Newsletter. Has Your Preteen/Teen had an Annual Physical? IN THIS ISSUE uu

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1 Fall 2016 Member Newsletter Maryland HealthChoice Program Has Your Preteen/Teen had an Annual Physical? A physical exam by your child s primary care provider (PCP) will not only allow him or her to develop a relationship with his or her doctor, but also identify any potential physical, mental or developmental health problems. During a physical, the doctor will do a variety of screenings, including: IN THIS ISSUE uu Member Rights and Responsibilities... 3 Your Links to Good Health... 5 Here When You Need Us 24/7 Nurse Advice Line... 5 Access to Clinical Practice Guidelines... 5 We Care About Your Health and Wellness and Want You to Earn $ Developmental screening Back to School Tips for Success... 6 Mental health screening Preventing the Flu: Good Health Habits Can Help Stop Germs... 6 Vision screening Need Help Managing Your Health Problems?... 7 Hearing screening Another important reason your preteen/teen needs to be seen yearly is to make sure they are up to date with all of the recommended immunizations (shots). According to the Centers for Disease Control and Prevention (CDC), there are four vaccines recommended for preteens and teens these vaccines help protect your children, their friends and their family members. One of the recommended vaccines for preteen/teen boys and girls is the HPV vaccine. The HPV vaccine can prevent certain cancers and other diseases caused by human papillomavirus (HPV). You can always ask your child s PCP if your child is due for any vaccines during any type of visit: checkup, sick visit, school physical, or sports physical. This is a time in your child s life when he or she (continued on next page) Contact Us Anytime You Need Help... 7 You Can Earn $35 in Gift Cards for Completing Online Momma & Me Workshops... 8 Free Interpreter Services Available... 8 Why Members Should Follow up with Their Primary Care Provider (PCP)... 9 Pregnancy and You...10 MedStar Family Choice Receives Top Quality Scores...11 What You Need to Know About Getting a Referral for a Specialist...12 Member Complaint/Grievance and Appeal Process...12

2 (continued from page 1) may be faced with many challenging decisions. Your child s doctor will talk with your son or daughter about certain behaviors or safety issues, such peer pressure, bullying, sexual activity, preventing sexually transmitted diseases, and the dangers of trying alcohol and drugs. Because MedStar Family Choice feels it is so important for your preteen/teen to receive his or her physical exam, we will give your child a $25 Walmart gift card. All 12- to 21-year-old members who receive their physical and shots before Dec. 31, 2017, will be entered in a drawing. The three lucky drawing winners will get to pick one of the following: an ipad mini, laptop computer or a $250 gift card to a clothing store, though certain rules apply. Their parent or guardian will also receive a $100 Walmart or Giant gift card (certain rules apply). If you need assistance getting your child s physical scheduled or if you have any questions, please call Janelle at or Theresa at Congratulations Members from Prince Georges County and Harford County completed their annual physicals, and won a drawing for a $250 gift card and an ipad mini. You could be next! Get your physical today! 2

3 Member Rights and Responsibilities You have the right to: Be treated with respect and dignity, no matter your race, color, creed, ancestry, marital status, political affiliation, national origin, age, sexual orientation, religion, gender, personal appearance, physical or mental disability, or type of illness or condition. Have access to care no matter your race, color, creed, ancestry, marital status, political affiliation, national origin, age, sexual orientation, religion, gender, personal appearance, physical or mental disability, or type of illness or condition. Choose someone who will have the legal right to make healthcare choices for you if you become unable to say your wishes yourself. Refuse any treatment by a provider and be told what might happen if you don t have the treatment. Discuss all of the appropriate or medically necessary treatment options, regardless of the cost or whether they are covered by your health plan. MedStar Family Choice does not restrict providers from discussing all of the appropriate or medically necessary treatment options with members. Privacy your medical records and all information about your health is private and will only be shared in a manner that follows state and federal laws. Privacy during treatment Information you may ask for information about MedStar Family Choice, its services, its doctors and other caregivers, and about your rights and responsibilities as a member of the health plan. Make recommendations regarding your rights and responsibilities as a member of MedStar Family Choice. Ask for the qualifications of the people treating you. Choose a primary care provider (PCP) from MedStar Family Choice s listing of doctors. Be told what your health problem is, what treatment you will be given and what risks are related to your illness and treatment. This must be told to you so that you understand the information. Talk to your doctor and help to make choices about your health care and treatments. Develop advance directives or a living will. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation. Request and receive a copy of your medical records and request that they be amended or corrected as allowed. Exercise your rights and know that the exercise of those rights will not adversely affect the way that MedStar Family Choice or our providers treat you. File a complaint, appeal or grievance with us and have it resolved in a reasonable amount of time. For example, the complaint, appeal or grievance could include a concern about the care you received. File a complaint, appeal or grievance against MedStar Family Choice with the state. State fair hearings Request that ongoing benefits be continued during an appeal or state fair hearing; however, you may have to pay for the continued benefits if our decision is upheld in the appeal or hearing. 3

4 (continued from page 3) Receive a second opinion from another doctor within MedStar Family Choice if you don t agree with your doctor s opinion about the services that you need. Contact us at for help with this. Receive other information about us, such as how we are managed. You may request this information by calling It is your responsibility to: 4 Read the member handbook so that you can understand the services provided and how to contact MedStar Family Choice with questions. Be courteous and respectful to MedStar Family Choice staff, healthcare providers and office staff. Tell the truth about your health. You must tell us about operations you had before, what medicines you use or have used in the past, and you must tell your provider any information we may need in order to provide care to you. Do what your doctor tells you to do to get well or stay well. Follow the plans and instructions for your care that you and your healthcare provider have agreed to. Live a healthy lifestyle, which includes seeing your doctor regularly and following preventive care guidelines, such as screenings and immunizations. Accept what might happen to you if you refuse treatment or if you do not follow the advice given to you. Tell your doctor if your health changes in any way that you did not expect. Know the name of your primary care provider (PCP) and get your PCP s okay before getting care from anyone else. Make appointments with your PCP during office hours instead of using the emergency room for things that are not emergencies. Be on time for all your appointments. Let the office know at least 24 hours ahead of time when you cannot keep an appointment. Carry your ID card and photo ID with you always. Tell the people in the doctor s office, lab, drug store, or anywhere that you are getting health care, that you are a MedStar Family Choice member. Ask questions about your care. Make sure that you understand what your health problem is, and that you understand your treatment and you participate in developing treatment goals that both you and your doctor agree on. Notify MedStar Family Choice of any car accidents, falls, etc., where someone else may be at fault. You must work with MedStar Family Choice concerning the accident and the bills. Call Member Services toll-free at if you are having any problems getting the care you need. Notify MedStar Family Choice, the local health department and/or your DSS caseworker if you move. Complete your renewal applications in a timely manner to prevent gaps in your health insurance. Report any other health insurance coverage to your doctor and MedStar Family Choice. Give your doctor a copy of your living will and advance directive if you have one. Report any known or suspected fraud and abuse as it relates to benefits, services or payments. Please contact our Member Services department at

5 Access to Clinical Practice Guidelines MedStar Family Choice members: did you know Clinical Practice Guidelines will be made available to all members upon request. Look for additional information in upcoming newsletters and on the MedStar Family Choice website at MedStarFamilyChoice.com. Your Links to Good Health You can find valuable information about all of the healthcare benefits offered at MedStar Family Choice on our website. If you are interested in additional information about MedStar Health hospitals, check out the following websites: MedStarHealth.org, ZocDoc.com and MedStarFamilyChoice.com. If you do not have access to the Internet, you may call our Member Services department at for a listing of classes. Here When You Need Us: 24/7 Nurse Advice Line MedStar Family Choice knows that a health problem can happen when you least expect it. That s why we offer a nurse advice line 24 hours a day, seven days a week. Just pick up the phone and call. If you have an illness, injury or just a question about your health, our nurse advice line can help you get the care you need whenever you need it. Call any time. We Care About Your Health and Wellness and Want You to Earn $25 MedStar Family Choice is excited to offer our members an online program to help them establish and reach their wellness goals. If you are ready to get motivated and improve your health, log in and create an account at MedStarFamilyChoiceHealthyLife.com. This secure online portal is easy to use, and there is something for EVERYONE! You can get started on your wellness journey by completing a health survey, exploring the health library, enrolling in a wellness workshop, or starting an exercise plan. There are many different tools you can use to monitor your progress: Weight log Body measurement log Healthy recipes Blood pressure log Health overview log Water tracker Members who complete their health survey and a three-week wellness workshop will be eligible to receive a $25 gift card. So don t miss out! Get started your health and wellness journey today! 5

6 TEEN TALK Tips Back to School Tips for Success Too much stress can affect the mind and body. Stress can affect many parts of your body that you may not realize. For teens, school is one of the top stressors. Preventing the Flu: Good Health Habits Can Help Stop Germs Want to stop cold and flu in their tracks? 1. Avoid close contact. Stress can be caused by: 2. Stay home when you are sick. Homework/school 3. Cover your mouth and nose. Family 4. Clean your hands. Working in group settings 5. Avoid touching your eyes, nose or mouth. Activities outside of school 6. Practice other good health habits. Helpful tips to lower stress, and stay health: Try to find a balance between school and personal time. It s ok to have fun, too! Find an activity you enjoy, such as reading or team sports. Eat a balanced diet, including fruits and vegetables. Talk to a close friend, family member, if you need extra help and are overwhelmed. 6 Source: CDC.Gov/Flu/Protect/Habits.htm Did you know? You can spread the flu before you know you are sick. Most people are contagious at least one day before having symptoms, and five to seven days after becoming sick. The time from when a person is exposed to the flu virus to when symptoms begin is about one to four days, with an average of about two days. People 65 years and older, people of any age with certain chronic medical conditions (such as asthma, diabetes, or heart disease), pregnant women, and young children are especially at risk for flu-related complications. Source: CDC.gov/Flu/KeyFacts.htm

7 Need Help Managing Your Health Problems? We understand that some health problems are hard to manage on your own. MedStar Family Choice has nurses and social workers who can help you manage health problems like diabetes, asthma, COPD, wounds, chronic pain, and even substance abuse. We also have a nurse who can help you if you have a highrisk pregnancy. MedStar Family Choice nurses and social workers are here for you if you need a transplant, have many health problems and need help coordinating your care, or have suffered an event that leaves you unable to care for yourself. You can learn more about our Complex Case Management program and our Disease Management programs on our website at MedStarFamilyChoice.com. If you would like to join one of our programs, you can call , option 2. Contact Us Anytime You Need Help Please contact MedStar Family Choice if you have any questions or concerns about the services we provide. The MedStar Family Choice staff is available Monday through Friday from 8:30 a.m. to 5 p.m. You can also call our Member Services department at toll free, Monday through Friday, from 8:30 a.m. to 5 p.m. Please call during normal business hours to have your issues addressed. You may leave us a nonurgent message after hours. Calls received after normal business hours will be returned the next business day. Important Numbers to Know: Outreach/Care Management phone: or Case Management fax: or Utilization Management fax: or Outreach fax: or Member Services phone: Nurse Advice Line phone: , 24 hours/7 days a week 7

8 You Can Earn $35 in Gift Cards for Completing Online Momma & Me Workshops Moms-to-be, Did you know that you can earn $35 in gift cards for completing the MedStar Family Choice, Healthy Life Portal Momma & Me online workshop? Earn $25 in gift cards for completing the Prenatal/Breastfeeding course. Earn $10 in gift cards for completing Infant Safety courses and enjoy access to topics like: Healthy Weight Gain Labor and Delivery Crib Safety... and many more Log in and register at: MedStarFamilyChoiceHealthyLife.com. Free Interpreter Services Available If you know a MedStar Family Choice member who does not speak English or doesn t speak it well call Member Services toll-free at We have interpreters to help members when visiting their doctors. We will also provide an interpreter to help members who do not speak English or read written information sent by Member Services. If you or someone you know is deaf or has trouble hearing, a TTY line is available. Just call In addition, members can access Maryland Relay for TTY assistance. MedStar Family Choice also has people available who can use sign language to help you during doctor visits. You, or someone who can speak for you, must let the Member Services representative know that you need an interpreter. Si necesita un interprete, por favor contacte al departamento de Servicio al Miembro al

9 Why Members Should Follow Up with Their Primary Care Provider (PCP) Your primary care physician gets to know you over a period of time. They get a sense of the person you are. They can get to know your values, your family situation, your job pressures, and maybe even your goals. These may seem like unimportant pieces in relation to your health care, but they can all have a major impact on your health. Understanding these things may provide valuable information as they show what is troubling you. Following up with your primary care physician can help ensure you are healing correctly after your ER visit and on your way back to healthy living. Another option for being treated quickly is MedStar PromptCare. These centers are meant to provide individuals with medical assistance for treating conditions that are not life-threatening, but require attention immediately. These minor conditions can include flu, fever, cuts, sprains, insect bites, and mild fractures. These facilities offer extended hours and do not require an appointment. Here are a few more reasons: Your primary care physician will be able to guide you through maintaining and improving your health, and ultimately coordinating your health care. Your primary care doctor treats you regularly and should be involved with your health. He or she can help educate you about your health. You should follow up with a primary care provider who can step back and look at the big picture of your health especially during times when a diagnosis is needed. This is what primary care physicians are trained to do. Any set of symptoms can have a lot of possible explanations. A primary care physician has to have an open mind, listen carefully and consider all the possibilities. Bottom line is follow up with your primary care physician after an ER or urgent care visit. Stay healthy! 9

10 Pregnancy and You If you are thinking about becoming pregnant: Talk to your doctor you should be in your best health before you become pregnant! Stop smoking. Stop alcohol and illegal drug use. Are your current medications safe in early pregnancy? Are your immunizations up to date? Discuss safe sex practices to avoid infections. Should you take any vitamins or folic acid? Once you become pregnant: Make an appointment with your OB provider as soon as possible. Women who receive early and regular prenatal care have healthier babies! You will need to have urine screening tests, blood tests, cervical cancer screenings, and cultures several times during the pregnancy. Your provider is unable to check your baby directly and this is the only way for the provider to determine if you are still healthy enough to carry your baby. You may have several sonograms during your pregnancy. Sonograms are used to check the baby s growth, the baby s anatomy (are things looking normal), the amount of fluid around your baby, and the health of your placenta and/or cervix. Sonograms are never indicated just to determine the sex of your baby. What do to prepare for your baby: Avoid secondhand smoke, alcohol and drugs. Sign up for childbirth classes. Pick a pediatrician (baby doctor) and make an appointment to meet them. Decide if you are going to breastfeed or bottle feed your baby. Baby supplies: car seat, crib or bassinet, clothes, diapers, feeding supplies. Choose a birth control method and discuss this with your provider. Ask family and friends for help at home after you deliver. Don t forget during that first week home, you will need to schedule you baby s first pediatrician appointment and your post partum appointment! You need to be healthy to care for your baby! MedStar Family Choice cares about your health and the health of your baby! Please call us using the numbers below with any questions or concerns: During business hours: , press 2 to speak with a nurse in our Maryland office After business hours: (24-hour nurse hotline) 10

11 MedStar Family Choice Receives Top Quality Scores The Maryland Department of Health and Mental Hygiene (DHMH) is required to review the quality of care provided to Maryland Medicaid members who a part of Healthchoice Managed Care Organizations (MCO). To ensure that the services provided to members meet established regulations, DHMH uses the Delmarva Foundation for Medical Care Inc. (Delmarva) as an outside agency to review quality and performance. MedStar Family Choice continues to receive top scores for performance standards by Delmarva. For the 2016 audit, MedStar Family Choice received a score of 100 percent on their performance review in all areas. This is the sixth year that MedStar Family Choice received 100 percent on the annual audit. This review looks at the following standards: The Delmarva results show that MedStar Family Choice: Demonstrates continuing strength within its operating structure resulting from its cross-departmental and community based communication and collaboration which are directed at improving member care and services MedStar Family Choice s EPSDT notification letter is very easy to understand and provides an overview of what EPSDT is, and offers a number for the member to contact should they wish to change their PCP to one that is EPSDT certified. Consistently meets timeframes for the appeals process and explains the appeal process clearly to its members Quality Improvement Accountability to the Governing Body Oversight of Delegated Entities Credentialing and Re-credentialing Enrollee Rights Availability and Accessibility Utilization Review Governing Body Continuity of Care Health Education Outreach Fraud And Abuse 11

12 What You Need to Know About Getting a Referral for a Specialist Did you know that most primary care providers (PCP) will give you great advice about the healthcare service you need? When you visit your PCP, if any of your medical conditions require you to see a specialist, the PCP will refer you to one in our network. If an innetwork provider is not available, MedStar Family Choice will help arrange one for you outside of our network. If your PCP can handle the condition without referring you, he or she will treat your medical condition. Remember, if you are a female member and your PCP is not a women s health specialist, you have the right to see a women s health specialist within the MedStar Family Choice network without a referral. Also, if you feel like you want a second opinion, you have the right to obtain one from another in-network provider. If another in-network provider is not available, MedStar Family Choice will help arrange a second opinion outside of the MedStar Family Choice network at no cost to you. You can contact your PCP or Member Services at for help getting a second opinion. A referral may be required. Always remember that most physicians will need to see you in the office before a referral is written to a specialist. If you have any questions or concerns about the healthcare services you receive, don t hesitate to contact the Member Services department toll free at to ask for help. Member Complaint/Grievance and Appeal Process The MedStar Family Choice complaint/grievance and appeal procedure can be found on our website at MedStarFamilyChoice.com or in your member handbook. If you do not have access to our website, you may call our Member Services department at for a copy of the process. The process includes information on: How to file a complaint, grievance or appeal, and the differences between them How quickly we will respond to you What to do if you do not agree with our decision In addition, members always have the right to contact the HealthChoice Enrollee Help Line at , Monday through Friday, 7:30 a.m. to 5:30 p.m., when you have a concern about a denial or appeal. The MedStar Family Choice member newsletter is a publication of MedStar Family Choice. Submit new items for the next issue to Arion Long, managing editor, arion.k.long@medstar.net. 16-MFCMD King Ave., Suite 400 Baltimore, MD PHONE MedStarFamilyChoice.com Kenneth Samet MedStar Health, CEO Arion Long Managing Editor Health Plan Communication Specialist David Finkel President Patryce Toye, MD Medical Director