Member Newsletter Vol. 1, What cancer screenings should I get? AETNA BETTER HEALTH OF MISSOURI. Early detection can lower your risk

Transcription

1 AETNA BETTER HEALTH OF MISSOURI Member Newsletter Vol. 1, 2016 What cancer screenings should I get? Early detection can lower your risk Cancer screenings can help detect cancer in the early stages. Early detection can mean more prompt and more effective treatment. Cancer screenings are a covered benefit for Aetna Better Health members. Read this guide to learn which screenings you should get: Breast cancer Cervical cancer Endometrial (uterine) cancer Colon & rectal cancer Lung cancer Prostate cancer Did you know? You do not need a referral to see a specialist who is in network. If you need help finding the right specialist for you, just call Member Services at We are here to help you!

2 Breast cancer screenings If you are a woman age 40 to 44: You have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if you wish to do so. If you are a woman age 45 to 54: Get mammograms every year. If you are a woman 55 or older: Switch to mammograms every 2 years, or can continue yearly screening. Screening should continue as long as you are in good health and are expected to live 10 more years or longer. All women: Should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening. You also should know how your breasts normally look and feel and report any breast changes to a health care provider right away. Some women because of their family history, a genetic tendency, or certain other factors should be screened with MRIs along with mammograms. (The number of women who fall into this category is very small.) Talk with a health care provider about your risk for breast cancer and the best screening plan for you. Endometrial (uterine) cancer screenings If you are a woman who has started menopause: Find out the risks and symptoms of endometrial or uterine cancer If you have any sudden bleeding or spotting, tell your provider right away If you have pelvic pain and/or a mass and weight loss, tell your provider right away If you are age 35 or older and are at high risk for hereditary non-polyposis colon cancer (HNPCC): Ask your provider if you should get an endometrial biopsy once a year Prostate cancer screenings Starting at age 50, men should talk to a doctor about the pros and cons of testing so they can decide if testing is the right choice for them. If they are African American or have a father or brother who had prostate cancer before age 65, men should have this talk with a doctor starting at age 45. If men decide to be tested, they should have the PSA blood test with or without a rectal exam. How often they are tested will depend on their PSA level. Source: American Cancer Society

3 Cervical cancer screenings All women should begin cervical cancer testing (screening) at age 21 If you are a woman age 21-29: Get a Pap test every 3 years If you are a woman age 30 to 65: You have two choices Get a Pap test combined with an HPV test every 5 years Get a Pap test every 3 years If your uterus has been removed but your cervix is intact: Follow the guidelines above If your uterus and cervix have been removed: You may stop getting Pap tests, unless the surgery was done as a treatment for cervical cancer or pre-cancer You are at risk for cervical cancer if: You are overweight Your diet is low in fruits and vegetables You are HIV positive You have a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use You were exposed to diethylstilbestrol (DES) before birth You have HPV You are a smoker You are on birth control pills You have had multiple pregnancies You have had Chlamydia You had your first child before the age of 17 Your mother or sister had cervical cancer If you have Human papillomavirus (HPV) or are at risk: You may need to be screened more often. Speak with your provider Vaccine: A vaccine exists for HPV (it is a covered benefit) Women who have been vaccinated against HPV should still follow these guidelines Colon and rectal cancer screenings Starting at age 50, both men and women should follow one of these testing plans: Tests that find polyps and cancer Flexible sigmoidoscopy every 5 years*, or Colonoscopy every 10 years, or Double-contrast barium enema every 5 years*, or CT colonography (virtual colonoscopy) every 5 years* Tests that mostly find cancer Yearly guaiac-based fecal occult blood test (gfobt)**, or Yearly fecal immunochemical test (FIT)**, or Stool DNA test (sdna) every 3 years* * If the test is positive, a colonoscopy should be done. ** The multiple stool take-home test should be used. One test done in the office is not enough. A colonoscopy should be done if the test is positive. The tests that can find both early cancer and polyps should be your first choice if these tests are available and you re willing to have one of them. Talk to a health care provider about which test is best for you. If you are at high risk of colon cancer based on family history or other factors, you may need to be screened using a different schedule. Talk with a health care provider about your history and the testing plan that s best for you. Lung cancer screenings If you meet all of the following criteria then you might be a candidate for screening: 55 to 74 years of age In fairly good health Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years Article Sources: American Cancer Society If you have questions about cancer screenings call Member Services at

4 Information you want Where you can find it Getting care Our website com/mo Member Services Member Handbook How to get care after hours, out of area, in an emergency, and for regular checkups 4 How to get authorization and the criteria used to make utilization management decisions 4 Benefit information and how to get care when you are out of the service area 4 Information about pharmacy benefits and co-pays (Managed Care members do not have co-pays) 4 Benefits and services that are covered and not covered 4 How we decide whether to cover new technology 4 Information about our care management programs, including case management, complex case management, behavioral health and substance abuse and disease management programs How to get key facts about providers, including: A listing of providers including PCPs, specialists, behavioral health providers and hospitals How to get services from your PCP 4 Provider's specialties Provider's affiliations Languages spoken by the providers How we update provider information How often we update provider information on our website Your privacy Our policies for collecting, using and disclosing member protected health information (PHI). Healthcare USA protects your oral, written and electronic PHI. We limit access to only those who need to know your information to do their job 4 How we are doing An explanation about what Health Effectiveness Data and Information Set (HEDIS ) and Consumer Assessment of Healthcare Providers and Systems (CAHPS ) are Our current HEDIS rates and CAHPS survey results Other Important Information What to do if you get a bill from a provider or receive a claim 4 How to get language assistance 4 Advance Health Care Directives 4 Clinical practice guidelines used in our programs incentives to employees or providers to reduce the use of services Member Rights and Responsibilities (changes will be provided in the member newsletter) 4 A statement about use of incentives. HealthCare USA does not provide any You can request any of this information verbally, in writing or translated to a different language. You can do this by calling Member Services at Monday-Friday. If you are visually or hearing impaired dial 711 or

5 We provide no rewards or incentives to deny care Aetna Better Health provides no incentives to employees or providers to reduce the health services you get. We will provide information on physician incentive plans to any member upon request. Member rights & responsibilities Help stop fraud & abuse Fraud and abuse of the MO HealthNet system is wrong and costs all of us money. You can help us make sure members and providers use the system fairly. Examples of fraud and abuse would be: Letting someone use your Member ID card or your red or white MO HealthNet card A doctor billing for services not provided Getting prescriptions with the intent of abusing or selling drugs Misusing the transportation benefit Aetna Better Health does not allow health care fraud, waste or abuse. We monitor, identify and report suspected fraud and abuse. We refer anyone who commits fraud or abuse to the State or law enforcement. If you suspect fraud or abuse, let us know right away. You can: Call Aetna Better Health at or Call MO HealthNet Division Participant Services at Did you know? If you are having trouble getting a timely appointment with your Primary Care Provider (PCP), we can help. Just call Member Services and we can help you set up an appointment As an Aetna Better Health 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 Direct access to women s health services We want you to know about ways to keep yourself healthy. We provide screenings at no cost to you. As a member of Aetna Better Health, you can get screenings for breast cancer, cervical cancer, chlamydia or STDs. (This is a benefit for MO HealthNet Managed Care members.) You can get these routine and preventive services from women s health specialists without referral or pre-authorization from Aetna Better Health.

6 Appointment time standards All Aetna Better Health providers have appointment time standards. This means that they must see you in a certain amount of time. You can see these standards listed below. If you have any questions about this, you can call Member Services at Provider type Appointment type Standards All types Emergency Immediately PCP, specialty care Urgent, not emergency Within 24 hrs PCP, specialty care Routine with symptoms Within 1 week or 5 business days - whichever is earlier PCP, specialty care Routine w/o symptoms Within 30 calendar days Maternity care First trimester Within 7 days of first request Maternity care Second trimester Within 7 days of first request Maternity care Third trimester Within 3 days of first request Behavioral health and Substance abuse Aftercare Within one (1) week or five (5) business days after hospital discharge whichever is earlier This is general health information and should not replace the advice or care you get from your provider. Always ask your provider about your own health care needs. Esta es información general de salud y no debe reemplazar el asesoramiento o la atención que usted recibe de su proveedor. Siempre consúltele a este sobre sus necesidades de atención médica. MO AET /07/16 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 Important toll-free numbers Member Services Transportation Transportation Fax 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 QUITNOW TTY/TDD 711 or