Concierge spring 2016

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

A PUBLICATION OF

SPRING 2016

Against the

Odds

With coordinated care, Reg and Kay make the most of every day

inside

LIFE

Four Tips to Avoid Returning to the Hospital

HEALTH

Help Taking Your Medications as Prescribed

WELLNESS

Understanding Your Drug Coverage

Answers to Your Questions About ThedaCare™ and Other Providers

Exclusive Reduced Rate for Network Health Medicare Advantage Members

CHICAGO Saturday, May 21 at 2 p.m.

Discounted tickets range from $23-53. Offer ends April 24.

Visit foxcitiespac.com/onlineoffers, click the Network Health Medicare Advantage Member 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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health

14 Preventive Care Investing in Your Future Health

6 Doctor’s Orders Understanding the Effectiveness of Your Medications

15 Understanding Your Drug Coverage

7 Help Taking Your Medications as Prescribed

life

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3 After the Lights and Sirens 4 Inpatient Versus Outpatient Know Your Hospitalization Status 5 Four Tips to Avoid Returning to the Hospital

8 Self-Administered Drugs Submitting Your Claims After You Go Home

16 Living with Diabetes Avoid the Ups and Downs of Blood Glucose 17 Understanding Respiratory Medications and How They Work Breathe at Ease 18 How Are Your Kidneys Doing?

19 Eat Your Fruits and Veggies 9 Communication Assistance Network Health Offers Services to Help 20 Spring Into Action You Get the Answers You Need 21 Need Help Submitting a Claim?

FEATURE 21 Know Your Rights and Responsibilities 10 AGAINST THE ODDS

With coordinated care, Reg and Kay 22 Using and Understanding Our make the most of every day Provider Network Answers to Your Questions About ThedaCare and Other Providers 14 Leave Your Worries at Home BACK COVER with Coverage That Travels with You Meet Ericka Lantz

wellness

Y0108_772_031016 Accepted 03152016 EDITORIAL STAFF President and CEO Chief Administrative Officer Marketing Coordinator

Lead Designer

Sheila Jenkins Penny Ransom Kari Navis Debra Sutton

ASK NETWORK HEALTH If you have questions about anything you read in this issue of Concierge, call customer service at 800-378-5234 (TTY users call 800-947-3529) Monday - Friday, 8 a.m. - 8 p.m. You can also learn more at NetworkHealthMedicare.com.

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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 a biannual publication of Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals. Š 2016 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.

NetworkHealthMedicare.com

life AFTER the Lights and Sirens

Remember to Contact Your Primary Doctor When You Return Home

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hether you’re recovering at home from a trip to the emergency room or you were treated at an urgent care center, it’s important to fill your primary doctor in on the details. Your health can change quickly, and your doctor will want the latest information to ensure the best possible care. Remember to do these four things when you get home, to help you recover quickly under your doctor’s care. a primary doctor, if you don’t have one.

1 Find Primary doctors can help you get or stay healthy

over an extended period, sometimes decades. If you don’t have a primary care relationship established, we can help you find a doctor, physician’s assistant (PA) or nurse practitioner (NP) you can see on a regular basis for routine care and help managing any conditions you may have. For assistance, visit NetworkHealthMedicare.com and click Find a Doctor or contact your health care concierge. your doctor up to speed. If you have an 2 Bring unexpected trip to the emergency room or urgent

care center, follow up with your primary doctor within NetworkHealthMedicare.com

30 days. He or she will want to know what happened, any treatments you received and any changes made to your medications. a copy of your medical records for your 3 Request primary doctor. If the emergency or urgent care

doctor is outside your primary clinic, your regular doctor won’t have immediate access to the information.

You can provide a full overview of the health care you received by requesting the records and sharing them with your primary doctor. down questions for your doctor. Keeping 4 Write a list of non-emergency questions can help you

remember to ask your doctor. During an upcoming appointment, bring your list of questions and share your concerns with your doctor. Many doctors even welcome phone calls from their patients.

Building a relationship with your primary doctor can be vital to your recovery, helping you avoid the stress and expense of future urgent or emergency care situations.

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life

Inpatient versus Observation Know Your

Hospitalization Status D

id you know that even if you’re staying at the hospital overnight, you could still be billed for outpatient services?

This terminology affects your costs for hospital services like X-rays, drugs and lab tests as well as if Medicare will cover care in a skilled nursing facility (SNF).

By Medicare’s definition, you are an inpatient starting when the doctor formally admits you to a hospital. The day before you are discharged is your last inpatient day in the hospital.

You are an outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests or X-rays and the doctor has not written an order to formally admit you to a hospital.

Regardless of your status, you have a right to know. If you have been in outpatient observation status for more than 24 hours, the hospital is required to give you an adequate oral and written notification within 36 hours. This written notification explains the following. u Your status as an outpatient u Reasons why you are being treated as an outpatient u How the status affects services, what you pay and eligibility for coverage

Remember, your health care concierge and our customer service department are available if you have questions or concerns, even while you are receiving care. Call 800-378-5234 (TTY users call 800-947-3529) Monday - Friday, 8 a.m. - 8 p.m. to learn more about inpatient versus outpatient status.

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NetworkHealthMedicare.com

Four Tips to Avoid Returning to the Hospital

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ccording to Kaiser Health News, approximately 20 percent of Medicare patients sent to the hospital will be readmitted within a month. While some returns are unavoidable, many can be prevented with clear communication, a good plan for support and monitoring by your primary doctor.

If you find yourself in the hospital, here are four tips to help you avoid a repeat trip.

1. Ask questions.

Good communication is key to your recovery. When you’re talking with your doctors and care team during your hospital stay, take detailed notes and ask for instructions in writing, especially during discharge. If the instructions aren’t clear, ask more questions until you understand. Inquire about any changes to your medications, diet and activity. Ask a family member or friend to listen to the instructions with you, so they can help you remember and stick to your plan.

2. Know your medications.

Medication issues are one of the top reasons people need to be rehospitalized. Remember, your doctor may change your medications during your hospital stay. Before you are discharged, make sure to speak with your doctor and pharmacist to understand when and how to take your prescriptions, especially any new medications.

3. Ask for help.

No one likes to be a burden, but friends, family and neighbors are usually happy to help you recover. Many people recover best in their own homes, so talk with your doctor or discharge planner before you leave the hospital about your needs. Depending on your situation, you may be eligible for home health care. Your Network Health Health Care Concierge is also a great resource for information on this benefit as you return home.

4. Make and keep follow-up appointments.

Schedule a follow-up appointment with your doctor before you leave the hospital. It’s important for your primary doctor to know about your recent hospital stay and changes in your health to help monitor your recovery and avoid another hospital stay.

To learn more about what to expect after being discharged from the hospital, visit GoEmmi.com and enter the code NETWORKDISCHARGE. As a Network Health member, this easy online learning program is available to you at no cost.

WHAT’S THAT?

HOME HEALTH CARE - Home health care is skilled care provided in your home after an illness or injury. Medicare-certified agencies coordinate visits by registered nurses, physical therapists and occupational therapists to assist with things like medication management, therapy or wound care.

NetworkHealthMedicare.com

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health Doctor’s Orders

Understanding the Effectiveness of Your Medications

D

id you know the majority of people over age 50 take at least one prescription medication for six months or more? For doctors, this is no surprise because the number of chronic diseases continues to rise. But for patients, it can be tough to follow the doctor’s orders.

How can you know if the medications are doing what they are supposed to do?

How can you tell if the medications are causing any side effects?

To make sure your medications continue to work effectively, you and your doctor should develop a plan to reevaluate your medications, review lab tests and check your health status. As part of this plan, you can help by scheduling and attending regular appointments and having the necessary lab tests performed as instructed.

It’s important to know why you take the medicines you do. For example, many members take over-the-counter aspirin for heart disease to help prevent a heart attack. If you take aspirin, know the proper dosage and frequency as well as the benefits, risks and potential interactions.

Medication side effects can vary, so it’s important to understand what risks are associated with your medications. For example, high blood pressure medications like lisinopril (ACE) or losartan (ARB) may cause changes in the body’s fluid balance. Diuretics like Lasix or hydrochlorothiazide (more commonly known as “water pills”) are prescribed to adjust body fluids, and your doctor will want to monitor how your body is reacting to the medication.

Remember, never stop any medications prescribed by your doctor without his or her approval. Discontinuing some medications suddenly can cause serious medical issues.

Heart medicines such as digoxin should be monitored regularly by a doctor to make sure they are prescribed at a therapeutic level to achieve the greatest benefit.

In this example, maintaining a therapeutic level ensures that the amount of medication in your body is at a sufficient level to help stabilize your cardiovascular system.

Doctors also need to monitor how your body is reacting to the illness and any persistent or long-term medications. Your doctor may prescribe lab tests because long-term prescriptions can affect organ function. Members who have heart disease may require a regular blood test to elevate potassium levels and to evaluate heart function. Those who have kidney disease may need a creatinine level as a part of their treatment plan.

During future visits, your doctor will use lab results and the updated history you provide to monitor for signs of adverse effects. He or she may simply adjust the dosage or prescribe a different medication. Together, you and your doctor can ensure your medications are working properly to maintain or improve your health.

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NetworkHealthMedicare.com

Help Taking Your Medications as Prescribed D

o you find it difficult to remember to take your medications? Or, have you ever stopped taking a prescription without discussing it with your doctor first? You’re not alone, but you could be making a dangerous mistake.

Taking medication as prescribed, otherwise known as medication adherence, is important for successful treatment of illnesses and conditions. Not following doctor’s orders can be a costly and potentially dangerous decision. Let’s look at frequent issues and some suggestions to help make taking your medications easier for you.

“I always forget to take my medicine.”

Make your medications part of your daily routine. If you take them at the same time and place, you’ll have an easier time remembering. Consider using a pill organizer to keep your medications in order.

“I am not sure why I even need this medication.”

Your doctor prescribed the medication for a reason. If you’re unsure what that reason is, ask your doctor to go over your medications again. Request the directions in writing to reference later, so you know the names and purposes of your prescriptions.

“My medications are too expensive.”

If you find yourself making decisions between paying for your medications and paying for other necessities, discuss your concerns with your doctor or pharmacist. Generic drugs are just as effective and more affordable. Your pharmacist may have other cost-saving suggestions your doctor can review.

“I have no way to pick up my medications.”

Ask your doctor and pharmacist about your concerns. Your doctor may be able to prescribe a 90-day supply. Pharmacists may be able to mail medications to you (sometimes at a lower cost) or coordinate refills for the same date each month.

“I don’t like the way it makes me feel.”

Side effects can be tough to deal with. Make a list of any side effects and discuss them with your doctor. You should also tell your doctor or pharmacist about over-the-counter medications you take, because they can interfere with your prescription medications.

NetworkHealthMedicare.com

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health

Self-Administered Drugs Submitting Your Claims After You Go Home

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hen you’re in the hospital, your doctor may ask that you continue taking your normal prescriptions or over-the-counter medications. In recent years, hospitals have moved away from letting you take your own medications from home because of liability risks, so you’ll typically be given your normal medications by your nurse.

When you get your bill, it may include the term “selfadministered drugs.”

Self-administered drugs are the prescription medications you normally take at home (including insulin) and other

STEP 1

over-the-counter medications. It is important for you to understand that these standard drugs may not be covered

by Medicare Part B (medical coverage).

Self-administered medications may be covered under Part D pharmacy coverage. If you have a Network Health plan that includes pharmacy coverage, you’ll want to look into submitting a claim for reimbursement. This type of claim is not automatically submitted by your doctor, so we have a few steps to make submitting your claim as simple as possible.

REQUEST AN ITEMIZED RECEIPT

By requesting an itemized receipt, you will have an easier time determining what will be submitted to Network Health by the doctor and which charges will need to be submitted separately. Receipts should include the following information.

u Date prescription was filled u Medicine name and strength u Quantity dispensed and days supply u Total amount charged for each prescription u Proof of full payment (receipt) u National Provider Identifier (NPI) Number (for location, u National drug code (NDC) number of the medication such as pharmacy or hospital) u Physician name, address and National u Any applicable Power of Attorney (POA) paperwork Provider Identifier (NPI) Number

STEP 2

COMPLETE A PRESCRIPTION DRUG CLAIM FORM FOR REIMBURSEMENT

Enclose your original itemized claim receipt for each prescription and submit a prescription drug claim form. You can access this form online at NetworkHealthMedicare.com.

Click on Member’s Corner and select Prescription Drug Claim Form. You can also request a printed copy from your health care concierge. This form is not required, but it will help us gather all necessary information and avoid delays.

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NetworkHealthMedicare.com

Watch for your next issue of Concierge in October.

STEP 3

SUBMIT YOUR CLAIM TO NETWORK HEALTH

Send your claim and supporting documentation to Express Scripts, Network Health’s administrator.

Express Scripts Attn: Medicare Part D P.O. Box 14718 Lexington, KY 40512-4718

Express Scripts will process your claim(s) within 14 days and notify you of the determination.

Remember, Network Health can only reimburse you for the Medicare-allowed amount of each drug, so there may be a difference in the bill you pay the doctor and the reimbursement you receive from Network Health.

We understand this process can feel like an added challenge when you’re recovering from a hospital stay. Your health care concierge would be happy to assist you in this process. Call 800-378-5234 (TTY users call 800-947-3529) Monday - Friday, 8 a.m. - 8 p.m. for assistance.

Communication Assistance

Network Health Offers Services to Help You Get the Answers You Need

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nsurance is complicated, and it’s our mission to make it as clear and easy to understand as possible. Did you know that Network Health offers free services to help you get the assistance you need?

ACCESSIBILITY BARRIERS

We offer TDD/TTY services for deaf, hard of hearing or speech-impaired individuals. For visually impaired individuals, our Medicare website is compliant with web-based technology and information standards for people with disabilities.

LANGUAGE BARRIERS

We have free interpreter services to answer any questions you may have about your health or drug plan. To get an interpreter, just call us at 800-378-5234.

Someone who speaks English can help you. This is a free service.

We offer translation in English, Spanish, Hmong, Chinese Mandarin, Chinese Cantonese, Tagalog, French, Vietnamese, German, Korean, Russian, Arabic, Italian, Portugués, French Creole, Polish, Hindi and Japanese languages.

For additional assistance with accessibility or language barriers, call customer service at 800-378-5234 (TTY users call 800-947-3529) Monday - Friday, 8 a.m. - 8 p.m. You can also learn more at NetworkHealthMedicare.com.

NetworkHealthMedicare.com

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COVER STORY

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NetworkHealthMedicare.com

AGAINST

ODDS

the

With coordinated care, Reg and Kay make the most of every day

S

hortly after Reg and Kay Freeman were married in 1961, they drove cross-country from Washington state back to the Fox Valley in Reg’s ’57 Buick. His service in the National Guard was complete, and they wanted to be settled back home in the Fox Valley before starting a family.

Looking back, the drive is a fond memory of days when you could camp along the side of the road and gas was only 27 cents per gallon.

At the time, neither would have ever imagined that driving—one of Reg’s true passions—would be something he would have to give up one day.

In the early nineties, Reg broke his leg and started noticing an odd sensation in his right toes. It spread to his thigh, and, for a time, his tongue and mouth. He saw his doctor. Then

another doctor. Then a team of specialists. “What I have is pretty rare. I’m a bit of a guinea pig. When I go see doctors, they bring other doctors and students in to learn from me.”

Eventually, doctors determined Reg has large fiber sensory ganglionopathy. The condition causes increasing damage to the nervous system, significantly limiting balance and mobility as it progresses. When he was first diagnosed, the prognosis was daunting. His body was having an autoimmune response, meaning the system that is supposed to defend his body against disease had begun attacking healthy cells.

His nerve function was deteriorating making him unable to sense the position of his legs. It also affected his sense of touch and equilibrium. Essentially, if Reg has his eyes closed, he can’t sense that his legs even exist.

By Kari Navis, Photography by Beth DesJardin, Trove Photography NetworkHealthMedicare.com

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COVER STORY

It was a tough diagnosis. Reg had to give up driving because his feet weren’t responding as they should. “It just wasn’t safe,” he said. He found himself relying on Kay for transportation. Kay didn’t have a problem driving, but she knew it bothered him. It was something he enjoyed doing.

“And I tried to tell her how to do it,” Reg admits.

Several years into his treatment, Dr. Steven Price at the Neuroscience Group found a study which suggested a drug called Rituxan might delay the effects of Reg’s condition.

Rituxan is typically used for treating cancer and rheumatoid arthritis, but it worked for Reg. With his symptoms somewhat stabilized, Reg was able get back to the life he enjoyed, with some limitations. While he isn’t able to live his dream of driving a Corvette, he was able to be tested and fitted for a special license and a car with hand controls.

At the time of his diagnosis, Reg discovered, “People who have this condition generally succumb to it within seven years of onset. That was 22 years ago, and I’m still here. I attribute that to all of the doctors I’ve been working with through the 12 | C oncierge

years.” Reg is quick to add that Kay has been a key part of his care through the years as well.

Even as Kay helps Reg manage his conditions, she has faced some health scares as well. Eight years ago, she went to see her primary care provider for some sharp, stabbing pains in her stomach. Her primary doctor, Dr. Kevin Andrasko at Affinity Medical Group, suspected diverticulitis and ordered a CT scan. Diverticulitis occurs when pouches form in the wall of the colon and become inflamed or infected. Two days later, they had a diagnosis. As suspected, Kay had diverticulitis.

She also had a growth the size of a grape on the outside of her kidney.

There was a good chance the growth was cancerous, and Kay quickly chose to have it removed. Within one week from her first visit with her primary doctor, the lump on her kidney was gone, and she was recovering at home.

“Dr. Andrasko, I feel, saved my life. Some other doctor might have just prescribed something for the diverticulitis and sent me home.” She thinks so highly of her primary doctor NetworkHealthMedicare.com

“

“

What I have is pretty rare. I’m a bit of a guinea pig. When I go see doctors, they bring other doctors and students in to learn from me.

- Reg Freeman

NetworkHealthMedicare.com

with Network Health, the more I’m able to personalize the information.” Craig said one of the things he loves most about his role is that he can help members in their time of need. “If I can answer their questions and help eliminate some of the fear of the unknown, I know I’m putting them at ease. ‘Is this procedure covered?’ ‘Is this doctor in-network?’ ‘What should I do with this bill?’ There are a lot of questions with insurance, and our members appreciate having someone they can talk to who understands.”

By having the assistance they need from Craig and their medical team, Reg and Kay can focus on things they enjoy.

They host their family at their Winneconne condo, spend time with their four grandchildren, enjoy playing dominoes and cards on their porch with friends, and work out twice a week at the local gym, taking advantage of their fitness benefits.

Despite being unable to stand, Reg makes exercise a priority.

“I feel stronger now than I did five or ten years ago.”

Kay’s philosophy to living a healthy life is simple— “You have to get out and do things.” Reg agrees, “We’re very fortunate.” It’s clear they’re thankful for a lot—for Craig’s assistance, their insurance coverage, their teams of doctors, their continued health, and, most of all, the incredible life they share.

“

The Freemans are great, but all of our members are special.

“

that she recommended him to several members of her family.

Like many other Medicare members, the Freemans are managing a handful of health conditions and see multiple physicians in addition to their primary doctors. Kay said, “We’re very good about six month and yearly exams. While we’re there, we make the appointments for the next time, so we have it scheduled.”

Reg feels, “Everyone who lives in this area is exceedingly fortunate compared to many other places in this country for the health care facilities that are within driving time. Wisconsin is very lucky.” When they have a question or need to find a specialist, they look to Network Health for assistance. One of their first calls is to their health care concierge, Craig Kandler.

Last summer, Reg sought out Craig’s assistance in finding an eye specialist. “A few years prior, I had surgery on my drooping eyelids, but it just didn’t work. It kept getting worse and worse. I talked to Craig and told him my situation. That afternoon he called back with three doctors.” One of them was Dr. Bradley Lemke, an ophthalmic plastic surgeon. “He’s done wonders with my eyes.”

The Freemans appreciate the personalized service they receive from Craig whenever they have a question or concern.

“He’s very perceptive and picks up immediately on what our concerns are. He’s easygoing and efficient, and he knows us.”

Craig is an experienced member of Network Health’s health care concierge team of more than 30 associates. “The Freemans are great, but all of our members are special,” said Craig. He’s assigned 2,500 members, and he estimates he can recognize more than half by their voice alone. “HIPPA rules and our desire to keep member’s personal information secure require that I confirm their names, addresses and other details when they call, but I usually recognize their voices when I answer a call.”

Craig approaches each call he receives as if he were speaking with his own parents. “The longer a member is

– Craig Kandler

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wellness Leave Your Worries at Home with Coverage That Travels with You

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or many retirees, the freedom to travel is an exciting adventure. Whether you’ve just returned from your favorite snowbird destination or you’re planning a summer vacation, remember that your Network Health coverage travels with you.

If you need medical care while traveling outside of Wisconsin but still within the U.S., you can see any doctor who accepts Medicare. Your medical services will cost the same as if you were visiting an in-network doctor in Wisconsin.

When you are traveling outside of the United States and its territories, Network Health provides some coverage

for emergencies. Outside the U.S., emergency care is covered at 75 percent up to a maximum of $100,000 every year. Remember to fill your prescriptions before you leave, because prescription drugs are not covered outside the U.S. More information can be found inside your 2016 Evidence of Coverage.

Wherever your journeys take you, make sure to show your Network Health ID card to help the doctor with the billing process. If you have questions about your travel benefit, call your health care concierge or 800-378-5234 (TTY users call 800-947-3529), Monday - Friday, 8 a.m.

- 8 p.m. Remember, those times are in the central time zone regardless if you’re on island time.

Preventive Care Investing in Your Future Health Did you know that Network Health and Medicare invest in your future health by covering many preventive screenings and services?

Many conditions respond best to treatment when discovered early, so it makes sense for both members and Network Health to identify issues early. Preventive services can include exams, shots, lab tests and screenings. They can even include health monitoring, counseling and education such as smoking cessation and medical nutrition therapy.

It can be tough to keep all the recommended preventive care and screenings straight. Some are annual screenings, and others are recommended once every five years. We have created a member-friendly chart to help you track your preventive care.

Visit NetworkHealthMedicare.com/members/PreventiveHealthChecklist.pdf to download a copy. To request a printed copy, call your health care concierge or customer service at 800-378-5234 (TTY users call 800-947-3529), Monday - Friday, 8 a.m. - 8 p.m.

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Paying for

PREVENTIVE CARE 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 who pay 100 percent of the Medicare approved amounts until the deductible is met.

After, they pay $0 for all Medicarecovered services.

If you have questions about preventive guidelines, please refer to your Evidence of Coverage document. This information is mailed to members and is available throughout the year online at NetworkHealthMedicare.com or by contacting us before you schedule the appointment.

NetworkHealthMedicare.com

M

Understanding Your Drug Coverage

edicare Part D, or prescription drug coverage, is complicated. At Network Health we want to be as clear as possible.

Let us help you understand the process. This year, our Network PlatinumPlus Pharmacy (PPO) and Network PlatinumSelect (PPO) plans include a pharmacy deductible of $200 for some drugs. By adding a deductible, Network Health was able to maintain low copayments for drugs in tiers 1 and 2 and reduce the cost of tier five drugs significantly.

WHAT IS A DRUG TIER?

WHAT IS CATASTROPHIC COVERAGE?

A drug tier is the cost category a drug belongs to. The tier a drug is on determines what you pay for the drug, and usually the higher the tier the more you pay. You can find out what tier a drug is on by looking it up in our drug list, called the formulary.

When your prescription payments reach $4,850, you enter the catastrophic coverage phase. In catastrophic coverage, you pay the greater of $2.95 or five percent of the cost for generic drugs. For brand name drugs, you pay the greater of $7.40 or five percent of the cost. Remember, your drug deductible and copayments count toward your drug costs for entering the catastrophic coverage phase.

WHAT IS A DRUG DEDUCTIBLE?

A drug deductible is a common component of many Part D plans because it helps offset the rising costs of pharmacy plans. The deductible is the amount you pay before your plan starts paying for any expenses. The good news is that our Medicare Part D deductible only applies to drugs in tiers 3, 4 and 5.

If you’re concerned about paying for your prescriptions, there may be ways to lower drug costs. First, ask your doctor if there is a generic drug equivalent for brand name drugs. Generic drugs are more likely to be categorized in tier 1 and tier 2, avoiding the Medicare Part D deductible. You can also save costs by filling your prescriptions at a preferred pharmacy. Preferred pharmacies offer lower copayments than standard pharmacies.

WHAT IS A COPAYMENT?

A copayment is the set fee you pay for a prescription drug. Your copayment will vary based on the drug tier and whether you are in initial coverage, the coverage gap or the catastrophic coverage period.

If you would like assistance with your Medicare Part D drug coverage, call your health care concierge or customer service at 800-378-5234 (TTY users call 800-947-3529) Monday - Friday, 8 a.m. - 8 p.m. You can also learn more at NetworkHealthMedicare.com.

WHAT IS THE COVERAGE GAP?

When total drug costs reach $3,310, you enter the Medicare Part D coverage gap. During the coverage gap, you pay 58 percent, and Network Health pays 42 percent for generic drugs. For brand name drugs, you pay 45 percent, Network Health pays 5 percent and the drug company pays 50 percent.

You leave the coverage gap and enter catastrophic coverage when what you pay reaches $4,850.

$

$

You enter the coverage gap when total drug costs reach $3,310. $

200

$

8 12 Generic ($20) $ $

Drug Deductible

INITIAL COVERAGE NetworkHealthMedicare.com

42

58 Brand ($100) $

$

$

11

.60

8.40 Generic ($20) $

0 7.4

5

2.9

45

$

5

50 Brand ($100) $

COVERAGE GAP

17.05 Generic ($20) $

92.60 Brand ($100)

$

CATASTROPHIC COVERAGE C oncierge | 15

wellness

Living with DIABETES Avoid the Ups and Downs of Blood Glucose

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f you’re living with diabetes or have been told by a doctor you’re prediabetic, learning about your blood glucose level is very important. Over time, high glucose can damage blood vessels, both large and small. This can lead to complications like heart attacks, stroke, kidney damage, blindness, nerve damage and risk of limb loss.

Prediabetes can be reversed by making lifestyle changes like increasing physical activity and consistently eating a healthy, balanced diet. The Centers for Disease Control and Prevention estimate that more than 30 percent of people with prediabetes will develop full-blown Type 2 diabetes within five years if they do not make lifestyle changes.

For some it’s easy to recognize high or low blood glucose, but it’s important to use a blood glucose monitor to know for sure.

Many things including food, physical activity and medications can raise or lower blood glucose, and both highs and lows can be dangerous.

Ask your doctor what your blood glucose target range should be and at what levels highs and lows would be dangerous for you. Work with your doctor to determine a plan of action should you find your levels higher or lower than your target range.

High Blood Glucose

Hyperglycemia means that your blood glucose may be around 200 or higher. You might experience the following. u Extreme thirst u Frequent urination u Hunger u Blurred vision u Drowsiness u Nausea

Low Blood Glucose

Hypoglycemia means that your blood glucose is under 70.

A drop in blood glucose can happen very quickly and result in the following symptoms. u Shaking u Fast heartbeat u Sweating u Anxiety u Dizziness u Hunger u Headache u Irritability u Impaired vision u Weakness u Fatigue

How Can I Prevent High or Low Blood Glucose? u u

Take your medications as prescribed.

Ask your doctor for an exercise plan that’s right for you. u Ask your doctor for a dietary plan including the amount of carbohydrates allowed at each meal. u Eat at least three smaller meals each day and avoid skipping meals. u Eat a variety of high fiber fresh fruits and vegetables. u Avoid sweets such as cookies, candy, donuts, cakes and pies.

To learn more about managing diabetes, visit GoEmmi.com and enter code NETWORKDIABETES. 16 | C oncierge

NetworkHealthMedicare.com

Understanding Respiratory Medications and How They Work W hen you’re living with a chronic lung condition such as chronic bronchitis, emphysema and chronic obstructive pulmonary disease (COPD), even the simple act of taking a breath can be a struggle.

One of the best ways to control respiratory conditions is to understand and follow your doctor’s guidelines for medications. It’s important to understand when to use them.

CONTROLLER MEDICATIONS – Controller medications are long-term treatments taken on a daily basis, even when you don’t have symptoms. Controller medications are not for emergency use. Instead, they prevent attacks by gradually keeping your symptoms under control for a longer period of time. Think of controller medications as routine maintenance of your symptoms because by taking them every day, you will prevent flare-ups.

RESCUE MEDICATIONS – Rescue medications provide quick relief by opening the lungs and relaxing airway muscles. They can ease worsening symptoms or stop an attack, usually providing relief in about 10 minutes. While rescue medications work fast, they only last for four to six hours.

INHALERS – To control your symptoms, your doctor may prescribe an inhaler. Inhalers deliver a measured dose of medication into your lungs. It’s important that you use your inhaler correctly, so all the medication you need reaches your lungs.

Controller medications help you breathe better over time.

Rescue medications help in an emergency situation. If you frequently find yourself using your rescue inhaler, ask your doctor about adding or adjusting a controller medication.

If you have any questions about your medications, check with your doctor or pharmacist now. Because when you’re short of breath, you’ll want to know how to treat your symptoms as quickly as possible.

NetworkHealthMedicare.com

I

f you’ve been diagnosed with chronic bronchitis, emphysema or COPD, let us help. Breathe at Ease is Network Health’s proactive condition management program designed to help members avoid flare-ups, control symptoms and potentially improve their lung conditions. It’s intended to supplement a physician’s care with one-on-one support from a respiratory therapist. To learn more, visit NetworkHealthMedicare.com/Breathe or call Caroline Alterman, clinical program manager, at 920-720-1677. Breathe at Ease is available at the following locations.

St. Elizabeth Hospital Attention: Robyn West, RRT 1506 S. Oneida St., Appleton, Wisconsin 54915 Phone 920-831-1498, Fax 920-831-1281 rwest@affinityhealth.org Mercy Medical Center Attention: Robyn West, RRT 500 S. Oakwood Rd., Oshkosh, WI 54904 Phone 920-831-1498, Fax 920-831-1281 rwest@affinityhealth.org Affinity Medical Group New London Attention: Robyn West, RRT 1420 Algoma St., New London, WI 54961 Phone 920-831-1498, Fax 920-831-1281 rwest@affinityhealth.org Calumet Medical Center Attention: Peggy Nolan, RRT 614 Memorial Dr., Chilton, WI 53014 Phone 920-849-1816, Fax 920-849-7529 pnolan@affinityhealth.org Holy Family Memorial Attention: Sandy Bauman, CRT, and Lori Newberg, CRT 2300 Western Ave., Manitowoc, WI 54220 Phone 920-320-4247(4AIR), Fax 920-320-3043 sbauman@hfmhealth.org or lnewberg@hfmhealth.org C oncierge | 17

wellness

How Are Your Kidneys Doing?

W

hen was the last time you thought about your kidneys?

These two bean-shaped organs have an incredible job.

They filter waste and extra fluid from the blood and produce urine. If waste builds up in the blood, it can make you feel sick. In fact, they’re so good at what they do that it can be tough to tell if something’s wrong.

Unlike many diseases, kidney disease often has no symptoms until it reaches an advanced stage. The National Kidney Foundation estimates that more than 26 million U.S. adults have chronic kidney disease (CKD), and most are undiagnosed. In fact, kidney disease is the ninth leading cause of death in the U.S.

How can you tell if you’re at risk of chronic kidney disease? u Do you have diabetes? u Do you have high blood pressure? u Do you have heart disease? u Did a member of your immediate family have kidney disease?

There are things you can do to prevent kidney disease and make sure your kidneys continue working well. Speak with your doctor, especially if you answered yes to the questions on the left.

Your doctor may order tests to measure your kidney function. A glomerular filtration rate (GFR) test measures how much blood your kidneys filter each minute. The doctor may also want to measure the level of proteins in your urine. This is done with an albuminuria or microalbuminuria test. Both tests are painless and routine diagnostic tools.

Kidney disease is a progressive disease, which means that the damage tends to be permanent. However, that doesn’t mean you can’t prevent further damage, and the treatments are very effective when caught in the early stages.

Maintaining proper diet and nutrition are important factors in living well with kidney disease. As kidney disease progresses, your dietary needs will likely change with each stage of the disease. Be sure to talk with your doctor about your individual nutrition needs.

For people with diabetes, controlling your blood pressure and improving your blood glucose levels can reduce the risk of kidney disease by 33-40 percent or help slow its progression.

To learn more about managing chronic kidney disease, visit GoEmmi.com and enter code NETWORKCKD. 18 | C oncierge

NetworkHealthMedicare.com

Eat Your Fruits and Veggies

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ou’ve probably heard the phrase, “Eat your fruits and vegetables” for most of your life. The benefits are just as real today as they were when you were a kid. Fruits and vegetables are great for many reasons.

u Provide essential vitamins and minerals to help keep you healthy and energized u Reduce the risks of certain diseases including heart disease and some cancers u Low in calories, provide fiber to keep you feeling full and make your digestive system happy u Available in many forms—fresh, frozen, canned, dried and 100 percent juice

Eating a diet rich in fruits and vegetables may cost a bit more, so here are a few ways to keep some green in your wallet as well as on your plate. u Plan ahead and make a list, stick to it and avoid

unnecessary items. u Frozen, canned and dried forms are all priced a little less than fresh. Keep an eye on the sodium content for these items. u Purchase fruits and veggies that can go a long way. Consider something you can eat raw as a snack and can also be added to a meal that can be eaten a few times during the week. u Buy in season. Fruits and vegetables tend to be less expensive when in season. u When your favorites are on special at the store, buy more.

You can freeze them or prepare a dish to freeze before it spoils.

NetworkHealthMedicare.com

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g n i r p SACTION

into

A

fter the long, dark winter, spring is a time of rejuvenation. Whether you’re spending time inside a gym or venturing outside, getting enough exercise and physical activity each day can improve and maintain your health and your quality of life. As Wisconsin weather improves, spring into action and discover the exciting benefits of exercise.

Exercise can prevent disease.

Research shows that exercise can help lower your risk of type 2 diabetes, heart disease, stroke, high blood pressure and high cholesterol. There is even evidence to suggest that exercise can boost your immune system, as long as you don’t overexert yourself.

Exercise helps control your weight.

Regular exercise can shrink your waistline. You’ll burn calories while working out. Plus, an increase in muscle mass over time means your body will burn more calories when you are at rest, too.

Exercise improves your strength, flexibility and balance.

Talk with your doctor about what type of activities are best for you.

Initially, you may feel weak or sore after you exercise. If you exercise consistently, these side effects will decrease and you will build muscle tone, gain flexibility and have better balance.

Exercise benefits brain power.

The benefits of exercise impact the body and mind. When you exercise, the serotonin level in your brain increases, improving your mood and mental clarity. Daily exercise can even help ward off depression.

TALK TO YOUR DOCTOR ABOUT EXERCISE

Ask your doctor what type of exercise is best for you at your next appointment. Your doctor can work with you to develop an exercise plan that fits your individual needs and interests. This conversation is especially important if you have a chronic health condition, so you can experience the benefits of exercise safely.

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NetworkHealthMedicare.com

wellness

Need Help Submitting a Claim?

M

ost hospitals and doctor offices will submit claims on your behalf. But, some medical facilities and pharmacies may require that you pay for care at the time it’s given. Your 2016 Evidence of Coverage explains how to ask Network Health to pay our share of a bill you received for covered medical services or prescription drugs. You must submit your claim to us within 12 months for medical claims and 36 months for prescription drugs from the date you received the service, item or drug.

How can I submit a claim? u Send us your request for payment, along with your itemized bill and documentation of any payment you’ve made.

It’s a good idea to make a copy of your bill and receipts for your records. u To ensure you’re sending all the information necessary, you can fill out a claim form to make your request for payment. You can find forms at NetworkHealthMedicare.com or contact our customer service department.

You don’t have to use the form, but it will help us process the information faster. u Mail your request for payment together with any bills or receipts to us at these addresses.

For Prescription Drugs Express Scripts, Inc. Attn: Medicare Part D P.O. Box 14718 Lexington, KY 40512-4718

For Medical Claims

Network Health Medicare Advantage Plans P.O. Box 120 1570 Midway Place Menasha, WI 54952

Contact your health care concierge or customer service if you have any questions at 800-378-5234 (TTY users call 800-947-3529), Monday - Friday, 8 a.m. - 8 p.m. If you receive bills and don’t know what to do about those bills, we can help. You can also call if you want to give us more information about a request for payment you have already sent to us.

Know Your Rights and Responsibilities

A

s a member of Network Health, you have both rights and responsibilities. For example, you are responsible for telling us if you have any other health insurance coverage in addition to our plan, such as Veterans Affairs (VA) benefits.

You also have rights including the right to make complaints and to ask us to reconsider decisions we have made.

For a full list of your rights and responsibilities, visit NetworkHealthMedicare.com, click on Member’s Corner and click on Your Rights and Responsibilities, under Resources. You may also request a printed copy by contacting your health care concierge or customer service at 800-378-5234 (TTY users call 800-947-3529) Monday - Friday, 8 a.m. - 8 p.m.

NetworkHealthMedicare.com

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USING AND UNDERSTANDING OUR PROVIDER NETWORK Answers to Your Questions About ThedaCare and Other Providers

A

s a result of our recent agreement with ThedaCare to extend our relationship through December 31, 2016, we first want to thank you for your patience and feedback throughout the situation. More than 3,000 calls came into our local Menasha office, and many of you waited on hold while we took time to talk to each member. Your voices were heard and became an integral part in reaching an agreement with ThedaCare. Throughout 2016, you can still access ThedaCare providers as you do now.

What happens now?

As the year continues, Network Health’s priority to put members first will not change. We’ve compiled important information to keep you informed and connect you with resources to ensure you’ll continue to have access to affordable, high quality health care through Network Health in 2016 and beyond. As Network Health grows, we’ll continue to serve northeast Wisconsin with a different kind of health insurance experience. We’re not a nationwide health plan, and we like it that way.

Will I have to change my plan for 2017?

You may have heard rumors that you’ll have to change your health plan if you want to use ThedaCare providers in 2017. Because Network Health has a variety of Medicare Advantage options available and we’re updating our plans for 2017, that’s not necessarily true. The most important thing will be to work with your Network Health agent before making any plan changes. If you don’t have an agent, call us for help finding one. Your current plan may still be a good fit, and when the annual enrollment period begins, your Network Health agent can help you understand all your options and choose the plan that’s best for you.

Details about our 2017 plans will be shared with you on or after October 1. You’ll also receive your Annual Notice of Change materials in September. You’ll want to make sure to review this material carefully because it will explain any changes to your current plan.

We hope you’ll find the information provided here valuable. As always, if you have questions or concerns, we’re here to help.

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HOW TO CHANGE YOUR DOCTOR If you want to change your doctor or specialist, we have lots of resources available to help you make a change quickly and easily.

Search for Doctors Online

Visit NetworkHealthMedicare.com and click Find a Doctor to search for all doctors and specialists near you.

The information in this search is updated daily. You can search by City, County, Hospital Affiliation, Specialty and more. You can also sort to only see doctors who are accepting new patients.

Use New Affinity Health System Resources

If you’d like to make an appointment with an Affinity Health System doctor, all Affinity providers are now accepting new patients. This includes doctors at St. Elizabeth Hospital in Appleton, Calumet Medical Center in Chilton and Mercy Medical Center in Oshkosh.

Recent changes and enhancements to Affinity’s model of care have improved access to doctors and streamlined scheduling.

An exclusive line with dedicated staff has been set up to serve Network Health members looking to connect with a new provider. Staff are available to help with any of the below services. u

Guidance to help members select the right physician based on individual needs u Help answering questions about primary and specialty care providers u Assistance with scheduling appointments with a new provider

For help finding a provider or to make an appointment, call Affinity Health System at 920-831-9000, Monday - Friday 8 a.m. - 5 p.m.

Connect with Other Providers

Network Health also has lots of other providers in our network. If you’d like to make an appointment with any of the doctors below, call their offices at the numbers listed. u

Family Care of the Fox Cities, Appleton, 920-730-2747 u Fox Valley Family Medicine, Appleton, 920-997-8409 u Mosaic Family Health, Appleton, 920-832-2783 NetworkHealthMedicare.com

u

Primary Care Associates, Appleton, 920-996-1000 u Kaukauna Clinic, Kaukauna, 920-766-4656 u Partnership Community Health Center, Menasha, 920-731-7445 u Premier Health, Neenah, 920-727-4946 u Dr. Kirtada Ringwala, Oshkosh, 920-236-3214 u Dr. Albert L. Fisher, Oshkosh, 920-236-3290 u Ministry Medical Group Chain O Lakes, Waupaca, 715-258-3650 u Fond du Lac Regional Clinic, Waupun, 920-324-6800 u Dr. Mariano Rosales Jr., Waupun, 920-324-3559

Other Providers in Ripon and Berlin

All Agnesian HealthCare providers are now accepting new patients. If you would like to make an appointment, call their offices at the numbers below. Services include family medicine, internal medicine, general surgery, orthopedics, dermatology, pediatrics, plastic surgery, obstetrics/ gynecology, medical oncology, interventional cardiology, urology, otolaryngology (ear, nose and throat), podiatry (foot and ankle), audiology, wound care, pulmonology and sleep medicine. u Agnesian Clinic Ripon, 790 Eastgate Drive, 920-745-3180 u Ripon Medical Center, Ripon, 835 Parkside Street, 920-745-3520 and 920-748-3101

Let Us Know About Your New Doctor or Call Us for Help Once you’ve chosen a new doctor or if you need additional help finding one, call your health care concierge or Network Health’s Customer Service department at 800-378-5234, Monday - Friday, 8 a.m. - 8 p.m.

(TTY user call 800-947-3529).

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COMMON QUESTIONS AND ANSWERS ABOUT THEDACARE From Our Health Care Concierges

1

Michael Johannes

What providers are ThedaCare and what’s happening with their contract with Network Health?

The following providers are ThedaCare providers. These providers are part of ThedaCare’s contract with Network Health that is currently set to end December 31, 2016. u Appleton

Cardiology - Neenah u Community Health Network u CHN Medical Center - Green Lake u Peabody Manor u Shawano Medical Center u ThedaCare Physicians u Wild Rose Community Memorial Hospital

2

u Appleton

Medical Center u Berlin Memorial Hospital u Juliette Manor u Riverside Medical Center u ThedaClark Medical Center u Waushara Family Physicians u ThedaCare New London Medical Center

If I want to keep my ThedaCare doctor in 2017, will I have to change my plan during this fall’s annual enrollment period?

Craig Kandler

Not necessarily. It’s important to work with your Network Health agent before making any changes to your plan. He or she can explain your choices specific to your situation. Network Health will have updated Medicare Advantage plans for 2017, but everyone’s needs are unique. Where you live, your use of health care services, your financial situation, health and preferences are all key to your plan decision. It will be important to review your Annual Notice of Change information that will arrive in September, because your current plan may still be a good fit.

3

I’d like to change my doctor. What do I do?

Elessa Oudenhoven

You can search for doctors online at NetworkHealthMedicare.com. If you’d like to change to an Affinity Health System doctor, you can get help finding one or make an appointment by calling 920-831-9000, Monday - Friday 8 a.m. - 5 p.m. Then, make sure to call Network Health to let us know what doctor you choose.

Lots of other providers are also part of our network. If you need help finding one or need a printed provider directory call us at 800-378-5234, Monday - Friday, 8 a.m. - 8 p.m. (TTY users call 800-947-3529).

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NetworkHealthMedicare.com

4

Is it true not all doctors in a ThedaCare facility are ThedaCare providers?

Theresa Hintz

Yes. It’s important to know that not all providers in a ThedaCare facility or location are ThedaCare providers. Many doctors are independent, and they provide care at multiple facilities. These providers are listed below, they are not ThedaCare providers and you can continue to see them at a different location. u Associates

in Gastroenterology u Ear, Nose and Throat Specialists of Wisconsin u Fox Valley Hearing Center u Fox Valley Perinatology u Fox Valley Pulmonary u Neuroscience Group u Physio O&P u Wisconsin Institute of Urology

5

u Digestive

Health Specialists u Forefront Dermatology u Fox Valley Nephrology u Fox Valley Plastic Surgery u Fox Valley Surgical Associates u Northeast Wisconsin Retina Associates u Rural Audiology u Women’s Health Specialists

Could I continue to use ThedaCare providers in 2017 and just pay the out-of-network cost?

Natalie Damro

This is something you’ll want to look at with your Network Health agent when 2017 plans come out. Like how our Medicare Advantage PPO members have the option to use out-of-network providers today, this may be a good option for some members in 2017. With our PPO plans, you pay less when you use providers in our network, but you can choose to see any doctor that accepts Medicare. Because everyone’s situation is different, you’ll want to work with your Network Health agent to determine if this could work for you.

Our plan changes and costs for 2017 haven’t been determined yet, but you’ll receive information about our 2017 plans by the end of September through the Annual Notice of Change mailing all Medicare Advantage members receive.

6

Will the ThedaCare contract ending December 31, 2016, affect NetworkPrime (MSA) or NetworkCares (SNP) members?

Toni Gagnon

No. NetworkPrime (MSA) is a type of Medicare Advantage plan where there is no such thing as in-network. If you’re a NetworkPrime member, any doctor or hospital that accepts Medicare should also accept your NetworkPrime coverage.

This could or could not be a ThedaCare provider.

NetworkCares members have always been able to get medical care in-network or out-of-network without any additional cost, as long as the provider bills Medicare and Medicaid. This won’t change.

NetworkHealthMedicare.com

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WHAT TO CONSIDER WHEN CHOOSING A DOCTOR Network Health’s Chief Medical Officer, Dr. Mary Davis, understands the importance of choosing the right doctor.

Every member’s needs are different, and she provides her three most important things to consider.

1. Comfort Your doctor should get to know you, and you should feel comfortable talking with him or her about personal information. Building a relationship will help your doctor know what is and is not normal for you. Plus, feeling at ease with your doctor will make it easier for you to ask questions.

2. Needs Everyone’s health care needs are unique. You may have practical needs for your health care based on where you live. The state of your health may lead you to a doctor who specializes in a certain type of care you need, or if you’re healthy, you might not need much care. Your financial situation and Network Health insurance coverage could also affect your choices.

Dr. Mary Davis

3. Preferences Your preferences for different factors can naturally help narrow your search for a doctor. For example, you might prefer a doctor who shares your gender or speaks a certain language. The amount of experience a doctor has might be another factor. As you consider your preferences, deciding which you value most may ultimately drive your decision.

Our Care Management Team Provides Personal Support Our nurses at Network Health are actively preparing personalized care plans for all members with health conditions in our care management program. If you see a ThedaCare doctor or specialist and you have a health condition and a care manager here at Network Health, you may have already received a phone call or likely will soon. In the months ahead, our nurses will be working one-on-one with members to make sure their health care won’t be disrupted.

If you’ve recently been diagnosed with a health condition, we can partner you with a nurse to help coordinate your care.

Our staff is available to anyone who has been diagnosed with a serious health problem. If you’d like to speak with one of our nurses, our care management team can be reached at 800-236-0208, Monday – Friday, 8 a.m. - 5 p.m.

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NetworkHealthMedicare.com

Save a Stamp – Sign Up for Email A

ll Network Health Medicare Advantage members have the option to sign up to receive their Annual Notice of Change (ANOC) materials by email, instead of through the mail.

We offer this because many members have told us they don’t need printed copies, and that they’d rather receive their material to their email address.

Plus, it saves on costs, and it saves the environment by cutting down on paper.

Takes Less Than Five Minutes – Sign Up Today

1. Have your Network Health member ID card handy (you’ll need your member ID number).

2. Go to NetworkHealthOptions.com.

3. Type in your last name, date of birth and member ID number.

4. Follow the instructions on the next screen and choose email.

5. Approve your selection, and you’ll get a thank you message and a confirmation email.

If you already signed up for email, you don’t have to sign up again.

Spouses Can Sign Up for One Packet

If multiple members live in your household (for example, husband and wife), and you’re on the same Network Health Medicare Advantage plan, you can sign up to get one packet of ANOC materials, instead of two. To sign up for this option, called householding, each member in your household will need to log in at NetworkHealthOptions.com to make this selection. You’ll both need to log in separately. Follow the instructions that appear to choose print and householding.

WHAT’S THAT?

Annual Notice of Change (ANOC) is the packet of materials you receive in September that tells you what’s changing for January 1 of the following year.

Here’s what’s included.

• Annual Notice of Change - a table showing changes to your plan • Evidence of Coverage - your plan policy that outlines all the details about your plan • Provider Changes - a list of added and removed in-network providers • Pharmacy Directory - list of pharmacies • Formulary - list of drugs (if you have drug coverage) NetworkHealthMedicare.com

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

Meet Ericka Lantz

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

Ericka Lantz is a member of our health care concierge team, a group of employees dedicated to providing exceptional customer service to our Medicare members. Let’s find out what inspires her at Network Health.

What made you want to be a health care concierge?

I officially joined the health care concierge team in

2010. I had past professional experience at other insurance companies, and I was amazed that Network Health was able to offer a program such as the health care concierges. I’m able to build one-on-one relationships with members, and that’s something I had never experienced before joining Network Health.

What is your day like?

A day here at Network Health is hectic but

rewarding. As a health care concierge, I have a

lot of responsibility in assisting our members and helping uphold Medicare guidelines. Calls from our members and doctors can range from simple solutions to more complicated circumstances that take some additional research or working with a doctor’s office or hospital, especially in fixing billing issues.

What is your favorite part of being an health

care concierge?

I am truly blessed with the opportunity to be a part

of the Network Health team. I love my job and the work I do to help others. I like building trust so members know I am here for them. Being able to turn a difficult situation around is one of the best rewards of being a health care concierge.

What do you think our Medicare members

appreciate most about Network Health?

I think our members appreciate working

with someone nearby. I feel like I have personal relationships with many members, and I love being able to interact with them person-to-person, not just as another stranger on the other end of the line.

What do you like to do in your free time?

My seven-year-old daughter and three-year-old

son are my heart. Together we love to play family

games and do activities such as swimming, going to the park and taking walks. I also love to cook, and in the summer, I like to garden and grow fresh herbs.

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.