Bear Facts. Dental Care. Get the. you need! The. Smiling Stork. helps pregnant members. A HealthCare USA Member Newsletter Volume

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1 The Bear Facts A HealthCare USA Member Newsletter Volume Get the Dental Care you need! All HealthCare USA members have a dental benefit. Not sure what benefit you have? Call us in Member Services at and we will help you. We will even help make your appointment and help with transportation. 1 1 Not all members are eligible for Transportation. Call Member Services if you are not sure. Smiling Stork Dental Program helps pregnant members We offer the Smiling Stork educational program to all pregnant members. This program provides Moms-to-be with information about the value of good oral health for mom and baby. It also helps you access covered dental services during pregnancy and up to 60 days after delivery. Please talk to your HealthCare USA Case Manager about the Smiling Stork Program or call Member Services for more information.

2 Annual Well Care Visits Matter Call your PCP and schedule YOUR well care visit TODAY! It s a COVERED BENEFIT! Getting an annual well care visit may be the most important thing you can do to get or stay healthy! Children age two and younger require even more frequent check ups. Adolescents and adults should also have an annual exam EVEN IF YOU ARE HEALTHY! By getting regular check-ups your Primary Care Provider (PCP) can tell you things about your health that you didn t know. They can give you tips about your weight, immunizations, exercise and nutrition among other things. Member Rights and Responsibilities Important Toll-Free Numbers As a HealthCare USA member, you have certain rights and duties. You can get a complete copy of your Rights and Responsibilities at any time. Here s how: Call Member Services at Go to Look in your Member Handbook please update your address & phone It is very important that HealthCare USA has your current address and phone number. We want to make sure you get all of your mail from HealthCare USA and MO HealthNet. To update your address and phone number just call FSD-INFO ( ) or visit their website at to access the FSD Program Enrollment System online to let them know when your address changes. You may lose your coverage if you are not able to get important mail about your eligibility. HEALTHCARE USA Member Services Transportation Transportation Fax Transportation mileagegasreimbursement@mtm-inc.net Behavioral Health Hour Nurse Line CMPCN 24-Hour Nurse Line (Children's Mercy Pediatric CARE Network) Family Support Division (FSD) Information Center Child Abuse/Neglect Missouri Hotline Hour Parent Support Line Missouri School Violence Hotline Poison Control Center Child Support General Information Food Stamp Hunger Line MO HealthNet Participant Services Smoking Cessation 800-QUITNOW TTY/TDD 711 or

3 BENEFIT UPDATE MO HealthNet and HealthCare USA will no longer cover or pay for early childbirth prior to 39 weeks unless your doctor says it is medically needed. Interpreter Services Available at Medical Appointments Contamos con servicios de interpretación para las citas con su médico ةيبطلا ديعاوملل ةرفوتم ةيوفشلا ةمجرتلا تامدخ Dịch Vụ Thông Dịch Viên Sẵn Có tại Các Cuộc Hẹn Khám Sức Khỏe.Russian Услуги переводчика на встречах с врачами We don t want the language you speak to keep you from getting the health care you deserve. If you do not speak or understand English, HealthCare USA will provide an interpreter at no cost to you: When you call Member Services When you call Transportation At your medical appointment The interpreter may be on the phone, in person or via video conference at some providers. Call Member Services at and we will get someone who speaks your language to help you. you did know? All members have vision benefit coverage for eye exams and glasses. Call Member Services or look in your member Handbook for details.

4 Are you at risk Are you at risk for diabetes? The first step to prevent diabetes is to understand your risk. Type 2 diabetes is the most common form of diabetes. To find out if you are at risk for Type 2 diabetes ask yourself the questions below. It is important to find out early if you are at risk for developing Type 2 diabetes. Early diagnosis and treatment can prevent serious health problems that Type 2 diabetes can cause. Diabetes can cause heart disease, kidney disease and stroke. Next step? Make an appointment with your health care provider today for diabetes screening. Look for future articles on how diabetes is diagnosed and the treatment for living a healthy lifestyle with diabetes. Nephropathy We talked about the importance of going to see your diabetic care provider. Checking your Hemoglobin A1c value is important too. The next topic is kidney disease. It is also called nephropathy. The kidneys have many tiny blood vessels. The blood vessels filter waste chemicals from your blood. High blood sugar from diabetes can damage these blood vessels. The kidneys are not able to do their job as well as usual when this happens. It s important to have your diabetic provider check you for nephropathy. Screening What are the risk factors? Your diabetic provider can check you by using tests that see if you have protein (albumin) in the urine. Finding out if you have protein in the Am I 45 years of age or older? Am I overweight? Do I have a mother or father with diabetes? Do I have a sister or brother with diabetes? Is my family background African-American, Hispanic/Latino, American-Indian, Asian-American, or Pacific-Islander? Did I have diabetes while I was pregnant, or gave birth to a baby weighing 9 pounds or more? Do I exercise less than three times a week?

5 Diabetes & You urine is important. It could help to prevent further damage to the kidneys. Treatment Keeping your blood glucose and blood pressure in control will help prevent nephropathy. Even a mild rise in blood pressure can make nephropathy worse. Losing weight and getting regular exercise can help lower your blood pressure. Eating less salt and staying away from alcohol and tobacco can help too. Sometimes, medicines may be needed to lower blood pressure. Not everyone with diabetes has kidney problems. The better a person keeps diabetes and blood pressure under control, the lower the chance of getting nephropathy. Sources: American Diabetes Association, Web MD Out of Network Services If you need a service and cannot find an in network provider, call your PCP to help you. If your PCP refers you to a provider that is not in the HealthCare USA provider network: Your PCP must get a pre-authorization from HealthCare USA HealthCare USA will pay for your care, if approved We will make sure to cover the needed service timely If HealthCare USA cannot provide the needed service in network, we will adequately and timely cover the service out of network as long as we are unable to provide the service in network. Not Sure? You can get a second or third opinion You may want an opinion from a different health care provider. In such cases, you must ask your PCP or HealthCare USA to get a second opinion. HealthCare USA will pay for it. You may get an opinion from a third provider if your PCP and second opinion provider do not agree. HealthCare USA will pay for a third opinion.

6 If you get a bill... let us know! HealthCare USA will pay for all covered MO HealthNet Managed Care services. You should not be getting a bill if the medical service you got is a covered MO HealthNet Managed Care benefit. If you choose to pay for a service, you must agree in writing that you will be responsible for the payment before getting the service. The written agreement must show the date and service. It must be signed and dated by you and the provider. The agreement must be made before you receive the service. A copy of the agreement must be kept in your medical record. You will not have to pay for covered health care services even if: The State does not pay your MO HealthNet Managed Care health plan Your MO HealthNet Managed Care health plan does not pay your provider Your provider s bill is more than your MO HealthNet Managed Care health plan will pay Your MO HealthNet Managed Care health plan cannot pay its bills You may have to pay for services you get if: You choose to get medical services that are not covered by MO HealthNet Managed Care or You go to a provider that is not a HealthCare USA provider without prior approval If you get a bill, do not wait! Call our Member Services office at HealthCare USA will look into this for you.

7 Show Your Cards... it's your responsibility When you receive medical care, all members have the responsibility to: Show your HealthCare USA Member ID Card Show your red or white MO HealthNet card Show any other insurance card you may have If you do not show ALL of your cards, you may get billed for a part of your care. Mileage Reimbursement Log 60 Day Limit 1 If you are using the Transportation Mileage Reimbursement benefit you must: Take the log to your provider visit Fill out the log Have the provider staff sign the log Mail the log to: MTM Transportation - BSG Dept 16 Hawk Ridge Dr Lake St Louis, MO or Fax your log within 60 days of the appointment to or Take a photo of the log with your phone and it within 60 days to: mileagegasreimbursement@mtm-inc.net Save your fax confirmation or until you are reimbursed If these steps are not followed in 60 days, you will not be reimbursed. To get a log, or get a postage paid envelope, call Member Services at or visit our home page at 1 Not all members are eligible for Transportation. Call Member Services if you are not sure. you did? know You can now take a photo of your mileage reimbursement log to and it to mileagegasreimbursement@mtm-inc.net

8 10 South Broadway, Ste St. Louis, MO in this issue... Interpreter Services If You get a bill Well Care Visits Matter Your Dental Benefits We are now a part of AETNA BETTER HEALTH We would like you to know that HealthCare USA is now part of Aetna Better Health. What does this mean? You have the same great health benefits We are still HealthCare USA but are now owned by Aetna Better Health You may begin to see the Aetna Better Health name and logo on mail we send you You may see Aetna on your caller ID it will be one of our friendly staff trying to reach you We are excited to be part of AETNA BETTER HEALTH. We know you will be too! To receive a translated copy of this document, call Member Services at Para recibir una copia traducida de este documento, llame al servicio para miembros al HCU15106 Approved 05/27/15