Balance Magazine Winter 2014-15

A PUBLICATION OF

W I N T E R

2 0 1 4

I didn’t want to

watch and wait.

How Network Health provided Mary Benesh-Zoeller the support she needed to fight melanoma.

L I F E , H E A LT H & W E L L N E S S

life

03

3

4

Toy Safety Tips for keeping playtime safe

E DITORIAL STAFF

President Sheila Jenkins

Understanding Your Risk for High Blood Pressure How to control your risk factors

5

Publications Jessica Coordinator Thomaschefsky

Good Questions for Your Good Health

Balance is published quarterly by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals.

Network Health Medicare Rates High on Quality

06

Learn more about our national rankings

S T O C O V E R Y

Pale

08

is the new

5 Ways to Stay Active This Winter

Find the right form of exercise to stay motivated this winter

Call Network Health’s new nurse line

14

Feeling Down?

Know when it’s more than just the blues

15 Insurance On the Go

Protect hearing – Well-meaning family members love to buy toys for your child that make noise.

Check to see if the toy has a volume control and adjust it accordingly. Not only will you save your child’s hearing, but your sanity as well.

You can also write to us at:

Make sure toys aren’t toxic – Craft and paint sets, crayons and modeling clay should be marked nontoxic. It’s also a good idea to restrict hobby kits and chemistry sets to kids over 12 years old.

Network Health Attention: Jessica Thomaschefsky 1570 Midway Pl. Menasha, WI 54952

Easy-to-use member smartphone apps

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Check the battery compartment – Small batteries can be a choking or swallowing hazard and could leak battery acid. Make sure the screws are tightened on these compartments.

Store toys safely – Toy chests should have safety hinges on the lid, as well as holes for ventilation.

WANT MORE HEALTH TIPS? Check out our new blog at copilotwi.com.

We add helpful information about health and well-being every week, so be sure to visit often.

Need to Talk to a Nurse?

in toys or games. Respect the age suitability warning on the toy (e.g. not suitable for children under three). Teach older children to keep toys that may have small parts or sharp points out of reach of younger siblings.

would like to tell us how Network Health improved your life, send us an email at

balance@networkhealth.com.

Network Health member Mary Benesh-Zoeller’s melanoma journey.

T

he chaos of Christmas morning has come and gone. Now that little ones finally have the toys they have had their eye on all year, it’s important to keep safety in mind. Here are a few tips to keep playtime safe.

Check for small parts – Children under three can choke on small parts and magnets contained

If you have questions or suggestions or

wellness 12

© 2014 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.

TELL US WHAT YOU THINK

TAN

13

BOARD

Peggy Huss, Dawn Rady, Mark Geiger, Renee Corral, Barb Gore, Chuck Rynearson, Teri Koepke

Understand the answers to three simple questions

7

Graphic Designer Gary Vossekuil

E DITORIAL

Influenza vs Stomach Flu Understand your symptoms to determine the best treatment

6

Information to help you get the most out of your coverage

Chief Administrative Penny Ransom

Officer

he alth

life

Toss plastic packaging – Do not allow children to play with plastic packaging as it poses a risk for suffocation.

Once the toys are out of the package, toss the plastic.

Wondering if any of your children’s toys have been recalled?

Check out the Consumer Product Safety Commission’s website at www.cpsc.gov for a current listing of recalled toys.

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health

life { YOUR CARE }

Understanding

Your Risk for High Blood Pressure

H

igh blood pressure is common among Americans—nearly one in three U.S. adults has high blood pressure according to the American Heart Association. Unfortunately, this leads to an increased risk for developing serious health conditions, like heart disease and stroke. Knowing the basics and being informed can help you manage your risk factors and bring blood pressure under control.

What is high blood pressure?

As your heart pumps blood to different parts of your body, the blood pushes against the walls of your blood vessels and arteries. The force it exerts is what doctors call blood pressure.

How to control your risk factors Lose weight. If you’re overweight, losing even five pounds can help lower your blood pressure.

Don’t use tobacco and limit alcohol. Smoking or chewing tobacco can raise blood pressure.

If you smoke, quit. And, only consume alcohol in moderation. Too much alcohol is also a contributing factor of high blood pressure.

High blood pressure usually has no warning signs or symptoms, so many people don’t realize they have it. The only way to know if you have high blood pressure is to have a doctor or other health professional measure it. Measuring your blood pressure is quick and painless.

Get active. Regular physical activity can help lower your blood pressure and keep your weight under control.

What causes it?

Eat a healthy diet. A diet rich in whole grains, fruits, vegetables, low-fat dairy and low in sodium has been shown to help lower blood pressure.

High blood pressure often has no direct cause, however, certain risk factors may increase your chance of developing it. Age, gender, race and family history are a few factors that cannot be controlled.

Fortunately, you can help control many of the others.

Reduce stress. Stress can raise blood pressure temporarily and may lead to overeating and tobacco or alcohol use. If you often feel overwhelmed or stressed, it’s important to take steps to change that.

Stomach Flu vs Influenza P

eople often mistake the stomach flu for influenza.

The symptoms are very similar and you may say that you have the flu; but the stomach flu and influenza are very different. The stomach flu is a gastrointestinal illness called gastroenteritis. Influenza is a respiratory illness. The following is a breakdown of each illness. It will help you determine the best treatment if you find yourself experiencing any symptoms.

Gastroenteritis (stomach flu) The stomach flu really has nothing to do with the flu as it’s commonly called. It’s typically caused by a virus or bacteria.

Although rare, it can also be caused by parasites found in food or unclean water. Symptoms include nausea, vomiting, diarrhea, stomach pain and abdominal cramps. Depending on the type of bug, you may also experience a headache and fever.

The biggest danger from the stomach flu is dehydration, so it’s important to stay hydrated. If not treated properly, you could end up in the hospital. Skip over-the-counter medications as they really don’t help. In fact, some may even make it worse. Time is the best medicine when it comes to feeling better.

Influenza Influenza is only caused by a virus and it affects the respiratory system. It usually comes on suddenly and symptoms can include fever, fatigue, muscle aches and respiratory congestion. Some people may experience vomiting and diarrhea, although this is more common in children.

Prevention is Key What should I do if I have high blood pressure?

It’s important not to ignore it. If left untreated, it can lead to stroke, dementia, heart and kidney problems and impotence.

Discuss your target blood pressure with your doctor. Together, you can decide what steps you need to take to achieve what’s healthy for you.

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networkhealth.com

News and tips to help you maintain a healthy and happy life

Both influenza and the stomach flu are contagious. The best defense against influenza is to get vaccinated. Washing your hands frequently with soap and water, using separate personal items around the house and disinfecting germ-filled hard surfaces can be effective ways of prevention against both illnesses. n e t w o r k h e a l t h . c o m

S AY W H AT ?

Influenza – A highly contagious viral infection of the respiratory system, causing fever and body aches.

Gastroenteritis – Inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and causing vomiting and diarrhea.

When to see a doctor Both the stomach flu and influenza can typically be treated at home and you don’t need to see a doctor. However, if your symptoms last more than a few days or you notice signs of dehydration you should schedule an appointment. Also, if you are at risk of complications from the flu (pregnant women, young children, adults over the age of 65 and people with a weakened immune system or chronic illness) you should see a doctor right away.

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health

Good Questions for Your Good Health D

id you know studies show that people who understand health instructions make fewer mistakes when they take their medicine or prepare for a medical procedure? It’s true. Informed patients can even manage a chronic health condition more effectively.

Communication with your doctor is key.

And, many health care professionals recommend Ask Me 3™, a patient education program designed to promote communication and improve health outcomes.

For a complete list of recent changes to our provider network, go to networkhealth.com/providerchanges.

The progr encourageam to underst s patients answers toand the simple qu three estions.

1. Wh

at is my m ain proble 2. What do m?

I need to d o ?

3. Why is it important for me to do this?

Ask questi

ons wh

en: • You see a doctor, n urse or ph • You prep armacist. are for a m edical test • You get or proced your medic ure. ine.

Make sure to ask thes e three que discuss yo stions next ur care with time you your docto better info r. It can he rmed and lp you be understan to take care d what you of your he need to do alth.

Your Right to Request an Independent Review We work hard to ensure member satisfaction, but it’s important to know you have the right to have an independent organization examine certain final decisions made by Network Health. Network Health contracts with three nationally-accredited independent review organizations to conduct reviews, and the decisions are binding for both Network Health and the member.

Decisions made by Network Health eligible for review are those where we determined the requested care or services did not meet our requirements for medical necessity, appropriateness, health-care setting, level of care, effectiveness, experimental treatment, rescission of a policy or a certificate, or coverage denial determination based on pre-existing condition exclusion. Requests for services that are not included in your 6 | balance • W i n t e r 2 014

benefits package are ineligible for independent review (including, but not limited to, benefits limitations and direct exclusions).

Typically, you must complete Network Health’s internal complaint process (called a grievance) before you can start an independent review. However, you do not need to complete the process if you need immediate medical treatment and a delay could jeopardize your life or health, or if we agree with you that it is in everyone’s best interest to proceed with your concern directly to independent review.

For more information on the independent review organization process, refer to your certificate of coverage or contact customer service at 800-826-0940 or 920-720-1300. networkhealth.com

Network Health Rates High on Quality N

etwork Health evaluates the quality of care and services provided to members using two nationally recognized tools, the Healthcare Effectiveness and Data Information Set (HEDIS®) and the Consumer Assesment of Healthcare Providers and Systems (CAHPS®). Each tool scores our service in a different way. To view Network Health’s results, visit networkhealth.com and search for HEDIS and CAHPS. If you have any questions, or for more information about Network Health’s Quality Improvement Program and national rankings, call 920-720-1229, or toll-free at 800-826-0940, ext. 01229.

DO YOU KNOW HOW HEALTH PLANS MAKE THEIR DECISIONS?

Visit networkhealth.com and click Member’s Corner. Next, select Resources and click the Learn More button. Then click the How Health Plans Make Their Decisions link. You’ll learn important information about service and appropriateness of care. Still have questions? Call our customer service department at 920-720-1300 from 8 a.m. to 5 p.m. on Mondays, Wednesdays, Thursdays and Fridays or from 8 a.m. to 4 p.m. on Tuesdays.

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S T O C O V E R Y

Pale

is the new

TAN Every winter for 10 years and for special occasions,

Mary Benesh-Zoeller would visit the tanning salon.

Not only did it provide her with bronzed skin, it was relaxing and put her in a better mood. However, it all came at a price.

By Jessica Thomaschefsky 8 | balance • W i n t e r 2 014

|

>>>

P h o t o g r a p h s b y B e t h D e s J a r d i n , Tr ove P h o t o g r a p hy

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On February 11, 2009, Mary’s life was forever changed. She had previously gone to see her primary care physician to have a blood blister removed from her right shin. The sample was sent to pathology and the results were a shock to both Mary and her doctor.

Mary, a computer skills teacher, received a phone call at work asking her to stop by her doctor’s office that evening. The nurse did not want to discuss the situation over the phone. Mary knew at that point the news was not going to be good. She was diagnosed with Stage 2B ulcerated nodule, a type of melanoma, which is more aggressive due to its vertical growth which is deeper into the tissue and goes directly into the blood stream. Her melanoma was caused by direct UV exposure from tanning beds. It’s nicknamed the black beast.

Mary was given some reputable websites to research and was referred to a local oncologist and surgeon to proceed with the next steps. She wanted to see a doctor right away, however, the oncologist she was referred to didn’t see Mary’s condition as life-threatening, and she was told to watch and wait to see what would happen. This was a hard thing to do since she is not the watch and wait type of person, especially when it comes to her health. At the time, Mary had another health insurance provider and was assigned a case manager, but never felt a real connection with her or her doctors. ds In 2012, Mary’s employer switched to Network Health and she was connected with Yvonne Morrow as her case manager. “She has been awesome, she gets my sense of humor, keeps me calm and understands me,” Mary said. “As a teacher, phone calls during the day are impossible. Yvonne gave me the option to email her and it’s made the communication process so much easier.”

In 2013, she needed a consult with a specialist in Chicago. She was terrified that she needed an isolated limb perfusion, which is typically saved as a last-ditch effort. Yvonne stepped in to coordinate care, coverage and all the steps involved to make the consult happen.

With the information the specialist was provided and the consult, it was determined that Mary did not need the procedure. Thanks to

S AY W H AT ?

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Yvonne and the specialist working together, Mary was saved a lot of pain and another major surgery.

Mary met Dr. Mark Albertini, a metastatic melanoma specialist, with UW Health in Madison. She was nine months into her diagnosis before seeing him and wishes she would have seen him sooner. “It’s so important to see a specialist of your cancer right away,” Mary said. “The first thing I tell someone who is newly diagnosed is to see a specialist, especially with melanoma because it’s so complex and challenging.” Dr. Albertini has an arsenal of options including access to the latest research. He’s not a hugger like Mary, but he always has a smile and a handshake to offer.

‘‘

wears sunscreen and in the summer wears sun protective clothing. She has also taken a six-week mindful meditation class, exercises and does yoga. This combination has been helpful in controlling her lymphedema and other side effects from treatment, as well as keeping her emotional health in check.

After her fifth reoccurrence with melanoma, Mary needed someone to talk to and again turned to Yvonne for assistance finding a professional therapist. Mary has also found great comfort in online support groups. After her sixth surgery, she wanted another opinion on her treatment. She asked for

She has been awesome, she gets my sense of humor, keeps me calm and understands me.

’’

- MARY BENESH-ZOELLER

She began four weeks of High-dose Interferon IV infusion treatments. The first two weeks of treatment went smoothly and she felt good enough to go back to work. However, by the fourth week of treatment, the side effects had kicked in. She couldn’t eat and had lost 20 pounds. She also became dehydrated and had to be taken to the hospital for an IV infusion. Luckily, she had the support of her significant other, Jeff, and her sister to care for her during treatment.

Another course of treatment that goes along with Interferon is 11 months of self-injections at a lower dose to be done three times per week. Mary made it through three weeks of injections before suicidal thoughts set in. She got to the point where she wanted her life to be over so that Jeff and her son, Caleb, could move on with their lives. “Your mind goes to crazy places and I was looking at everything in three month increments,” Mary said. “I cancelled my gym membership and leased a car instead of purchasing one because I didn’t know what was going to happen.” She called her doctor to explain what was going on and was told to stop the injections immediately. She felt a huge weight lifted off her shoulders.

Three weeks after stopping the injections, another spot appeared on her leg. She called her dermatologist, Dr. Michelle Holder, whom she adores. “She’s a hugger and I’m a hugger,” she said. Mary let the receptionist know that she had a suspicious spot and was a melanoma patient. She had an appointment within 24 hours.

“I go to bed at night thinking about melanoma and wake up thinking about it,” she said. “It’s staring at me every morning in the shower because of the scars on my leg.” Mary’s outlook on life has changed and she no longer takes the little things for granted. To avoid taking medications, she takes a multivitamin, vitamin D,

Isolated limb perfusion – Specialized medical technique used

Lymphedema – A build-up of

to deliver a high dose of anticancer drugs, such as chemotherapy, directly to an arm or leg to control melanoma that is confined to that area.

fluid in the tissue under the skin, causing swelling in the arms or legs.

n e t w o r k h e a l t h . c o m

suggestions from one group and was given a name and email address of a specialist in Florida. With the help of Yvonne, Network Health and Dr. Albertini, Mary was able to travel to Florida and consult with Dr. Jeffrey Weber at Moffitt Cancer Center. “The process went really fast,” Mary said. “I had surgery on June 5 and on July 11 I was in Florida.”

Melanoma is challenging because some treatments work and some do not. It tends to travel to the liver, lungs and brain but can spread to other parts of the body as well, making it unpredictable. Patients will try just about anything and Mary is always willing to participate in clinical trials. She is also an advocate for sun protection and likes to share her story in hopes that it will prevent someone else from going through what she has.

October 17, 2014, is another day Mary will never forget.

After receiving a PET scan, she was declared NED (no evidence of disease). Yvonne continues to check in at least once a month to see how Mary is managing her side effects and her emotional health. In fact, Yvonne and Mary met face-to-face this past summer at a local coffee shop. “I am proud of the way Mary has taken care of herself, physically and emotionally.” Yvonne said.

S AY W H AT ? n e t w o r k h e a l t h . c o m

High-dose Interferon IV infusion – Medication used to lessen the chance that the melanoma will come back after surgical removal.

‘‘

Your mind goes to crazy places and I was looking at everything in three month increments.

’’

-- M A R Y B E N E S H - Z O E L L E R Metastatic melanoma – Least common type of skin cancer but the most deadly due to how quickly it can spread to other parts of the body.

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wellness

Tools to empower your personal health

5 Ways to Stay Active This Winter O

ne of the most popular New Year’s resolutions is to start exercising. Winter weather can make sticking to that resolution difficult. It’s easy to stay snuggled up on the couch but don’t let the winter months cause you to hibernate, especially after eating all those holiday treats. Finding the right form of exercise will give you the motivation you need to stay active this winter.

1

2 Don’t think of it as exercise, think of it as playing.

Go outside and make a few snow angels, build a snowman or go sledding. The best part is it won’t feel like a work out, but you’ll still get your heart rate up and burn some calories.

Clean your house.

All that bending, squatting and stair climbing burns calories.

FEBRUARY IS AMERICAN HEART MONTH Heart disease is the leading cause of death in the United States.

Show yourself some love this February by learning about the risk factors for heart disease and stroke. You can greatly reduce your risk by eating a healthy diet, being physically active, getting enough sleep and avoiding stress. To find out more, visit the American Heart Association website at heart.org.

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Feeling

Down?

How to know when it’s more than just the blues

T

he short, dark days can make many of us feel like we’ve caught a case of the winter blues. While slight mood changes can be normal, it’s important to know when it might be something more serious.

Understand what depression is Depression can be caused by a combination of genetic, biological, environmental and psychological factors. According to genetic research, depression can result from genes acting together with environmental factors. Seasonal depression, often called seasonal affective disorder (SAD), is a type of depression that occurs each year at the same time.

Some types of depression run in families, but it can occur in people without family histories. In other cases, trauma can cause depression. Loss of a loved one, career or any other stress can trigger depression. However, some episodes of depression can occur without any obvious triggers, too.

3

If you haven’t exercised in a while or if you have any health issues, check with your doctor before starting any new activities.

Try a new winter sport.

Get the whole family involved and go ice skating or skiing.

You shouldn’t feel ashamed or embarrassed if you think you’re experiencing depression. Instead, take steps to understand it and know when you should talk to your doctor.

Recognize symptoms • • • • •

Persistent sad, anxious or empty feelings Feelings of hopelessness or pessimism Feelings of guilt, worthlessness or helplessness Irritability or restlessness Loss of interest in activities or hobbies you used to enjoy • Fatigue and decreased energy

• • • • •

Difficulty concentrating, remembering details and making decisions Insomnia or excessive sleeping Overeating or appetite loss Thoughts of suicide or suicide attempts Aches or pains, headaches, cramps or digestive problems that do not get better even with treatment

Know if you’re at risk

5 Pop in a fitness DVD or video game.

4 Join a gym or try a fitness class.

According to the National Institutes of Mental Health, each year about 6.7 percent of U.S. adults experience major depression. Women are 70 percent more likely than men to experience depression during their lifetime.

Fortunately, even in severe cases, depression can be effectively treated.

And, the earlier treatment begins, the more effective it is. The first step to getting appropriate treatment is to visit a doctor or mental health specialist. If an antidepressant is prescribed, be sure not to skip doses or quit treatment early. It can take up to eight weeks before an antidepressant takes full effect. Give your medication a fair chance by taking it as prescribed and giving it time to work. n e t w o r k h e a l t h . c o m

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wellness

Need to Talk to a Nurse?

Call Network Health’s New Nurse Line Starting January 1, 2015, all Network Health members* will have free access to a new nurse line available 24/7, 365 days a year through Health Dialog. This new nurse advice line is available to you at no cost and can be accessed by calling 888-879-8960 (TTY 888-833-4271). Health Dialog has been providing services for over 19 years, and the nurses you’ll speak with can help answer medical care questions specific to you.

Here are some examples of when to call.

• When you have a symptom like a sore throat, muscle pain or a fever • When you have questions about your medicines or are prescribed a new medicine and want to know more about it Ministry Health Care associates and their families who are insured by Network Health will continue to use Affinity NurseDirect at 800-362-9900.

*

Network Health’s Self-Management Workshops

For more information or to sign up for a workshop, call us at 920-720-1655 or 800-769-3186, extension 01655. Or, visit us at networkhealth.com/workshops.

Click Learn More for details about each workshop, and you’ll also find a link to where you can find dates and times for each workshop.

Insurance On the

Living Well with Chronic Conditions Designed specifically for anyone with a chronic condition, such as arthritis, high blood pressure, heart disease, chronic pain or anxiety, this workshop teaches self-management skills and develops a step-by-step plan to achieve specific goals.

The six-week class meets once a week for two and a half hours.

Healthy Living with Diabetes For any adult living with type 2 diabetes, this workshop is designed to help you better manage your diabetes. Classes cover topics like healthy eating choices and habits, the benefits of exercise, other techniques for dealing with symptoms and how to work with health care providers. This six-week workshop meets once a week for two and a half hours.

F

orget your Member ID card at home? Access your card from anywhere by downloading our member ID card app. We’ve also got an app for your pharmacy card. These easy-to-use smartphone apps make your life easier by enabling you to access your member ID card and your pharmacy card when you don’t have them with you. If you have family members on your health plan, they can also download the app.

Get your Member ID eCard • Visit networkhealth.com/mobile.

• Download the Network Health member ID app to your smartphone.

• Open the app and enter your member ID number (found on your member ID card under the Network Health logo).

Stepping On

• Enter your four-digit PIN (found on the back of your member ID card).

A program for older adults who may have fallen, have a fear of falling or are at risk of falling. This program empowers older adults to step outside of their homes with the confidence to improve their quality of life. This seven-week workshop meets once a week for two hours.

Your entire family can use the same PIN because there is only one issued per household.

Get the CVS Caremark mobile app With this app you will be able to manage your prescriptions, find a local pharmacy, check drug coverage and more. Before you download the app you will first need to set up an account with CVS Caremark.

Additional Local Support Groups C.O.P.E. with COPD Education and support to help those with chronic lung disease. For more information, call 920-203-8821 or 920-235-2542.

• Visit networkhealth.com and click Member Sign In at the top of the page.

Better Breathers

• Once logged in, click on the CVS Caremark link under the My Health column.

A community-wide support group for people with COPD and other chronic lung diseases.

For more information call 920-738-2558 or 920-738-5364.

• Follow the redirect to the CVS Caremark page and follow the instructions to create a new account.

Once your account has been created, go to networkhealth.com/mobile to access the app and download to your smartphone.

Fox Valley Diabetic Education and Support Group Open to people with type 1 or type 2 diabetes and/or their loved ones. Classes are free and no registration is needed.

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networkhealth.com

Go

If you have any questions, please call our customer service department at 920-727-1300 or 800-826-0940 from 8 a.m. to 5 p.m. Monday, Wednesday, Thursday and Friday or from 8 a.m. to 4 p.m. on Tuesdays. n e t w o r k h e a l t h . c o m

Verify Your Primary Care Provider Your primary care provider (PCP) is your main doctor who coordinates everything relating to your health care. It’s important for Network Health to have your PCP on file so that we can serve you better.

Use our PCP verification tool and choose or confirm the provider that we have on record for you. To find this tool, go to the Member Sign In page on our website and log in to My Account.

Once you are signed in, click Verify your PCP which is listed under the My Health column. You will be directed through the verification process. It may take up to three business days for your updated information to show up on your My Account page.

You can also call our customer service department at 920-720-1300 or 800-826-0940 to verify or select a PCP. W i n t e r 2 01 4

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1570 Midway Pl. Menasha, WI 54952

MAILED ON 12/30/14

EXPERIENCE NETWORK HEALTH

AT NETWORK HEALTH, WE SPEAK YOUR LANGUAGE. Shopping for health insurance isn’t what it used to be.

We understand choosing a plan is about balancing benefits, wellness, the right doctors and your budget. It’s also important to know what you’re signing up for so there aren’t any surprises along the way. Isn’t it time you experienced a different kind of Wisconsin health plan?

MeetNetworkHealth.com 800-826-0940

­ MO plans underwritten by Network Health Plan. POS plans underwritten by Network Health Insurance Corporation, or Network H Health Insurance Corporation and Network Health Plan. Self-funded HMO and POS plans administered by Network Health Plan.

SAL-209-01-11/14