Voltee para español! fall 2011 The Key to a good life is a great plan Health TALK IN this issue Flu shots... Page 1 Teen checkups... Page 2 Depression... Page 2 Nutrition... Page 3 Breast cancer... Page 3 Pharmacy changes... Page 4 Appeals... Page 6 Quality... Page 6 Flu fighters Arm your family against the flu. Fall has arrived and so has flu season. The fever, muscle aches and other flu symptoms aren t just uncomfortable for you and your child. The flu can mean serious complications, especially for young children. Protect your family. Make sure everyone gets the new flu vaccine every year. The U.S. Centers for Disease Control and Prevention recommends the yearly vaccine for everyone age 6 months and older. It can lower the risk of complications. It can prevent time off school and work. Ask your pediatrician to let you know when this season s vaccine is available. PRSRT STD U.S. Postage PAID United Health Group UnitedHealthcare Community Plan 9200 Worthington Rd., 3rd floor Westerville, OH 43082 Don t wait! Talk to your child s doctor about the new flu vaccine. Need to find a new doctor for your child? See the provider directory at www.uhc community plan.com or call member services at 1-800-895-2017 (TTY 711). AMC-020-OH-CHIP
3 REASONS teens need checkups 1. Immunizations: Teenagers need shots for meningitis, whooping cough and HPV. Some teens need to catch up on shots they missed as children. 2. Puberty: The doctor will make sure your teen is developing well. Your teen can ask questions about changes in his or her body. 3. Education: The doctor will talk to your teen about important issues like safety, sexual health, and avoiding violence, drugs and alcohol. Your teen should feel comfortable with his or her doctor. Some teenagers prefer a doctor who is the same sex as them. Sometimes, the pediatrician who was great with your young child is not a good fit for your teen. Change doctors if you need to. Time for a new doctor? See the provider directory at www. uhc community plan.com or call member services at 1-800-895-2017 (TTY 711). Fighting the blues Children and teens can get depression. It s normal for children to feel sad sometimes. Teenagers can be moody and sullen. Most of the time, these feelings go away. But for some kids, they don t. This could mean depression. Depression is a medical problem. It is nothing to be ashamed of. More than 20 million Americans have it. Some signs your child could be depressed include: a sad mood that doesn t go away. not wanting to do things he or she once enjoyed. eating much more or less than he or she used to. trouble sleeping or sleeping too much. lack of energy. a hard time thinking. thinking about death or suicide. Get treatment. If your child has symptoms of depression most of the time for more than a few weeks, talk to your child s doctor. You can also find a mental health provider by calling member services at 1-800-895-2017. Question & answer 1 out of 8 teens are depressed. Depression can be treated. Medication can help. So can therapy. Your child can also try lifestyle changes. Exercising, getting enough sleep and eating healthy may improve your child s mood. Q. I have a headache, but my doctor can t see me right away. Is there something else I can do? A. Yes! Calling your doctor is an excellent first step, but you may also call the United- Healthcare NurseLine at 1-800-542-8630 for advice. Nurses are available 24 hours a day, 7 days a week to talk with you about your healthcare needs. Applying a cold compress to the forehead or following the directions for a non-prescription pain reliever may help as well. 2 HEALTH TALK
MyPlate The food pyramid is no more. MyPlate has replaced it. The new system is simpler. It divides the plate into four sections with one side dish. 1. Fruits and Vegetables: They should make up half your plate. Choose a variety of each. They can be fresh, frozen or canned. 100 percent juice is okay, too. 2. Grains: Eat a variety of grains, like bread, pasta, rice or oatmeal. At least half of these should be whole grains. 3. Protein: Choose lean proteins most often, like fish or skinless chicken. Add protein from vegetable sources, like beans or soy. 4. Dairy: Low-fat or fat-free milk, cheese and yogurt are also part of a healthy diet. Set the table. Learn how to make the best choices in each food group. Find out how many servings of each food group you need. Visit www. choose my plate.gov. Be a survivor Breast cancer screening saves lives. Breast cancer is the second leading cause of cancer death among U.S. women. But today, there are more than 2 million breast cancer survivors in the U.S. That s partly because breast cancer can be cured if it is found early. Screenings can help find the disease before there are any symptoms. Here are the screenings recommended by the American Cancer Society: Self-exam: Women should start doing monthly breast self-exams at age 20. A healthcare expert can show you how. Tell your doctor right away if you notice any changes in the look or feel of your breasts. Clinical breast exam: Your doctor should check your breasts during a regular physical exam. Women ages 20 to 39 should get checked at least once every three years. Exams may be more frequent as you get older. Mammogram: Women aged 40 and older are at the highest risk of breast cancer. They should get this specialized breast X-ray every year. Women with a higher risk of breast cancer African-American women have the highest risk of death from breast cancer. may need a special screening plan. African- American women have a higher risk of breast cancer before age 45. They also have the highest risk of death from breast cancer at all ages. Talk to your provider about your risk of breast cancer. Make a plan for regular screening. Be whole. Janet s Law says that health plans must pay for reconstruction for women who have breast cancer surgery. Do you have questions about your benefits for breast cancer detection and treatment? Call member services at 1-800-895-2017 (TTY 711). fall 2011 3
Prescription for health Changes to your Ohio Medicaid pharmacy coverage The State of Ohio has made important changes to your prescription drug coverage. They apply to everyone who gets healthcare through an Ohio Medicaid managed care plan. This includes members of UnitedHealthcare Community Plan. Starting October 1, 2011, the companies that provide managed care benefits to Ohio Medicaid members will pay for prescription drugs and certain prescription medical supplies. This means that you will need to get your prescription drugs at a pharmacy that accepts UnitedHealthcare Community Plan. how the changes will affect you: 1. You must use the new member ID card that you received in September 2011. Starting October 1, you must use your new card to get prescriptions at the pharmacy, and to get medical supplies and other healthcare. Your new card lets pharmacies know that UnitedHealthcare Community Plan will pay for your prescriptions. Call member services if you did not receive your new card. 2. You can get your prescription drugs at any pharmacy that accepts UnitedHealthcare Community Plan. We will only pay for prescriptions you get from pharmacies that have a contract with us. Ask your pharmacy if it accepts UnitedHealthcare Community Plan. If you plan to travel out of state, be sure to fill your prescriptions before you leave. 3. You can keep getting certain prescription medical supplies at no cost to you. This includes diabetic supplies, inhaler spacers, peak flow meters, syringes, needles, alcohol wipes and condoms. The pharmacy or medical equipment supplier cannot charge you for these prescription medical supplies. Contact UnitedHealthcare Community Plan to find out how to obtain any medical supplies you need. 4. Your doctor will need to get prior authorization for some prescription drugs. If UnitedHealthcare Community Plan requires prior authorization for one of your prescriptions but your doctor has not gotten it, the pharmacy will tell you that the prescription is not covered unless your doctor gets prior authorization. If you need to fill the prescription immediately, but your doctor is not available to get prior authorization, ask the pharmacy about giving you a short-term supply of the prescription. Ask your doctor or pharmacy if there is another prescription that will work for you that does not require prior authorization. 4 HEALTH TALK
How to refill a prescription that needs prior authorization If you have a prescription for a drug that needs prior authorization, you will receive a letter from UnitedHealthcare Community Plan telling you what your doctor needs to do. If you need to refill a prescription for a drug that needs prior authorization, and Ohio Medicaid paid to refill it on or after April 1, 2011, here s what to do: CONTROLLED SUBSTANCES: You can refill your prescription without prior authorization until October 31, 2011. Controlled substances include many pain medications, such as hydrocodone. Some anxiety medications such as diazepam, and some seizure medications, such as phenobarbital, are also controlled substances. Ask your pharmacist if any of your medications are controlled substances. NON-CONTROLLED SUBSTANCES: Most other drugs can be refilled without prior authorization from UnitedHealthcare Community Plan until December 31, 2011. ANTIDEPRESSANTS AND ANTIPSYCHOTICS: Prescriptions for standard antidepressants or antipsychotic pills, or injectable antipsychotics, can be refilled without prior authorization unless: they were not prescribed by a psychiatrist who has a contract with UnitedHealthcare Community Plan or whom you see at a Community Mental Health Center. they were not prescribed for use as approved by the FDA. If either of these applies, then you can refill them without prior authorization until January 31, 2012. More information is available. Questions or problems with your prescription coverage or pharmacy? Questions or problems with your doctor? Need emergency care while out of the service area? Contact UnitedHealthcare Community Plan at 1-800-895-2017. fall 2011 5
Appealing Do you have a problem with your health plan? United- Healthcare Community Plan wants to know. We have procedures in place. They say how we help members with grievances and appeals. A grievance is when you tell us you are dissatisfied with a provider, the plan or any matter other than an action taken by the plan. An appeal is when you ask us to change a decision about your coverage. Here s how. See your Member Handbook to learn more about grievances or appeals. It s available on our website at www. uhc community plan.com. You can also call member services at 1-800-895-2017 (TTY 711) to ask for a copy. We care about quality Programs help you get the care and services you need UnitedHealthcare Community Plan s Quality Improvement program works to give our members better care and services. Each year UHC Community Plans report how well we are providing healthcare services. Many of the things we report on are major public health issues. In 2010, we improved the number of well child visits, lead screenings and childhood immunizations our members had. In 2011, we have been working to improve the number of members who get breast and cervical cancer screenings, prenatal and postpartum visits, and asthma and diabetes care. We also conduct member surveys so we can see how well we are meeting our members needs. Our 2010 surveys showed that most of our members rate the healthcare they receive about the national average. We listened to our members. In 2011, we have been working to improve our members overall satisfaction with UnitedHealthcare Community Plan. Get it all. If you would like to know more about our Quality Improvement program and our progress toward meeting goals, please write to UnitedHealthcare Community Plan, Quality Improvement, 9200 Worthington Rd., 3rd floor, Westerville, OH 43082. Who to call Member Services Find a doctor, ask benefit questions or voice a complaint. 1-800-895-2017 (TTY 711) NurseLine Get 24/7 health advice from a nurse. 1-800-542-8630 (TTY 711) Healthy First Steps Get pregnancy and parenting support. 1-800-599-5985 (TTY 711) Our website Use our provider directory or read your Member Handbook. www.uhccommunityplan.com 6 HEALTH TALK