ealthword Tobacco Awareness Safety Alert! Prescription Drugs Spring 2015 Your newsletter from BlueChoice HealthPlan National Day

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1 Member Rights HIPAA External Review Claims and Benefit Information ealthword Spring 2015 Your newsletter from BlueChoice HealthPlan Tobacco Awareness National Day Medication Safety Alert! Prescription Drugs Tools for the Informed Consumer

2 Health and Wellness National Day Walking is one of the first things we learn to do and one of the most important. A brisk 30-minute walk each day is one of the healthiest things you can do for yourself. Regular walking can help lower your blood pressure and reduce your risk of diabetes and heart disease. The problem is working those 30 minutes into your busy schedule. That s why we want you to join us at a National Walk@Lunch event near you and start a commitment to walk every day. Columbia: Wednesday, April a.m. until 2 p.m. S.C. State House Greenville: Friday, May 1 11 a.m. until 2 p.m. Falls Park Charleston: Friday, May 1 11 a.m. until 2 p.m. Marion Square So put the date on your calendar and plan to start walking toward better health! Making the Most of Your Doctor Visit Visiting the doctor can be stressful. But there are things you can do to make it less stressful and get the most out of each appointment. Here are some tips: Before Your Appointment Make a list of the medications you take. Include: Prescription medications Over-the-counter medications Vitamins and herbal supplements Be prepared to discuss your family medical history, including ailments that may run in your family. Are there questions or concerns you need to discuss with your doctor? Write them down so you won t forget. Consider following these tips during your appointment: Take notes. It can be hard to remember everything the doctor says. Take a notepad with you to your appointment. Tell your doctor about your concerns and questions. Discuss any symptoms you are having and tell the doctor how long you ve had those symptoms. Make sure you are honest with your doctor. Don t leave anything out. This may mean disclosing personal information, but your doctor needs all the details to determine what type of treatment you need. Before you leave, be sure you have answers to these important questions: ONE What is my main problem? TWO What do I need to do? THREE Why is it important for me to do this? FOUR Are there any less expensive medicines I can use? 2 HealthWord Spring 15

3 Health and Wellness Tobacco Awareness Nationwide we are experiencing greater public awareness about health risks associated with tobacco use. This has led to an increased number of smoke-free workplaces and other public places, such as restaurants and bars. We have learned that any exposure to tobacco smoke is harmful. This includes occasional use or exposure to secondhand smoke. As a result, approximately 80 percent of Americans are non-tobacco users. There are still concerns. The Health Consequences of Smoking: 50 Years of Progress, the 50th Anniversary Surgeon General s Report on Smoking and Health published in 2014, reports 1 in 5 individuals are tobacco users and 9 out of 10 tobacco users started before age 18. Although cigarettes may be the most common type of tobacco product used, other forms are used as well. Cigars are often not inhaled and may be viewed as less harmful and addictive. In the past, cigar smoking was most associated with older men. But with the availability of smaller, flavored cigars, young men and women are now smoking them. Smokeless tobacco sold moist or dry is also known as snus, snuff, chew or dip. People use smokeless tobacco by placing it between the cheek and the gum. After a while, they spit it out. Water pipes, also known as hookahs, are used to smoke flavored tobacco. Hookah lounges are places where a group of people get together to share a water pipe with drinks or after a meal. Hookah lounges are a growing trend among young adults who do not normally smoke cigarettes or use other forms of tobacco. Electronic cigarettes (e-cigs), also known as vape pens, e-hookahs and hookah pens, often look like traditional cigarettes. These are battery-powered vaporizers. They turn a liquid, usually containing nicotine from tobacco and flavorings (e-liquid), into an aerosol that the user inhales. The amount of nicotine in the aerosol may vary by brand. At this point, there is little information about the safety of electronic cigarettes. What can you do? Be an advocate: Inform family members and friends about the dangers of tobacco use. If you know someone who is trying to quit using tobacco, be patient and supportive. If you use tobacco, consider making 2015 the year that you quit. HealthWord Spring 15 3

4 Health and Wellness Antibiotics Aren't Always the Answer Using antibiotics too often can make them ineffective when you need those most to treat bacterial infections. Antibiotic overuse may also lead to developing antibiotic resistant infections. If you or your child has a viral infection (like an upper respiratory infection), antibiotics are generally not recommended. Play it safe and talk to your child s doctor about what treatments are most appropriate. Medication Safety Alert! Did you know some medicines you take to control diabetes, heart problems or high blood pressure need extra follow up to make sure they are working the right way for your body? If you have been taking any of these medicines for more than six months and haven t been back to the doctor for follow up blood lab tests, please call your doctor s office to schedule an appointment. Medicines that need follow-up lab tests at least once a year to make sure they are working well in your body are: Angiotensin converting enzyme (ACE) inhibitors Angiotensin receptor blockers (ARBs) Digoxin Diuretic (water pills). Depending on the test results, your doctor might need to make changes to your medicines to make sure you are as healthy as possible. Call your doctor s office to schedule your next follow-up appointment if you haven t already done so. 4 HealthWord Spring 15

5 Health and Wellness ACE INHIBITORS/ARBS Angiotensin converting enzyme inhibitors Benazepril Captopril Enalapril Fosinopril Lisinopril Moexipril Perindopril Quinapril Ramipril Trandolapril Angiotensin II inhibitors Azilsartan Candesartan Eprosartan Irbesartan Losartan Olmesartan Telmisartan Valsartan Antihypertensive combinations Aliskiren-valsartan Amlodipine-benazepril Amlodipinehydrochlorothiazide-valsartan Amlodipinehydrochlorothiazide-olmesartan Amlodipine-olmesartan Amlodipine-telmisartan Amlodipine-valsartan Azilsartan-chlorthalidone Benazepril-hydrochlorothiazide Candesartan-hydrochlorothiazide Captopril-hydrochlorothiazide Enalapril-hydrochlorothiazide Eprosartan-hydrochlorothiazide Fosinopril-hydrochlorothiazide Hydrochlorothiazide-irbesartan Hydrochlorothiazide-lisinopril Hydrochlorothiazide-losartan Hydrochlorothiazide-moexipril Hydrochlorothiazideolmesartan Hydrochlorothiazidequinapril Hydrochlorothiazidetelmisartan Hydrochlorothiazidevalsartan Trandolapril-verapamil DIGOXIN Digoxin DIURETICS Carbonic anhydrase inhibitors Digoxin Lanoxin Lanoxicaps Cardoxin Digitek Acetazolamide Diamox Diamox Sequels Methazomalide Daranide Glauctabs MZM Neptazane Loop diuretics Torsemide Demadex Bumetanide Bumex Furosemide Lasix Ethacrynic acid Edecrin Sodium Edecrin Potassium-sparing diuretics Triamterene Dyrenium Spironolactone Aldactone Amiloride Midamor Thiazide diuretics Indapemide Lozol Thalitone Chlorthalidone Hydrochlorothiazide HydroDiuril Metolazone Zaroxolyn Mykrox Methyclothiazide Aquatensen Aquazide H Enduron Esidrix Microzide Bendoflumethazide Naturetin Saluron Chlorothiazide Diuril Diuril Sodium Polythiazide Renese Miscellaneous diuretics Pamabrom Aqua-Ban with Pamabrom Aqua-Ban Diurex Aquagels Diurex Water Capsules Mannitol Aridol Osmitrol HealthWord Spring 15 5

6 ollars & Sense Dollars and Sense Prescription Drugs: Tools for the Informed Consumer Rising drug costs continue to add to the ever-increasing cost of health care. Most people have seen their pharmacy costs rise. One thing you can do to combat this trend is become better informed and work with your doctor to make the most of your health care dollars. As a BlueChoice HealthPlan member, you have access to lots of information at your fingertips when it s convenient for you. Our Drug Coverage and Cost tool can help you make smart decisions about prescription drugs. You can compare costs and search for generic alternatives or preferred brand drug options that may be available at lower cost to you. There s just no downside to becoming an informed consumer! Get started today. When you go to our website, log into My Health Toolkit directly from the home page. If you ve never done this, it only takes a few minutes to register. Once logged in, select the Benefits tab at the top of the page. Then go to the pharmacy section and select Drug Coverage and Cost. When you access the links in the Prescription Drugs section for the first time, you will need to register at Caremark is an independent company that provides pharmacy benefit management on behalf of BlueChoice HealthPlan. After the initial registration, you will only have to log into My Health Toolkit to view your pharmacy-related information. 6 HealthWord Spring 15

7 Dollars and Sense Save Time: Go Paperless Eliminate the paper clutter and go paperless with your Explanations of Benefits (EOBs). When you go paperless, you will receive notifications when new EOBs are available. Then, just log in to My Health Toolkit to view and download your secure EOB. EOBs are available 24 hours a day, seven days a week. This way you save time by going green! If you aren t receiving notifications about paperless EOBs, that means we don t have an address on file for you. It is easy to get started: Visit Log in to My Health Toolkit (or create a profile if you haven t set it up already). Choose Change Notifications under the profile menu. Select online. Provide a valid address. Any time you receive health care services, we ll let you know by as soon as your new paperless EOB is available in My Health Toolkit. HealthWord Spring 15 7

8 Healthier Lifestyles A Serious Health Risk for Men and Women Did you know? Chlamydia is the most commonly reported bacterial infection in the United States, affecting millions of people every year according to the Centers for Disease Control and Prevention (CDC). The CDC is an independent agency that provides health information on behalf of BlueChoice HealthPlan. This infection is a health concern for men and women of all ages. Chlamydia can cause severe health complications, including infertility. Screening is essential. The only way to find out if you have chlamydia is to get tested. Many people with this communicable disease do not have any symptoms, so they don t even realize they are infected. When to get tested. Ask your doctor if you should get tested during your yearly health exam or doctor s visit. You may not be tested automatically for this infection. Testing is simple. Your doctor can screen for chlamydia using a simple urine test or during a Pap test. If the test is positive for chlamydia, the doctor can prescribe medications and inform you of ways to prevent this infection from recurring. Get screened. Don t delay chlamydia screening if the doctor recommends it for you. It may save you from damaging your health permanently. 8 HealthWord Spring 15

9 Healthier Lifestyles Mom Support Program Health Coaching for Moms Depression is common during and after pregnancy. Having a baby can be one of the most exciting and rewarding events in your life. It can be stressful, too. Many mothers experience sadness, fear, confusion and anxiety during pregnancy and after childbirth. Women who have depression during pregnancy are more likely to have symptoms after giving birth. Depression is a serious illness. It is more than just feeling blue for a few days. Depression can interfere with your ability to function, including your ability to care for yourself and your child. The good news is that depression is treatable. It is important to start treatment as soon as depression is recognized. Companion Benefit Alternatives (CBA) offers a Mom Support Program for members through health coaching. CBA is a separate company that manages behavioral health benefits on behalf of BlueChoice HealthPlan. The Mom Support Program is free and voluntary. Health coaches can offer you extra support while helping you get your life back to normal. We do this by: Providing guidance and support through scheduled phone calls. Identifying facilities and providers to best help the mother. Setting short- and long-term goals throughout recovery. Supplying family members with information to help their loved ones.* You do not have to suffer alone if you are feeling depressed during pregnancy or after having a baby. With treatment and support, you can get back on the road to happy motherhood. If you or someone you love could benefit from this program, please contact CBA s health coaching team at , ext Source: U.S. Department of Health and Human Services, an independent agency that provides health information on behalf of BlueChoice HealthPlan. HealthWord Spring 15 9

10 Your Health Plan Member Rights and Responsibilities As a member, you have certain rights and responsibilities. A summary is available online and we update it as needed. If you do not have access to the Web and need a copy of your Member Guide, our Prescription Drug List or the Member Rights and Responsibilities, please call our Member Services department at , Monday through Friday, 8:30 a.m. until 6 p.m. HIPAA Notice of Privacy Practices This is a reminder that our Notice of Privacy Practices is available to you through our website, www. BlueOptionSC.com, per the Health Insurance Portability and Accountability Act (HIPAA). Or, you can call our Member Services department at to receive one by mail. External Review Procedures We are committed to quickly resolving your concerns and problems. There are state and federal laws that allow you to ask for an external review, in some cases, when we deny payment for a claim. These situations have different guidelines based on various things. Please call Member Services to find out your specific options for an external review. The Health Carrier External Review Act, a state law, allows you to ask for an external review in some cases when we deny payment for a claim. If you qualify for an external review, we will inform you in writing and explain the process to follow. For more details about the appeals process, please see your Member Guide or visit us online at Women s Health and Cancer Rights Do you know that your coverage, as required by the Women s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services? These services include all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses and complications resulting from a mastectomy, including lymphedema. Check your certificate of coverage or individual contract for information on this benefit or call BlueChoice for more information. Claims and Benefit Information Want to know if we paid a specific claim, what your benefits are for a specific service or what your copayments and other charges were? Find this information and more when you visit the secure My Health Toolkit section of our website. 10 HealthWord Spring 15

11 Your Health Plan Member Guide Your Member Guide is a great place to find many important details about your benefits. You can find your Member Guide on our website. Go to and select the Members tab. Then choose Resources on the right side of the page and then Member Guide. The guide will help you understand your Blue Option Member Guide Blue Option Plans benefits and make the most of your coverage. Here s some of the information in the guide: How to access primary care, specialty care, behavioral health services, hospital services and much more How to get after-hours care, urgent care and emergency care How to find care and coverage when you re outside the service area How to submit a claim yourself How we coordinate benefits How we administer benefits for appropriate services, including our policy on not providing incentives to deny coverage of care or services How we decide what new technology we will include as a covered benefit How to get information on our quality improvement program How to voice a complaint or appeal a decision How our privacy practices work How to get information about network providers qualifications and other provider information How your benefits work Restrictions on benefits you receive outside the system How to get language assistance Prescription Drug Information Get details about medications, price comparisons, your prescription history and up-to-date information on our pharmacy procedures and prescription drug lists. Plus, if your coverage offers a mail-order pharmacy benefit, you can order your refills online. Just go to the Pharmacy section under Benefits in My Health Toolkit. We Leave Medical Decisions To Doctors and Patients! We make decisions about approving services based on the appropriateness of care and in agreement with your plan of benefits. We do not reward providers or other individuals for denying coverage or care. And we do not offer financial incentives to decision-makers to encourage decisions that result in underutilization of care. Quality Program At BlueChoice, we are proud of the quality improvement activities we have to benefit our members. To maintain our high standards, we have an active Quality Improvement program that oversees quality improvement studies, member satisfaction surveys and member complaints. We continuously monitor clinical and service quality issues. We document this process in our annual Quality Improvement Evaluation and Action Plan. If you would like to receive more information about our Quality Improvement program or the annual evaluation, please call us at You can also find information about various aspects of plan performance and quality indicators on our website in the About Us section. HealthWord Spring 15 11

12 Post Office Box 6170 Columbia, SC PRSRT STD US POSTAGE PAID PERMIT NO 1240 COLUMBIA SC HealthWord is a publication of BlueChoice HealthPlan. BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. HealthWord is a newsletter for BlueChoice HealthPlan members. It provides information only and does not replace the advice of your doctor. You always should see your doctor for personal medical advice. Do you have questions about your BlueChoice HealthPlan coverage? Try our website at We re open 24 hours a day here! Member Services Phone Numbers: :30 a.m. to 6 p.m., Monday Friday ealthword Spring 2015