Connection IN THIS ISSUE: MANAGE YOUR HEALTH WITH V-CARE. CUSTOMER SERVICE AT Viva Health. Fall/Winter 2017

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1 Connection CUSTOMER SERVICE AT Viva Health An important part of Viva Health s commitment to customer service is that we continually evaluate our own performance and strive to exceed members expectations. To that end, we surveyed our members about their experience with Viva Health earlier this year. Nearly 92% of members said they were always or usually treated with courtesy and respect by Viva Health s customer service team. We also learned that 93% of members said their claims were always handled or usually handled quickly and correctly. Almost 94% said that it was always or usually easy to get the care, tests, and treatment they needed in the Viva Health network. We re proud that the overwhelming majority of members said they were very likely to renew their coverage with Viva Health. Viva Health is always working to improve our members experience. If you receive anything other than the best customer service from Viva Health, we want to know about it. Please call Viva Health s Customer Service Department during regular business hours (Monday-Friday, 8 a.m.-5 p.m.) at It is our privilege to provide you with quality health care coverage. Thank you for being a Viva Health member. At Viva Health, we understand that the health care system can sometimes be difficult to navigate. We know that a newly diagnosed medical condition can be scary and confusing, and that at times it can be hard to know how to manage your own health. That s why Viva Health has a care management program called V-Care. V-Care is designed to help our members stay as healthy as possible by providing education, tools, and support at no cost to the member. The goal of V-Care is to provide members with the information they need to successfully manage their health conditions. The V-Care team of nurses, social workers, behavioral health specialists, and care coordinators look for opportunities to help keep you well. We can work with 2 A Message from Dr. Tara Bryant 3 Colorectal Cancer Awareness 4 Flu Shot FAQ 5 Pricing Your Medications 5 Member Q&A: Signing Up for Medicare IN THIS ISSUE: Fall/Winter 2017 MANAGE YOUR HEALTH WITH V-CARE you over the phone, talk to you at your doctor s office, or even meet with you in your home to give you the tools and support you need to live a healthy life. Whether you need a lot of guidance or just have a question or two, you can count on the V-Care team to help you access the care you need and stay on top of your medical conditions. Doctors and hospitals refer members to the V-Care program, and Viva Health also reaches out to members who may need some help. If you think you could benefit from V-Care, you can refer yourself to the program, too. To find out more information or ask for help, call the V-Care program at MY V-CARE ( ), Monday through Friday, 8 a.m.-5 p.m. The V-Care team is here for you! 6 When to Keep Your Child Home from School 7 What to Do When You Need Care Out-Of-Network 7 Encouraging Doctor-To-Doctor Communication 1

2 A Message from Dr. Tara M. Bryant, Chief Medical Officer for Viva Health The idea of wellness means a lot of different things to each of us. Of course, being free of disease aids in our feeling of wellness no high blood pressure, no diabetes, or no migraine headaches. But, a feeling of wellness is more than just being disease-free. Wellness can also be a sense of peace and of happiness. Physical activity such as walking can help improve health and wellness, even without weight loss. People who are physically active live longer and have a lower risk for heart disease, stroke, type 2 diabetes, depression, and some cancers. With so many of us sitting for most of the day at work, I want us to pursue wellness by incorporating more activity in our day, every day. Your goal is to stand up and move, but start out by thinking small. Ask yourself, How can I make a tiny change each day that I know I can stick to? Can you walk around the block at your home or office twice a day? Can you go for lunch at the place that s a block or two further away? If you can commit to just one small change for 60 days, you will start to see a lot of differences. Standing and walking do more than just relieve aches and reduce body fat. These simple activities are also associated with: Balanced blood sugar levels A brighter mood and reduced anxiety Tighter core muscles, which means a flatter belly More energy throughout the day, especially in the afternoon A stronger lower back that keeps your core tight and resists pain You ll enjoy that unbeatable feeling of I did it! and you may even find that your clothes fit better than before. After 60 days, you ll be well on your path toward wellness. Be well, Tara M. Bryant, M.D., B.S.N. Don t forget your flu shot this season! Learn more on page 4 2

3 KNOW YOUR OPTIONS GETTING SCREENED FOR COLORECTAL CANCER Did you know that colorectal cancer is the third leading cause of cancer-related death in the United States? More than 90 percent of colorectal cancer diagnoses occur in people age 50 years and older. The American Cancer Society suggests that all men and women begin regular screenings for colorectal cancer at age 50. If you have a family history of colorectal cancer, polyps, or inflammatory bowel disease (among other risk factors), talk to your doctor about undergoing screenings earlier and more often. The U.S. Department of Health and Human Services believes that if all men and women age 50 and older were screened regularly, 6 out of 10 deaths from colorectal cancer could be prevented. Often, there are no signs or symptoms of colorectal cancer until it has reached a relatively advanced stage. Early detection greatly improves the chances for a full recovery. Don t avoid or delay getting screened. Contact your doctor today! A MESSAGE FROM THE AMERICAN CANCER SOCIETY We at the American Cancer Society are doing our part to eliminate colorectal cancer through education, prevention, screening, and early detection. We want to encourage patients to have a discussion with their doctors and understand all of their options for screenings. If we can educate the population on how and when to be screened, we know that this disease can be prevented. Through screening, your health provider can detect colorectal cancer at an earlier stage and may even remove it at the same time. The American Cancer Society is trying to eliminate the stigma that goes along with colonoscopy screenings and FIT tests because we know that screenings will save lives. The best type of screening is the one that you will actually do, so whether it s a colonoscopy, a flexible sigmoidoscopy, or a FIT test, all bring us one step closer to detecting and ultimately eliminating colorectal cancer. STAGES OF COLORECTAL CANCER SCREENING OPTIONS All Viva Health plans cover colorectal cancer screening and many plans offer the following routine screening options for free for members ages See your plan documents for more information. 1. Colonoscopy every 10 years a procedure that inspects the rectum and entire length of the colon that typically requires a trip to a hospital or clinic and involves sedation. Polyps found can be removed during the procedure, preventing cancer in addition to detecting or removing it. 2. Flexible sigmoidoscopy once every 5 years similar to a colonoscopy but involves a shorter tube and inspects the rectum and the lower part of the colon, generally without sedation. Polyps found can be removed during the procedure during the procedure, but if they are pre-cancerous or cancerous, you will need a colonoscopy to look at the rest of the colon. 3. Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) once a year at home. Ask your doctor if this is the right screening option for you. These tests mainly find cancer and are not as good at detecting polyps. If the test is positive, a colonoscopy is usually required. Cologuard is not a covered test, so please make sure the test your physician orders is covered. 90% 39% 5-YEAR SURVIVAL RATE IF FOUND AT THE LOCAL STAGE DIAGNOSED AT AN EARLY STAGE PARTLY DUE TO LOW TESTING RATES Sincerely, Anna Lisa Weigel Health Systems Manager, Hospitals American Cancer Society, Inc., South Region POLYP Most colorectal cancers develop from these noncancerous growths. IN SITU Cancer has formed, but is not yet growing into the colon or rectum walls. LOCAL Cancer is growing in the colon or rectum walls; nearby tissue is unaffected. REGIONAL Growth is into tissue or lymph nodes, beyond the colon or rectum walls. DISTANT Cancer has spread to other parts of the body, such the as liver or lungs. Image source: American Cancer Society ( 3

4 One of the most important things you can do for your health each year is getting a flu shot. You may think influenza is only serious when contracted by children or seniors, but the flu can be very serious for adults of all ages, especially those who have chronic medical conditions like asthma or diabetes. Educate yourself about the flu shot by reading common questions and answers below. Then, be sure to take a few minutes to receive your vaccination for this flu season. Those few minutes will protect your health and the health of those around you. The Centers for Disease Control and Prevention (CDC) recommends only the flu shot again for the flu season and recommends against use of the nasal spray flu vaccine because of effectiveness concerns. FLU SHOT FAQ Dr. Bryant got her flu shot this year! Have you gotten yours yet? WHO NEEDS THE FLU SHOT? Almost everyone 6 months of age or older should get a flu shot, unless you have a history of severe allergic reaction to any component of the vaccine. WHY DO I NEED A FLU SHOT? Even healthy people can get very sick from the flu and spread it to others. Getting the flu shot significantly decreases your risk of you getting sick and passing the flu virus to others. I VE HEARD YOU CAN GET THE FLU EVEN WITH THE SHOT. WHAT S THE POINT? The flu shot will prevent the flu most of the time. Even if you still get the flu, the vaccine reduces the severity of the disease and decreases the rate of complications by 50 or 60 percent and the rate of death by approximately 80 percent. Getting vaccinated is the most effective way to protect against the flu and its serious complications. The shot can help lessen your reaction and decrease the time it takes for you to get better. DOES THE FLU SHOT GIVE ME THE FLU? No. The flu vaccine does not contain the live virus, so it is impossible to get the flu from the vaccine. Side effects such as mild soreness, redness, or swelling at the injection site, headache, or a low-grade fever may occur in some people for a day or two. FLU SEASON IS NOT UNTIL WINTER. WHY SHOULD I GET A SHOT NOW? Each year, the flu season varies in timing, severity, and duration it does not have to be cold outside to be flu season. Flu season lasts a lot longer than most people think. It can start as early as October and continue through May. It takes your body about two weeks after receiving the vaccine to develop protective antibodies against the flu virus. Get your vaccine now so your body is able to fight the virus when you are first exposed. WHERE DO I GO TO GET THE FLU SHOT? You can receive the flu shot from your doctor or any pharmacy in Viva Health s network that provides the shot. If you are 65 years old or older, talk to your doctor or pharmacist about the high-dose flu shot. WILL MY Viva Health PLAN COVER THE FLU SHOT? All Viva Health plans cover the flu shot at 100% at the doctor s office, and most cover the flu shot at 100% at the pharmacy. If you have any questions about coverage for the flu shot, the high-dose flu shot, or other vaccines, call Viva Health Customer Service at , Monday-Friday, 8 a.m.- 5 p.m. 4

5 HOW TO PRICE YOUR MEDICATIONS THROUGH EXPRESS SCRIPTS When you fill a prescription for the first time, you don t always know what to expect at the pharmacy counter. Will your prescription be covered? How much will it cost? Are there less expensive but equally effective alternatives? Express Scripts, Viva Health s pharmacy benefit manager, has an online tool to help you with these questions. Available on the Express Scripts mobile app or website, the Price a Medication tool lets you check your coverage and assess your out-ofpocket expense for a medication before checking out at the pharmacy. You can also use Express Script s Price a Medication tool for your current medications to find out what you could save by using 90-day fills and home-delivery for long-term medications. To use this tool through the Express Scripts app, follow the steps below. Log in to the Express Scripts mobile app. If you haven t used the app before, search for Express Scripts in your device s app store, download the app, and create your account. From the app s home page, select Price a Medication. Search for your medication by typing its full or partial name. Select your drug strength and form, e.g., 50 mg tablet. Enter your address or zip code to price the medication at different retail pharmacies. Select your dose, e.g., 2 tablets per day. Then select your supply, e.g., 90 days supply via home delivery. View your results, making note of savings from 90-day supplies versus 30- day supplies and home-delivery versus retail pharmacy. If you have questions about less expensive but equally effective alternatives to your medication, talk to your doctor. While pricing your medications, you may receive a notification that your prescription requires a prior authorization before it is filled. You or your pharmacist should ask your prescribing doctor to initiate this process. If you have questions about other notifications or anything else related to your medications, talk to your doctor or pharmacist. QUESTIONS ABOUT YOUR PRESCRIPTION BENEFITS? If you have questions about your prescription benefits, or if you have a specific question about prior authorizations for retail drugs, call Viva Health Customer Service during regular business hours (Monday-Friday, 8 a.m.-5 p.m.) at If you have questions after hours, or if you have a specific question about prior authorizations for specialty drugs or your home-delivery prescriptions, call Express Scripts Member Services at MEMBER Q&A: SIGNING UP FOR MEDICARE WHEN DO I SIGN UP FOR MEDICARE IF I M 65 OR OLDER AND WORKING? If you are 65 or older and your employer has fewer than 20 employees, you should strongly consider signing up for Medicare Parts A and B. Group coverage sponsored by employers with fewer than 20 employees pays secondary for members 65 and older. This means if you do not take both Medicare Part A and Part B when you re eligible, you will not have a primary payer and it will be like having very little coverage. WHEN DO I SIGN UP FOR MEDICARE IF I AM YOUNGER THAN 65, DISABLED, AND WORKING? The same is true if you are younger than 65 and disabled and you have group coverage sponsored by an employer with fewer than 100 employees. In that situation, Viva Health will be your secondary payer if you are eligible for Medicare due to disability. WHAT IF I M COVERED BY A RETIREE PLAN? If you are eligible for Medicare and covered by a retiree plan, Medicare is the primary payer in many cases, such as when you are 65 and older or disabled. Viva Health s payment amounts will assume Medicare paid its share first even if you are not enrolled in Medicare. I STILL HAVE QUESTIONS. WHO CAN HELP ME? If you have any questions regarding coordinating your coverage between Medicare and your employer-sponsored plan, please contact Viva Health Customer Service during regular business hours (Monday-Friday, 8 a.m.-5 p.m.) at

6 ENCOURAGE DOCTOR- TO-DOCTOR COMMUNICATION: Ask your other health providers to send records to your PCP Your primary care physician (PCP) is a vital partner in maintaining your overall health. Because of this, it is important for your PCP to be informed about the care you receive from other health care providers. If you visit a specialist or an urgent care facility, or if you have an emergency and need to go to the emergency department, ask the other health care provider to send records from your visit to your PCP s office. With a more complete picture of your overall health, your PCP can stay up-to-date, observe issues, detect patterns, and help you better manage your health and wellness. WHEN TO KEEP YOUR CHILD HOME FROM SCHOOL Is your child s tummy ache a sign of the flu or just Monday morning moaning? Is a little cough reason enough to miss a big test? Parents often face the difficult decision of whether to keep a child home from school. Experts advise sending a child to school only if he or she is well enough to learn. This means the child s symptoms do not disrupt his or her ability to concentrate in class and do not distract classmates, according to Dr. Cindy Devore, a member of the American Academy of Pediatrics Council on School Health Executive Committee. If a parent suspects the child is faking the illness, Dr. Devore suggests looking at the total child. Does the child usually complain of illness right after a break or weekend? Does the child demonstrate behaviors like social isolation and mood swings that could suggest a bigger reason for avoiding school? Contacting your child s pediatrician can help determine whether the symptoms are physically or emotionally based. Symptoms that may warrant a day at home or visit to the doctor include: persistent fever (temperature higher than degrees Fahrenheit when taken by mouth) severe sore throat that lasts more than 48 hours, especially when accompanied by a fever a significant rash, particularly when other symptoms are present large amounts of discolored nasal discharge severe ear pain an uncontrolled cough diarrhea severe headache, especially with a fever Parents can allow children to return to school after symptoms are gone for at least 24 hours. Source: American Academy of Pediatrics ( Calling for Advice: If you re on the fence about whether or not your child should stay home due to illness, call your child s doctor for advice. TAKE ADVANTAGE OF THE MEMBER PORTAL Do you need to review your claims history or look at a recent explanation of benefits (EOB)? Remember that the Viva Health member portal is a convenient way for members to access this kind of information online. Log on and register your account today by visiting 6

7 WHAT TO DO WHEN YOU NEED CARE OUT-OF-NETWORK As a Viva Health member, you agree to get your health care from doctors, hospitals, and other medical providers who have a contract with us. These providers are in our network, and we call them network providers or participating providers. You can search for a network provider in our provider directory, available online at Viva Health will cover services from out-of-network providers, subject to the approval of Viva Health s medical director, for medically necessary services not available from network providers. The only other services that Viva Health will cover from an out-of-network provider are emergency services and urgently needed care to treat an unforeseen injury or illness when you are not in the Viva Health service area. If you have an emergency, you can seek care without delay, including through 911. Always call Viva Health within 24 hours or as soon as reasonably possible after you receive emergency services. Remember: if you go to the emergency room for treatment of a non-emergency medical condition, the services may not be covered. If you are outside our service area and you have questions about your health condition, you can contact your primary care physician (PCP) or the physician on-call if after hours. If you cannot reach your PCP s office, Viva Health has an on-call nurse who can assist after hours, available by calling Customer Service. KNOW SOMEONE WHO QUALIFIES FOR MEDICARE? TELL THEM ABOUT Viva Health offers Medicare Advantage plans that take the place of original Medicare (Part A, Part B and, if you need prescription drug coverage, Part D) to those who qualify. Viva Medicare is the first and only Alabamabased plan to earn 4.5 out of 5 stars from the Centers for Medicare and Medicaid Services. Viva Medicare was named by U.S. News and World Report as one of the best Medicare Advantage plans in the country, and the only one to receive that recognition in Alabama. Viva Medicare has also earned the top customer satisfaction survey score in the state for the past eight years, according to the Medicare & You handbook, a Medicare publication. Viva Medicare is enrolling now through December 7 for our 2018 Medicare Advantage plans help us spread the word! ABOUT Viva Health, Inc. is a health maintenance organization that has provided quality, affordable health care coverage in Alabama for more than 20 years. At Viva Health, we work hard to improve your health and provide access to a network that includes the most respected physicians and hospital providers in the market. Viva Health provides a wide variety of health plans to more than 250 Alabama companies. Recently recognized as the Best Family Health Insurance in 2017 by Birmingham Magazine, Viva Health always puts its members first. One of our members said it best: We know we can always count on Viva Health to provide our family with the best coverage possible. Viva Health is headquartered in Birmingham and has nearly 500 employees. All customer service calls are answered by Viva Health employees right here in Alabama. 7

8 Homepage: Member Portal: Provider Directory: Viva Health, Inc th Street North, Suite 1100 Birmingham, AL Toll Free: TTY Users: Alabama Relay Service at 711 Hours: Monday-Friday, 8 a.m.-5 p.m. After hours: Viva Health s on-call nurse: , Option 1 Pharmacy inquiries: , Option 2 For general/non-urgent inquiries, response within 1 business day vivamemberhelp@uabmc.edu Viva Health Connection is published for Viva Health s commercial members. The material in this newsletter is not intended to be personal medical advice. Talk to your health care provider about this and any other health information. The benefit information provided in this newsletter is a brief summary, not a complete description of benefits. Any benefits described may not apply to all Viva Health plans. For more information, consult your plan documents and contact the plan. Limitations, copayments, and restrictions may apply. Viva Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務. 請致電 (TTY: 711). VIVAConnection_Fall-Winterr2017_V th Street North Suite 1100 Birmingham, Alabama PRSRT STD US POSTAGE PAID BIRMINGHAM, AL PERMIT NO. 2061