Housecalls: The Mental Health, Exercise and Safety Issue - Spring 2012

HouseCalls Health or wellness or prevention information

Volume 15 Issue 1

The

MENTAL HEALTH, EXERCISE and

SAFETY

Issue

med-hcmentsafexer-0112 Y0034_12_1429 File & Use 03/31/2012

1-800-965-4022 TTY/TDD 711 or 1-800-526-0844 (Illinois Relay) HealthAllianceMedicare.org

What We’re Talking About

1

Mental Health,

Exercise

and

Safety From the Editor

Better ratings equal higher quality.

Our star ratings speak for themselves.

We address topics like hoarding, a safety concern that can also be a mental health problem. You will also read about how being social, exercising, eating right and getting your affairs in order relate to your mental health and safety, as well as your physical health.

HMO PPO

W

e pride ourselves on bringing our Medicare Advantage members the information they need to get healthy and stay healthy. We are always seeking ways to improve our star ratings, which represent the level of care our members receive. In 2011, we received 4.5 stars for our HMO plans and 4 stars for our PPO plans. Five stars is a perfect score, and Health Alliance Medicare is striving toward it.

By following simple tips, working with your doctor and responding accurately and clearly to star rating-related surveys (see back cover for more information), you can help make our plans even better. Keep each issue of House Calls this year.

Bring them with you to your annual wellness visit, and discuss anything appropriate to your situation.

This issue focuses on mental health, exercise and safety. These sometimes overlap, and all affect other aspects of your life.

2

Thank you for reading. If you have any questions, please call 1-800-965-4022 weekdays, 8 a.m. to 8 p.m.

TTY/TDD users, please call 711 or 1-800-526-0844 (Illinois Relay).

You likely noticed the updated look of House Calls, now a twice-a-year keepsake. We feel our new logo and look is more representative of us and our members. Other materials you receive will feature the new look soon.

As always, we hope House Calls helps you stay informed on important health and benefit topics.

Boost Your

Brainpower T wo key things help your mind stay fit— social interaction and mental activity. The best brain-boosting hobbies combine the two, like taking a class, volunteering and exercising in a group.

Learning something new keeps life stimulating, especially during retirement. Community colleges and park districts offer a variety of courses that allow you to interact with others while challenging your mind.

Volunteering with a local organization offers the opportunity to interact with others, which also stimulates your brain. Help your church, local library, animal shelter or even a branch of a larger organization like the Alzheimer’s Association.

3

Dancing with a partner or in a group may be one of the best physical activities you can do that is also good for your mind. When you dance the salsa, a waltz or even the electric slide, your brain whirls to keep up with the steps while you laugh and interact with others around you. In addition, for those already living with dementia, dancing can help slow further progress.

Learning something new helps keep life stimulating, especially during retirement.

Get your Groove On You’re in luck. Dancing opportunities abound throughout Illinois. Check with your local senior center, community college, park district or ballroom dance center for information on dance classes and events.

Springfield: Springfieldparks.org 217-544-1751

Danville: Dacc.edu 217-443-3222

Peoria: Peoriaparks.org 309-682-1200

Decatur/Springfield area: Pldc.org 217-486-3691

Champaign: Regentballroom.com 217-359-5333

Carbondale area: Cornerdancehall.com 618-303-5266

Bloomington: Wrainbowballroom.com 309-824-4007

4

Hoarding It’s Not Just on Television

L

ately, it seems like almost every cable television station has a show about hoarding and people who live in less-than-desirable conditions because they can’t let go of anything—even trash. While these people represent extreme cases, even mild hoarding can be a problem. As we get older, we tend to hang onto things. This often creates dangerous living areas— especially for seniors who tend to have more issues with falling and balance.

Clutter leads to other negative effects. It makes it harder to keep track of things you need like bills, medication and contact information for your friends and loved ones.

According to the Mayo Clinic, hoarding is a treatable mental illness.

Here are some signs you or a loved one may be a hoarder.

• Cluttered living spaces • Keeping stacks of newspapers and junk mail • Moving items from one pile to another without discarding anything • Difficulty making decisions • Difficulty letting others touch or borrow possessions If hoarding affects you or someone you love, speak with your doctor as soon as possible. He or she can make a referral to a mental health provider who can help with a treatment plan. A mental health care provider can also recommend community resources to help sort through the clutter.

5

Go Electronic to De-Clutter A simple way to de-clutter is cutting down on the amount of mail you receive. Many companies now offer an option to receive notices, bills and other communications electronically (through email, on their website, etc.).

6

Exercise Your Right for Balance

E

veryone knows enjoying good health ties to a balanced lifestyle. Physical (eating right, getting regular exercise) and emotional balance (taking personal time, as well as sharing time with friends and loved ones) are keys to staying well.

Physical Balance

Physical balance, like many skills, decreases as we age. According to the U.S. Centers for Disease Control and Prevention (CDC), falling is a major problem.

• One of every three Americans over the age of 65 falls each year.

• Among individuals 65-84, falls account for 87 percent of all fractures.

• Falls are the second leading cause of spinal cord and brain injury.

One CDC study showed men and women, ages 65 to 97, who did muscle strengthening and balance exercises reduced the risk of falls and fall injuries by as much as 35 percent.

You can start by incorporating balance-focused exercises in your everyday activities. For instance, while cooking dinner you might want to balance on one leg and then the other while holding on to the counter or a chair. Tai chi is excellent for balance, too, because it involves slow, coordinated movements while shifting weight to both sides of the body.

Emotional Balance

Emotional balance is just as important. Exercise boosts activity in the brain, leading your body to release natural antidepressants.

Talk to most anyone who exercises, no matter their age, and they’ll attest to a “feel-good” phenomenon after exercise.

The bottom line is good balance doesn’t come from doing nothing. And balance doesn’t have to be elusive. Find your balance by strengthening your body and mind through regular exercise.

Did You

You Can Learn How to Prevent a Fall?

Fall prevention is important as we age. In the Champaign area, check out the Fall Prevention and Balance class through Carle Therapy Services. Based on the Otago Balance Exercise program, this weekly class aims to reduce falls and minimize the damage when falls do occur.

To learn more, call 217-383-6651.

7

Think-Ahead Documents

Can Ease Your Worries

W

e experience positive moments with family and friends. We celebrate our personal accomplishments. And sometimes we worry. We worry about our financial situation, and we worry about when serious health conditions or aging will catch up with us.

We worry about dying.

You can ease the worry by making sure those who love you understand your wishes. Advance directives—like living wills and power of attorney— can ease your worry. And because worrying may make mental and physical health problems worse, addressing this particular area could help you feel better and be healthier.

Power of Attorney

A health care power of attorney is a document naming another person, called your “agent,” to make health care decisions for you if you’re unable to do so. Most people choose a trusted relative or friend.

Your agent won’t have to pay for any health care services he or she arranges.

To designate a health care power of attorney, complete and sign the Illinois Statutory Short Form Power of Attorney (POA) for Health Care. One witness, other than the attorney or designated POA, must also sign the form.

After the power of attorney for health care goes into effect, your agent can make any health care decision you could make if you were able. You can limit your agent’s powers or give your agent special instructions in your documents.

Living Will

A living will is a document stating you do not want your physician to use death-delaying procedures if you develop a terminal condition.

The surest way to create a living will is to fill out and sign the Living Will Declaration in the Illinois Living Will Act. Two witnesses must watch the signing.

If you have a living will, your physician can still provide pain medication and other care to make you comfortable.

A living will takes effect when a physician certifies you have a terminal condition.

Complete with Forms

Take Action

Need Help?

If you haven’t looked into these steps, 2012 is the year to take action. Those wonderful moments in your life can be even better with a few less worries in the back of your mind.

Be sure to share copies of both important documents to your agent, physician, family and friends. Discuss your wishes with them all, as well.

If you’d like a copy of the Health Alliance booklet, Planning Ahead, please call 1-800-965-4022 or send your full name and mailing address to memberservices@healthalliance.org

For more information about advance directives, please call the Senior HelpLine at 1-800-828-8966 or visit the Illinois Department on Aging website at state.il.us/aging.

8

Are Generic Mental Health Drugs Effective?

M

any people live with depression.

Fortunetely, the stigma of depression as a weakness is a thing of the past. More people are realizing the benefits of taking antidepressants. Even better, treatment is now more affordable because generic versions of popular antidepressants are readily available.

Many people have a negative impression when they hear the term “generic,” but it isn’t always accurate.

In the case of prescription drugs, all it means is the patent the original drug manufacturer had has expired, and other drug companies can now make comparable drugs at a lower price. The Food and Drug Administration (FDA) requires all generics to have the same active ingredients as the brands they copy. They must be as safe and effective as the brand-name drug.

Brand-Name Antidepressant Celexa® Prozac® Paxil IR® Zoloft® Remeron® Wellbutrin® Effexor®

Brand-Name Tier/Monthly Copayment (After Meeting Deductible) Tier 4/$95 Tier 3/$45 Tier 4/$95 Tier 3/$45 Tier 3/$45 Tier 3/$45 Tier 4/$95

The financial benefits of generic medications are great.

Generic drugs are more affordable for consumers, and they help keep health care costs stable.

Many smart consumers are switching to generics when they’re available and appropriate. The table below lists common brand-name antidepressants and their generic counterparts. Dr. John Beck, Health Alliance medical director and psychiatrist at Carle Physician Group in Urbana, says finding an antidepressant—generic or otherwise—is about good communication.

“It’s important to work closely with your provider and let him or her know about any side effects you have.” Beck continues, “Adjustments can be made to ensure you’re getting the benefits you need from your medication.”

Generic

Generic Tier/ Monthly Copayment

citalopram fluoxetine paroxetine sertraline mirtazapine bupropion venlafaxine

Tier 1/$0-$10* Tier 1/$0-$10* Tier 1/$0-$10* Tier 1/$0-$10* Tier 1/$0-$10* Tier 1/$0-$10* Tier 1/$0-$10*

*HMO 20Rx members receive Tier 1 drugs for $0 at Walmart and Sam’s Club and $8 at all other network pharmacies. PPO 10Rx and PPO 30Rx members receive Tier 1 drugs for $0 at Walmart and Sam’s Club and $10 at all other network pharmacies.

Free Tier 1 Preferred Generic Drugs at Walmart When you get your free Tier 1 preferred generic drugs at Walmart or Sam’s Club, you pay nothing now and nothing later. This benefit is as good as it sounds.

In addition, if you are wondering if you could save by switching to generics, call the Health Alliance

9

Medicare Member Services number for a medication review.

Other pharmacies are available in our network.

If you choose another pharmacy, you’ll pay the standard copayment listed in the Evidence of Coverage you received in September or when you joined our plan.

Simon Says

An Insider’s Perspective on Pharmaceuticals

Staying On Top of Your Medication

Has Never Been Easier

T

aking your medication as your doctor says is essential to getting and staying healthy. This is why we offer DailyMed.

With more than 30 years of

DailyMed costs the same as your standard pharmacy coverage. It features added benefits.

experience, Health Alliance clinical

• DailyMed delivers directly to your door. This saves you a trip to the pharmacy. Health Alliance member Loella Shaw echoes this benefit’s convenience. “It’s not always handy for me to go the drug store. I live 12 miles away and with the weather—you just never know.”

pharmacist Simon Leung provides insight into understanding your pharmacy benefits.

WorldDoc Provides Health Tips and Resources WorldDoc is a free Internet program for our members. Log in to your account at HealthAlliance.org and click on WorldDoc. You will find resources, tips and health information.

• Doses come in a special packet with the time of day and how you should take it right on the packet.

This makes it easier to carry the medicine with you, too. You don’t have to lug the whole bottle around when you travel or are gone for the day; just grab the packet and go. Loelle recently took her packets to London. “They’re in long strips. You just fold them up; put them in your suitcase—you never have to worry about pills spilling.”

• DailyMed also makes it easier for caregivers, especially if the person they care for is not able to share dose and timing information.

The library section features helpful articles, including information on stress management. Or visit the pharmacy area for medication safety tips.

Health Alliance Medicare does not access your information on WorldDoc. It is strictly for your benefit.

10

• DailyMed Customer Service stands ready to help.

“They are very polite, very nice people. If you have any problems, if you have any new prescription, they call you directly,” Loella says.

You can go online to DailyMedRx.com to learn more and call 1-866-720-9855 to sign up.

Mental Health Question

My doctor asks me questions about whether I’m feeling “blue.” Why?

Answer

Doctors use the following questions to assess if their patients are experiencing normal ups and downs or symptoms of depression. Your doctor isn’t prying.

He or she is trying to see if you could use some extra help—counseling, medication or both.

• Over the past two weeks, have you felt down, depressed or hopeless?

• Over the past two weeks, have you felt little interest or pleasure in doing things?

11

Q&A

Please answer these questions from the U.S. Preventive Services Task Force honestly. Depression isn’t something you should feel embarrassed or ashamed about. It’s also not something you just have to live with.

If you answered “yes” to either of these questions, talk with your doctor or a trusted family member or friend. You could feel better and enjoy your life more with just a little help.

Where the Heck are

My Keys?

By Patrick Harness, Health Alliance Medicare Community Representative

L

ast winter, when we had all that snow, I came home with a car full of groceries.

After bringing in the first load, I looked for my keys and discovered they were not in my pocket. Ah, I must have left them in the front door lock again. When I checked, they weren’t there, either. Where in the world did I leave them? After an anxious search, I discovered I had dropped my keys into one of the grocery bags. I was relieved to find them but was so aggravated with myself for being so careless.

We all have lapses in memory or have trouble making sense of a situation. As caregivers, we may notice our family members or friends experiencing a decrease in cognitive abilities or memory loss. Of course, we worry they are experiencing something serious.

Here’s some guidance from Heather Mulder, manager of education and outreach for the Greater Illinois Chapter of the Alzheimer’s Association.

“If you suspect there is a problem, get (your friend or loved one) to their doctor. Memory loss and dementia-like symptoms can be brought on by a variety of situations—dehydration, medication interactions, vitamin deficiencies and depression, to name a few. Life-threatening conditions like high blood pressure or mini-strokes require immediate treatment,” Mulder says.

“Once identified, these conditions can be treatable, and the symptoms can be reversed. Early detection of any type of dementia allows people to have the

opportunity to take advantage of available treatments and to make plans for the future.”

The Alzheimer’s Association offers valuable resources on its website, alz.org.

While there, enter “10 signs of Alzheimers” in the search bar for tips on spotting this disease.

Here at Health Alliance Medicare, our senior case manager Laurie Edwards shares her experiences and how we can help.

“As case managers working with mostly senior members, we often encounter members who are experiencing dementia or are caregivers for a family member with dementia,” she says.

“Our efforts center on maintaining doctor’s appointments, taking medication as prescribed and watching for warning signs that might indicate potential problems so the member can be treated in his or her home, the most familiar setting.

“We also assist with community resource planning for things not covered by medical insurance.”

As caregivers, it’s likely some of our loved ones may develop a form of dementia. Being wellinformed may provide some comfort and insight during a difficult situation—that, and a little patience.

For more information about community resources for seniors, contact Patrick at 1-800-965-4022 or patrick.harness@healthalliance.org.

12

Real Fitness in Real Life

Key to Staying Fit...

G

Have Fun

ladys Williamson, 93 and a Health Alliance Medicare member, swims twice a week at the Four Seasons Fitness Center in Bloomington. She competes in the National Senior Games, winning several gold medals. She also swam twice in the 1.2-mile Central Illinois Open Water Swim, receiving awards each time.

children who also became swimmers. For a while, neighbors called their private pool the Kappa Swim Club, where they hosted fun swim competitions.

It wasn’t until her late 60s that Gladys started swimming competitively.

“I don’t go for speed,” Gladys says. Typically she swims freestyle for her competitions, but last year she decided to try the 50-meter backstroke. She Gladys grew up on a farm, so being active and living doesn’t know how to do the fancy flip turns at the end of each length, but she doesn’t mind. She adds, healthy was natural. “I always wanted to learn to “It’s about having fun and not letting it feel like swim,” Gladys says, “but opportunities were rare.” work.”

She’d go every chance she got, and by the time she was in college at Illinois State University, she was a “The key for me,” she says, “so I stay motivated, is regular swimmer. to put my swimsuit on right when I wake up.” That way she is ready after her morning coffee and she’s Her husband was an avid swimmer, too. So, not likely to make excuses. Swimming is easy on she says, “It was sink or swim.” They raised four her joints, and she credits it as one of the reasons she’s so healthy.

“People say I am inspiration to them, but I don’t know about that,” Gladys humbly adds. Then she jokes, “I have motivated so many, I now have to go early in the morning before all the lanes fill up.” Following her lead, her children recently started swimming competitively, too.

She encourages friends and others to keep moving. It doesn’t have to be much, but, “It should be something enjoyable.”

13

Home-Visit Nurse Practitioner Lives What She Teaches Patti Reichard, a nurse practitioner for the Health Alliance Medicare homevisit program, also enjoys a healthy life. She wants to be a model for our members.

Between running after her toddler grandson and meeting with members, Patti strives for 150 minutes of exercise every week, per the Surgeon General guidelines. For her, that equals a 30-minute walk, five times a week.

She also follows the Mediterranean diet. “It has been called the healthiest diet in the world,” Patti explains. It includes fruit, vegetables, whole grains, nuts, olive oil, fish, poultry and small amounts of lean red meat. “Besides, I just like to eat those things.”

Hearing the experiences of members inspires her. Patti says, “I hope I am as healthy and active as Gladys when I am 93, and I intend to reach 93.”

14

Food vs. Mood

I

t’s a vicious pattern. You are stressed out (and who isn’t these days?) so you grab the nearest bag of chips or tub of ice cream and dig in. Or maybe you are so busy you don’t have time to make meals, so you go to the drive-through or pop in a quick-nuke meal. If the pattern continues, your body starts to crave those things. You become a slave to your cravings for bad food, and your body and mind pay the price. You may even convince yourself and others it is OK. The truth is all those poor choices add up. They lead to weight gain and can affect hormones and chemical

reactions in your brain. It can make you depressed to not have control over your cravings or over the way those choices affect your body. The more sugary, starchy and fatty foods you eat, the more you want later.

On the flip side, those who rein in their bad food habits find those cravings fade fairly quickly. They may even feel some of those foods don’t taste good after all.

People who fill up on lean meat, vegetables and whole grains regularly, with a treat only occasionally, find they have more energy, their minds are less sluggish, and mood swings from sugar highs and lows are rare.

How do you discard harmful eating habits?

First, take the power back. Start by talking with and Weight Watchers. These programs teach you how

your doctor. He or she may suggest working with a dietician or direct you to tools and other resources.

Next, make yourself accountable. Studies

to select beneficial and delicious foods.

Last, follow through. Make it easier by telling

yourself it’s OK to slip up now and again. Healthy eating may take some trial and error. You may find show one of the most successful tools for eating giving yourself one day a week to eat like a king helps healthy is keeping a diary of what you eat. You may you stick to your plan. Or you may find setting up a want to use a free online food tracking website, like myfitnesspal.com or livestrong.com. Many people are reward system motivates you. The key is to stick with it. If you mess up one day, start the next one fresh. surprised at what or how much they eat.

Eating healthy doesn’t have to mean giving up all the goodies. It is about learning to eat in moderation so those goodies don’t make you ill.

If you need support to keep you on target, join a healthy eating group. Health Alliance Medicare members receive discounts through Jenny Craig

Three Bean Salad • 1/2 pound fresh green beans, • 1/4 cup red wine vinegar washed and cut into thirds • 1/2 cup extra-virgin olive oil • 1 (15-ounce) can red kidney • 1/4 cup flat-leaf parsley, beans, rinsed and drained chopped • 1 (15-ounce) can garbanzo • 2 teaspoons sugar or Splenda® beans or edamame beans, rinsed and drained • Salt or salt substitute and • 2 rounded teaspoons Dijon mustard

freshly ground black pepper

Directions Place pot on stove. Cover and bring to a boil. Place a metal colander over boiling pot. Add minimal salt or salt substitute to water if desired. Take half-pound cut fresh green beans, and place them in the colander. Cover the colander with pot lid. Steam beans five minutes. Remove beans and cold shock under running water. Drain green beans and set aside.

In a bowl, combine mustard, sugar and vinegar. Whisk in oil. Add kidney beans, garbanzo beans, green beans and parsley and toss to coat evenly. Season salad to taste, with minimal salt and pepper. Marinating overnight in fridge is recommended. Serve cold.

Share this yummy and healthy dish with friends.

15

Essentials

Learn the smart, simple way to make the most of your Health Alliance Medicare benefits.

Health Alliance Ensures Reasonable Access to Services

Better Service, Better Care, Safely

Health Alliance is committed to providing you with efficient, cost-effective, quality health care coverage. Health Alliance never encourages underutilization of care. We do not give financial inducements or set quotas for denying care or coverage, nor do we keep statistics identifying individual providers and their denial rates. The utilization decisions our medical directors, nurse coordinators, pharmacy coordinators and pharmacists make are based only on appropriateness of care and service and the existence of coverage. There are no incentives, financial or otherwise, to deny access to services.

Our Quality Management department continually strives to improve the services we provide you and the doctors and hospitals we work with. Our goal is to establish standards of care, identify opportunities and drive interventions to enhance care and measure effectiveness. Through regular monitoring and annual evaluation, we continue to meet our goals. To view our complete program, visit HealthAllianceMedicare.org, select “About Us” and then click the “Quality Improvement program” link under “History and Philosophy.” Some examples of our initiatives include:

Health Alliance Medicare Services Is Here to Help 1-800-965-4022 TTY/TDD 711 or 1-800-526-0844 (Illinois Relay) Monday through Friday, 8 a.m. to 8 p.m.

We can help you with questions about claims, coverage, appeals, pharmacy issues, preauthorization, utilization management and information about the doctors, clinics and hospitals we work with. After normal business hours, leave a message and we will return your call the next business day. Please note that all non-urgent review requests received after normal business hours will be recorded as being received the next business day.

Please call us if any of your personal information has changed, including: • Name • Other insurance • Address • Primary Care Physician • Phone number

16

Clinical Guidelines Health Alliance encourages our doctors to consult nationally recognized standards, called clinical guidelines, when providing care to our members.

These evidence-based treatment suggestions have been developed to help doctors choose appropriate health care treatment for specific medical conditions. Doctors can review the guidelines on the Health Alliance website or call 1-800-851-3379, ext. 8112 (Monday-Friday, 8 a.m. to 5 p.m.) for a hard copy.

NCQA® Accreditation We participate in a health plan accreditation program with the National Committee for Quality Assurance (NCQA®). This ensures we meet a rigorous set of nationally recognized standards for quality and service to our members and providers. For more information, visit the NCQA® website at ncqa.org.

continued

HEDIS® and CAHPS®* Health Alliance participates in the annual Healthcare Effectiveness Data and Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data collection programs through NCQA®. HEDIS® is the measurement tool used by the nation’s health plans to evaluate performance in terms of clinical quality and customer service.

CAHPS® is a nationally recognized survey tool that measures members’ satisfaction with their health plan.

To view the most recent HEDIS® and CAHPS® scores for Health Alliance, visit HealthAlliance.org and click “About Us” at the top of the page.

To check out our wellness programs and other helpful health information, visit HealthAllianceMedicare.org and click on “Healthy Programs” under “Extras.”

*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA®).

• Look for a participating provider.

CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ®).

• View the Health Alliance Medicare Part D Formulary.

Safety Health Alliance is committed to improving health care safety so our members with medical problems do not feel worse because of an error during treatment.

Our Never Events and Patient Safety Committee focuses on quality at the point-of-service, as well as interventions that reach out to our members to encourage patient safety awareness and active participation in their own care.

• Evaluate drug interactions, view drug claims history and see how much you’ll need to pay for prescriptions.

Be Well – Solutions For Your Health

• Review HEDIS®/CAHPS® results and other quality initiatives.

®

®

Take Charge Online You can often find convenient information and tools online at HealthAlliance.org. Simply log in* with your user name and password to: • View eligibility.

• Check the status of a claim.

• Order a new ID card.

• Access WorldDoc, our comprehensive online medical resource.

• Find copayments or coinsurance.

• View member rights and responsibilities.

• Read the Notice of Privacy Practices.

• Pay your bill.

Health Alliance programs help you achieve and maintain your best possible health.

• I Can Quit (smoking cessation) • Active with Asthma • BP Beat (blood pressure)

You’ll also find information about: • Medical and pharmaceutical management policies and procedures, including how we review new technology.

• How to submit a claim.

• ChoLESSterol

• Which benefits and services are included and excluded from your coverage in and out of the service area.

• Get in Check (diabetes) • ImmYOUnize • Road to Relief (migraine headaches) The Personal Health Coordination program is offered by nurse case managers for members who need help managing a chronic health condition or assistance gaining access to needed care and services. For more information or to enroll in this program, members or their caregivers may call 1-800-851-3379, extension 8061.

Health Alliance Medicare members can receive discounts at various gyms, health clubs and weight loss centers. To learn more, call 1-888-382-9781.

17

• How to obtain emergency care, primary care, specialty care and behavioral health services during and after normal business hours in and out of the service area.

• How to obtain information about in-network physicians and hospitals, including searching for providers.

• How to file a complaint or appeal, including your right to involve an external review organization.

To sign up for a user name and password, follow these steps: 1. Go to HealthAlliance.org 2. Click on “Register” at the top right of your screen 3. Select an account type 4. Enter the requested information and click submit 5. Login to your email account to verify your email address by following the link provided in the confirmation email * If you don’t have Internet access, you can request printed copies of the materials on our website by calling Health Alliance Medicare Services.

Keep Your Member Materials Handy

our website Privacy Policy or our Notice of Privacy Practices, please contact Health Alliance Medicare Services. This information is also available on our website at HealthAllianceMedicare.org.

We Partner with Physicians We regularly seek input from all doctors in our network regarding policies under development or review. Through regular (every other month) e-newsletters, we communicate with our physician network. Practicing physicians are also involved on several of our committees to foster idea-sharing and improve the quality of our programs.

You Have the Right to an Independent Review

To make the most of your benefits, read your member materials, including your annual Evidence of Coverage book, and any materials you received when you became a member. These materials are a convenient source for quick information about your coverage. If you need additional copies of your member materials, please contact Health Alliance Medicare Services at 1-800-965-4022, MondayFriday, 8 a.m. to 8 p.m. TTY/TDD users call 711 or 1-800-526-0844 (Illinois Relay).

We Speak Your Language If you are more comfortable speaking a language other than English, try our telephone translation service, Language Line. We provide access to interpreters who speak 140 different languages.

Simply call Health Alliance Medicare Services and state which language you speak. Si usted necesita un interprete para traducir esta información, por favor llamar al teléfono gratis 1-800-965-4022 y pregunte por la “Language Line.”

Documents may be available in alternate formats or languages. Please call 1-800-965-4022.

We Respect Your Privacy Protecting your medical information is a responsibility we take very seriously. Health Alliance follows Health Insurance Portability and Accountability Act (HIPAA) regulations to ensure that your information is kept confidential. This means we will only use and disclose your information in ways that are permitted by law. For a complete copy of

18

For members with Medicare Part C, medical benefits, if we deny any part of your first appeal, the entire case, including your appeal letter, will automatically be forwarded for another review with a government-contracted independent review entity (IRE).

For members with Medicare Part D prescription drug benefits, if we deny any part of your first appeal, you or your appointed representative may ask for a review by a government-contracted independent review entity (IRE). You must file a written appeal request within 60 calendar days after the date you were notified of the decision on your first appeal to the written address included in the redetermination notice you receive from us.

For more information, please read your Evidence of Coverage or call 1-800-500-3373, MondayFriday, 8 a.m. to 5 p.m.

Planning Ahead You have a right to accept or refuse treatment and to complete an advance directive. If you’re not satisfied with how we’ve handled an advance directive, you have the right to file a complaint with the state survey and certification agency.

Information on advance directives and how to file a complaint are addressed in your Evidence of Coverage under “Your Rights to Use Advanced Directives.” For more information, contact Health Alliance Medicare Services to request a copy of the brochure “Planning Ahead.”

Health Alliance Medicare is a health plan with a Medicare contract.

HEALTH ALLIANCE 301 S VINE ST. URBANA IL 61801-3347

Surveys Show Where We Can Improve

W

hen you join a Medicare Advantage plan, different organizations track the quality of the care and coverage you receive. One way they do this is through surveys.

Every year the Center for Medicare & Medicaid Services (CMS) sends out two surveys, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the Health Outcome Survey (HOS). It is important to take time to understand each question and answer as best as you can.

Sometimes the questions can be confusing or require you to recall your medical history from the past 12 months. This can be difficult. Please answer to the best of your best ability, but do not leave a question blank.

When you receive a survey, it is important to complete it and mail it back. If you don’t return the HOS, a representative will call you to offer assistance with completing the survey (though he or she cannot provide or suggest answers).

The CAHPS and HOS surveys feed into the overall star rating of the plan from the Centers for Medicare & If you need help, please call the numbers on Medicaid Services (CMS). the surveys.

Fraud Alerts Be Smart With Your ID Card Letting a friend or relative use your insurance ID card to get care or medication is illegal. It also can mess up your medical records, which can, in turn, make getting care later more difficult. It can result in fraudulent claims in your name. It may be tempting to help someone in need, but the consequences just aren’t worth it. Instead, help your friend find resources to cover care and medication.

A PUBLICATION OF HEALTH ALLIANCE MEDICARE

HouseCalls

Don’t Let The “Grandma Scam” Catch You Recently, a Health Alliance Medicare employee’s family member was the target of the “Grandma Scam.” This scam involved someone posing as a

Chief Executive Officer Jeffrey Ingrum Chief Medical Officer Robert Parker, MD Vice President of Corp.

Communications Jane Hayes

Editorial Board James Burke, MD Patrick Harness Jennifer Marquardt Laura Mabry Reba Karr, RN

college-age grandchild, stuck in Mexico, asking for $2,200 to help him get home. He claimed he didn’t want his parents to know because they’d be mad.

Luckily, the woman receiving the call used her wits and told the person she’d call back. She then called her family and learned, as she suspected, the grandson was definitely not in Mexico.

The family made a police report and learned how this scam typically occurs. Scammers use social media and other sources such as obituaries to gather family names and then use those to target potential victims.

If you get a similar call, please make sure it is legitimate.

Becky Aiken Hollie Wilson Lisa Gascoigne Nancy Keith

Editor Katy Hawthorne Graphic Design Jason Bentley HealthAllianceMedicare.org 1-800-965-4022 TTY/TDD 711 or 1-800-526-0844 (Illinois Relay)