New Jersey 2015 ISSUE I Weight-Loss Myths: 3 Popular Weight-Loss Ideas That Are False Myth 1: Starches are fattening. Foods that are high in starch provide the carbohydrates that our bodies use for energy. This includes bread, rice, pasta, beans, fruits, potatoes and yams. These foods can be good if you eat the proper amounts. Eating too much of them can cause problems. So can adding fatty toppings like butter, cheese or sour cream. Myth 2: Low-fat or fat-free means no calories. Low-fat or fat-free foods often contain sugar, flour or starch thickeners. These add calories. Always check nutrition labels. This way, you know how many calories are in the food you eat. BMI Below 18.5 Weight Status Underweight 18.5 24.9 Normal 25.0 29.9 Overweight 30.0 and above Obese What is BMI? It is a number that shows body fat. It s a measure of your weight and height. BMI can screen for weight issues. Refer to the above chart. To calculate your BMI online, visit 1.usa.gov/1dSzT3p. Myth 3: Eating after 8 p.m. causes weight gain. When you eat doesn t affect your weight. Weight is affected by what you eat, how much you eat and how much physical activity you get. Your body stores extra calories as fat. So think about your calorie intake for the day. Also watch your body mass index, or BMI. Source: Weight-control Information Network, http://win.niddk.nih.gov/publications/myths.htm 092-15-001
Keep Your Child Safe From Lead Lead is a metal and is found in some paints, dust and other sources. It can be harmful, especially to children younger than age 6. All homes built before 1978 are likely to contain some lead-based paint. However, it is the peeling/chipping of the paint that causes a problem. Why Is Lead Harmful? Exposure to lead can be bad for developing brains and other organs. It can cause serious problems, such as: Speech, language and behavioral problems; Learning disabilities and attention deficit disorder (ADD); and Damage to the brain and nervous system. What Can You Do? Make sure your child has a blood lead test. This should happen at ages 12 months and 24 months and between ages 2 and 6. Other steps you can take: Wash floors, windowsills, toys and pacifiers often. Use cold tap water for making baby formula, drinking and cooking. Let the water run for a couple of minutes first. Keep children away from areas of peeling paint. Are you remodeling or renovating your home? Avoid exposure to lead dust. For tips on handling lead, call 1-800-424-LEAD (5323). Lastly, don t try to remove leadbased paint yourself. Prevent Childhood Lead Poisoning When lead-based paint peels, it makes lead dust. This dust can poison children if they breathe it or swallow it. Certain water pipes may contain lead. Lead may be found in candy imported from other countries. Avoid eating candies imported from Mexico. Lead can be found in some toys. If your child has had contact with chemicals and is unconscious or having trouble breathing, call 911. You may also contact your area Poison Control Center 24/7 at 1-800-222-1222. Source: Centers for Disease Control and Prevention, www.cdc.gov 2 Member Newsletter
When Should Children Get Check-Ups? Children grow quickly and this rapid growth makes check-ups important in a child s early years. A child s first check-up should be two or three days after birth. Then check-ups should be done regularly between months 1 and 18. At 12 months and 24 months, check-ups should include a blood lead test. After a child turns age 2, check-ups should happen yearly. An eye screening and a flu shot should be done at the age 3 check-up. At ages 4 and 5, check-ups include eye screenings, urine tests, vaccines and a catch-up blood lead test if the child hasn t been tested yet. Starting at age 6, kids need a check-up and flu shot every year. This helps doctors make sure the child is growing up healthy. Source: www.cdc.gov/vaccines/schedules CAHPS : Health Care Quality From Your Point of View What is CAHPS? It stands for Consumer Assessment of Healthcare Providers and Systems. It s a program that asks members what they think about their quality of care. In February, you may get a CAHPS survey by mail or over the phone. If you do, please complete and return it. Your answers will be kept private. They will help WellCare improve programs and services for you. You make a difference! Topics in the survey may include: How well you can access the care you need; How well your providers communicate with you; Your experiences with Customer Service; and The health care information you receive. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality. To learn more about CAHPS, its products and its services, visit www.cahps.ahrq.gov. Member Newsletter 3
Heart Disease Facts: What You Need to Know About Heart Disease, High Blood Pressure and Cholesterol According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for both men and women. Maintaining healthy blood pressure and cholesterol levels reduces your risk for heart disease. Ask your primary care provider (PCP) to perform these screens. Here are some tips to protect your heart: Have your PCP check your blood pressure yearly. A reading of 119/79 or lower is normal blood pressure. If you re taking medications, take them as directed by your PCP. Get your cholesterol checked at least every five years. Refer to the chart below. Eat lots of fruits, vegetables and low-fat dairy. Try to avoid salt and saturated fat. Take three brisk 10-minute walks a day, five days a week. Limit alcohol. Don t smoke. If you smoke, quit as soon as you can. Visit www.cdc.gov/tobacco for tips. Make an appointment with your PCP for screenings. Or call Customer Service at 1-888-453-2534 for help with choosing a PCP. Healthy Cholesterol Levels Total cholesterol LDL, or bad, cholesterol HDL, or good, cholesterol Triglycerides Less than 200 mg/dl Less than 100 mg/dl 60 mg/dl or higher Less than 150 mg/dl Sources: American Heart Association, retrieved from www.heart.org; Centers for Disease Control and Prevention, retrieved from www.cdc.gov/heartdisease/facts. htm, www.cdc.gov/dhdsp/data_statistics/ fact_sheets/fs_cholesterol.htm, www.cdc. gov/dhdsp/data_statistics/fact_sheets/ fs_bloodpressure.htm 4 Member Newsletter
When Should Dental Care Start? Dental Care Tips for Your Child Run a damp washcloth over your baby s gums following feedings. Never allow your child to fall asleep with a bottle containing anything but water. Schedule your child s first dental visit when the first tooth comes in, but no later than his or her first birthday. Take your child for a dental checkup between ages 1 and 2, and then every six months until age 18. Make sure that all treatment recommended by your dentist is completed. Brush with just a smear of fluoride toothpaste and a soft toothbrush for children younger than age 2. Use a pea-sized amount of toothpaste with fluoride for children ages 2 and older. Ask your PCP or dentist about fluoride supplements. Ask About Fluoride Varnish Fluoride varnish is a safe coating that is painted on a child s teeth. It makes teeth stronger and helps prevent or stop cavities. Ask your child s health care provider or dentist about fluoride varnish. Source: MedlinePlus, www.nlm.nih.gov/medlineplus Click or Call for the Latest Drug Coverage Updates Want to find out about the medications we cover? Visit our website, newjersey.wellcare.com. You ll find our Preferred Drug List (PDL). You can learn about recent additions and removals. You ll also learn about any changes to medication requirements or coverage limits. Do you want to get this information by phone? Call us at 1-888-453-2534. Member Newsletter 5
What Is a Medical or Dental Emergency? When Should You Go to the Emergency Room? A medical emergency comes on suddenly. It puts your life or health in danger. It s something that needs care right away. Examples include heart attacks, severe chest pains, broken bones, shortness of breath, a drug overdose, poisoning or bleeding that won t stop. If you have a medical emergency, call 911 right away. Or go straight to an emergency room. Are you sick, but don t think it is an emergency? Call your primary care provider (PCP). If you have a dental emergency, call your dentist first. If the office is closed, an answering service will have your PCP or dentist call you. He or she will tell you what to do next. For instance: You may need an office visit right away. You may be referred to another doctor or urgent care clinic. You may get a home treatment over the phone. A prescription may be phoned in to your pharmacy. You may need to go to the emergency room. Your PCP can tell the hospital staff about your condition. You may also call our Nurse Advice Line. You can speak to a nurse anytime at no charge. Call 1-800-919-8807 (TTY 711). Situations that don t need emergency care include: Persistent cough or cold; Earache or pain; Sore throat; and Headaches. Different medical and dental problems need different levels of care. Your PCP or dentist are the best people to tell you what you need. When in doubt, call your doctor or dentist. If you need to call 911, be sure to speak slowly and clearly. Give your name, address and telephone number. Tell them who needs care. Provide details about the medical problem. Don t hang up until the operator tells you to. Source: www.emedicinehealth.com/ script/main/art.asp?articlekey=60041 6 Member Newsletter
Utilization Management The Right Care in the Right Setting What is utilization management? It s a review process to help everyone get the best quality of care available. This process helps determine the right place and care for a condition. Here are some things you should know about the process: Decisions are based on the best use of care and services. The people who make decisions don t get paid to deny care. No one does. We don t encourage denial of care in any way. You have the right to appeal any denials. The appeal process will be explained, if needed. If you have questions about the utilization management program or coverage decisions, or need language assistance, please call Customer Service at 1-888-453-2534. TTY users call 1-877-247-6272. You may also review the Utilization Management Program section of your Member Handbook. You may call to ask for materials in a different format. This includes other languages, large print and audiotapes. There is no charge for this. Always talk with your doctor(s) about the care that is right for you. This material does not replace your doctor s advice. It is based on third party sources. We are presenting it for your information only. You should review your plan or call Customer Service to find out if a service is covered. Call 911 or your doctor right away in a health emergency. Member Newsletter 7
550 Broad St., 12 th Floor Newark, NJ 07102 PRSRT STD U.S. Postage Paid Wellcare Health Plans Para solicitar este documento en Español, llame al Servicio al Cliente al 1-888-453-2534 (TTY 1-877-247-6272). NJ027900_CAD_NEW_ENG State Approved 02062015 WellCare 2015 NJ_10_14 63013 In This Issue We re pleased to deliver another newsletter issue. It s full of helpful ideas about ways to live healthier. Here s what you ll find: Tips on child dental care; Information on preventing heart disease; and Where to get the latest drug coverage updates. There s much more inside, so please take a moment to explore. As always, we wish you good health. Numbers to Know We re just a phone call (or click) away! Call Customer Service: 1-888-453-2534 TTY 1-877-247-6272 Monday Friday, 8 a.m. to 6 p.m. Or visit newjersey.wellcare.com Nurse Advice Line: 1-800-919-8807 (TTY 711) 24 hours a day/7 days a week 10867MB