om the air. Flu include: fever symptoms , cough, nasal discharge, hea muscle aches dache, and weaknes s, shortness o chills, sweati f breath, ng, fatigue an d appetite loss Antibiotics ar . e not effectiv e against viral tions. Bed rest , painkillers an infecd warm fluid relieve the sy s may help mptoms. Sym ptoms usually within seven go away to 10 days. To prevent th e flu, get a flu has a 70 perce shot. The vac nt to 90 perce cine n t preventing illn success rate in ess in a healt hy person un der age 65.
arents and teachers, now there’s a new way to teach your kids how to be healthy and encourage them to practice what they learn. BlueAnn Ewe, ambassador of health and wellness for Arkansas Blue Cross and Blue Shield, is looking for boys and girls throughout the state who want to have fun ... and stay healthy. Arkansas Blue Cross’ favorite sheep, BlueAnn Ewe, is at the center of her own clubs for kids focused on health and wellness. The BlueAnn Health Club and the BlueAnn Class Club now are available for elementary schoolaged children in homes and classrooms throughout the state. The BlueAnn clubs are part of the Blue & Youth Health Program, which seek to improve the health status of our communities, starting with the young people of our state. In three years, the Blue & Youth Health Program has reached more than 139,000 students through three educational components: 1) the BlueAnn Ewe Elementary School Education lesson; 2) High School Heroes; and 3) the Wildwood musical tour. Now the Blue & Youth Health Program has expanded to include two new components: A) The BlueAnn Health Club — a free club geared to individual children. B) The BlueAnn Class Club — a free club for classroom use. The BlueAnn Health Club and the BlueAnn Class Club will provide children with opportunities to learn about healthy habits and participate in activities to encourage overall healthy behaviors or practices. “The clubs will be offered free to participants and will be designed to include incentives for participating in healthy activities,” said Patrick O’Sullivan, Arkansas Blue Cross vice president of Advertising and Communications. “We want the BlueAnn clubs to make learning about health fun for kids. We hope that the club activities will help Arkansas children learn about and practice healthy behaviors now — while they are young — so that when they are older, they can be their healthy best.”
The BlueAnn Health Club is geared to elementaryschool-aged children (approximately 5-10 years old). The BlueAnn Class Club is geared to first-grade students, although kindergartners may participate. Parents enroll their children for the BlueAnn Health Club, and teachers enroll their classes for the BlueAnn Class Club. Both clubs will provide a membership welcome packet. Once a child becomes a member of the BlueAnn Health Club, he or she will receive quarterly mailings from Arkansas Blue Cross for two years. Participation in the BlueAnn Class Club will be for the school year, during which the class will receive three mailings. The goals of both clubs are to: 1. Teach children about health and wellness, and provide ideas and activities for healthier behavior. 2. Involve parents/teachers in the educational process. 3. Encourage and reward healthy behaviors in club members. “We have been teaching children about health and wellness now for three years in classrooms and community settings,” said Damona Fisher, Arkansas Blue Cross public relations coordinator and club coordinator. “The BlueAnn clubs now will provide an avenue for that information to translate into healthy behaviors. We want to help kids understand how to be healthier and then encourage them to practice what they learn.” To do that, the club materials include a month-long activity project (Healthy Habits Activity Calendar) that records healthy behaviors. When the activity project is complete, club members/classes send in their finished product to Arkansas Blue Cross, and their names are submitted for an opportunity to win some great prizes. Subsequent packets also will contain a new activity sheet to complete and return (if the member desires) for more chances to win prizes. BlueAnn Health Club — for individuals Each child who joins the BlueAnn Health Club will receive an initial membership packet and seven subsequent packets of health information and activities. The membership welcome packet will be sent first and will
contain a Healthy Habits Activity Calendar — a onemonth activity chart and stickers to help kids record healthy behaviors they do each day — and several fun items for the member. As an immediate reward for completing and returning the monthlong project, each child will receive a BlueAnn poster. Plus, the child’s name goes into a drawing for a chance to win some fun prizes, including the grand prize of a bicycle and safety helmet. Each subsequent club packet will contain a funfilled health newsletter — Ewe News — as well as a wellness activity project to be completed and returned to Arkansas Blue Cross (if desired), and a small gift item related to the packet health topic. Club members will be encouraged to read the newsletter and complete the healthy habits games. Each time an activity project is completed and returned, the child’s name is added to the prize bank for more chances to win prizes. Members’ names will be maintained in the prize bank, and they will be eligible for prize drawings held throughout the two-year membership. Prize drawings will be held twice a year. At the end of the two-year membership period, members will receive a BlueAnn Health Club Graduation Certificate congratulating them on learning health habits and working hard to be a healthy kid. BlueAnn Class Club — for first-grade classes Each class that joins the BlueAnn Class Club will receive an initial membership packet and two subsequent packets of health information and activities, as well as small gift items for their enjoyment. The membership welcome packet will be sent first and will contain the Healthy Habits Activity Calendar and several fun items for the class. The two subsequent club packets will contain a
health newsletter, a group wellness activity project sheet and gift items related to the packet health topic. Class Club members will be encouraged to read the newsletter and complete the healthy habits games. To be eligible for the prize associated with the Class Club, the teacher/class must complete the Health Habits Activity Calendar and return it to be included in the drawing. For each subsequent Group Wellness Activity project completed and returned, the class receives another chance to win a prize. Class prizes will be given away in each Arkansas Blue Cross region of the state at the end of the school year. The grand prize is a “Build a Healthy Sundae” party for the class with BlueAnn Ewe. The winning classroom teacher receives a special gift. At the end of the school year, each class member will receive a BlueAnn “Blue Ribbon Class” ribbon congratulating them on their efforts to be healthier. All teachers who sign their class up for the program will receive a BlueAnn Ewe canvas bag. Signing up Parents and teachers interested in enrolling their children or class for one of the BlueAnn clubs should call 1-800-515-BLUE, toll-free, and ask for the BlueAnn Club.
Information will be processed immediately and membership welcome packets will be mailed within 24 hours. Allow two weeks for delivery. BlueAnn Health Club members then will receive packets every three months for two years. BlueAnn Class Club classes will receive two subsequent packets during the school year. “We hope the BlueAnn Clubs will be an exciting, interactive way for kids to learn about health with their parents or teachers and begin to take small, achievable steps toward healthy habits for life,” said Fisher. “After all, the Arkansas Blue Cross mission states that we want our members to be healthy. Through the BlueAnn Clubs, we hope to promote that mission to our young members as well.”
W O M E N ’ S
Menopause — a natural part of life Prevention of osteoporosis — a lifelong commitment Researchers estimate that 23 percent of American women age 50 and older have osteoporosis. Osteoporosis is the progressive loss of bone density and thinning of bone tissue. The leading cause of osteoporosis is hormone deficiencies, so women who are menopausal may be at risk. There are no symptoms of osteoporosis in its earliest stages. However, symptoms occurring late in the disease include: fractures of the vertebrae, wrists or hips; low back pain; neck pain; bone pain or tenderness; loss of height over time; and stooped posture. Treatment options should be discussed with your primary care physician. They may include medications (such as estrogen replacement therapy), lifestyle changes such as regular exercise and a diet that includes calcium, vitamin D and protein. Prevention of this disease is a lifelong commitment. It should start with regular exercise and a proper diet.
Menopause, also known as the change of life, is a word that may strike dread, fear or relief in the hearts of many women. However, knowing the meaning of menopause and its symptoms and treatment options can help women better prepare for this natural part of life. Menopause is the transition period when the ovaries stop producing eggs, menstruation decreases (eventually ending) and the body decreases its production of female hormones — estrogen and progesterone. Menopause usually occurs between the ages of 40 and 55. Symptoms may include hot flashes and skin “flushing,” mood changes, decreased sex drive, irregular menstrual periods and vaginal dryness. Natural menopause usually requires no treatment. Surgical menopause that occurs prior to natural menopause may require estrogen replacement therapy (ERT). Physicians may recommend ERT to reduce the undesirable symptoms of menopause, help decrease vaginal drying and prevent osteoporosis (see article this page) after menopause. If you have questions or concerns about menopause, please contact your primary care physician.
Feeling cranky? It’s not you — it’s PMS! Feeling a little cranky or “on edge” a few days each month? You may be suffering from premenstrual syndrome (PMS). Premenstrual syndrome is a symptom or collection of symptoms that occurs regularly in relation to the menstrual cycle, usually beginning five to 11 days prior to the onset of the cycle. An exact cause has not been identified, but it may be related to social, cultural, biological and psychological factors. From 70 percent to 90 percent of women are affected by this syndrome during childbearing years. Physical symptoms may include headache; swelling of ankles, feet or hands; backache; abdominal cramps (heaviness, fullness or pain); muscle spasms; breast tenderness; weight gain; cold sores; acne flare-up; nausea,
bloating, bowel changes; decreased coordination; food cravings; decreased tolerance to sensory input (noise or light); and painful menstruation. Other symptoms may include: anxiety or panic; confusion; difficulty in concentrating; forgetfulness; poor judgment; depression; irritability, hostility or aggressive behavior; increased guilt feelings; fatigue; decreased selfimage; sex drive changes; paranoia or increased fears; slow, lethargic movement; low self-esteem; and overreaction to sensory changes (noise or light). Treatment options include regular exercise and a balanced diet (with increased intake of whole grains, vegetables, fruit and a decreased intake of salt, sugar, alcohol and caffeine).
Diabetes and You know the facts Chances are, you or someone you know either has diabetes or knows someone who does. Roughly 16 million Americans are afflicted with the sometimes deadly disease, according to a 1995 estimate; half of them are undiagnosed. There are two types of diabetes: • Insulin-dependent diabetes, also referred to as type I or juvenileonset diabetes. • Noninsulin-dependent diabetes, also known as type II or adult-onset diabetes. Diabetes occurs when a person’s body does not produce insulin, doesn’t produce enough insulin or can’t properly use the insulin that is produced. Insulin, produced in the pancreas, is used to break down glucose (sugar) once it enters the bloodstream. It enables cells to absorb the glucose. Insulin-dependent diabetics either produce no insulin at all or not enough to be used. This type of diabetes usually occurs in children or adults below age 40 and requires insulin injections. Noninsulin-dependent diabetics produce insulin, but their cells are unable to break down the sugar that enters the bloodstream. This type of diabetes usually occurs in adults age 40 or older and can be treated with insulin injections, oral medications, a combination of injections and oral agents or by a strictly modified diet and exercise
Arkansas Blue Cross and Blue Shield is a corporate sponsor of the 1999 Walk To Cure Diabetes sponsored by the Greater Arkansas Chapter of the Juvenile Diabetes Foundation. The event will be held on Saturday, Oct. 2. If you would like more information about juvenile diabetes or the Walk To Cure Diabetes, call (501) 372-7515. Arkansas Blue Cross also is a corporate sponsor of America’s WALK for Diabetes sponsored by the American Diabetes Association. The walk will be held Saturday, Oct. 16. For more information about diabetes, call 1-800-DIABETES. For more information about the walk, call (501) 221-7444.
13 People with diabetes use glucometers to measure blood glucose levels.
regimen. Of the 16 million estimated Americans with the disease, 7 million to 7.5 million are type II diabetics. Common symptoms of diabetes include: • Fatigue, lethargy. • Increased thirst. • Increased urination. • Blurred vision. • Weight loss. • Hunger. • Infections or cuts that don’t heal. Long-term complications of diabetes include blindness, heart disease, risk of stroke, high blood pressure, kidney disease, amputations, dental disease, pregnancy complications and nerve damage. As there is no cure for the disease, treatment of diabetes is an ongoing process consisting of oral medication or insulin injections, blood glucose level monitoring, exercise, meal planning and special attention to medical and other social factors such as stress. Don’t hesitate to consult your primary care physician if you or a loved one exhibit the symptoms of diabetes. Working closely with your primary care physician will go a long way in ensuring people with diabetes a longer life with fewer problems related to the disease.
14 Health Advantage members usually don’t have to worry about filing claims because health care providers ordinarily handle that task. But occasionally, situations arise that require members to file claims. In such instances, here’s how the process works.
Filing a claim for out-ofservice area medical services Members must present their Health Advantage identification card each time health services are received. Most providers will file a claim for services rendered. If the hospital or physician will not file a claim, the member may file the claim on behalf of the provider. In such cases, the member should submit Standard Form 1500, with a copy of the bill for services received, to Health Advantage. The claim must be submitted within 180 days of the date on which expenses first were incurred. The claim form and a copy of the bill must be sent to: Claims Health Advantage P.O. Box 8069 Little Rock, AR 72203-8069
Reimbursement for covered medical services If a member makes payment, other than required co-payments/co-insurance, for services covered by Health Advantage, a claim for reimbursement may be filed. The request must be made within 180 days of the date on which expenses first were incurred. The request for reimbursement (with a copy of receipt for payment for services received and a copy of the bill attached) must be sent to: Claims Health Advantage P.O. Box 8069 Little Rock, AR 72203-8069
Pharmacy Services Reimbursement for pharmacy charges may be requested by submitting the Prescription Claim Form, #API-079 (with a copy of the sales receipt) to: Advance Paradigm, Inc. P.O. Box 853901 Richardson, TX 75085-3901 (NOTE: Prescription medications purchased from “out-of-network” pharmacies within the service area are not covered.)
ge Health Advanta members —
UM GUIDELINES Health Advantage provides utilization management (UM) services to our members using nationally accepted utilization management guidelines and internally developed medical policy. For Medi-Pak HMO members, Health Advantage uses UM guidelines developed by the federal Health Care Financing Administration (HCFA) and local intermediary medical policy. Health Advantage applies criteria on a case-by-case basis considering the individual medical needs of the member and resources available through the health care delivery system. Medical decisions are made based on information provided by the member’s primary care physician, any specialist(s) involved in the care and the member’s medical records. Authorizations for “Out of Plan” care must be requested by the physician before the service is provided, except in an emergency. The member’s physician may request a review of the criteria used for decision-making, either in writing or by telephone. A Health Advantage physician reviewer is available to discuss the criteria with the member’s physician during business hours.
DRUG COVERAGE DETERMINATION If you are a Health Advantage member with a drug card benefit, remember that coverage for any prescription medication is subject to the Health Advantage formulary.
The formulary is a specific list of covered medications. It was developed, and is maintained, by the Arkansas Blue Cross and Blue Shield Pharmacy and Therapeutics Committee, which includes Arkansas pharmacists and consulting physicians. Medications in the Health Advantage formulary reflect those prescriptions that usually are prescribed by the Health Advantage network of physicians. The criteria used to determine formulary status for particular medications include safety, uniqueness, effectiveness and cost. Occasionally, a Health Advantage member may have an adverse or harmful reaction to a formulary medication or determine that a medication is ineffective in the treatment of a particular disease or condition. In these cases, members may be able to obtain coverage for a non-formulary medication through the Prior Authorization process. This will require a letter of medical necessity from the prescribing doctor. Additionally, medical records or further documentation from the member’s physician may be requested. For more information on authorization of a non-formulary medication, Health Advantage members may call (501) 221-3733 or 1-800-843-1329.
NEW HEALTH MANAGEMENT PROGRAMS Health Advantage members with chronic diseases will benefit from new Health Management Programs. Certain diseases or conditions may require long-term or continual care. For example, people with diabetes are monitored by their physicians throughout their lifetimes. However, a person with an ear infection may need to see
his or her physician only once for proper treatment. The new Health Management Programs offered by Health Advantage are focused on those members who have chronic conditions (such as diabetes, coronary artery disease, etc.) or those who are pregnant and may be at a higher risk for complications. Health Advantage identifies member needs in the population and places those members in a Health Management Program. For example, members in the Diabetes Health Management Program received educational materials in May 1999. In November 1998, every primary care physician and endocrinologist in the Health Advantage network received a BlueGuide, which contains clinical practice guidelines for diabetes adapted from the American Diabetes Association (ADA). In April, they received additional helpful materials, including profiles summarizing their care of diabetic patients. Health Advantage is measuring physician performance against the guidelines and is monitoring how our diabetes patients are faring. The outcome of the tracking may lead to more member education, case management for high-risk patients (coordinated through the member’s physician), home health care or other options. Health Advantage also is attempting to eliminate barriers to care in order to promote the best care possible for members who have diabetes.
Leading erhaps no other issue affects as many people as health care. In light of P this fact, Arkansas Blue Cross and Blue Shield thought our customers might want to get to know some of the many state senators and represen-
Sen. Dave Bisbee (R) (Dist. 33) Rogers Committee on Committees; Public Health, Welfare & Labor; Transportation, Aging and Legislative Affairs (O/H) 501-636-2516 Sen. Cliff Hoofman (D) (Dist. 18) North Little Rock Vice chairman, Joint Performance Review; Insurance and Commerce; Joint Budget; Public Health, Welfare and Labor; Rules, Resolutions & Memorials (O) 501-371-9224 (H) 501-758-9692 Sen. Kevin Smith (D) (Dist. 7) Stuttgart Chairman, Joint Advanced Communications & Information Technology; Children & Youth; Committee on Committees; Insurance & Commerce; Joint Budget; Revenue & Taxation (O) 870-673-3573 (H) 870-673-3422 Sen. William L. â€œBillâ€? Walker Jr. (D) (Dist. 17) Little Rock City, County & Local Affairs; Joint Retirement & Social Security; Public Health, Welfare & Labor; Rules, Resolutions & Memorials (O) 501-375-8683 (H) 501-375-5275 Rep. Mike Creekmore (D) (Dist. 51) Hensley Joint Performance Review; Public Health, Welfare & Labor; State Agencies & Governmental Affairs (H) 501-888-1966
Rep. John Eason (D) (Dist. 97) Marianna Aging, Children & Youth, Legislative & Military Affairs; Public Health, Welfare & Labor No phone Rep. Danny Ferguson (D) (Dist. 91) Forrest City Energy; Insurance & Commerce; Revenue & Taxation (H) 870-633-8256 Rep. Jeff Gillespie (D) (Dist. 27) Danville Vice chairman, House Management; Insurance & Commerce; Joint Performance Review; Public Transportation (O) 501-495-9388 (H) 501-495-7912 Rep. Bobby Glover (D) (Dist. 81) Carlisle Insurance & Commerce; Joint Budget; Joint Performance Review; Revenue & Taxation (O) 870-552-7150 (H) 870-552-3140 Rep. Brenda Gullett (D) (Dist. 75) Pine Bluff Vice chairman, Joint Advanced Communications & Information Technology; City, County & Local Affairs; Public Health, Welfare & Labor (O) 870-535-3050 (H) 870-541-0620 Rep. David Haak (R) (Dist. 21) Texarkana Public Health, Welfare & Labor; State Agencies & Governmental Affairs (O) 870-772-7931 (H) 870-772-1774
the Way tatives of the Arkansas General Assembly who spend numerous hours working on health care issues. (Upcoming issues of Blue & You will feature additional profiles of our legislators.) Rep. David Hausam (R) (Dist. 2) Bentonville Vice chairman, Joint Retirement & Social Security; Insurance & Commerce; Revenue & Taxation (O) 501-444-4009 (H) 501-273-7050 Rep. Don House (D) (Dist. 78) Walnut Ridge Insurance & Commerce; Public Transportation (H) 870-886-3532 Rep. Jim Lendall (D) (Dist. 52) Mabelvale Agriculture & Economic Development; Joint Advanced Communications & Information Technology; Public Health, Welfare & Labor (H) 562-0011 Rep. Jim Magnus (R) (Dist. 55) Little Rock Chairman, Joint Advanced Communications & Information Technology; Insurance & Commerce; Revenue & Taxation (O) 501-220-5243 (H) 501-227-0464 Rep. Randy Minton (R) (Dist. 69) Ward Public Health, Welfare & Labor; State Agencies & Governmental Affairs (O/H) 501-843-3147
17 Rep. David Rackley (R) (Dist. 63) Sherwood City, County & Local Affairs; Public Health, Welfare & Labor (O) 501-416-0357 (H) 501-834-1626 Rep. Marvin Steele (D) (Dist. 96) West Memphis Agriculture & Economic Development; Public Health, Welfare & Labor; Rules (O) 870-735-2850 (H) 870-735-3922 Rep. Tracy Steele (D) (Dist. 59) North Little Rock Aging, Children & Youth, Legislative & Military Affairs; Joint Advanced Communications & Information Technology; Public Health, Welfare & Labor (O) 501-324-9333 (W) 501-376-9466 Rep. Chaney Taylor, Jr. (R) (Dist. 41) Batesville Aging, Children & Youth, Legislative & Military Affairs; Public Health, Welfare & Labor (O) 870-793-5297 (H) 870-793-3545 Rep. Shawn Womack (R) (Dist. 40) Mountain Home Public Health, Welfare & Labor; State Agencies & Governmental Affairs (O) 870-424-5000 (H) 870-424-4422
Hot Springs (Left to right, seated): McDougal and Smith; (standing) Petruk, Burton, Kiburas and Flint.
(Left to right): Hall, Washington Regional President and CEO Patrick Flynn, Brown, Tompkins, Arkansas Blue Cross Regional Executive Mel Blackwood, Mills, Morrison and St. Mary’s Hospital Vice President Sister Janice Greenwood.
Little Rock (Left to right): Carr, Hayman, Studdard, Sellers, Rife and Simmons.
Jonesboro (Left to right, seated): Delaney, Shannon and Barton; (standing) King, Cannady and Jones.
Texarkana (Left to right): Elam, Kipple, Coulter, Clemens, McGraw and Cayce.
rom teachers to tap dancers, those honored as Arkansas’ Ageless HeroesSM represented the best examples of good health, vigor and vitality. The 1999 Ageless Heroes continue to be honored throughout the state by Arkansas Blue Cross and Blue Shield, local hospital partners and Health Advantage Medi-Pak HMO. The Ageless Heroes Awards program is a part of the Blue Cross and Blue Shield Association’s commitment to healthy aging. Ageless Heroes categories are: Vigor and Vitality — demonstration of extraordinary physical or mental abilities; Community Involvement — commitment to a community and its members; Love of Learning — pursuit of knowledge by study or experience; Creative Expressions — unique expressions of talents; Bridging the Generations — grandchild’s expression of admiration for grandparent; Against the Odds — overcoming the challenges of a disability. The 1999 Ageless Heroes winners honored to date are listed by region and in the following order: Vigor and Vitality, Community Involvement, Love of Learning, Creative Expressions, Bridging the Generations and Against the Odds. NORTHWEST REGION — Ulis Morrison, 89, of Marshall; Carl Tompkins, 77, of Bella Vista; Bob E. Hall, 69, of Fayetteville; Ree Mills, 83, of Springdale; Elizabeth “Daisy” Henry, 73, of Booneville; and Carmon Brown, 68, of Henderson.
SOUTHWEST REGION (Southwest Arkansas and Northeast Texas) — Aubrey “Shine” Elam, 74, of Waldo; Charles Downs, 69, of Hope, and Joann Cayce, 66, of Thornton; Oscar Coulter, 68, of Nashville and Louise Carlton Clemens, 81, of Texarkana, Texas; Charles Kipple, 96, of Texarkana, Ark.; Myrtle Haggard, 87, of Hooks, Texas; and Frances McGraw, 85, of Ashdown. NORTHEAST REGION — Mary Etta West, 75, of Bald Knob; Flo Jones, 69, and Demetra Parrish Barton, 103, both of Jonesboro; Doyle Cannady, 68, of Corning; Mary Elizabeth King, 73, of Cotton Plant; Percy Shannon, 77, of Newport and Ray Knight, 71, of Forrest City; and Mildred Delaney, 81, of Batesville. CENTRAL REGION — Ione Studdard, 80, of North Little Rock; James F. Carr Jr., 85, of Searcy; Truett Goatcher, 74, of Little Rock, and Bernice S. Hayman, 82, of Little Rock; Robert Rife, 89, of Little Rock; Hubert Sellers, 80, of Judsonia; and Ginny Simmons, 80, of Benton. SOUTH CENTRAL REGION — Len Burton, 69, of Hot Springs Village; Joe Petruk, 66, of Hot Springs; Ora R. Flint, 78, of Hot Springs; Joe Kiburas, 76, of Hot Springs and Joe Sedlon, 90, of Mount Ida; and Frances Smith, 83, and Jim McDougal, 62, both of Malvern.
rkansas Blue Cross and Blue Shield is a good corporate citizen. Our employees raise money and spend many hours helping those causes near and dear to the hearts of Arkansans. Recognizing Readers St. Edward Mercy Medical Center in Fort Smith concluded its second “Read to Succeed” program for students in kindergarten through sixth grade in the Fort Smith public schools and at Christ the King school recently. The reading program encourages students to read as well as encourages parents to read to small children. An awards ceremony was held on May 16. BlueAnn Ewe attended the ceremony to help award bicycles and helmets to the top readers in each grade level. Arkansas Blue Cross provided a BlueAnn Ewe with better readers safety helmet for and bikes. each student who received a bike. This was the second year for the West Central Regional Office to partner with St. Edward in rewarding the students for participation in the program. Prevention Convention Arkansas Blue Cross and Blue Shield’s Northeast Regional Office staff participated in St. Bernards Regional Medical Center’s 1999 Prevention Convention recently. BlueAnn Ewe greeted young people who attended the event to learn about farm safety. Helping the Helper’s Hands Joann Cayce is known by thousands of people who have been touched by her giving spirit and hard work getting people back on their feet after a tragedy. Cayce, of Thornton, one of the Southwest Arkansas 1999 Ageless HeroesSM and founder of Cayce’s Charities (a non-profit organization which helps the needy), shared her stories with those attending the Ageless Heroes reception in Texarkana. Following the reception,
Christus St. Michael and Arkansas Blue Cross staff members pulled together to help meet immediate needs. Christus St. Michael donated blankets and sheets, and Arkansas Blue Cross, with the help of a local vendor, provided numerous first-aid items. When all was boxed, about 17 cases of supplies were shipped to help out Cayce’s Charities.
Healthy Start Back-to-school Our Children First coalition presented its second annual “Wild About Wellness” Back-to-School Health Fair sponsored by Arkansas Blue Cross, Christus St. Michael and KKYR Radio 102.5, among other local businesses, on Aug. 6-7 at the Four States Fairgrounds in Texarkana. More than 2,000 children and their parents attended the two-day event. More than 1,100 children received health screenings. Staff members from the Arkansas Blue Cross Southwest Regional Office in Texarkana coached kids in playing BlueAnn’s Bean Bag Toss for a chance to win fun and healthy prizes. BlueAnn even stopped by to encourage the Back-to-schoolers toss bean bags kids to be their for healthy prizes. healthy best. High School Heroes About 20 High School Heroes and BlueAnn Ewe took their message of how to resist pressure to smoke to more than 150 fifth-graders at Hillcrest Elementary School in Jonesboro. During the second semester, junior and senior students from Jonesboro High School taught the younger set about the deceptive appeals of tobacco advertising and how to resist smoking. High School Heroes was developed by the Arkansas Lung Association and currently is active in 21 counties in Arkansas. Arkansas Blue Cross serves as the statewide title sponsor of the studentto-student teaching program.
— a guide to health insurance terminology
f your head is spinning after reading all the health care terminology (including abbreviations and acronyms) on an insurance form or in a health care article from your local newspaper, never fear … Arkansas Blue Cross and Blue Shield is here to help. We want you to be an informed customer, so in each issue of this quarterly publication, Blue & You, we will explain the meaning behind those health insurance words, acronyms and abbreviations you may encounter when reading health care-related information. Co-insurance — A method of cost-sharing in a health insurance policy that requires a group member to pay a stated percentage of all remaining eligible medical expenses after the deductible amount has been paid. Co-payment — A specified dollar amount that a member must pay out-of-pocket for a specified service at the time the service is rendered.
disclosing the amount of time that individual had coverage. The information included in this form will enable an individual to establish his or her prior creditable coverage for purposes of reducing any pre-existing condition exclusion imposed on the individual by any subsequent group health plan coverage. Certificates of Creditable Coverage may be issued by: Other group health plans (including COBRA) Individual Major Medical coverage Medicare, Part A or B Medicaid CHAMPUS Federal Employees Health Benefit Plan (FEHBP) Medical care programs of Indian Health Services of Tribal Organizations State health benefits risk pools Public health plans Peace Corps
Deductible — A flat amount a group member must pay before the insurer will make any benefit payments.
CSR (customer service representative) — Arkansas Blue Cross staff member who helps external and internal customers with questions or problems.
Network — The group of physicians, hospitals and other medical care providers that a specific managed care plan has contracted with to deliver medical services to its members.
EOB (Explanation of Benefits) — A document sent to members describing the handling of charges submitted to Arkansas Blue Cross for services provided.
Pended — A claims term that refers to a situation in which it is not known whether an authorization has or will be issued for delivery of a healthcare service, and the case has been set aside for review.
HMO (health maintenance organization) — A health care system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee.
Premium — A prepaid payment or series of payments made to a health plan by purchasers, and often plan members, for medical benefits. Underwriting — The process of identifying and classifying the insurance risk represented by an individual or group. COB (Coordination of Benefits) — The internal claims procedures established so that Arkansas Blue Cross claims involving worker’s compensation, subrogation or the nonduplication of benefits clause can be pended and handled through common correspondence when additional information is needed from the policyholder, physician, hospital or a commercial insurance company. COC/COCC (Certificate of Creditable Coverage) — A Certificate of Creditable Coverage is a form issued by the group health plan or the health insurance carrier to insured individuals,
Arkansas Blue Cross and Blue Shield P.O. Box 2181 Little Rock, AR 72203-2181
Published on Mar 16, 2010