MEMBER
MESSENGER Fall 2018
In each issue: Provider Updates Benefit Information Finding a Specialist
The lowdown on antibiotics
Pre-approval of services Opioid Dependence Avoiding this deadly addiction
Why choose a primary care provider? Our top 5 reasons
Getting claims paid with Optum sanfordhealthplan.com
The good, the bad and the ineffective
Tobacco Cessation FIVE STEPS
to stop tobacco use
Women's Health
What can you do to live a healthier life?
Annual Notice
Pre-approval of services You must contact Sanford Health Plan to receive pre-approval for certain medical services, including some outpatient procedures, all inpatient procedures and admissions. Pre-approval is also needed for dental anesthesia, specialty medications, home health care, durable medical equipment, cancer services and treatment, genetic testing and transplants. A complete list of services requiring pre-approval is available in your plan document, the Member Portal or by contacting Customer Service. If your provider refers you to see an out-of-network provider or facility, you must also receive pre-approval by Sanford Health Plan before you can receive care. This includes facilities such as Mayo Clinic and University of Minnesota. If approved, your medical care will be processed at an in-network level. Remember, some services may be excluded even if your doctor recommends them, such as acupuncture and cosmetic procedures. See your plan document for additional information on non-covered services. Contact Sanford Health Plan at least three days before the requested service to ensure the timely processing of your request. If you need an urgent approval (within three calendar days), please contact us by phone. Services that require pre-approval: • A ll inpatient hospital/facility admissions, including: o M edical o NICU nursery o S urgery
o Mental health
o I npatient Rehabilitation
o Substance use disorders
o L ong Term Acute Care
o Skilled nursing and subacute care
• S elect outpatient services (Log in to the Member Portal for a full list.) • H ome health • H ome IV services • Spine Surgery • Air Ambulance services • S elect durable medical equipment (DME) • Transplant services • Clinical Trials • O ncology services (Provider must request) • Prosthetic limbs, select orthotics and prosthetics • Genetic testing • I nsulin infusion devices and pumps • Referrals to non-participating from participating providers Always refer to your policy for more information on covered benefits and pre-approval requirements. Not all services prescribed or recommended may be covered by your plan. Remember, you (the Member) are ultimately responsible for obtaining pre-approval from the plan to receive in-network coverage, however a health care practitioner’s office will also satisfy this requirement.
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Opioid Dependence: Avoiding this deadly addiction Every day 115 Americans die from opioid overdose. What starts as a prescription for pain has become one of the major public health concerns in the U.S. Be aware of these warning signs of abuse:
Misusing opioids increases the risk of: • Substance use addictions • O verdose • Death
• C ombining opioids with alcohol, sedatives or other medications
Protect yourself. Talk to your health care provider.
• T aking larger doses or taking more often than prescribed
• T ell your health care provider about all other medications you are taking
• T aking opioids in a different manner like crushing or injecting
• A sk if there are other treatments for pain, like physical therapy or non-opioid medications • Avoid alcohol and illegal drugs
Risk of abuse is greater with: • A history of substance abuse • M ental health concerns • A ge 65 or older • P regnant
• Store medications in a safe place • T alk with your health care provider about how to stop taking opioids safely • U se opioids only as directed by your health care provider • Don’t share prescriptions with friends or family • T alk to your health care provider about what to expect from your medications
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Why choose a primary care provider?
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Our top five reasons A HEALTH RESOURCE
You’ll have a resource and health advocate who knows your history.
CONVENIENCE
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You’ll have easy access to preventative care and screenings, care for chronic conditions and acute care for illnesses.
HEALTH MAINTENANCE
A primary care provider can help you avoid health problems by determining if you are at increased risk for certain conditions and if you are, help you prevent them from developing.
EARLY DETECTION
Regular checkups with one provider who knows you well will make it more likely that health issues will be detected early when they’re most treatable.
BETTER COMMUNICATION
It’s easier to talk about sensitive issues with someone you know!
Find a primary care provider at sanfordhealthplan.com or contact customer service for assistance.
Getting claims paid with Optum If you need medical care and another person or company is responsible, please contact Sanford Health Plan. We have partnered with Optum to help us handle claims that could be someone else’s responsibility. If you receive a call or form in the mail from Optum, please respond within 10 days or your claims may be denied. You can reach Optum at (800) 529-0577 or complete the form online at icc.optum.com. 4
The lowdown on antibiotics The good, the bad and the ineffective
Antibiotics are used to stop the growth of or to destroy bacteria and other microorganisms. They are used chiefly in the treatment of infectious diseases.
THE GOOD Antibiotics kill bacteria that are causing your discomfort or illness.
THE INEFFECTIVE
THE BAD
• A ntibiotics will do nothing for a viral infection
•T hey also kill the healthy bacteria in your gut, allowing more harmful bacteria to grow in its place
• They won’t keep others from catching the virus
•Y ou may have a drug reaction. Make sure to ask your pharmacist about any common side effects. •M ay contribute to your antibiotic resistance
How antibiotic resistance happens • Many germs are around and in you, and a few are drug resistant. • A ntibiotics kill bacteria that are causing the illness, as well as good bacteria protecting the body from infection that are usually in your gut. • Drug resistant bacteria can grow and take over. • Some bacteria give their drug resistance to other bacteria causing more problems. • I f additional courses of antibiotics don’t work as expected, you may be considered to be resistant to that antibiotic for a particular strain of bacteria. Sources: Get Smart Campaign, Antibiotic Resistance, cdc.gov, 9/26/17.; Dictionary.com: Antibiotic, dictionary.com, 9/26/17.
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Five steps to stop tobacco use Tobacco use is the largest preventable cause of disease and premature death in the United States, and about half of all Americans who smoke will die because of the habit, according to the Centers for Disease Control and Prevention. People start smoking or chewing tobacco for many reasons, most often when they’re young because of peer pressure or wanting to fit in. However, many don’t think of the long-term effects. Nicotine in cigarettes makes them extremely addictive. There’s a misconception that other forms of tobacco are safer because they don’t have nicotine. But in fact, all forms of tobacco—dip, cigars, cigarettes, pipe tobacco, loose tobacco—have dangerous carcinogens. And even though e-cigarettes are gaining popularity as a smoking alternative, they’re not FDA approved, so no one knows what may be in them. They are too new to have reliable studies on how harmful they may be to people’s health.
COMMIT TO QUIT People of all ages and backgrounds are affected by tobacco use. Regardless of how long you’ve used tobacco, or how many times you may have tried to quit in the past, it’s possible for anyone to quit, as long as you commit to changing your behavior. 6
Here are
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Make a plan
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TIPS
to quit using tobacco
Set a quit date. Give yourself some time to prepare for this change in your life. Then stick to it. Make a list of all the reasons you want to quit. Refer to this list often as motivation. Write down every time you smoke or chew—when and why do you get the urge? This can help you figure out triggers to avoid. Make a list of positive things you can do to distract yourself when you get the urge to smoke or chew. Set small milestones to strive for, and reward yourself when you reach them.
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Get support
Tell your friends and family about your plan to quit. They can encourage you, and hold you accountable if they see you slipping back into old habits. Get connected with your state’s quit line at (800) QUIT-NOW (800-784-8669) TTY:711. All states have quit lines in place with trained coaches who provide information and help with quitting. Specific services and hours of operation vary from state to state. Join a community support group if one is available. Check with your local clinics, hospitals or heath care providers about support groups or workshops that may be available in your area. Use online resources from organizations such as: • American Cancer Society • American Lung Association • National Cancer Institute
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Commit to changing your behavior
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Talk to your doctor
Tell your primary care physician that you’d like to quit smoking. They may have resources or recommendations available to you. Make the talk part of your yearly physical so your provider holds you accountable and checks in with your health and progress. Discuss if and when you should have a lung cancer screening. (This is a free or low cost preventive benefit.) Ask if medication could help you quit. Some options include: • Bupropion SR (Zyban) or varenitine (Chantix), which are prescription nicotine-free pills. • Nicotine replacements, for people who are addicted to nicotine, including: • Nicotine patch (available over the counter without a prescription) • Nicotine gum or lozenge (available over the counter without a prescription) • Nicotine inhaler (prescription needed) • Nicotine nasal spray (prescription needed)
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Don’t give up
If you have a setback, remind yourself of all the reasons you want to quit. Use them as your motivation to stay on track. If you’ve tried to quit in the past without success, try a new approach this time around. Keep trying different techniques, avoiding triggers, figuring out how to get over your cravings, and celebrating the progress you make.
Quitting smoking is one of the most important things you can do for your health. Make the commitment to quit—for yourself, for your loved ones, for your future.
Stay away from places or people that make you want to smoke or chew. Don’t keep tobacco near you. Exercise, drink a lot of water, and eat healthy foods—you’ll feel better, and likely not have cravings like you used to. Practice meditation or take deep breaths. Cravings typically only last a few minutes, some simple deep breaths can help you beat the cravings for good.
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Provider Update To see the most current list of providers, visit sanfordhealthplan.com/ memberlogin
Benefit Information For additional Health Plan benefit information, visit sanfordhealthplan.com/ memberlogin or call Customer Service at (800) 752-5863.
Finding a Specialist If your doctor refers you to a specialist, but the specialist is not available as soon as you would like, you have options. Ask the clinic if a similar specialist is available or call Sanford Health Plan Customer Service.
CONTACT US
Women's Health What can you do to live a healthier life?
Get the conversation started with your primary care provider at your next well woman visit. A well woman visit is a yearly preventive checkup with your primary care doctor that is a covered benefit. This is a great time to check in on how you are doing and what changes can be made to help you reach your health goals. In addition to talking with your doctor about your health, you may need certain immunizations, tests or screenings depending on your medical history and age. For a complete list of your preventive health guidelines and other screenings and immunizations, go to sanfordhealthplan.com.
DON’T HAVE A PRIMARY CARE DOCTOR? Contact customer service or go to the provider directory at sanfordhealthplan.com.
memberservices@ sanfordhealth.org (800) 752-5863
Annual Notice
TTY: (877) 652-1884
You should have received the Sanford Health Plan Annual Notice in April 2018. The notice contains important information about your plan, including how and where to find coverage documents, how to sign up for one of our health management programs, services that require pre-approval, care setting information, the member appeal and complaint process, network information, federal rules, regulations, privacy information and more. If you didn’t receive your notice, please contact Sanford Health Plan to request a copy.
Language Line: (800) 892-0675
SVHP-2876 5/18