Super Seniors Aging well in America Medi-Pak Rx â€” Affordable and available now, p. 16
directory on the appropriate Web site (see list of Web site addresses on opposite page) for a participating home health provider. Q. I recently retired and would like to continue my coverage. Whom do I contact for more information? A. You should contact the group administrator with your previous employer. Q. Whom do I contact to continue my coverage under COBRA (Consolidated Omnibus Budget Reconciliation Act)? A. You should contact your group administrator.
We’re here to serve you Following is a list of commonly asked customer service questions that may help you ﬁnd the answer you need. The question-andanswer list below should be helpful to you as a member of Arkansas Blue Cross and Blue Shield and its family of companies.
Q. I need a copy of an Explanation of Beneﬁts (EOB) form. How do I get this? A. To obtain a copy of an EOB, you may call Customer Service (see opposite page for a list of telephone numbers) or register with My Blueprint online (see opposite page for list of Web addresses or refer to Page 15 for information on registration). Q. I have health insurance through my own policy and my husband’s policy. Will you coordinate beneﬁts? A. Yes. Q. Will I be able to add my grandchild to my coverage policy? A. Your grandchild may be added if you obtain full legal guardianship through the court system and have proof of full ﬁnancial responsibility for the child. Q. My prescription has been rejected at the pharmacy. Whom should I contact for assistance? A. If your plan covers pharmacy beneﬁts, please call the Customer Service number on the back of your health insurance ID card. Q. Do I have coverage for outpatient physical therapy? A. Yes. You should refer to your provider directory to locate providers or visit our online provider directories on our Web sites (see opposite page for Web site addresses). Q. My physician has ordered home health visits for me. Are they covered under my policy? A. Many of our members have this coverage. Refer to your policy for details, or call Customer Service. Also refer to the provider
Blue & You Autumn 2005
Q. Is precertiﬁcation required for inpatient or outpatient services? A. As long as you are covered by one of our plans, precertiﬁcation is not required. Q. How do I order my Certiﬁcate of Credible Coverage form? A. You should contact Customer Service or your group administrator. Arkansas State Employees/Public School Employees (ASE/PSE) members should contact the Employee Beneﬁts Division at (877) 815-1017. ❊ For access to customer service 24 hours a day, seven days a week, call My BlueLine. For more information, see Page 15.
is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, health-care professionals and other persons interested in health care and wellness. Vice President of Advertising and Communications: Patrick O’Sullivan Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com Designer: Gio Bruno Contributors: Chip Bayer, Tammi Bradley, Janice Drennan, Damona Fisher, Kathy Luzietti and Mark Morehead
Customer Service Numbers Category
Little Rock Number (501)
State/Public School Employees
Arkansas Blue Cross and Blue Shield health insurance plans for individuals and families 378-2010
Arkansas Blue Cross Group Services 378-3070
Federal Employee Program (FEP)
BlueAdvantage Administrators of Arkansas
Pharmacy Customer Service: Arkansas Blue Cross Health Advantage BlueAdvantage Specialty Rx Medi-Pak (Medicare supplement) Medicare (for beneﬁciaries only): Part A (hospital beneﬁts) Part B (physician beneﬁts)
1-800-863-5561 1-800-863-5567 1-888-293-3748 1-866-295-2779 378-3062
1-800-MEDICARE (633-4227) 1-800-MEDICARE (633-4227)
this issue Autumn 2005 2 4 5 6 8 9 10 11 12 14 15 16 17 18 20 23 24 25 26 27
For information about obtaining coverage, call: Category
Little Rock Number (501)
Medi-Pak (Medicare supplement)
29 30 31 32
Health insurance plans for individuals and families
Regional Ofﬁce locations are: Central, Little Rock; Northeast, Jonesboro; Northwest, Fayetteville; South Central, Hot Springs; Southeast, Pine Bluff; Southwest, Texarkana; and West Central, Fort Smith.
Blue Comes Through Americans living healthier, wealthier and longer Eat well, live well Obesity & smoking may lead to rapid aging Grow old along with me … but encourage me to exercise A closer look at vision health Pain and stiffness could equal arthritis Taking care of your skin Recognizing Alzheimer’s disease An active mind is a healthy mind A balancing act — Staying sure-footed Depression & seniors BLUEINFO: Three tools to get the info you need Medi-Pak Rx — Affordable and available now! Questions and answers about Medi-Pak Rx Diagnostic imaging and the dangers of radiation Group and individual health plans: what’s the difference? Ask the Pharmacist AWP brings about network changes BlueSecure: our new long-term care insurance product URAC case management accreditation renewed Women’s Health and Cancer Rights Act Robert Kerr named associate medical director Nexium® replaces Protonix® on drug formulary Jesson appointed master for second time BlueAnn and FOX 16 News at Nine provide grants BlueAnn to host children’s theatre series at Wildwood Arkansas Fitness Challenge reaches out across state Elementary students build healthy sundaes with BlueAnn Blue & Your Community Blue Online
Customers who live in these regions may contact the regional ofﬁces or call the appropriate toll-free telephone numbers above.
www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com
Blue & You Autumn 2005
There’s good news, and then there’s more good news …
Americans are living healthier, wealthier and longer independent longer. There is an encouraging trend: in the past 20 years, the rate of nursing home use has declined. Being older does not mean you must be in poor health and lose your independence. The following approaches to living can help you live a longer, healthier life. • Healthy Lifestyle — Remain physically and mentally active, eat a healthy diet, and do not use tobacco. • Early Detection of Disease — Have recommended screenings to detect chronic diseases. Check with your Medicare or health-insurance plan to determine which screenings are covered (and recommended). • Immunizations — Review the following to help you make decisions about ﬂu and pneumonia vaccines.
Age 40-64: Inﬂuenza Vaccine — Annually for those at high risk (residents of chronic-care facilities and persons suffering from chronic cardiopulmonary disorders, metabolic diseases including diabetes mellitus, hemoglobinopathies, immunosuppression or renal dysfunction)
lder Americans today are healthier, wealthier and better educated than previous generations. And, life expectancy for Americans has reached an all-time high according to the latest U.S. mortality statistics released by the Centers for Disease Control and Prevention. Life expectancy is at 77.6 years, up from 77.3 in 2002. Thanks to healthier lifestyles and better health care, there also are more seniors than ever before. One hundred years ago, there were 3 million people in this country aged 65 or older. Today, there are more than 33 million. However, the aging of America is triggering a huge demand for health-care and social services. At least 80 percent of seniors have at least one chronic condition, and 5 percent have at least two. These conditions can cause pain, disability and loss of function. Approximately 12 million seniors have reported that chronic conditions limit their activities. Their quality of life suffers as a result, and demands on family and caregivers can be challenging. The key is prevention. By preventing disease and injury, seniors can remain
Blue & You Autumn 2005
Pneumococcal Vaccine — Clinical discretion based on risk for persons with medical conditions that increase the risk of pneumococcal infection (e.g., chronic cardiac or pulmonary disease, sickle cell disease, nephrotic syndrome, Hodgkin’s disease, asplenia, diabetes mellitus, alcoholism, cirrhosis, multiple myeloma, renal disease or conditions associated with immunosuppression) Age 65 and older: Inﬂuenza Vaccine — Annually Pneumococcal Vaccine — Once with a booster in 5 years • Injury Prevention — Falls are the most common cause of injuries to older adults. Removing tripping hazards in the home and installing grab bars are simple measures to reduce risk. (See article on Page 12 for more information on injury prevention.) A healthy lifestyle complete with healthy behaviors can help seniors improve their health. Getting older is not a reason to let your health decline. The good news is that you can live longer and healthier by making healthy choices. ❊ Source: Centers for Disease Control & Prevention
Eat well, live well N
utrition is important to the health of everyone. Its beneﬁts include increased mental activity, resistance to illness, higher energy levels, healthier immune systems, quicker recuperation and the ability to deal with chronic health problems. But, as we age, nutrition becomes more and more important. As the body ages, metabolism slows down, making it harder to process certain vitamins and minerals. The need for some nutrients, like sodium, decreases while the need for others, like calcium, increases. Amending one’s diet to meet changing nutritional needs is often fraught with problems. Many seniors experience a whole host of life changes that make proper nutrition difﬁcult. For example, newly single seniors may not know how to cook healthy meals. Seniors often reduce their amount of physical activity for physical or medical reasons, which speeds up the natural decrease in the body’s metabolism. Weight gain is the result. Physical ailments and prescription medications often affect the appetite, either causing one to overeat or not eat enough. Also, less saliva and stomach acid make it more difﬁcult for the body to effectively break down food and absorb important vitamins. Natural physical changes, such as the increased risk of fragile bones, means a need for more calcium and vitamin D. Then there are emotional factors. Loneliness and depression often impact a person’s appetite. And, since poor diet can contribute to depression, a very unhealthy cycle can be the result. While proper nutrition becomes crucial as we age, it does not
have to become complicated. If you are concerned about your diet, the best thing to do is check with your doctor about nutritional recommendations. In the meantime, a few simple suggestions can go a long way toward establishing proper nutrition. • Eat plant-based foods. Try recipes that include a variety of whole grains, fresh vegetables and fruits, beans, peas, nuts and seeds. This provides for a wide range of nutrients from a number of different sources. • Drink plenty of water. The body depends on water to function. It is a major component in saliva and in the ﬂuid around joints. Doctors recommend approximately six eight-ounce glasses of water per day. • Watch fat, cholesterol and sodium intake. The body does need some fat to supply energy and to help absorb certain vitamins. But too much fat, particularly saturated fat, can raise the risk of heart disease. Some fats, like those in olive oil and nuts, are better than others. Eat a low-fat diet and choose your fats wisely. • Watch your calories. As metabolism slows, the need for calories decreases. Reducing calories doesn’t always mean eating less food. It could mean it’s time to eat better foods, like fruits, vegetables and whole grains. Your doctor can help you determine how many calories you need per day. • Write down what you eat. By writing down what you eat, you identify eating trends and habits. This is helpful in developing accountability for your diet and in making healthy changes. The importance of a healthy diet cannot be overstated. The result of good nutrition is an improved quality of life. ❊ Sources: WebMd.com and HelpGuide.org
Obesity & smoking may lead to rapid aging
besity and smoking can speed up the aging process, according to researchers at St. Thomas’ Hospital in London and the University of Medicine and Dentistry in New Jersey. The study revealed that those who smoke cigarettes or who are obese have shorter telomeres (the caps on chromosomes) that prevent them from fraying. This makes them biologically older than their lean, non-smoking counterparts. Each time a cell divides, its telomere loses a small piece of DNA. When it becomes too short, cells can no longer divide. So, the telomere shortening acts as a “chromosomal clock” counting down the cellular generations. The loss of telomere length is closely associated
with the aging process. This is why telomeres are believed to hold the secrets of youth and the aging process. They conducted the study from blood samples from 1,122 women between the ages of 18 and 76. The scientists found a decrease in telomere length that corresponded directly to the more obese women were and the amount of cigarettes they smoked. According to the study, being obese adds approximately 8.8 years of aging, and being a smoker adds approximately 4.6 years of aging. Those who are obese smokers are at the greatest risk; they are, on average, biologically 10 years older that their lean, nonsmoking counterparts. ❊ Sources: MSNBC.com, CNN.com and NewScientist.com
Blue & You Autumn 2005
Grow old along with me … E
xercise . . . everyone knows it’s important. For older people, it’s critical for maintaining health, preventing disease and disability, and remaining independent as they age. If, as Robert Browning wrote, “the best is yet to be,” we must take charge of aging and its effects on our bodies. Taking charge means staying active while making other healthy lifestyle choices, such as eating nutritional foods, getting regular checkups and adhering to a physician’s advice when a health problem exists. You can’t take aging sitting down. It will only defeat you. You have to get up, get moving and actively ﬁght for your health and independence. No one is too old or out of shape to begin an exercise program. However, if you don’t exercise on a regular basis now and are a man over 40 or a woman older than 50 — or if you have a chronic condition, such as heart disease or diabetes — you should consult your physician before beginning an exercise program. Beginning an exercise program is as easy as choosing an activity that suits you and carving out some time in your day to devote to it. Walking, dancing and gardening are examples of activities that many people enjoy. Some people prefer sports, such as golf, tennis or badminton. Aerobic dancing and running and other high-impact exercises may not be right for people with arthritis because of possible stress on joints or those with chronic lung or heart conditions because these activities require a high level of endurance. Consult a physician if you don’t know if an activity is right for you. Whatever activity you choose, do it on a regular basis (such as daily or every other day) at a time that you can reserve for yourself. If your routine becomes boring, mix in a new activity. Three kinds of exercise are necessary for optimum health: 1. Aerobic exercise for heart and lung health (vigorous walking, jogging, swimming, cycling, aerobic dancing, basketball). Aerobic exercise builds your endurance. As little as 30 minutes a day is beneﬁcial, and those 30 minutes can be accomplished in
Blue & You Autumn 2005
three, 10-minute sessions. Less than 10 minutes at a time is not beneﬁcial unless you are just beginning to exercise after leading a sedentary life. 2. Strength training (weight lifting, calisthenics, weight machines, hiking) to tone your muscles. Keeping muscles in shape will make it easier for you to perform normal, everyday activities. Strength training helps reduce the symptoms of: • Arthritis (reduces pain and stiffness and increases strength and ﬂexibility).
• Diabetes (improves glycemic control). • Osteoporosis (builds bone density and reduces risk for falls). • Obesity (increases metabolism, which helps burn calories and helps with long-term weight control). • Back pain (strengthens back and abdominal muscles to reduce stress on the spine). • Depression (improves state of mind and may help you sleep better). Some exercises are both aerobic and involve strength training. Stair climbing is an example. It improves endurance and strengthens leg muscles. 3. Flexibility and balance exercises (yoga, ballet, stretching): Simple exercises that involve bending, stretching and balancing will help prevent falls and broken bones. You don’t need expensive equipment to exercise. The basics are a good pair of shoes, a sturdy chair, comfortable clothing and a little space. Dumbbells and ankle weights can be added as your strength increases. If you don’t want to buy weights at ﬁrst, you can begin weight lifting with soup cans. You should do strength exercises at least twice a week, but don’t work the same muscle group on any two days in a row. Gradually increase the amount of weight you use. Your goal in aerobic exercise should be to build endurance gradually. You might begin by walking vigorously on level surfaces and progress to walking up hills or climbing staircases, going a little farther or on a more difﬁcult route as you progress. If you live where the weather is too hot or cold for outdoor
but encourage me to exercise exercise, you might want to consider investing in a treadmill; or you can go to a shopping mall to walk. Many malls open early for walkers and sponsor walking clubs. You also can include physical activity in your daily routine. Park at the outer edge of the parking lot when you go shopping so that you will have to walk a little farther. Walk instead of driving short distances. Take the stairs instead of the elevator whenever you can. When you make exercise a habit, it becomes an integral part of your life. Once exercise becomes routine, when you are not able to exercise on schedule, you will probably feel a sense of loss; and you just won’t feel as good as you do when you exercise. You’re never too old to exercise, and it’s never too late to start. You can call the National Institute on Aging toll free at 1-800-222-2225 to order free exercise guides or visit their Web site at http://www.niapublications. org. Most of the publications are free. Exercise is the best ammunition we have in ﬁghting disease and disability in old age. Remember the words of another great poet, Dylan Thomas, “Do not go gentle into that good night; rage, rage against the dying of the light.” ❊
Sources: “Rabbi Ben Ezra,” by Robert Browning, published 1864; “Do Not Go Gentle Into That Good Night” by Dylan Thomas, published 1952; “Exercise: A Guide from the National Institute on Aging;” “Exercise: Getting Fit for Life,” National Institute on Aging; and the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention
Blue & You Autumn 2005
A closer look at vision health
ood eyesight plays a vital role in your mobility and the enjoyment of life at any age. However, as today’s baby boomers become tomorrow’s senior citizens, the number of Americans who are legally blind will grow by millions, according to new ﬁgures from the government’s top vision research group. Nearly three million Americans aged 40 and above are considered either blind or have low vision, but a report last year by the National Eye Institute projects an estimated increase of 70 percent in the number of blind persons in the United States. Additionally, it projects an increase in the number of adults with low vision. One of the most common vision problems facing seniors is cataracts (a clouding of the lens of the eye that can impair vision). Cataracts are a leading cause of vision loss among adults 55 and older. More than half of all Americans aged 65 and older have some degree of cataract development. Cataracts develop when there is a buildup of protein in the lens that makes it cloudy. This prevents light from passing through a normally clear lens, causing some loss of vision. No one knows what
Blue & You Autumn 2005
causes the buildup of protein responsible for clouding the lens. The majority of people with cataracts don’t realize the problem because there are often no warning signs, or they assume poor sight is a natural part of growing older. By detecting and treating eye disease early through annual, dilated eye exams, seniors can preserve their sight. When symptoms are present, they can include: • Vision that is cloudy, blurry, foggy or ﬁlmy • Sudden nearsightedness • Changes in the way you see color, especially yellow • Problems driving at night because oncoming headlights are distracting • Problems with glare • Double vision • Sudden temporary improvement in close-up vision The good news is that cataracts can be treated. Schedule an eye exam, and talk with your doctor about which treatment is right for you. If your vision is acceptable, eyeglasses — including bifocals and contacts — may be prescribed, eliminating the need for surgery at that time. Your doctor may decide that the best treatment for you is cataract surgery, which involves removing the clouded lens and replacing it with a clear, plastic one. This outpatient surgery is usually successful in restoring vision. Better than nine out of 10 people who have cataract surgery have improvement in vision. Vision loss of any kind is a difﬁcult condition. Fortunately, there are many things you can do to help maintain your good eye health. One of the most important things is to see your ophthalmologist if you experience eye infections or symptoms of disease like loss of or blurred vision, light ﬂashes, eye pain, redness, itching, swelling, and irritation around the eye or eyelid. Practice disease prevention by managing diseases that may cause blindness, like glaucoma and diabetes. Protect your eyes from the sun’s harmful rays because constant exposure to ultraviolet (UV) light can damage your eyes. Too much exposure increases pigmentation in the eye, causing a discoloration known as “brown” or “sunshine” cataracts. Eye diseases such as macular degeneration have been linked to UV exposure. Because eye problems such as cataracts are so common in older adults, it’s important to have your eyes examined on a regular basis. According to the American Academy of Ophthalmology, people aged 40 to 64 should have a comprehensive eye examination every two to four years; people 65 and older should have a comprehensive eye examination every one to two years.
Sources: American Academy of Ophthalmology, www.aao.org; WebMD.com; and the Cleveland Clinic Cole Eye Institute
Taking care of your skin A
Pain and stiffness could equal arthritis I
f you are feeling a little pain or stiffness in your joints, you may be one of 43 million Americans who have arthritis. Arthritis is one of the most common chronic health conditions and the No. 1 cause of limitation in movement in the United States.
What is arthritis? Arthritis is the umbrella term for more than 100 different diseases that cause pain, swelling and limited movement in joints and connective tissue throughout the body. It is usually chronic, which means it lasts a lifetime. Anyone at any age may be diagnosed with arthritis. Some forms also can affect other parts of the body, including various internal organs. Many people use the word “arthritis” to refer to all rheumatic diseases. However, the word literally means joint inﬂammation; that is, swelling, redness, heat and pain caused by tissue injury or disease in the joint. The many different kinds of arthritis comprise just a portion of the rheumatic diseases.
What are the symptoms of arthritis? Symptoms of arthritis are pain, stiffness, swelling (sometimes) and difﬁculty moving a joint. If you notice one or more of these symptoms for more than two weeks, you should see your physician. Physicians can diagnose arthritis based on an overall pattern of symptoms, medical history, physician examination, X-rays and laboratory tests. Most treatment programs include a combination of medication, exercise, maintaining an appropriate weight, rest, use of heat and cold, joint protection techniques and, sometimes, surgery. If you are experiencing symptoms of arthritis (or you know someone who is), please seek a diagnosis and treatment from your physician. Arthritis, continued on Page 22
lthough we don’t typically think of it as such, our skin is the largest organ. It is made up of water, protein, lipids and a number of minerals and chemicals and weighs, on average, six pounds. Skin is the body’s protection against infections and germs and one of the primary organs in regulating body temperature. Throughout the years, of course, skin changes. As we age, our skin becomes rougher and thinner. It bruises more easily. It loses elasticity and develops wrinkles, spots and benign growths. Aging skin is natural and to be expected, but proper skin care can slow the process and help one to maintain healthy skin longer. The difference between aging skin and premature aging skin is light exposure. Here are a few light-related skin care tips: • Do not sunbathe or visit tanning beds. • Apply sunscreen before going out in the sun. • Wear wide-brimmed hats and loose, tight-knit clothing that covers your skin when you expect prolonged exposure to the sun. Other practices can be damaging to skin as well — bathing, for example. Soaps are surfactants, which strip the hydrating lipids from the skin, leaving it dry. Following a couple of tips can help to prevent dry skin: • For frequent hand-washing, use moisturizing soap lotions rather than regular soap. • Apply moisturizer immediately after a shower or bath. The tips below are practical ways to improve skin health: • Drink plenty of water. • Make sure makeup is thoroughly removed before going to bed. • Eat a balanced diet. • Use formulated toners or astringents to remove ﬁne traces of oil and dirt from your face. • Moisturize. These skin-care practices are beneﬁcial to people of all ages. The sooner you begin to care for your skin, the better off your skin will be as you age. ❊ Source: WebMD.com
Blue & You Autumn 2005
Recognizing Alzheimer’s disease •
lzheimer’s disease is a form of dementia, a term used to describe a group of brain disorders that cause memory loss and, over time, a decline in mental function. In fact, Alzheimer’s disease is the most common form of dementia, affecting about 4.5 million men and women in the United States. With this condition, nerve cells in the brain die, making it difﬁcult for the brain’s signals to be transmitted properly. A person with Alzheimer’s disease has problems with memory, judgment and thinking, which makes it hard for the person to work or take part in day-to-day life. The death of nerve cells occurs gradually over a period of years. Most patients’ symptoms progress slowly throughout the years. Symptoms may not be noticed early. Sometimes it is only when family members look back that they realize when the changes started to occur. Common symptoms of Alzheimer’s disease include: • Impaired memory and thinking. The person has difﬁculty remembering things or learning new information. In the later stages of the disease, long-term memory loss occurs, which means that the person can’t remember personal information, such as his or her place of birth or occupation, or names of close family members. • Disorientation and confusion. People with Alzheimer’s disease may get lost when out on their own and may not be able to remember where they are or how they got there. They may not recognize previously familiar places and situations. They also may not recognize familiar faces or know what time of the day it is, or even what year it is. • Misplacing things. The person forgets where he or she put things used every day, such as glasses, a hearing aid, keys, etc. The person also may put things in strange places, such as leaving their glasses in the refrigerator. • Abstract thinking. People with Alzheimer’s disease may ﬁnd
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certain tasks — such as balancing a checkbook — more difﬁcult than usual. For example, they might forget what the numbers mean and what needs to be done with them. Trouble performing familiar tasks. The person begins to have difﬁculty performing daily tasks, such as eating, dressing and grooming. Planning for normal day-to-day tasks also is impaired. Changes in personality and behavior. The person becomes unusually angry, irritable, restless or quiet. At times, people with Alzheimer’s disease can become confused, paranoid or fearful. Poor or decreased judgment. People with Alzheimer’s disease may leave the house on a cold day without a coat or shoes, or could go to the store wearing their pajamas. Inability to follow directions. The person has difﬁculty understanding simple commands or directions. The person may get lost easily and begin to wander. Problems with language and communication. The person can’t recall words, name objects (even ones that are very familiar to them — like a pen), or understand the meaning of common words. Impaired visual and spatial skills. The person loses spatial abilities (the ability to judge shapes and sizes and the relationship of objects in space) and can’t arrange items in a certain order or recognize shapes. Loss of motivation or initiative. The person may become very passive and require prompting to become involved and interact with others. Loss of normal sleep patterns. The person may sleep during the day and be wide-awake at night.
How is it diagnosed? It is important to visit a doctor if you or a loved one experiences any of these symptoms so you can receive the proper evaluation and diagnosis. There are other conditions — such as depression, a head injury, certain chemical imbalances or the effects of some medications — that can produce symptoms similar to Alzheimer’s disease. Many of these conditions are treatable. Your doctor can determine if the symptoms probably are due
to Alzheimer’s disease after a thorough medical, psychiatric and neurological evaluation. Your physician will evaluate other possible causes of dementia to rule out all other factors before settling on Alzheimer’s disease as a diagnosis. Currently no deﬁnitive diagnostic test for Alzheimer’s exists. A deﬁnite diagnosis of Alzheimer’s disease is possible only after death, when a pathologist can more closely examine a patient’s brain for the telltale changes associated with Alzheimer’s disease.
What’s the prognosis? The course of Alzheimer’s disease varies from person to person. The duration of the illness could be short (two to three years) or long (up to 20 years). Usually the parts of the brain that control memory and thinking are affected ﬁrst but, over time, cells die in other areas of the brain.
Eventually, a person with Alzheimer’s will need complete care. If the person has no other serious illnesses, the loss of brain function itself eventually will cause death.
Can Alzheimer’s disease be prevented? Because the exact cause of Alzheimer’s disease is not known, there currently is nothing that can be done to prevent it. It is important to remember, however, that there are causes of dementia other than Alzheimer’s disease that may be preventable such as eating properly, exercising, quitting smoking, and limiting how much alcohol you drink. Your doctor can advise you about other healthy lifestyle habits you can adopt that may help prevent dementia. ❊ Sources: Alzheimer’s Association, alz.org; and WebMD.com
An active mind is a healthy mind A
s you age, remember to keep your mind sharp as well as keeping your body strong. It’s essential to continue to learn and challenge yourself. Regardless of age, an active and agile brain continues to produce dendrites, which are connections between nerve cells that allow these cells to communicate with one another. This helps you store and retrieve information more easily. Age doesn’t keep someone from learning new things; it provides wisdom and experience to help integrate new skills into your life. Here are some ideas to help you keep your mind active. 1. Take classes at your local community or technical college or at your local arts center. 2. Learn a foreign language. 3. Read regularly, and keep a journal. 4. Stay up-to-date on technology. Learn about computers, and connect to the Internet. Consider using e-mail to keep in touch with family and friends. 5. Join a book club or other discussion group. 6. Attend plays and concerts. 7. Visit a museum. 8. Explore your musical or artistic talents. Start a new hobby such as bike riding or bird watching. 9. Do crossword puzzles. 10. Start a new career, or use your spare time to volunteer. 11. Take a dance class. 12. Spend time with friends. 13. Set goals. According to researchers at the Albert Einstein College of Medicine in New York and the Karolina Institute in Stockholm, Sweden, the most active seniors, both mentally and physically, reduced their risk of developing dementia by 63 percent when
compared with the least active seniors. Researchers found that the best activities are those that challenge the brain, are done with other people and might even involve a good workout, such as learning a line dance. Although bird watching or dancing can’t vanquish Alzheimer’s (a disease partly caused by genetic factors), research suggests that complex leisure activities give seniors a better shot at delaying the onset of Alzheimer’s. Delay is crucial because there is no cure for the disease, and nearly half of all seniors older than 85 have Alzheimer’s. Scientiﬁc studies suggest that Alzheimer’s begins to attack the brain many years before the ﬁrst symptoms of memory loss actually appear. Physical activity also might help by triggering the production of brain cells, neurons that can take the place of those damaged by age or disease. Research suggests that the best activities offer a combination of mental, social and physical activity. For example, learning the waltz involves all three — learning complicated steps, social interaction with a partner and a workout. Research also suggests that seniors who participate in complex activities have a 40 to 50 percent reduction in the risk of developing Alzheimer’s. According to research, activities that seem to offer the most “risk reduction” include gardening, taking classes, attending political events, and taking regular trips to the museum or theater. Activities in a social situation give seniors an extra bonus. Evidence suggests that a busy and entertaining schedule can help ward off Alzheimer’s, but no deﬁnitive proof exists. The best advice is to take up an activity you enjoy. Don’t watch birds if they bore you, and don’t do crossword puzzles if they just make you mad. Find something enjoyable to exercise your brain and your body; you deserve it. ❊ Sources: CNN.com, USATODAY.com and the National Institute on Aging Blue & You Autumn 2005
A balancing act — Y
ou may be only a step away from becoming a victim of the leading cause of unintentional home injuries — slips and falls. According to “The State of Home Safety in America™” (2004) conducted by the Home Safety Council, falls are by far the leading cause of unintentional home injury death. Falls account for an average of 5.1 million injuries and nearly 6,000 deaths each year. Falls also are one of the main disabling conditions of the elderly due to fractures, which may have a signiﬁcant impact on a person’s functioning, independence and quality of life. Falls are not just the result of getting older. The causes of falls are known as risk factors. Although no single risk factor causes all falls, the greater the number of risk factors to which an individual is exposed, the greater the probability of a fall. Many of these risk factors are preventable. As obvious as it may sound, a lack of knowledge about risk factors and how to prevent them contributes to many falls. Some people believe that falls are a normal part of aging, and as such are not preventable. Falls are usually caused by a number of things. By changing some of these things, you can reduce your chances of falling.
1. Maintain a regular exercise program. Exercise is one of the most important ways to reduce your chances of falling. It makes you stronger and helps you feel better. Exercises that improve balance and coordination are the most helpful. Researchers at Emory University in Atlanta found the Chinese martial art of Tai Chi improved balance in older people after just a few weeks and cut the risk of falling nearly in half. Lack of exercise leads to weakness and increases your chances of falling. • Engage regularly (e.g., every other day for about 15 minutes daily) in exercise designed to increase muscle and bone strength, and to improve balance and ﬂexibility. Many people enjoy walking and swimming. • Undertake daily activities in a safe manner, such as reaching and bending properly, taking time to recover balance when rising from a chair or bed, learning the proper way to fall,
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and learning how to recover after a fall. • Wear proper ﬁtting, supportive shoes with low heels or rubber soles. • Before taking any exercise class, be sure to get approval from your health-care provider. Ask about the best type of exercise program for you.
2. Make your home safer. •
• • • •
• • • • • • • • •
About half of all falls happen at home. To make your home safer: Remove things you can trip over (such as papers, books, clothes and shoes) from stairs and places where you walk. Reduce clutter everywhere. Remove small throw rugs or use double-sided tape to keep the rugs from slipping. Keep items you use often in cabinets you can reach easily without using a step-stool. Have grab bars put in next to your toilet and in the tub or shower. Use non-slip mats in the bathtub and on shower ﬂoors. Improve the lighting in your home. As you get older, you need brighter lights to see well. Lamp shades or frosted bulbs can reduce glare. Use night-lights around the house. Have handrails and lights on all staircases. Wear shoes that give good support and have thin, non-slip soles. Avoid wearing slippers and athletic shoes with deep treads. Repair cracks and abrupt edges of sidewalks and driveways. Oil or water spills on the ﬂoor are dangerous; wipe up all spills immediately. Use a change in color to denote changes in surface types or levels. Have at least one telephone extension in each level of the home, and post emergency numbers at each telephone. Keep electrical and telephone cords out of the way. Arrange furniture so that you can easily move around it (especially low coffee tables). Make sure chairs and couches are easy to get in and out of. Adjust height of bed to make it easy to get in and out of. Have a ﬁrm chair, with arms, to sit and dress. Remove caster wheels from furniture. Use a television remote control and a cordless telephone.
Staying sure-footed 3. Have your health-care provider review your medicines. Have your doctor or pharmacist look at all the medicines you take (including ones that don’t need prescriptions, such as cold medicines). As you get older, the way some medicines work in your body can change. Some medicines, or combinations of medicines, can make you drowsy or light-headed, or can cause your blood pressure to drop or spike, which can lead to a fall. • Know the common side effects of all medications taken. • Talk with your physician or pharmacist about ways to reduce your chances of falling by using the lowest effective dosage, regularly assessing the need for continued medication, and the need for walking aids while taking medications that affect balance. • Remove all out-of-date medications and those no longer in use. • Have a physician or pharmacist conduct a “brown bag” medicine review of all current medications. Take everything in for them to review. • Limit intake of alcohol because it may interact with medications.
4. Have your vision checked. Have your eyes checked by an eye doctor. You may be wearing the wrong glasses or have a condition such as glaucoma or cataracts that limits your vision. Poor vision can increase your chances of falling. • Have regular checkups by an ophthalmologist to discern the extent of age-related eye diseases such as cataracts and glaucoma. • Use color and contrast to deﬁne balance-aiding objects in the home (such as grab bars and handrails). • Add contrasting color strips to ﬁrst and last steps to identify change of level. • Clean eyeglasses often to improve visibility. ❊
Quick Facts... • The risk of falling increases with age and is greater for women than for men. • Two-thirds of those who experience a fall will fall again within six months. • A decrease in bone density contributes to falls and resultant injuries. Eat or drink sufﬁcient calcium. Get sufﬁcient vitamin D to enhance the absorption of calcium into the bloodstream. • Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and ﬂexibility. All contribute to falls and the severity of injury due to falls. Do weight-bearing exercises regularly. • At least one-third of all falls in the elderly involve environmental hazards in the home. • The most profound effect of falling is the loss of independent functioning. Twenty-ﬁve percent of those who fracture a hip require life-long nursing care. About 50 percent of the elderly who sustain a fall-related injury will be discharged to a nursing home rather than return home. • Most falls do not result in serious injury. However, there is often a psychological impact. Approximately 25 percent of community-dwelling people aged 75 or older unnecessarily restrict their activities because of fear of falling. • The majority of the lifetime cost of injury for people aged 65 or older can be attributed to falls. Those in need of using walking aids should use them appropriately; seek professional advice if in doubt. Remember, many falls can be prevented. Lack of knowledge leads to lack of preventive action, resulting in falls. Get the facts, take action … and stay on your feet.
Sources: Colorado State University Cooperative Extension, American Red Cross, Centers for Disease Control and Prevention, Home Safety Council
Blue & You Autumn 2005
he loss of a spouse, chronic medical conditions, medications — they all could be culprits for depression in the elderly. Studies suggest that approximately 15 percent of all older adults experience depression at one time or another. The National Institute of Mental Health statistics suggest that more than 18 million American adults are suffering from depression in any given year. Depression is not a normal part of aging. In older adults, depression often goes undiagnosed and untreated because of several unusual characteristics: 1) Sometimes the elderly develop illnesses (such as Alzheimer’s disease or Parkinson’s disease) whose symptoms overlap with the symptoms of depression. 2) The side effects of many drugs mimic or aggravate the symptoms of depression. 3) Depression often causes mental cloudiness or confusion. That makes depression harder to diagnose because everyone loses some mental sharpness as a normal part of aging. 4) Older adults may complain of persistent fatigue, experience unexplained weight loss or appetite loss, have problems sleeping or have difﬁculty concentrating when they are depressed. Many people see these complaints as a normal part of aging, but they could be a symptom of depression. 5) The losses that many older adults face (loss of job, loss of
Blue & You Autumn 2005
& seniors spouse, loss of physical or mental vitality) may contribute to depression. Everyone feels sad or melancholy occasionally. When a person is depressed, the feelings of sadness or hopelessness continue for a prolonged period of time. People with depression usually exhibit at least some of the following symptoms: • Depressed most of the day, nearly every day • Loss of pleasure in daily activities • Signiﬁcant weight loss or gain • Change in mobility either by slowing down or exhibiting nervous gestures • Feelings of worthlessness, self-reproach or excessive guilt • Diminished ability to concentrate • Suicidal thoughts • Difﬁculty sleeping and difﬁculty concentrating • Memory loss Untreated depression leaves the elderly at a serious risk for suicide. Compared with other age groups, the elderly commit suicide twice as frequently. If you think you or someone you love may be experiencing depression, please talk to your physician for a diagnosis and treatment. ❊ Sources: Depression.Com, National Institute of Mental Health and Medline Plus
Quick Depression Facts 1. Depression is a normal part of aging. False 2. For the most part, depression cannot be treated. False 3. Depression is strictly a mental condition. False (Brain chemistry, hormones and other physical conditions can contribute to depression.) 4. Depression can be a side effect of an illness, virus or medication. True 5. Depressed individuals usually recognize their illness and seek treatment. False 6. Symptoms of depression include changes in eating and sleeping habits. True 7. Early treatment for depression can prevent tremendous suffering. True 8. A diagnosis of depression can be made after a person has experienced sadness and loss of pleasure in normal activities for more than two weeks. True (A mental health professional considers these symptoms and other factors when making a diagnosis.)
BLUEINFO My Blueprint
www.ArkansasBlueCross.com • www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com
It’s easier and faster now to register to use My Blueprint, the online customer self-service center for Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas members. Visit our Web sites to use My Blueprint. Members who want to use “quick registration” can enter their health plan ID number, name, date of birth and Social Security number (SSN). If we have your SSN on ﬁle in our membership system, we can authenticate you and let you choose your own log-in ID and password. If you choose not to enter your SSN, or we don’t have it on ﬁle to authenticate you, you can still register and wait for your password to arrive via U.S. Postal Service. Even if you have to wait for your password to arrive in the mail, you will be able to change it to something easy to remember after you log in the ﬁrst time. Hang onto your log-in ID that appears when you register online because you will need to use the ID along with your password to enter. Remember that any covered person, not just the policyholder or group employee, can register. The Arkansas Blue Cross family of companies is trying to make your Web sites more user friendly while continuing to protect the privacy of your personal health information. ❊
My BlueLine With My BlueLine, you have access to customer service 24 hours a day, seven days a week. If you are a customer of Arkansas Blue Cross, Health Advantage or BlueAdvantage, you can get answers to your claims or beneﬁts questions anytime, day or night. Call the telephone number on your ID card, or refer to Page 3 for Customer Service telephone numbers. My BlueLine is an interactive voice response (IVR) system that recognizes speech patterns to help answer questions when you call current customer service telephone lines. When you call a customer service line and select My BlueLine, it will prompt you with a question, and all you have to do is simply respond to the question. When you call, remember to have your ID card on hand. For privacy purposes, the system will ask you questions to verify your identity as the caller — such as your member ID number as it is listed on your membership card. If you prefer, you immediately may choose the option of speaking to a customer service representative (during regular business hours).
HealthConnect Blue HealthConnect Blue is a complimentary, conﬁdential health information service that puts members in touch with Health Coaches by telephone or e-mail and offers health information online to help members make more informed decisions about their health care. Currently all Health Advantage members and eligible Arkansas Blue Cross and Blue Shield members* have access to HealthConnect Blue. Members can call a toll-free telephone number (1-800-318-2384) to speak with a Health Coach to get the support and health information they need 24 hours a day, 7 days a week. Health Coaches are specially trained health professionals such as nurses, respiratory therapists and dietitians. Members may call as often as they like at no cost. A Health Coach can offer information and support to help members work with their doctors to make conﬁdent health decisions that are right for them. Members also can access free health information online by using the HealthConnect Blue link at www.HealthAdvantage-hmo.com or at www.ArkansasBlueCross.com. ❊ * Includes all Health Advantage HMO members, all public school employees and state employees covered by Arkansas Blue Cross or Health Advantage.
BLUEINFO Blue & You Autumn 2005
Medi-Pak Rx — Affordable and M
edi-Pak Rx, the new Medicare prescription drug coverage offered by Arkansas Blue Cross and Blue Shield, now is available. Medi-Pak Rx is the Arkansas Blue Cross version of the new federal prescription drug program known as Medicare Prescription Drug Coverage or Medicare Part D. This coverage plan, a result of the passage of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), is dependent upon private companies selling these new Medicare prescription drug policies. Those interested must purchase these insurance policies from a private company. These Medicareapproved prescription drug insurance plans are partially sponsored by the government, which helps keep costs down. However, you do not enroll with Medicare for prescription drug coverage. “We are excited about the opportunity to be one of the state’s leaders in providing this important insurance coverage,” said Ron DeBerry, vice president of Statewide Business at Arkansas Blue Cross. “Medi-Pak Rx will help our members reduce their current and future drug costs.” Medi-Pak® members should receive a Medi-Pak Rx enrollment kit in the mail. If you do not receive a kit by the end of October and would like to have one, please call 1-800-840-6424. Remember, to receive prescription drug coverage you must enroll in MediPak Rx — even if you currently are enrolled in a MediPak plan. With the new Medi-Pak Rx plans, you will pay a monthly premium, but the premium amount depends on the plan you choose. The premium for Medi-Pak Rx may be paid one of two ways: 1) By deducting the premium amount from your Social Security check (just as you do with your Medicare Part B premium) or 2) Through a bank draft (automatic deduction from your checking or savings account). It’s important for Medi-Pak members to know that a Medicare-approved drug discount card is not the same as Medicare Part D. These discount cards served as a forerunner to the Medicare Part D program. If you currently have a drug discount **30-day supply Blue & You Autumn 2005
card, it’s important to note that the Medicare drug discount card program will end May 15, 2006, or when your Part D coverage becomes effective, whichever comes ﬁrst.
Why is Medi-Pak Rx important? Prescription drugs are expensive. Even if you don’t take a lot of medications now, you shouldn’t have to worry about the cost if your health changes and you need them later. If you do take a lot of prescriptions, you should never have to skip a dose or a reﬁll to reduce your costs. Medi-Pak Rx offers a better way to help with prescription drug costs.
The Arkansas Blue Cross Medi-Pak Rx Plans Arkansas Blue Cross is offering three prescription drug plans: Medi-Pak Rx Basic, Classic and Premier. Medi-Pak Rx prescription drug plans work in the same way that other insurance plans work. After you have joined a plan, and your coverage is in effect, you will pay a portion of the prescription drug cost, and the plan will pay the rest. All Medi-Pak Rx insurance plans cover both brand-name and generic drugs. The chart below explains what your out-of-pocket costs will be based on the plan you choose. Getting your prescriptions ﬁlled with a Medi-Pak Rx insurance plan is simple. You will receive a Medi-Pak Rx insurance card. Just present your card when you have a prescription ﬁlled at any of our network pharmacies. Medi-Pak Rx members must use network pharmacies to receive plan beneﬁts, except in emergency circumstances. In addition, mail-order prescription drug services are available. You can have your prescription ﬁlled by our network mail-order pharmacy, and your prescription will be delivered to your home.
Medi-Pak Rx Beneﬁts
available now! Who is eligible for the Medi-Pak Rx plan? Effective Nov. 15, 2005, all beneﬁciaries eligible for Medicare Part A or enrolled in Medicare Part B are entitled to purchase a new Medicare Part D drug insurance policy. If you are a member of Medi-Pak Plan I, you have a prescription drug beneﬁt in your current policy. Medi-Pak Plan I members have additional choices to make in relation to enrolling in Medi-Pak Rx and will receive a letter from Arkansas Blue Cross outlining the details.
How can you obtain coverage? To get Medicare Part D prescription drug coverage, you must
join a Medicareapproved, prescription drug insurance plan and reside in the service area of the plan. Medicare Prescription Drug Coverage is available only through prescription drug plans offered by private companies, such as Arkansas Blue Cross.
When does enrollment begin? There is a limited-time initial enrollment period for joining a prescription drug plan. If you currently enrolled in Medicare, that time is from Nov. 15, 2005, to May 15, 2006. If you join after Medi-Pak Rx, continued on Page 22
Questions-and-answers about Medi-Pak Rx Q. Is Medi-Pak Rx included with Medi-Pak Medicare supplement insurance policies? A. No. Medi-Pak Rx prescription drug insurance plans are separate from our Medi-Pak Medicare supplement insurance policies. Both are backed by the strength and stability of Arkansas Blue Cross and Blue Shield, an Arkansas company you know and trust. For many, the Medi-Pak name equals savings, security and value. The same will be true of our MediPak Rx prescription drug insurance plans. Q. Are prescription drug insurance plans all the same? A. Not at all. While the government requires the plans to meet certain criteria, plans from different insurers and companies will vary in coverage, costs, drug lists (formularies), participating network pharmacies, and service. Therefore, it’s important for you to carefully review the plans you’re interested in to make sure they meet your needs. Q. What is a formulary? A. A formulary is a list of prescription drugs covered by insurance. Q. What if I don’t see my prescription drugs on the formulary? A. At least once per month, the current formulary will be updated and is available on our Web site: www.ArkansasBlueCross. com. You can search the online formulary for your drugs, and print a copy from your computer. You also will be able to view information on how to obtain an exception to the plan’s formulary or cost sharing, if needed. We also encourage you to talk to your physician about your prescriptions to see if there are
any appropriate alternatives that are included on the drug lists. Q. Will I beneﬁt from Medi-Pak Rx even when I’m paying 100 percent of my prescription costs? A. Absolutely. When you give an in-network pharmacist your Medi-Pak Rx card, you are guaranteed to receive our negotiated discount price. Q. What if I am traveling out-of-state and need to ﬁll or reﬁll a prescription? A. Medi-Pak Rx has a large national network. To ﬁnd the nearest participating pharmacy, call the toll-free telephone number on the back of your ID card, or go to our Web site at www.ArkansasBlueCross.com. Q. Can I still use my prescription drug discount card? A. Beginning May 15, 2006, the Medicare prescription drug discount card program will end. If you are interested in continuing to save on your prescription drugs, you will need to join a Medicare-approved prescription drug insurance plan, such as Medi-Pak Rx. If you join a prescription drug plan before May 15, 2006, your prescription drug discount card will expire on the date your new prescription insurance begins. Q. What if I change my mind after I join? A. If, after this initial enrollment period ends on May 15, 2006, you ﬁnd a Medicare prescription drug plan that better meets your needs, you can switch plans during the next enrollment period. Enrollees will have the option to switch plans once a year, between November 15 and December 31, beginning in 2006. ❊
Blue & You Autumn 2005
Understanding diagnostic imaging and the dangers of radiation The dangers of “false positives”
hile the beneﬁts of high-tech radiology services — such as CT (computed tomography) scans — are well known when it comes to diagnosing diseases and trauma, the beneﬁts are not without risks. Scientiﬁc studies leave little doubt that radiation commonly used in medical treatment poses a risk of cancer or other health concerns, according to research by the National Academy of Sciences.
The dangers of radiation exposure
The effects of radiation are thought to be cumulative. According to the United States Nuclear Regulatory Agency, any increase in dose is assumed to result in increased risk. The higher the dose, the sooner the effects will appear, and the higher the risk of morbidity or incidence of disease. To put it all in perspective — if you are walking around an urban environment, you are being exposed to natural radiation. The amount of that exposure would depend on the size of the city, but almost everyone is being exposed at some level. In terms of radiation exposure, one chest X-ray would be the equivalent of walking around the city for three days (on average). The following chart from the National Radiation Protection Board (UK) should help you understand the doses from medical imaging compared to natural radiation: Imaging Study
Number of Chest X-rays
Equivalent Natural Radiation Exposure
Chest X-Ray Head CT Chest/Abdomen CT Heart (Nuclear Scan)
1 100 400 900
3 days 1 year 4 years 9 years
According to 2002 data from the National Institutes of Health, approximately two to three million CT examinations were performed on children, and children are at an especially high risk from radiation exposure. According to a study published in the American Journal of Roentgenology, the estimated lifetime cancer mortality risk attributable to the radiation exposure from an abdominal CT in a 1-year-old child is 0.18 percent (almost two per thousand). And, each year in the United States, approximately 600,000 CTs are performed on children less than 15 years of age. A rough estimate is that 500 of them will ultimately die from cancer attributable to that radiation exposure.
Blue & You Autumn 2005
In addition to the concerns about radiation exposure is the risk of chasing a “false positive” or a problem that doesn’t really exist. Here is a possible scenario to explain what “chasing a false positive” might involve. You visit your doctor for a pain in your side of unknown cause. After your physician reviews your medical history and takes into account your age, physical health and other factors — he’s not sure about the cause of the pain either. He decides to take an X-ray in his ofﬁce. After reviewing the X-ray, he may see a small shadow or blip on the X-ray, but nothing deﬁnitive. If your physician is conservative, he may decide at this point that the risks of radiation exposure outweigh the possible beneﬁts and may choose to wait three months and take another X-ray. He’s seen hundreds of these ﬁlms, and he really suspects it is nothing but a shadow or remnants of an old scar. On the other hand, he may decide to order a CT scan. You have the CT scan, and the radiologist who reviews it also ﬁnds nothing deﬁnitive. His ﬁnal report is “iffy,” and he notes a “questionable area, can’t be certain of the cause.” He recommends a follow-up CT or a biopsy. So what does the physician do? He feels compelled to order another CT or he now refers you to a surgeon for an invasive procedure (such as a biopsy). And very possibly there is nothing wrong with you. You have taken time off work, you are stressed and worried, the cost continues to rise and all because the physician involved may be chasing a “false positive” from an advanced imaging test. This is the consequence of the overuse of high-tech imaging technologies to ﬁnd images of questionable signiﬁcance … high cost, loss of wages, stress and, eventually, pain. The risks far outweigh the possible beneﬁts at this point. It is much more likely that the continued tests and procedures could result in a new health problem for you (something resulting from the tests and procedures) when you really didn’t have a problem at the beginning of this entire process.
The proliferation and cost of high-tech radiology services Besides being a health risk, high-tech radiology services also are very expensive. The government and private insurers have no choice but to take action to stem the staggering increases in the cost of diagnostic imaging due to increased use. According to IMV, a medical marketing research and consulting ﬁrm, there were 45.4 million CT procedures performed in 2002 compared to 39.6 million in 2001. Additionally, there was a 58 percent increase in the number of PET scans performed from 2002 to 2003. Many health insurance plans now pay more for imaging services than they pay for primary-
Overuse causes concern as radiation exposure increases for patients care physician services. On a yearly basis, the use of diagnostic imaging is increasing at a rate of 19 percent per year. Scans are very costly: an MRI (magnetic resonance imaging) generally costs between $700 and $1,000; PET (positron emission tomography) scans cost between $1,800 and $2,000; and CT scans can cost from $300 to $500. Although patients may pay a small copayment, and their insurance company may pay the balance, the end result of the steep price tag could be higher premiums or higher copayments for you, the patient.
Why the increase in scanning? Between 1993 and 1999, there was an increase of 29.9 percent in the use of medical diagnostic imaging for Medicare beneﬁciaries. However, Medicare beneﬁciaries are not the only group seeing an increase in the use of scanning. Reasons for the increase in use are varied, but it could be attributed to the following: 1. Self-referral among non-radiologists who may operate their own in-ofﬁce imaging equipment (and beneﬁt ﬁnancially from ordering tests). 2. Need to repeat exams due to poor-quality images. 3. Lack of familiarity of physicians with the complexities of ordering imaging. 4. Use of imaging in place of time-consuming history-taking and physical examination. 5. Constant threat of lawsuits. 6. Patient expectations. 7. Public infatuation with “high-tech” and its availability. From its own experience, National Imaging Associates, Inc. (NIA), a company that assists companies in evaluating the proper use of such tests, estimates that about one-third of advanced imaging tests are either inappropriate for the medical problem at hand or do not contribute to a doctor’s diagnosis or a patient’s outcome.
Beneﬁts vs. Risks As the understanding of radiation has increased, so has the concern for public safety. The use of medical imaging generally has been thought to have a positive risk/beneﬁt ratio (in other words, the beneﬁts outweigh the risks). However, the concern is not for one or two CT scans, but the fact that during a lifetime, many individuals will have multiple CT scans, resulting in signiﬁcant radiation exposure. Radiologists always have been aware of the need to keep radiation exposure to a minimum. However, a study in Radiology,
published earlier this year by The Radiological Society of North America, indicated that when it comes to CT exposure, many radiologists and referring physicians are unaware of the radiation dose delivered during a CT scan and its possible risks. The Food and Drug Administration (FDA) and other federal and state agencies regulate medical procedures that use radiation. These agencies, along with the U.S. Environmental Protection Agency (EPA), issue guidelines designed to reduce unnecessary use of radiation in diagnosis and treatment and to ensure that technicians, equipment and techniques meet standards that minimize radiation exposure. Of course, most diagnostic imaging is appropriate, and vigilant physicians will order scans if the beneﬁts outweigh the risks. However, patient demand for the newest technology, changing practice patterns of physicians who are increasingly dependent on laboratory and imaging tests results, and duplicate imaging all result in an increase in scanning. To reduce radiation exposure, it is important to educate the public and health-care providers regarding radiation exposure. By practicing utilization management, health plans can reduce costs and decrease radiation exposure for its members. According to researchers writing for The British Journal of Radiology in 2002, all CT scans should be clinically appropriate. They suggest that those ordering medical radiation imaging ask themselves the following questions: Will the information gained help the patient? Is the scan medically necessary? Is there an alternative imaging procedure? In other words, all scans should be problem-directed, not just a “ﬁshing expedition.”
Making the right decision Since any radiation exposure carries some risk, it is necessary to decide whether the beneﬁts of radiation justify its use. Before receiving X-rays or any other type of medical treatment involving radiation exposure or dose, it is sensible to discuss the need for and beneﬁts of the procedure and its alternatives with your physician. ❊ Sources: The British Journal of Radiology (UK), Radiology, The U.S. Food and Drug Administration, AHIP Coverage, National Imaging Associates, The U.S. Environmental Protection Agency, National Academy of Sciences, IMV, and CNN.com
Blue & You Autumn 2005
What’s the difference I
f you are considering leaving your job in the corporate world to become self-employed … not so fast. Before you quit your job, think about your health insurance options. While you were accepted into your employer’s group health insurance plan with no hesitation, it might not be so easy when you are out on your own looking for individual health insurance.
Individual health insurance The most important thing to remember is that you enroll in a group insurance plan with your employer (you cannot be excluded) but you apply for individual health insurance. The two insurance options are unrelated, and when you leave the protection of your group insurance plan, you are starting from the beginning in your search for health coverage. Being enrolled in an Arkansas Blue Cross and Blue Shield group insurance plan does not guarantee your application for individual health insurance will be approved. Additionally, being in one of Arkansas Blue Cross’ individual health insurance plans does not guarantee acceptance into another. To change plans, you must go through medical underwriting and start the whole process again — there is no transfer of credit toward meeting deductibles or pre-existing periods. “Individual business does not take into account previous health insurance coverage. If you apply for individual coverage, it doesn’t matter if you were on another Arkansas Blue Cross individual health plan or moved here from the woodlands of Canada, you are starting from scratch,” said Ron DeBerry, vice president of Statewide Business. Applicants for individual health insurance plans (BasicBlue®, Blue Solution PPO and HSA Blue PPO) at Arkansas Blue Cross are subject to the following: 1) Medical underwriting (which is the process of evaluating and assuming risks according to your insurability). 2) A 12-month pre-existing condition clause. Individual health insurance plan rates are set on a singular basis and assume everyone is new to the health insurance medical underwriting process. Individual coverage plans do not offer continuous coverage or deductible credit. There are four things Arkansas Blue Cross may do when someone has applied for individual coverage for him/herself and/or family: 1) Approve as applied — Applicant will receive the coverage requested at the standard rate. 2) Approve with exclusions — Arkansas Blue Cross may exclude a condition or body part from coverage. 3) Approve with a surcharge — An applicant may be charged an additional percentage of the base rate if the applicant is a smoker, regularly uses a speciﬁc medication, etc.
Blue & You Autumn 2005
between group and individual health plans? Know the facts before you decide to make a switch 4) Reject the application. Approximately 75 percent of all applicants are approved for individual health insurance, with 60 percent of applicants being approved as applied (15 percent are approved with exclusions or surcharges). Standard rates for individual health insurance plans are based on the applicant’s ability to pass full medical underwriting. When a person applies for individual health insurance, and wants to include family members, each family member also must pass medical underwriting. If you misrepresent or omit medical history information and do not disclose conditions or medications you are taking, your individual coverage may be rescinded. According to DeBerry, it’s not true that health insurance companies only want healthy people in their individual health insurance plans. Medical underwriting is based on a risk perspective in relation to the applicant’s medical history. “Individual business is similar to property and casualty insurance. I can’t tell you that your 17-year-old son is going to be in a wreck in his new car, but I can tell you that it is more likely than you being in a wreck,” said DeBerry. “We look at on-going risk factors for conditions you may have had or will have … you may have a condition that will manifest itself down the road. We make our decisions based on medical records and by nationally published underwriting guidelines. It takes a lot of the subjectivity and guesswork out of it.” Many people shopping for individual health insurance may already have group coverage but ﬁnd that they can receive a more affordable rate for their children or spouse with individual coverage. Additionally, people with individual insurance only pay for the beneﬁts they need. For example, a single 25-year-old male may share the cost of maternity coverage in a group plan but could eliminate that cost with individual health insurance. With individual plans, the insured may pay less in premium costs but may be required to pay a higher deductible or more out-of-pocket expenses and coinsurance.
Group health insurance Group health insurance plans work differently than individual health insurance plans. If you are employed with a company that offers group health insurance, generally all you have to do is enroll and pay your share of the premium, subject to the rules of the plan for timely enrollment. While large group (50-plus employees) insurance generally is based on the group’s historical claims and medical history, for small group coverage (2 to 50 employees), you are required to complete medical applications for both yourself and family members that you plan to include in your group coverage. However, no matter what conditions you have or may have had, you cannot be excluded from the group plan. Underwriting may use the information to rate the group as a whole, but it will not exclude you from receiving medical coverage.
Again, just as with individual health coverage, if you give false information on your medical history information form or do not disclose conditions or medications you are taking, your group coverage will be rescinded or terminated and you may not be able to obtain health insurance from Arkansas Blue Cross in the future. “If you are a diabetic and fail to disclose it on your medical enrollment form for group health insurance, you can lose your coverage,” said David Greenwood, director of Enterprise Underwriting. “We can’t exclude you from the group health insurance plan for having diabetes if it is disclosed; we just need everyone to be truthful in completing their applications for rating purposes. It’s not enjoyable for us to have to call someone and tell them their insurance is being canceled because the information on their medical enrollment form was inaccurate. It’s a very difﬁcult thing to have to do. It’s something we would prefer that everyone could avoid. “People with health problems are aided by the small group insurance laws and regulations. While disclosure may impact the group rates, it helps ensure health insurance coverage will be there when needed,” said Greenwood. Even with group coverage, there are underwriting rules (set by the insurer) that impact the offering of coverage. Arkansas Blue Cross requires that all employers who offer group plans to their employees have a certain percentage of their eligible employees enrolled in the plan and that employers contribute a certain minimum percentage to the premium cost of group health insurance. Some people may recall the Health Insurance Portability and Accountability Act (HIPAA) and believe that it provides for portability of insurance when they change jobs — whether they are with a group or are seeking individual health insurance. That is a misconception. It does allow an individual to continue group insurance coverage when there is a job change, but it does not apply to individual health insurance. It also allows for “creditable coverage” which credits past coverage when applying pre-existing rules. Again, this applies when enrolling for group coverage with a new company, but not for individual policies. Whether you are enrolled in a group or individual health insurance plan at Arkansas Blue Cross, it is always a good idea to look closely at all your options before making a career or health insurance change. If you are thinking about leaving the protection of your group health insurance plan for an individual plan — be sure to weigh all your options carefully. Health insurance should be an important part of any career decision. If you have questions about individual health insurance products, please call 1-800-392-2583 ❊ or visit our Web site at www.ArkansasBlueCross.com.
Blue & You Autumn 2005
Arthritis, continued from Page 9
How is arthritis pain treated?
There is no single treatment that applies to everyone with arthritis. Your doctor will develop a management plan designed to minimize your speciﬁc pain and improve the function of your joints. A number of treatments can provide short-term pain relief. Following are some examples: 1. Medications — Because people with osteoarthritis have very little inﬂammation, pain relievers such as acetaminophen (Tylenol®) may be effective. Patients with rheumatoid arthritis generally have pain caused by inﬂammation and often beneﬁt from aspirin or other nonsteroidal anti-inﬂammatory drugs (NSAIDs) such as ibuprofen (Motrin® or Advil®). 2. Heat and cold — The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs. 3. Joint protection — Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.
What causes arthritis pain? The pain of arthritis may come from different sources. These may include inﬂammation of the synovial membrane (tissue that
lines the joints), the tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain. The pain of arthritis varies greatly from person to person, for unknown reasons. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint.
What exercise is best for someone with arthritis? Three types of exercise are best for people with arthritis: 1. Range-of-motion exercises (e.g., dance) help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase ﬂexibility. 2. Strengthening exercises (e.g., weight training) help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis. 3. Aerobic or endurance exercises (e.g., bicycle riding) improve cardiovascular ﬁtness, help control weight and improve overall function. Weight control can be important to people who have arthritis because extra weight puts extra pressure on many joints. Some studies show that aerobic exercise can reduce inﬂammation in some joints. Arthritis affects people in different ways. It’s always best to discuss treatment options, pain management and exercise programs with your physician. ❊ Sources: The Arthritis Foundation® and the National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
Medi-Pak Rx, continued from Page 17 May 15, 2006, you will have to pay a penalty unless you can show that you had creditable coverage under another plan. Creditable coverage is deﬁned as coverage that is, on average, at least as good as the prescription drug plan you want to join.
Low-Income Beneﬁt Beneﬁciaries with limited savings and low incomes will receive a more generous beneﬁt package with special provisions. Low-income Medicare beneﬁciaries who are eligible for these special beneﬁts will be contacted by the Social Security Administration (SSA). If you think you qualify but have not been contacted by SSA, you may want to give them a call at 1-800-772-1213.
Blue & You Autumn 2005
Questions? If you would like to receive a Medi-Pak Rx enrollment kit, please call toll-free 1-800840-6424. The kit has everything you need to know about Medi-Pak Rx and includes a list of participating pharmacies. If you have a question concerning Medi-Pak Rx, please call (501) 378-2937 in Little Rock or toll-free 1-800-392-2583. ❊
Ask the Pharmacist Questions and Answers on Generic Drugs Q. What are the differences between generic and brand-name drugs? A. There are two main differences between generic and brandname drugs. The ﬁrst difference is the name. The brand name is the name under which the product is sold and is protected by a patent for up to 20 years. For example, the company that developed acetaminophen gave it the brand name, Tylenol®. When the patent expired, other companies began producing the same product and selling it under its generic name, acetaminophen. In many cases, the same company that manufactures the brand name also produces a generic version. The other difference between generic and brand-name drugs is that generic drugs are not advertised. The lack of advertising helps keep costs down — think of generic drugs as the unadvertised brand. Q. Are generic drugs really the same as brand-name drugs, or are they inferior imitations? A. All drug makers must adhere to strict manufacturing requirements from the U.S. Food and Drug Administration (FDA) to earn approval to sell their products. FDA regulations require that generic medications be made with the same standards of purity, stability, strength and quality as their brand-name equivalent. A generic drug must demonstrate the same chemical ingredients as its brand-name counterpart. Q. Does every brand-name drug have a generic alternative? A. No. If a patent still protects a drug, it can only be supplied as a brand-name product by one company. When the patent expires, other companies may apply to the FDA to produce a generic version of the drug. Additionally, the original manufacturer usually will continue to make the brand-name product and
a generic version, often using the same or side-by-side assembly lines. Q. What kind of savings can I expect by using generic drugs? A. Generic drugs can cost 30 to 80 percent less than the equivalent brand-name drug. Of every health-care dollar spent on medicines, consumers spend less than a dime on generic drugs and the other 90 cents on brand-name drugs. Q. Why does my employer encourage the use of generic drugs? A. America’s prescription drug bill is growing astronomically. Our total prescription drug bill has risen 15 percent or more each year during the past seven years. The top 50 prescription drugs accounted for 44.4 percent of the total drug sales in 2001. Sales of these 50 prescription drugs grew 21.4 percent in 2001. The total prescription drug expenditure in 2000 was $121.8 billion, or approximately $430 per person. Of that total, approximately $11 billion or $38 per person was spent on generic drugs. That means more generic drugs are being dispensed, and people are paying less for them. Using more generic drugs could help us lower our overall spending on medicines, which is good for employers, insurers and consumers. Q. Where can the consumer get more information about the beneﬁts of generic drugs? A. The pharmacist plays an important role in explaining the quality and ﬁnancial beneﬁts offered by generic drugs. Surveys show that when consumers discuss generic drugs with their pharmacists, the majority conclude that generic drugs are a safe and effective alternative to brand-name drugs. Your physician also can help you make informed decisions about generic drugs. He can help you decide if a generic drug is available to treat your ailment or illness. Be sure to consult these health-care professionals, as they understand the value of generic drugs. ❊
Blue & You Autumn 2005
AWP brings about network changes, introduction of True Blue PPO T
he new Any Willing Provider (AWP) law, ofﬁcially known as the Patient Protection Act, is now effective in Arkansas, as a result of a legal ruling in June by the 8th U.S. Circuit Court of Appeals at St. Louis. The law basically requires a health plan to accept into its network of participating providers any doctor, hospital or other eligible provider that is willing and able to meet the standards of that health plan.
So what changes will AWP bring? Most importantly, no action will be required on the part of our customers, and AWP will not change anyone’s health-plan beneﬁts. Deductibles, coinsurance and medical services that are covered will not change because of AWP. What will change are the networks of doctors and hospitals currently used by our fully insured customers accessing the Arkansas’ FirstSource® PPO or Health Advantage HMO networks. The FirstSource PPO network will remain in place and will be used by our self-insured group customers, who are not affected by the AWP law. Those fully insured members who previously used the FirstSource PPO network continued to do so until October 1. During August and September, we developed a new AWP-compliant network called True Blue PPO. In late September, current PPO members received new membership ID cards (showing the True Blue PPO
Blue & You Autumn 2005
logo as their network) and began using the new True Blue PPO network on October 1. This new True Blue PPO network is open to any doctor or hospital willing and able to meet the standards established for the network. Arkansas Blue Cross and Blue Shield believes that most of the doctors and hospitals who are currently members of the FirstSource PPO also will be members of the new True Blue PPO. And, a number of doctors and hospitals that are not in the FirstSource PPO are likely to join the True Blue PPO network. Health Advantage members will continue to use the Health Advantage HMO network, which is now open to “any willing provider.” But because of AWP, members likely will see an increase in the number of doctors and hospitals included in the network within the next three to six months. Written applications currently are being accepted from doctors and hospitals that are interested in joining the new AWP-compliant True Blue PPO and Health Advantage HMO networks. All providers will have to pass a detailed credentialing process before being accepted as a network participant. This credentialing process may take 60 days or more to complete. Because new providers don’t automatically or instantly become part of these networks, please verify that a provider is in your network before visiting that provider for a covered service. The best way to determine if a doctor or hospital has been included in any of these networks is to check the appropriate provider directory on either the Arkansas Blue Cross or Health Advantage Web sites (www.ArkansasBlueCross.com or www.HealthAdvantage-hmo.com). ❊
Most importantly, no action will be required on the part of our customers, and AWP will not change anyone’s health-plan beneﬁts.
Arkansas Blue Cross and Blue Shield introduces BlueSecure, its new long-term care insurance policy
n a continuing effort to better meet the needs of Arkansans, his wife, Kay. Dr. Maris serves on the Arkansas Blue Cross board of Arkansas Blue Cross and Blue Shield now is offering BlueSecure, directors and understands the importance of LTC insurance from an affordable, long-term care (LTC) insurance policy that can help many perspectives. policyholders protect their assets by helping them plan for long“I ﬁrst became interested in long-term care insurance in the term care when they need it. process of ﬁnancial planning for my family’s future,” Dr. Maris said. “How Americans will pay for their long-term care needs is an “As a physician, I have many aging patients whose need for care important issue,” said William Grzesiak, and assistance increases as their health diminishes and they no longer LTC sales and marketing director are capable of living independently. for Arkansas Blue Cross. “In fact, in As medical director for four nursing February, the federal government homes in my area, I observe the need began a public awareness campaign for long-term care insurance on a in ﬁve states, including Arkansas, daily basis. And as an aging person encouraging people to plan for their myself, I want to have things in order ﬁnancial future by investigating such so that if and when I need long-term things as LTC insurance.” care assistance, it will not be a ﬁnancial Long-term care includes in-home burden on my wife or children. I care, assisted living and nursing home believe BlueSecure is a way for me care, and Alzheimer’s or hospice Mahlon Maris, M.D. (left), a family practice physician to ensure that desire, so I purchased from Harrison, and his wife, Kay, purchase the ﬁrst facility. Providing for it can place a a policy right away. I was impressed BlueSecure policies sold in Arkansas from Cynthia substantial burden on the resources of Cornell, long-term care sales representative, and Mel with the variety of options provided even the most supportive family. Blackwood (right), regional executive with Arkansas with this product. Long-term care “Arkansas Gov. Mike Huckabee Blue Cross’ Northwest Regional Ofﬁce. insurance like BlueSecure can help held a news conference in January, support our aging population.” and, in February, sent a letter to the thousands of Arkansans BlueSecure includes optional riders that allow individuals who are between the ages 50 and 70, stressing the need to to customize a plan that best meets their needs. Unique to consider some form of LTC coverage,” said Grzesiak. “In addition, BlueSecure are ﬁve choices of inﬂation protection riders. A 25 television and radio commercials have been running in Arkansas percent discount on annual premiums is available to couples who for several months, giving people a toll-free telephone number to apply for coverage at the same time, even if one partner is turned call to receive more information about options available to them. down for coverage. Now Arkansans can look to Arkansas Blue Cross for their LTC Many people associate long-term care with nursing homes, but coverage.” the majority of such care is actually delivered in “assisted living” An estimated 40 percent of the 13 million Americans receiving 1 facilities or in the home. Medical insurance, disability income long-term care services are between the ages of 18 and 64. insurance, retirement health insurance, VA plans or Medicare Individuals age 65 and over have a 48.6% chance of entering a supplements usually do not cover these costs. BlueSecure covers nursing home2. an array of long-term care choices and helps to protect ﬁnancial Long-term care insurance premiums are based on a person’s assets from being eliminated. age at enrollment. The younger he/she is when enrolling, the lower “For many, the goal is a comprehensive product that provides his/her premiums will be throughout the life of the policy. coverage in a person’s home, an assisted-living facility and in a “Long-term care is the greatest uninsured risk Americans nursing home,” said Grzesiak. “People also want to have coverage face,” said Grzesiak. “Accidents and catastrophic illness are for different types of care, from a registered nurse to an attendant unpredictable and may strike anyone at any time of life. The longer who makes sure medications are taken properly. An extra beneﬁt you live, the greater the chance you will need long-term care. Most of good policies is access to long-term care management experts. people are familiar with health insurance that pays doctor and This service gives policyholders the support of professionals in hospital bills, but they may not be aware of LTC insurance. Longselecting and arranging for the services they need.” term care insurance can help defray the costs of the help needed For more information about BlueSecure, call Arkansas Blue when a prolonged illness or mental incapacity makes it hard to Cross toll-free at 1-800-489-0463. ❊ bathe and dress, take medicine properly, or perform other normal daily living activities.” 1. Health Insurance Association of America (HIAA), An Employer’s Guide to Long-Term Care Mahlon Maris, M.D., a family practice physician from Harrison, Insurance, 2002. was the ﬁrst person to purchase a BlueSecure policy for himself and 2. Advanced Corporate Planning, 2004 – “Long-Term Care Insurance” Blue & You Autumn 2005
Arkansas Blue Cross and Blue Shield renews URAC case management accreditation
rkansas Blue Cross and Blue Shield (along with Health Advantage and BlueAdvantage Administrators of Arkansas) recently again was awarded Case Management Accreditation by URAC, a Washington, D.C.-based health-care accrediting organization that establishes quality standards for the healthcare industry. URAC’s Case Management Accreditation standards require companies to establish a process to assess, plan and implement case management interventions. Arkansas Blue Cross ﬁrst received Case Management Accreditation in 2003. “We are honored again to receive Case Management Accreditation from URAC,” said Mike Brown, senior vice president of Enterprise Networks. “We are very pleased to be recognized in the industry for providing outstanding services. Such a distinction also underscores the quality of our work with customers, patients, clients, payors, and providers by demonstrating compliance with national standards for case management services. “Although our Plan had received URAC accreditation previously, given the greatly expanded requirements for accreditation with the addition of 43 new standards, this is a very special achievement.” URAC’s Case Management Accreditation standards address
approaches to ensuring that appropriate patient protections have been established, such as policies for conﬁdentiality of patient information, informed consent, dispute resolution and other issues. The standards cover staff structure and qualiﬁcations, quality improvement, information management, oversight of delegated functions, ethics, complaints, and the case management process. “By applying for and receiving URAC Case Management Accreditation, Arkansas Blue Cross has demonstrated a commitment to quality health care,” said Garry Carneal, URAC president and CEO. “Quality health care is crucial to our nation’s welfare, and it is important to have organizations that are willing to measure themselves against national standards.” URAC, an independent, nonproﬁt organization, is a leader in promoting health-care quality through accreditation and certiﬁcation programs. URAC’s standards keep pace with the rapid changes in the health-care system, and provide a mark of distinction for health-care organizations to demonstrate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in setting meaningful standards for the healthcare industry. ❊
Women’s Health and Cancer Rights Act
he Women’s Health and Cancer Rights Act of 1998 introduced changes in insurance coverage for mastectomy. In accordance with the law, all group and individual health plans that provide medical and surgical beneﬁts for mastectomy now will cover reconstructive breast surgery, if elected by the covered individual following mastectomy, including: • Reconstructive surgery on the breast on which the mastectomy was performed. • Reconstructive surgery on the unaffected breast needed to “produce a symmetrical appearance.” • Prostheses and treatment of complications of any stage of a mastectomy, including lymphedema. The provisions of the Women’s Health and Cancer Rights Act of 1998 apply to all group health insurance coverage effective on the ﬁrst day of the plan year (which in most cases is the anniversary date of the group contract) after Oct. 21, 1998. The law went into effect on all individual insurance policies (BlueCare PPO and PPO Plus, BlueSolution PPO, etc.) issued, renewed or in effect on or after Oct. 21, 1998.
Blue & You Autumn 2005
These provisions apply to all policies issued by Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas and are subject to the applicable copayments, coinsurance, beneﬁt limitations, exclusions and beneﬁt maximums. If you have questions about your insurance coverage, contact your group beneﬁts administrator or a customer service representative at your local Arkansas Blue Cross ofﬁce.
Robert Kerr named associate medical director
obert L. Kerr, M.D., a family practice physician, has been named associate medical director for Arkansas Blue Cross and Blue Shield. As associate medical director, Kerr will assist the medical director in the provision of professional and technical counsel designed to promote effective operation of existing Plan services and for the planning and development of future products, programs and services. The associate medical director works closely with all division managers and other personnel to apply his professional and technical knowledge toward the promotion of improved services to members and health-care providers. Kerr will review and advise on medical policies, procedure codes and nomenclature. Prior to joining Arkansas Blue Cross, Kerr was in private
practice in Mountain Home. He also served as a surgeon in the U.S. Air Force. Kerr was on staff at Baxter Regional Hospital in Mountain Home, where he served as chief of staff and chief of surgery, and served on the Physician Hospital Organization board and the hospital’s Board of Governors. A native of Dermott, Kerr attended Arkansas A&M (now the University of Arkansas at Monticello), and received his medical degree from the University of Arkansas for Medical Sciences (UAMS). He completed a pediatric internship at UAMS and a surgery residency at the John L. McClellan Memorial Veterans Hospital in Little Rock and at UAMS. He is board-certiﬁed in family practice. Kerr and his wife, Mary Anne Law Kerr, have three children. ❊
Nexium® replaces Protonix® on drug formulary
ffective Aug. 1, 2005, Nexium® replaced Protonix® on the Arkansas Blue Cross and Blue Shield and Health Advantage drug formularies. The two covered proton pump inhibitor (PPI) drugs now will be Nexium and Prevacid®. Protonix no longer is covered by Arkansas Blue Cross or Health Advantage. This change is, in part, due to increased requests from our members to add Nexium to our drug formulary. We listened to you, and we are responding to your needs. PPIs are a group of drugs whose main action is pronounced and long-lasting reduction of gastric acid
production. Although your pharmacy beneﬁts do not over overthe-counter medications, please remember that Prilosec OTC® (an over-the-counter PPI) is available without a prescription in the 20 mg strength for a substantially lower cost. You should contact your physician or pharmacist to assist you with any changes before you need to reﬁll your prescription. If you have any questions regarding this change to our drug formulary, please call Pharmacy Customer Service at 1-800-863-5561.
Jesson appointed master for second time
rkansas Blue Cross and Blue Shield board member Bradley Jesson has been sworn in a second time, along with David Newbern, to serve as master in the Lake View school-funding case. The former Arkansas Supreme Court justices were originally appointed as masters in this case on Feb. 3, 2004, by Arkansas Gov. Mike Huckabee. They were sworn in for the second time on June 16, and charged with the task of fact-ﬁnding. In a story published in the Arkansas Democrat-Gazette, Jesson said, “What we are authorized to do is ﬁnd facts and not advise the
court or anyone else on what the law is.” The ﬁrst time they served, the court assigned them 10 speciﬁc areas to look into that were, according to Jesson’s comments in the Arkansas Democrat-Gazette, “very speciﬁc.” Their job required them to examine a number of laws, statutes and regulations. This time they received no such instructions and were given a deadline of September 1 for reporting back. ❊
Blue & You Autumn 2005
BlueAnn and FOX 16 “News at Nine” provide grants for classrooms
lueAnn Ewe has had the great opportunity to meet Arkansas students from Alma to Yellville and visit classrooms throughout the state through her Healthy ClassAct and Class Club connections. Hanging out with students and teaching them how to stay healthy are two favorite things about her job. Teaching children and providing them with the tools necessary to learn is a top priority for Arkansas Blue Cross and Blue Shield and for FOX 16 “News at Nine.” That is why we are joining together to help reach teachers and students “One Class at a Time.”
One Class at a Time Financial challenges face all of our schools and many teachers reach into their own pockets to help our children. Each month, FOX 16 “News at Nine” and Arkansas Blue Cross will award a $500 grant to a teacher/classroom around the state of Arkansas to help supplement class needs. Teachers in need of supplies, classroom tools, ﬁeld trips, books, computers or other educational necessities can go online to www.FOX16.com and apply for a grant. The grant program is open to pre-school through 12th-grade classroom teachers in both public and private schools, directors of enrichment programs, or school-based clubs.
How It Works
be used for classroom needs, activities and academic enrichment. All applications will be evaluated by an advisory board. “One Class at a Time” is open to teachers and schools within the state of Arkansas. Winners will be notiﬁed by the 25th day of each month, and grants will be issued by the last day of the award month. Teachers may apply as many times as they like but are eligible to receive only one grant per academic year. Only one application per project will be accepted and reviewed. All applications will remain on ﬁle for the entire grant period and will be reconsidered each month. Each month BlueAnn and FOX 16 news personalities will travel to a school to award a grant to the winning teacher. That award will be ﬁlmed and shown on FOX 16 “News at Nine.” The winners also will be posted on the Web site. For complete award criteria or a grant application, visit www.FOX16.com. ❊
Each month, one classroom will be awarded a $500 grant to
BlueAnn to host children’s theatre series at Wildwood
ntroduce your children or grandchildren, ages 5-12, to the delights of opera and musical theatre with an enchanting series of one-hour shows narrated in a “kid-friendly” environment. It’s the “Family Series,” sponsored by Arkansas Blue Cross and Blue Shield, to be held at Wildwood Park, 20919 Denny Road, in Little Rock. BlueAnn Ewe, ambassador of good health, will make an appearance at each of the shows to welcome attendees. Tickets for the three-show series are $30 and may be ordered by calling Wildwood at (501) 821-7272, extension 232. The shows include: • Patience or Bunthorne’s Bride Sunday, Oct. 23, 2005 – 3 p.m. An abridged version of Gilbert & Sullivan’s comic opera, Patience tells the story of a simple milkmaid pursued by two rival poets, Bunthorne and Grosvenor. Patience does not even like poetry, and the silliness of the story, along with Gilbert & Sullivan’s clever music, will keep the audience laughing.
Blue & You Autumn 2005
Amahl and the Night Visitors Sunday, Dec. 4, 2005 – 3 p.m. The classic Christmas opera, ﬁrst written for television, tells the story of Amahl, a poor, crippled shepherd boy who receives a visit from the three kings searching for the Christ Child. Through a miracle of generosity, Amahl is healed. Youngsters will delight in this abridged version of the opera as they relate it to the Biblical Christmas story. • Little Red Riding Hood Sunday, Jan. 22, 2006 – 3 p.m. Wildwood’s Young Artist Tour production features three young professional singers in their ﬁrst major roles. Children and adults will delight in this classic version of the well-known fairy tale. After its debut at Wildwood, the production will tour elementary schools throughout the state of Arkansas. Additional information, including driving directions to Wildwood, can be found at www.wildwoodpark.org. Bring the kids to three great shows and see BlueAnn, too!
Arkansas Fitness Challenge reaches out across state
mployees of Arkansas Blue Cross and Blue Shield and the Arkansas Department of Health recently completed their second year in the Arkansas Fitness Challenge. In fact, thousands of other Arkansans laced up their sneakers and got in on the fun in 2005. The Arkansas Fitness Challenge is an employee contest that encourages participants to work toward the public health goal of achieving 30 minutes of exercise most days of the week. At the end of the contest last year, the two host entities developed and produced the Arkansas Fitness Challenge Employee Fitness Contest Kit, which was given to Governor Mike Huckabee for the Healthy Arkansas initiative. It was made available free to companies and organizations who were interested in holding an employee ﬁtness contest in their workplace. The Kit included a contest structure, preparation, promotion and evaluation tools as well as yearlong worksite wellness suggestions. More than 300 requests were made for the Kit, and more than 45 groups representing large and small companies, banks, schools and universities, Arkansas Fitness Challenge 2005 contest representatives celebrate better health at physician ofﬁces, the State Capitol. churches, hospitals and state agencies signed up for the Challenge. Representatives from many of those groups attended the AFC wrap-up media conference in July at the State Capitol to celebrate successful contests in their workplaces. Some groups held internal contests; some found a “foe” and challenged another group in their community. What began as a challenge between the Booneville Community Hospital and the Booneville Human Development Center soon became a Logan County effort, involving government ofﬁcials as well as a barbershop. A traveling trophy was the prize to be won between St. Bernards Health System and Arkansas State University in Jonesboro. It will sit at St. Bernards this year, but ASU already is gearing up for a comeback in 2006! Students at Jessieville High School created a ﬁtness Web site to support their efforts as they were challenged by Hot Springs Health and Fitness. Teams combined exercise with a weight-loss program to determine the “Biggest Loser” as well as the contest winner. Arkansas Methodist Medical Center in Paragould held an internal contest and customized materials for that part of the state as well as provided biometric screenings before and after the contest for employees, offered food diaries and nutritional counseling, and awarded prizes. Arkansas Steel Associates in Newport also held an internal contest, and employees liked the exercise aspect so much that they added a weight-loss component to the mix, losing a total of 214 pounds among participants. The
sisters of Holy Angels Convent participated in the Challenge by exercising to classical music and customizing exercise for age groups. They even tagged the Governor as their role model and dubbed their walking routine “the Huckabee Shufﬂe.” These are just a few of the groups who caught the ﬁtness bug. Congratulations to all who stepped up to the challenge and made the ﬁrst move toward better health and ﬁtness, including: • Baker Elementary School employees in Bentonville challenged Old High Middle School employees. • The Booneville Human Development Center challenged the Booneville Hospital. They distributed ﬂyers about the contest to organizations throughout their community, and their contest became a Logan County affair with several organizations — BDC Chamber of Commerce/ Booneville, Booneville City Employees, Booneville Elementary and High School, Booneville Senior Citizen’s Center, Doris Davis Bookkeeping, First Western Bank, Jim and Jason’s Barber Shop, Logan County Health Department, Magazine Elementary and High School, North Logan Mercy Hospital/Paris, Russell Cellular/Booneville, Thomas Spivey, DDS/ Booneville — challenging each other. • Four schools within the Dardanelle Public School District challenged each other and combined the contest with the 10,000 Steps program. • HealthSouth at Jonesboro challenged Thomas & Betz. • Hot Springs Health and Fitness challenged the Jessieville School District. • Little Rock Housing Authority has challenged North Little Rock Housing Authority. • St. Bernards Medical Center, Jonesboro, challenged Arkansas State University. • Stanford Insurance challenged Bismarck High School and has also challenged other clients to enter the contest. • Arkansas Methodist Medical Center, Paragould • Arkansas Steel Associates, Inc., Newport • Cabin Rural Health Services, Hampton • CHRISTUS St. Michael Health System, Texarkana • Holy Angels Convent, Jonesboro • Hot Springs Parks and Recreation • International Paper, Pine Bluff • Mercy Health Systems, Rogers • Navigator Telecommunications, North Little Rock • Potlatch, Pine Bluff • Prestolite Wire, Paragould • Twin City Bank, headquartered in North Little Rock • Vera Lloyd Presbyterian Home for Children, Monticello • Ken Rash’s of Arkansas, Little Rock • The Bock Association contacted their corporate ofﬁce after reading the Kit and received permission for 30 minutes of company time, three times per week to exercise. • Pilgrim Lutheran Church in Jonesboro formed a Wellness Group, which met two times per week and used the Kit for wellness information and encouragement of physical activity.
Everyone is a winner with better health! The Employee Fitness Contest Kit still is available free to Fitness Challenge, continued on Page 32 Blue & You Autumn 2005
Elementary Students build healthy sundaes with BlueAnn
or the sixth year, students around the state constructed creamy creations with the assistance of BlueAnn Ewe, health ambassador for Arkansas Blue Cross and Blue Shield, at “Build a Healthy Sundae” parties in their classrooms. The students, who are members of the BlueAnn Class Club, completed a Healthy Habits Activity Calendar under the direction of their teachers to become eligible for a “Build a Healthy Sundae Party” with BlueAnn in their classroom. To complete the Healthy Habits Activity Calendar, students practiced at least one healthy habit each day — brushed their teeth, got a good night’s sleep, exercised, buckled their seat belt, ate healthy foods, etc. — and recorded their habits with a sticker on a calendar for 20 school days. As a reward for their efforts, BlueAnn Ewe paid a personal visit to seven classrooms and served the students bowls of frozen vanilla yogurt which they topped off with granola, fresh bananas, multigrain cereal, strawberries, cherries, nuts, sprinkles and/or fat-free whipped topping. Students also enjoyed low-fat animal crackers, juice and water with their treats.
Following their cool refreshments, the students played games with BlueAnn and watched and learned the words to BlueAnn’s music health videos. Each student and teacher also received a party favor during the festivities. The BlueAnn Class Club is offered free through Arkansas Blue Cross to elementary-school-age students to provide them with opportunities to learn about healthy habits and participate in activities that encourage overall healthy behaviors. Teachers enroll their classes for the BlueAnn Class Club. Participation is for one school year, renewable each fall as the new school year begins. In 2004-05, there were 339 classes enrolled (more than 11,000 students) in the Class Club. The BlueAnn Class Club is part of Arkansas Blue Cross’ Blue & Youth Health Program, a health-education effort to improve the well-being of Arkansas citizens, beginning with the young people of the state. Regional 2004-05 Sundae Party winners were: Northwest Region
Marleen Dye’s ﬁrst-grade class, Garﬁeld Elementary Northeast Region
Glenda Horton’s ﬁrst-grade class, Lubker Elementary School, Bald Knob South Central
Region Julie Brewer’s ﬁrst-grade class, Kirby Elementary School
Southwest Region Jennie Jones’ ﬁrstgrade class, Kilpatrick Elementary School, Texarkana Lenita Fox’s third-grade class, Riverside East Elementary, Caraway West Central Region
Melody Carson’s kindergarten class, Euper Lane Elementary School, Fort Smith Central Region
Southeast Region Rita Kay Holthoff’s special learning class, Reed Elementary School, Dumas
Blue & You Autumn 2005
Blue & Your Community A
rkansas Blue Cross and Blue Shield strives to be a good corporate citizen. Our employees raise money and spend many hours helping those causes near and dear to the hearts of Arkansans.
Hitting the Health Bis-marck
stadium and lit the Olympic Flame. In keeping with the Health and International Studies Magnet School’s program, an honor guard led a procession of countries around the track. BlueAnn Ewe assisted in the medal presentation, during which every student earned a medal. Eagle Mountain recognized BlueAnn Ewe for being a great health ambassador to the school during the 20042005 school year.
About 350 folks from Bismarck and the surrounding area attended the Community Health Fair there April 30 in an effort to get on the road to better health. Our South Central Regional Ofﬁce staff and BlueAnn Ewe greeted families and signed up kids for the BlueAnn Health Club. Free health screenings Shopping for Good Health and activities, music, BlueAnn Ewe and Sparky were among the food and lots of fun celebrities at the ﬁrst ever Fort Smith Health Mall were available for on May 7 in the Fort Smith Convention Center. Our those who attended. West Central Regional Ofﬁce staff greeted Angela Stanford, a attendees as they perused 50 booths devoted to local insurance agent, health care, wellness, ﬁtness and safety. Almost 800 said the health fair people attended the event, which was sponsored by also was a ﬁrst step the Healthy Congregations Campaign, a “grassroots” in helping to open organization that seeks to improve the health status a community health Local ﬁreﬁghters teach BlueAnn and kids techniques of the greater Fort Smith area through active health clinic to help meet at the Bismarck Community Health Fair. education efforts in local churches. The one-stopthe ongoing needs of shopping health extravaganza featured several free Bismarck residents. health screenings, scores of educational offerings, live music, a “bounce-around” for the kids, healthy snacks and appearances by All Heart at the Walk lovable characters, including BlueAnn. Sparky is the mascot for Members of the Southwest Regional Ofﬁce staff and Sparks Health System in Fort Smith. BlueAnn participated in the American Heart Association Heart Walk May 7 in Texarkana. The event was held at Spring Lake Park, and our team helped the community raise $65,000 in support of the AHA’s work to prevent heart disease. BlueAnn went hoofto-paw with other local mascots in a special warm-up prior to the Walk start. Liberty Eylau School District raised the most money and won the T-shirt design contest.
“Medal-ing” in Healthy Activities Members of our Northeast Regional Ofﬁce staff and BlueAnn Ewe were special guests at the Eagle Mountain Magnet Games held May 5 in Batesville. Students spent the day involved in numerous healthy activities. The opening ceremony began after torch runners (one per classroom) entered the
Fayetteville Business Leader Forums Our Northwest Regional Ofﬁce recently completed a series of Business Leader Forums focused on Consumer-Driven Health Plans. The forums were designed to educate community leaders in the Siloam Springs, Rogers, Springdale, Harrison and Mountain Home areas about the growing interest in these new health plans as well as help them gain insight into: 1) key drivers of health-care costs, 2) alarming trends, and 3) building strategies for the future. Ray Bredfeldt, M.D., Northwest Regional medical director for Arkansas Blue Cross, presented “Take Control of Your Health-care Cost” and Larry Shackelford, chief executive ofﬁcer of Medical Services of Northwest Arkansas, presented “ConsumerDriven Health Plans — the Employer’s Perspective.” According to feedback, many concerns and commonalties were identiﬁed and business leaders emerged more adequately prepared to explore beneﬁt options. ❊
BlueAnn assists in medal presentations at the Eagle Mountain Magnet Games in Batesville.
Blue & You Autumn 2005
Blue How to use our provider directories No matter which health-beneﬁt plan you have, you save money out of your pocket when you use in-network providers (physicians and other medical providers, such as physical therapists, hospitals and other medical facilities) for your medical care. Health plans charge lower copayments and less coinsurance when you visit providers contracted to provide services to their members because the plans negotiate lower rates from these in-network providers and pass the savings on to members. Health plans create provider networks to keep your premium costs lower, not to create inconvenience for you or to limit your freedom of choice. Although Arkansas’ Any Willing Provider law might result in additional providers entering your plan’s network, you should always check to see if a provider participates in the network before you make an appointment. Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas require that a physician meet certain contracting standards before the provider becomes part of their networks. You can ﬁnd out if a provider is included in your plan’s network quickly and easily by visiting the appropriate Web site and clicking on the “Provider Directory” link on the home page: www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com The most accurate way to ﬁnd your network when you get to the “Provider Directory” page is to enter your member ID number from your health-plan ID card. (BlueAdvantage members are required to take this route because their search is customized for each member.) This takes you directly to your plan’s network. Then you may enter a provider’s name or search for providers by specialty, gender, language, city, county or region. In the provider directory search results, you will ﬁnd a “detail” button beside the physician’s name. The detail for most physicians will show you the provider’s educational background, hospital afﬁliations, board certiﬁcations, gender and language. For each physician, you may access a map and driving directions to the provider’s location. An alternative search route is to click on the name of your health plan (i.e., Blue Solution PPO, HSA Blue PPO, BlueChoice POS, Health Advantage HMO) on the “Provider Directory” page. This plan name also appears on your member ID card. Beginning Oct. 1, 2005, any Arkansas Blue Cross member who has been in the Arkansas’ FirstSource PPO network will be transferred to the True Blue PPO network, which is the new AWPcompliant network. The easiest way to ﬁnd the network is to click on the “True Blue PPO” link on the Provider Directory introduction
Online page, which lists all of the network choices. BlueAdvantage members in the Arkansas’ FirstSource PPO network will remain in that network because their groups are self-insured and not affected by the Any Willing Provider law. A “Quick Search” also is available to look up the name of a speciﬁc provider. The results will list all the networks that include that provider. You need to make sure that your network is on the list. If you get confused when you are searching for a provider, click on the “E-Mail Customer Service” link at the bottom of any page to request help in locating an in-network provider. ❊
www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com
Fitness Challenge, continued from Page 29 groups or organizations interested in holding a contest with their employees. The Kit is available in notebook or CD format by calling toll-free 1-800-686-2609 or can be downloaded at www.ArkansasBlueCross.com (click on “Employers” tab), www. HealthAdvantage-hmo.com (click on “Employers” tab), or www. BlueAdvantageArkansas.com (click on “Employers” tab). ❊
Arkansas Blue Cross and Blue Shield P.O. Box 2181 Little Rock, AR 72203-2181