Concierge winter 2015

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

A PUBLICATION OF

WINTER 2015

Soaring High Follow two Network Health members as they skydive for the first time in decades

inside

LIFE

Five Tips That May Help Lower Your Blood Pressure

HEALTH

The Not-So-Obvious Signs of Depression

WELLNESS

Managing Multiple Medications

Exclusive Reduced Rate for Network Health Medicare Advantage Members

Motown The Musical Sunday, April 10 at 1 p.m.

Discounted tickets range from $23 - $53 until February 4, 2016 Visit FoxCitiesPAC.com/OnlineOffers, click the Network Health logo, select Find Tickets, type MEDICARE in the promo code field and follow the instructions to make your purchase.

This offer is only valid for Network Health Medicare Members and their families. Not valid on previously purchased tickets. Valid while supplies last.

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life

wellness

3 Measuring our Medicare Success at Network Health

12 Managing Multiple Medications

4 Five Tips That May Help Lower Your Blood Pressure

14 Palliative Care – A Big, Scary Term for Symptom Management

health 5 Medicare Scams Don’t Fall Victim to Medicare Fraud 6 The Not-So-Obvious Signs of Depression

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7 Let Network Health Help You Keep Your Resolution with Gym Membership Reimbursement FEATURE 8 Soaring High Follow two Network Health members as they fly high with fellow veterans

13 Is Your Pharmacy a Preferred Pharmacy?

14 Breaking Down Obstacles to Care 15 Network Health’s Self-Management Workshops 16 What Can You Expect When You Need Care 17 Schedule and Track Your Screenings BACK COVER Meet Sam Schnell

Y0108_745r1_121015 EDITORIAL STAFF President and CEO Chief Administrative Officer Marketing Coordinator Graphic Designer

Sheila Jenkins Penny Ransom Kari Navis Debra Sutton

EDITORIAL BOARD Renee Corral, Colleen Davison, Sarah Dencker, Melanie Draheim, Jessica Fischer, Mark Geiger, Natalie Knaack, Teri Koepke, Joan Merwin, Barbara Ott, Dawn Rady, Chuck Rynearson and Jeanne Skinner

ASK NETWORK HEALTH If you have questions, about anything you read about in this issue of Concierge, call customer service at 800-378-5234 (TTY users call 800-947-3529) Monday through Friday, 8 a.m. – 8 p.m. From October 1, 2015, to February 14, 2016, we are available seven days a week from 8 a.m. to 8 p.m. You can also learn more at NetworkHealthMedicare.com.

Network Health offers TDD/TTY services for deaf, hard of hearing or speech-impaired individuals. Anyone needing these services should call 800-947-3529. Bilingual language assistance or translation services are also available. Callers may leave a message 24 hours a day, seven days a week.

Concierge is published quarterly by Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals. © 2015 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.

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life 98

%

of Medicare members who join Network Health, stay.* That tells you something.

*Based on the percentage of Network Health Medicare Advantage (PPO) members who stayed in the plan for 2015, for coverage starting January 1, 2015.

Measuring Our Medicare Success at Network Health W hen discussing Medicare Advantage coverage with friends and family, it’s important to compare apples to apples. You need to know both the coverage and service you’ll receive because your choice is important to your quality of life and health. But with so many companies and plans to choose from, how can you know you made the right choice?

Medicare rates all health and prescription drug plans each year, based on a plan’s quality and performance. Medicare Star Ratings help you know how well our plan is doing. You can use these Star Ratings to compare our plan’s performance to other plans. For 2015, Network Health Medicare Advantage plans received the following Overall Star Rating from Medicare.

4.5 out of 5 Stars

Some of the areas Medicare reviews for these ratings include the following.

• How members rate our plan’s services and care • How well our doctors detect illnesses and keep members healthy • How well our plan helps our members use recommended and safe prescription medications

Thank You

Every October, we hold our Network Health Medicare Member Appreciation Events. We love getting the chance to meet our members from all over northeast Wisconsin.

Once again, more than 10,000 of you attended to learn more about your benefits. You asked great questions, and we appreciated that many of you brought a guest so they could learn about Network Health. We hope you also stuck around to see a movie and eat some popcorn. Thanks again to all those who attended.

Manager, Appeals and Grievances

You can find out more about our Star Rating and other measures including quality and member satisfaction ratings from The Healthcare Effectiveness Data and Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey at NetworkHealthMedicare.com/ Why-Network-Health/Top-Coverage.php. You can also request a hard copy of Medicare evaluates plans based on a 5-star these ratings by calling your health care concierge at 800-378-5234 rating system. Star Ratings are calculated each (TTY users call 800-947-3529), Monday through Friday 8 a.m. – 8 p.m. year and may change from one year to the next.

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life

Five Tips That May Help Lower Your Blood Pressure

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ccording to the American Heart Association, about 80 million Americans are living with high blood pressure. Left untreated, high blood pressure can lead to life-threatening conditions like heart disease, heart attack and stroke, to name a few.

It’s a good idea to ask your doctor about your blood pressure, any necessary medication and potential lifestyle changes that will help keep it in check. Together, you can decide what steps to take to achieve a level that’s healthy for you.

If you haven’t already, it’s time to start a conversation with your doctor. Here are five tips to help lower your blood pressure.

Get moving. Aim for 40 minutes of activity, three to four days per week. Go for a walk, take the stairs or go for a swim. Start small with short activities and continue adding a few minutes as you build your stamina.

Eat a healthy diet. A low-sodium diet rich in whole grains, fruits, vegetables and low-fat dairy has been shown to help lower blood pressure. Watch for hidden sodium in processed foods that don’t seem salty.

Maintain a healthy weight. For more guidance on weight control, ask your health care concierge about face-to-face weight loss counseling with your doctor at no cost to you.

Avoid tobacco and limit alcohol. Smoking and drinking alcohol in excess may cause high blood pressure. Ask your health care concierge about your options for smoking cessation programs.

Reduce stress. Sometimes managing stress can be as simple as saying “no” to avoid overscheduling or taking on too much responsibility. Don’t underestimate how much reducing stress can lower your blood pressure.

Know Your Numbers

Knowing your normal blood pressure can be helpful in monitoring a number of conditions. If your initial blood pressure taken at your doctor’s office is higher than usual, ask to have it rechecked before you leave.

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health Living with High Blood Pressure?

Get more tips to help manage your blood pressure with Emmi®. As a Network Health member, you have access to this easy online tool at GoEmmi.com with the code NETWORKBP.

MEDICARE SCAMS

Don’t Fall Victim to Medicare Fraud

Medicare fraud costs American taxpayers billions of dollars each year and results in higher medical costs for everyone. As your partner in health care, Network Health has some tips to help avoid Medicare fraud.

• Never sign blank insurance claim forms.

• Do not do business with door-to-door or telephone salespeople who tell you that services or medical equipment are free or available for no direct cost to you.

• Only give your insurance/Medicare identification and Social Security numbers to those who have provided you with medical services.

• Keep accurate records of all your health care appointments and verify your explanation of benefits and all bills for services.

• Always watch your credit card and bank statements for any improper billing activity or fraudulent withdrawals.

Remember, you can always call our Values Line to report and discuss activities or occurrences you believe are improper.

The hotline is confidential, and you may report concerns anonymously. Your concerns will be investigated and appropriate action will be taken to address the problem. The Values Line number is 800-707-2198.

Sometimes people do not report scams because they are ashamed or embarrassed. It is important to know, it’s not your fault. If you feel you are the victim of an insurance scam, we are here to assist you. Call 800-378-5234 (TTY 800-947-3529), Monday - Friday, 8 a.m. - 8 p.m. or email us at medicaresiu@networkhealth.com.

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health

The Not-So-Obvious Signs of Depression Depression can affect anyone, but the stakes get higher as we age. Why? Because depression and other mental health concerns impact our overall wellness and have the potential to complicate other medical conditions—sometimes in unexpected ways.

Knowing the Symptoms Many people don’t realize that depression is a legitimate medical condition, rather than a character flaw or mood. Recognizing changes in your quality of life can be a key step in improving your outlook. Watch for these signs, and discuss symptoms with your doctor.

u Persistent sad, anxious or empty feelings u Feelings of hopelessness or pessimism u Feelings of guilt, worthlessness or helplessness u Irritability or restlessness u Loss of interest in activities or hobbies you used to enjoy u Fatigue and decreased energy u Difficulty concentrating, remembering details and making decisions u Insomnia or excessive sleeping u Overeating or appetite loss u Thoughts of suicide or suicide attempts u Aches or pains, headaches, cramps or digestive problems that do not get better with treatment

These symptoms of depression can affect all areas of your life—draining energy, interest and motivation for things you previously enjoyed.

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Understanding Triggers Common triggers of depression include the loss of a loved one, physical illness, limited mobility, isolation and a reduced sense of purpose. Holidays can be especially tough. While sadness, grief and feelings of loneliness are normal emotions, they can quickly develop into depression if they persist, worsen or interfere with your daily activities.

Asking for Help NE

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The good news is that depression is treatable and Wcan beHEmanaged through a variety of treatment options including ORK AL T T lifestyle changes, counseling and medication. Lifestyle changes can significantly reduce symptoms, and many people with depression find some degree of relief by getting healthy amounts of sleep (not too much, not too little), eating a healthy diet, exercising, volunteering or trying a new activity.

PLATINUM

FITNESS

Support groups can be helpful during stressful times, and there are several medications available to treat depression.

I T N E S Scare and lifestyle changes to combat depression.

Talk to your doctor about the best combination ofFmedical

Did You know?

PLATINUM FITNESS

u You can be depressed without feeling sad. If you feel unmotivated, anxious or have unexplained aches and pains, discuss these symptoms with your doctor.

u Depression is a common side effect of certain medications. If you notice a change in your demeanor as you start taking a new medication, ask your doctor right away.

u The winter blues can be a medical condition. Don’t underestimate the effects of seasonal affective disorder (SAD).

Ask your doctor about treatments such as light therapy to make your Wisconsin winter a little brighter. u You can learn more about overcoming depression with Emmi®. As a Network Health member, you have access to this easy online tool at GoEmmi.com with the code NetworkMH.

Let Network Health Help You Keep Your Resolution with Gym Membership Reimbursement

PLATINUM FITNESS

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id you know that your Network Health Medicare Advantage (PPO) membership can help cover the costs of a gym membership? As New Year’s resolutions fade and winter stretches on, stay active by joining a local gym. Network Health reimburses you for up to $432 per year at in-network facilities and $216 per year to other gyms that are out of the network. Visit NetworkHealthMedicare.com/FitnessReimbursement to print and submit your form. You may also request a paper copy by calling 800-378-5234 (TTY users call 800-947-3529).

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COVER STORY

Follow two Network Health members as they fly high with fellow veterans 8 | C oncierge

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soaring

high

ccording to Bud Genereaux, when you’re a paratrooper, “There’s only one way back home.” He and Oliver (Ollie) Disotell would certainly know as former paratroopers in the U.S. military. Yet neither man could say exactly how many missions they had completed as they added one more successful jump to their records. In fact, Bud said, “I don’t know how many times I went up in an airplane before I finally landed in one.”

On a hot summer day in August, Bud and Ollie along with seven other veterans met at Skydive Adventures in Omro to take part in a jump organized by the 4th Wisconsin Chapter of H.O.O.A.H.—an acronym for Helping Out Our American Heroes. Many military vets are familiar with the acronym H.O.O.A.H.

The expressions were different during Bud and Ollie’s stints in the service, but the sentiment is the same—heard, understood and acknowledged. In Bud’s day, they said “Airborne,” and Ollie’s crew said “Semper Fi.” At 95 years old, the last thing Ollie had planned on was jumping out of an airplane, but when H.O.O.A.H. approached him, he was excited to give it a try for the first time since the end of World War II. When Ollie was 21, he said, “I saw a sign that said join the Marine Corps and see the world, so that’s what I did.” He served from December 10, 1941, to December 10, 1945, four years to the day with most of that time spent in the South Pacific.

Ollie trained as a parachute rigger. He was tasked with overseeing the packing and maintenance of parachutes as

By Kari Navis, Photography by Rein Photography Locations – Berlin Public Library and Skydive Adventure

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COVER STORY

It was an altogether different experience.

You can’t compare it.

Bud Genereaux served in the Army’s 187th Airborne Regimental Combat Team during the Korean War.

- Bud Genereaux

well as dropping supplies to forces on the front lines. He admits, he watched closely as the Skydive Adventure’s crew packed his chute.

When asked how this jump was different from previous jumps, Ollie and Bud agreed that this was a new experience, even for these seasoned paratroopers. “It was an altogether different experience. You can’t compare it,” said Bud. He recalled that in his time in the Korean War as part of the Army’s 187th Airborne Regimental Combat Team, you lined up with your crew on a static line and, one by one, jumped into the unknown, trying to avoid enemy fire. This summer, he jumped with his wife Dorothy, their family and friends looking on, including Aurora, one of his fourteen great-grandchildren.

The camaraderie veterans have with one another was clear throughout the day, as they took turns at the jump site. With veterans from World War II, Korea, Vietnam, Desert Storm, Iraq and Afghanistan, you could see and hear the mutual respect and support they share with each other, along with a lot of stories and some heartfelt laughs.

Ollie remembers one instance during a 300-mile round-trip flight to deliver supplies to a remote island location. One engine had failed, and the pilot needed to conserve as much fuel as possible if they were going to get back to base. Ollie passed on orders, telling the crew to, “Lighten the ship.” Unfortunately, someone on the crew took him a bit too literally and tossed everything he could—including the life rafts—out the cargo bay.

Luckily, the damaged plane was able to make a safe landing back at the base. The harrowing situation has become one of many stories Ollie recounts with a knowing smile and a certain spark in his eye, as though it happened yesterday instead of more than 70 years ago.

A gift for storytelling—some humorous, some tragic, some inspiring —is a trait many veterans share, and, interestingly, Bud and Ollie have a lot in common in addition to their jump this past summer.

Both men are longtime residents of Berlin, Wisconsin. After NetworkHealthMedicare.com

returning home from the wars with little more than the bags they carried, they both went on to run successful local businesses until they retired.

Bud owned two local restaurants and was a successful life insurance agent for 30 years. Ollie retired in 1984 from Farmers and Merchants Bank and owned a few businesses including a laundromat and dry cleaners and a car dealership. You might even run into him at the bank when he stops in to visit and grab a cup of coffee with friends in the morning.

Bud and Ollie are both members of the VFW, volunteered with the local Lions Club, are in good health and have been Network Health Medicare members for several years. To Ollie, the question of how long he has been a member is like asking how many times he jumped out of a plane, “You don’t count them all.”

Bud’s relationship with Network Health is one of a kind, as he’s both an independent agent and a Medicare member. Bud worked with several insurance companies, and he particularly likes Network Health. “Of all the companies I’ve worked for, this is the best of any product I’ve had to sell. People get their money’s worth out of Network Health, both from the standpoint of benefits and the standpoint of service.” When he had his knee replaced a few years ago, Network Health’s coverage really came through for him. “The concierge system is something I’ve never experienced before. It’s absolutely fantastic.”

Bud especially loves Network Health’s Platinum Fitness benefit which reimburses his gym membership. He’s there three days each week and finds it helps him maintain his health, stay active and continue doing what he loves—spending time with his family, working in his daughter’s insurance agency and traveling.

After this jump with H.O.O.A.H, Bud and Ollie just might add skydiving to the list of hobbies that will keep them soaring high for years to come.

The organization H.O.O.A.H. is run by volunteers who carry out a mission to lend support to servicemen and women, their families and returning veterans with a high level of understanding and compassion. According to Vice President William Kocken, “This event ‘Freedom Freefall’ was designed to get veterans out and give them an experience they wouldn’t otherwise get. Every one of our veterans jumping has spent time in a combat zone. This is our way to give back to some of them.” H.O.O.A.H. also volunteers at the Wisconsin Veterans Home at King and provides services to veterans and advocates for suicide prevention awareness, as veterans readjust to civilian life. To learn more, visit HOOAHInc.org.

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Oliver (Ollie) Disotell was a U.S. Marine in the 1st Battalion, 1st Marine Regiment during WWII. He also served in the Army National Guard upon his return.

wellness Managing MULTIPLE Medications Can you list what each of your medications is and what it’s for? Can you name the dosage? These will be some of the first things your doctor asks when you seek care.

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etwork Health Medicare Advantage members who have several health conditions can take part in a unique voluntary program designed to help members understand and track their medications. This program helps you and your doctor make sure your medications are working to improve your health. It’s called medication therapy management, and it’s designed to help you with the following. l Improve your medication use l Reduce the risk of dangerous drug reactions and interactions l Make sure you’re taking medications correctly and as prescribed l Ensure you are on the most appropriate and cost effective medications By helping you manage your medications, Network Health can help you stay organized and avoid potentially harmful drug interactions.

WHO IS ELIGIBLE?

Do you meet these three criteria? If so, medication therapy management is designed for you.

1

Do you have at least three long-term (also called chronic) medical conditions listed below? l Asthma l Chronic heart failure l Chronic obstructive pulmonary disease l Depression l Diabetes l End stage renal disease l High blood fat levels l High blood pressure l Osteoporosis Do you take seven or more daily medicines covered by

2 Medicare Part D for long-term medical conditions?

Does your Part D covered medication cost more than the

3 Centers for Medicare and Medicaid Services (CMS) specified

If you answered yes to all three of these questions, let Network Health assist you with your medication therapy program.

annual cost threshold of $3,138 (or $261.50 per month)?

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TAKING PART IN THE PROGRAM If you meet the eligibility requirements, you’re automatically enrolled in medication therapy management and will receive the following help at no cost. You may opt out of this voluntary program, but we hear from members who value the support. The program includes A comprehensive medication review by Network Health each year. l Take advantage of the chance to review your medications with a pharmacist or other health care professional, including over-the-counter drugs and herbal products. This review will help you get the best results from your medicines. l A letter that outlines this review and suggests next steps to manage your medications. l

A targeted medicine review by Network Health at least quarterly. l If needed, Network Health’s care managers will provide you and/or your doctor specific information about making changes to your medication therapy. l

If you’re eligible for this program, watch for an introductory letter that explains how you can take advantage of this program. Let Network Health help you get a handle on your medications.

MY PERSONAL MEDICATION LIST

Having a list of all your medicines will help doctors, pharmacists and hospitals best take care of you.

It can also prevent potential errors or problems. Share your list with family, and if you go to the hospital or emergency room, take your list with you.

KEEP THIS LIST UP TO DATE WITH

l

Prescription medications l Over-the-counter drugs l Herbals l Vitamins l Minerals

Use the chart below as a guide to start your own list. Record this information for each drug you take.

Medication and strength I take How I use it Why I use it Date I started using it

Date I stopped using it

Why I stopped using it For a complete and easy-to-print medication guide, visit NetworkHealthMedicare.com/PersonalMedicationList.

Is Your Pharmacy a Preferred Pharmacy?

Whether your pharmacy is considered a preferred (lower cost) or standard pharmacy depends on the contract they have with Network Health. Throughout the year, these contracts may change, which can impact the price you pay for medications. Due to recent changes, we encourage you to visit NetworkHealthMedicare.com or call customer service at 800-378-5234 (TTY 800-947-3529) Monday - Friday, 8 a.m. - 8 p.m.

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wellness

Palliative Care P

A Big, Scary Term for Symptom Management alliative care is often associated with end of life care, but symptom management doesn’t have to be scary. In fact, it can help improve quality of life for many patients with chronic conditions. Each day, our members benefit from one-on-one support provided by Network Health’s registered nurse care managers. It’s like having your own personal nurse to help you manage your condition.

Network Health nurses can assist you by • • • • •

Working with doctors to coordinate your care Explaining medical instructions Giving tips on how to manage symptoms and pain Providing guidance on how to avoid problems Calling to follow up and check on your well-being

If you are living with a serious, chronic condition, ask if Network Health’s registered nurse care managers can help you. To learn more, call 920-720-1602 or 866-709-0019 (TTY 800-947-3529). You can also learn more about palliative care with Emmi®. As a Network Health member, you have access to this easy online tool at GoEmmi.com with the code NETWORKPALLIATIVECARE.

WHAT’S THAT?

PALLIATIVE CARE

The goal of palliative care is to provide the best possible quality of life for people facing the pain, symptoms and stress of a serious illness.

Breaking Down Obstacles to Care

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reatment plans are only helpful if you follow them. What if your doctor’s orders conflict with your religious beliefs or create tension with your cultural practices? What if you can’t afford the treatment? If you find yourself facing decisions between following your beliefs or your doctor’s orders or you are struggling to pay for treatment, Network Health can help.

Network Health’s care management team helps people overcome barriers to treatment requirements every day including the following. u Beliefs and concerns about the condition and treatment u Access, transportation and financial barriers to obtaining treatment u Cultural, religious and ethnic beliefs that conflict with treatment

Call 920-720-1602 or 866-709-0019 (TTY 800-947-3529) to speak with a nurse who can help make your treatment plan fit the rest of your life.

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Network Health’s SELF-MANAGEMENT WORKSHOPS W

e connect you and your caregivers with workshops that provide the tools you need to manage the most common symptoms of your condition. For more information or to sign up for a workshop, call us at 800-769-3186, extension 87160. Or, visit us at NetworkHealthMedicare.com/members/help-taking-charge-of-health-conditions.php. Click Read More for details about each workshop including dates and times.

Breathe at Ease

For members living with chronic obstructive pulmonary disease (COPD), we offer an exclusive program to help manage your condition at no cost. The program provides access to a respiratory therapist (RT) specializing in chronic lung problems.

You’ll also have access to educational resources and tools, helpful tips for the best way to manage your condition, a one-on-one condition management appointment and follow up with an RT throughout the year.

Living Well with Chronic Conditions

This six-week workshop is for anyone living with a chronic condition such as COPD, arthritis, heart disease, anxiety, migraines, depression, asthma or other conditions. This workshop teaches self-management skills including goal setting, reducing stress and fatigue, physical activities, healthy eating, stress relief, relaxation and more. This class meets once a week for two and a half hours and caregivers are welcome to attend.

Healthy Living with Diabetes

For any adult living with type 2 diabetes and their caregivers, this six-week workshop helps people better manage their condition and related challenges. Each session is designed to help you learn practical ways to deal with your diabetes, discover better nutrition and physical activities, meal planning, carb counting, label reading, sick days, monitoring and preventing low blood sugar and talking with medical professionals. This workshop meets once a week for two and a half hours to help you set goals and create a step-by-step plan to improve your health.

Stepping On

This program is for older adults living independently who may have fallen, worry about falling or are at risk of falling. This program promotes confidence and awareness by teaching strength and balance exercises, as well as how medication, nutrition, footwear and vision play important roles in the risk of falls and injury. This seven-week workshop meets once a week for two hours and caregivers are welcome to attend. Community professionals such as a vision specialist, police or safety officer, physical therapist and pharmacist will also be in attendance to provide helpful information.

ADDITIONAL LOCAL SUPPORT GROUPS Better Breathers

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.

Fox Valley Diabetic Education and Support Group

Open to people with type 1 or type 2 diabetes and their loved ones. Classes are free and no registration is needed. For more information, call 920-997-0038.

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wellness

What Can You Expect?

When you experience a sudden or long lasting illness, it’s normal to want more information. Where can you look to learn more about the standards of care you can expect?

Network Health provides clinical practice guidelines to help you and your doctors make decisions regarding appropriate health care for some conditions. These conditions may be sudden (acute) or long lasting (chronic) in nature and include medical topics such as low back pain and diabetes, as well as behavioral health conditions such as depression. These evidence-based guidelines are available to both you and your doctor on Network Health’s website.

Visit NetworkHealthMedicare.com to access the guidelines by selecting Member’s Corner, and clicking on Clinical and Preventive Guidelines under Resources. If you have any questions about the standard of care you are receiving after discussing with your doctor, you can call your health care concierge at 800-378-5234 (TTY users call 800-947-3529), Monday through Friday, 8 a.m. – 8 p.m.

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Schedule and Track Your Screenings

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t can be tough to keep all the recommended preventive care and screenings straight, but they are crucial for early detection and treatment. January is a great time to review your preventive care needs for the upcoming year so you can schedule them with ease.

Keep this chart handy to help you track care as you receive it. If you have questions, please refer to your Evidence of Coverage document.

Remember, costs and coverage for these services can vary depending on the plan you are enrolled in. This is especially true for NetworkPrime (MSA) members. If you have any questions about your coverage for these preventive screenings, contact your health care concierge at 800-378-5234 (TTY 800-947-3529) before you schedule the appointment.

COVERED PREVENTIVE SERVICE FREQUENCY One-time visit within the Welcome to Medicare visit first 12 months of having TIP - Ask your doctor’s office to schedule your “Welcome to Medicare” Medicare Part B preventive visit when you make this appointment.

APPOINTMENT SCREENING SCHEDULED COMPLETE

OR

#

Every 12 months (once you’ve had Part B for longer than 12 months)

Every 12 months

Annual wellness visit Must be at least 12 months after your “Welcome to Medicare” preventive visit.

TIP - You are able to have lab screenings for early detection of diabetes, high cholesterol or blood disorders. As part of your wellness visit OR your routine physical, you can have a fasting blood sugar, lipid panel and/or complete blood count that are included in the cost.

Note: These screening labs are intended to assist in early detection of new health conditions and are not part of routine monitoring of existing health conditions.

Annual routine physical exam To be covered, this exam must include preventive medicine evaluation and management, including an age and gender appropriate history, examination and counseling/anticipatory guidance/risk factor reduction interventions.

TIP - You are able to have lab screening for early detection of diabetes, high cholesterol or blood disorders. As part of your wellness visit OR your routine physical, you can have a fasting blood sugar, lipid panel and/or complete blood count that are included in the cost.

Note: These screening labs are intended to assist in early detection of new health conditions and are not part of routine monitoring of existing health conditions.

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COVERED FREQUENCY One-time vaccination

Varies

Varies Twice within 12 months

Every 12 months Every 12 months Every 12 months Every 12 months Every 24 months

Every five years

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PREVENTIVE SERVICE

APPOINTMENT SCREENING SCHEDULED COMPLETE

Pneumonia vaccine Most people only need this vaccine once in their lifetime, unless advised by a doctor. Pneumonia booster vaccines must be administered at least one year from the initial vaccine.

Medical nutrition therapy Three hours of counseling are offered during the first year of medical nutrition therapy services. After, two hours are offered each year for people with diabetes and/or kidney disease but not on dialysis when ordered by your doctor.

Obesity screening and counseling Intensive counseling for people with a body mass index (BMI) of 30 or more received in a primary care setting.

Tobacco cessation counseling If you have signs or symptoms of tobacco-related disease. If you have signs or symptoms of a tobacco-related disease, you may be responsible for additional costs.

Annual flu shot recommended in the fall or winter.

Cardiovascular disease Behavioral therapy in a primary care setting only.

Depression screening in a primary care setting only.

Diabetes screening Based on results, you may be eligible for up to two screenings every 12 months.

Bone mass measurement If medically necessary, these may occur more frequently.

Cardiovascular screenings This screening includes blood tests for the detection of cardiovascular disease.

Date of last screening Date of last screening

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CANCER SCREENINGS COVERED FREQUENCY

PREVENTIVE SERVICE

APPOINTMENT SCREENING SCHEDULED COMPLETE

BREAST CANCER SCREENINGS – RECOMMENDED FOR WOMEN AGE 40 AND OLDER Every 12 months

Mammogram

Every 24 months

Clinical breast exam

Date of last screening

CERVICAL AND VAGINAL CANCER SCREENING Every 24 months

Cervical and vaginal cancer screening For those at high risk, one Pap is test recommended every 12 months

Date of last screening

COLORECTAL CANCER SCREENINGS – RECOMMENDED FOR PEOPLE AGE 50 AND OLDER Every 12 months

Fecal occult blood test

Every four years

Flexible sigmoidoscopy or barium enema For people at high risk, a colonoscopy or barium enema is recommended every 24 months

Date of last screening

Every 10 years

Colonoscopy For people at high risk, a colonoscopy or barium enema is recommended every 24 months

Date of last screening

PROSTATE CANCER SCREENINGS – RECOMMENDED FOR MEN AGE 50 AND OLDER Every 12 months

Digital rectal exam

Every 12 months

Prostate specific antigen (PSA) test

FOR THOSE AT RISK OR HIGH RISK One-time ultrasound Every 12 months

Every 12 months Every 12 months

Every 12 months Every 12 months

Abdominal aortic aneurysm screening Recommended for people at risk, as determined by your doctor Alcohol misuse counseling One alcohol misuse screening for adults who misuse alcohol but are not alcohol dependent. Up to four counseling sessions per year for people who screen positive for alcohol misuse Glaucoma screening Recommended for people who are at a high risk of getting glaucoma Sexually transmitted infections (STI) screening and counseling Recommended for people at risk for chlamydia, gonorrhea, syphilis and Hepatitis B. Two counseling sessions may be covered each year for adults at increased risk of STI HIV screening Recommended for people at risk of contracting HIV Hepatitis B vaccine Recommended for people who are at intermediate or high risk of contracting Hepatitis B

NetworkHealthMedicare.com

C oncierge | 19

1570 Midway Pl. Menasha, WI 54952 Health or Wellness or Prevention Information

Meet Sam Schnell

Each issue, we’ll feature a Network Health associate who works with Medicare members just like you. Today, let’s talk to Sam Schnell.

A

s a Medicare health coach at Network Health, Sam helps guide members on their own personal preventive health journeys. Building on her background in health coaching and personal training, she develops a personalized plan to help each member she works with get or stay healthy.

How do you help Medicare members?

As health coaches, we help Medicare members make healthy lifestyle changes. We focus on prevention and maintaining – if not improving – quality of life. We’re here to help with topics like nutrition, exercise, weight loss and even stress management.

Why is it important for members to take the Health Questionnaire?

The Health Questionnaire provides a snapshot of a member’s health. It’s good for members to know this information, and it can help start a conversation with a health coach like me. It identifies what a member is doing great and pinpoints some things to work on which will make a difference.

What makes working with Medicare members special?

My favorite thing about working with Medicare members is that they are open to suggestions and learning new things. Many members are so busy enjoying life, they forget to make time for themselves. I can help you find a balance between the things you want and love to do and the need to take good care of yourself.

What inspiration can you share for a healthy 2016?

It is never too late to make positive changes.

Whether you want to enjoy your retirement, travel the world or see the grandkids grow up, you can find inspiration and motivation at any age. Small changes can lead to great improvements in your overall health, and we love hearing our members’ success stories.

Anything you think Medicare members might find interesting about you personally?

I practice what I preach. I despised running and thought I would never be able to. Then I tried it.

Now it’s one of my favorite passions. I bring this up because if you tell yourself you can’t do a certain exercise, you won’t. Tell yourself that you can, and let us help you discover things you never imagined.

Network Health Medicare Advantage Plans are MSA and PPO plans with a Medicare contract. NetworkCares is a PPO SNP plan with a Medicare contract and a contract with the Forward Health Wisconsin Medicaid Program. Enrollment in Network Health Medicare Advantage plans depends on contract renewal.The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change January 1 of each year.