HAWAI I 2015 ISSUE II Caring for Hawai i Caring for Family: A Message from Ohana s Behavioral Health Director Aloha! I want to thank my colleagues at Ohana for an incredible welcome. The opportunity to be a part of the Community Care Services (CCS) program is exciting. It s given me a chance to connect with members that I have known, in some cases, for decades. The CCS team at Ohana had a great start in 2013 under the guidance of former director Edward Elles. We have built on this foundation and will continue to work toward improving the service we deliver to you. We know that our CCS members often face great challenges in homelessness and access to psychiatrists, therapists and pharmacies. This is especially true in rural areas of O ahu and the neighbor islands. As a team, the CCS staff will continue to link you with providers and support the care managers who help you. We re committed to supporting you in your recovery journey. Working together is vital, and we intend to strengthen our relationships with you, our providers and our state partners to make the CCS program even better in 2015. Lena Jones, LCSW Get Help with Mental Illness Are you or a loved one feeling sad, worthless or hopeless? Are you seeing and/or hearing things that aren t there? These could be signs of either depression or schizophrenia. Schizophrenia is a mind disorder marked by a breakdown of thought processes. If you do have any of these signs, help is available. Talk with your primary care provider (PCP). He or she can talk with you about diagnosis and treatments and refer you to specialists if needed. Call us if you need help finding a PCP or making an appointment. Numbers to Know We re just a phone call (or click) away! Call Customer Service toll-free: 1-888-846-4262 TTY 1-877-247-6272 Monday Friday, 7:45 a.m. to 4:30 p.m. Hawai i Standard Time Or visit www.ohanahealthplan.com Call the toll-free Nurse Advice Line at: 1-800-919-8807 TTY 1-877-247-6272 24 hours a day/7 days a week OH15-106 Q2 Member Newsletter HI5CADNEW64396E 0115
Protect Your Children with Immunizations Keeping children safe is every parent s goal. Vaccinations (also called immunizations or shots ) are a big part of reaching that goal. They help keep children from getting very sick. They even save lives. Vaccinations have helped to control many serious diseases. But those diseases can come back if children stop getting these shots. Some things you should know about vaccinations: They can and do save lives. They can stop diseases that once killed many children. They are safe. They are thoroughly tested by scientists and doctors before they are given to children. They protect your child and other people. When your child is vaccinated, it may keep them from spreading disease to someone else. They protect future generations. Stopping diseases now means we can protect children of the future. They save time and money. Think of the bills and time spent when a child is sick. They also ensure a child is ready to start school on time. Vaccinations are covered for members at no additional charge. Talk with your child s doctor about protecting your child from diseases. Source: National Vaccine Program Office, www.vaccines.gov/more_info/features/fiveimportant-reasons-to-vaccinate-your-child. html Ask about Fluoride Varnish Fluoride varnish is a coating that is painted on a child s teeth. It helps prevent or stop cavities. Ask your child s health care provider or dentist about fluoride varnish. Why is it recommended? Cavities can cause pain and infections that can be bad for children s general health. They can lead to problems with eating, speaking, playing and learning. Fluoride varnish makes teeth stronger, stops cavities from getting bigger and prevents new cavities from forming. Is it safe? Yes. It is safe for children of any age. It can be used on babies from the time their first teeth come in. Source: Fluoride Varnish: Frequently Asked Questions, New York City Department of Health and Mental Hygiene Ohana is here to help! You can speak to a nurse 24/7 about any concerns you may have about your health care. Call the Nurse Advice Line at 1-800-919-8807. 2 Member Newsletter
The Value of a Mammogram Have you been putting off getting your mammogram? You aren t alone. Many women have fears about getting this test. Maybe you ve been told it s too painful or too expensive. We ve put together some highlights to help you understand the importance of this annual screening. Mammograms can help reduce the number of deaths from breast cancer. What if your mammogram does come back with a potential issue? There will be an estimated 232,000 new cases of breast cancer diagnosed this year. Early detection is a key part of successfully treating it. Think you aren t at risk? The top two risk factors for getting breast cancer are being female and getting older. Just by being a woman you re at risk. Genetics may also play a role. There may also be a higher risk factor if it runs in your family. Ask your PCP or OB/GYN about getting your mammogram. It s a covered benefit for Ohana members. Rides to your appointment are also covered. Call Logisticare if you need transportation: Call two days in advance to schedule an appointment: 1-866-790-8858 Call one day in advance to confirm an appointment: 1-866-481-9699 Sources: National Cancer Institute, Breast Cancer Fact Sheet, www.cancer.gov/ cancertopics/factsheet/detection/mammograms/print; and Breast Cancer, www. cancer.gov/cancertopics/types/breast Member Newsletter 3
Did You Know? Grievances and Appeals What is a grievance? A grievance is when you call or write to complain about a provider, the plan and/ or service. A grievance could be about wait times during provider visits; the way your providers or others act; or unclean provider offices. You can file a grievance at any time. Your doctor or another provider can also file a grievance for you if you authorize them to do so. What is an appeal? An appeal is a request you can make when you don t agree with our decision about the health care you re getting and/or our timeliness. You can request an appeal for things like the denial of a service your doctor asked us to provide. How to file an appeal You must file your appeal within 30 days from the date you get the notice of our decision. You can file by calling or writing to us. If you file by calling, you must follow up with a written, signed appeal. If needed, we can help you file your appeal. You can also get help from others or your provider. They can file for you if you give them your written permission. You can file a grievance or appeal by calling Customer Service. The toll-free number is on the front page. Please see the Member Handbook for more information. Substance Abuse Can Happen to Anyone What is a substance abuse problem? It s any drinking or drug use that harms the user or places others at risk. Anyone at any age can get into trouble with drugs or drinking. People often use drugs or alcohol to relieve stress or deal with emotional pain. It may seem to work for a while. But it only makes things worse in the end. Help is available Substance abuse can be treated. You can call a referral line to find support near you. The toll-free number is 1-800-662-HELP (4357). National resources: Substance Abuse and Mental Health Services Administration: www.samhsa.gov SAMHSA 24/7 Treatment Referral Toll-Free Line: 1-800-662-HELP (4357) Partnership for a Drug-Free America: www.drugfree.org Narcotics Anonymous: www.na.org Cocaine Anonymous: www.ca.org Alcoholics Anonymous: www.aa.org Department of Health, Alcohol and Drug Abuse Division, www.health. hawaii.gov/substance-abuse Sources: Substance Abuse Consumer Fact Sheet, NC Division of Mental Health, Developmental Disabilities and Substance Abuse; and Health Bulletin #61, New York City Department of Health and Mental Hygiene 4 Member Newsletter
It s Good to Know Your Rights and Responsibilities As an Ohana member, you have the right: To receive information about the organization, its services, its practitioners and providers and member rights and responsibilities To be treated with respect and dignity To have your privacy protected To participate with practitioners in making decisions about your health care To a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost and benefit coverage To voice complaints or appeals about the plan or the care it provides To make recommendations regarding the plan s member rights and responsibilities policy You also have responsibilities as a member: To supply information that the plan and its doctors and providers need to provide care To follow plans and instructions for care that you have agreed on with your doctor To understand your health problems To help set treatment goals that you and your doctor agree to These are just some of the highlights. To learn more, visit www.ohanahealthplan.com or see your Member Handbook. Click or Call for the Latest Drug Coverage Updates Want to find the latest about the drugs we cover? Be sure to stop by our website. You ll find our Preferred Drug List (or PDL for short). You can learn about recent additions and removals. You ll also find changes to any drug requirements or coverage limits. Just go to www.ohanahealthplan.com. You can also call us for updates at the toll-free number listed on the front page of this newsletter. Physician (doctor) Incentive Plan You have the right to ask for information about Ohana s Physician Incentive Plan. To ask us for this information, please call Customer Service. Our toll-free number is 1-888-846-4262. TTY users may call toll-free 1-877-247-6272. Member Newsletter 5
Make Your Health Care Choices Known There could be a time when you re not able to let others know your health care choices. There are legal documents you can fill out when you re not able to speak for yourself. These forms are known as advance directives. An advance directive can let you: Pick a person to make choices about your medical or behavioral care for you Say what kind of medical treatment you want to receive or not receive if you become too ill to tell others what your wishes are You have the right to make an advance directive. You have the right to make choices about your health care. This includes the right to accept or refuse behavioral, medical or surgical treatment. Other than for conscience reasons, your wishes should be followed. What if your wishes are not followed? You may file a report with the Office of Health Care Assurance. Please see your Member Handbook for details on how to file a complaint. You can view the Member Handbook online at www.ohanahealthplan.com. What if you decide to make an advance directive? Then remember to talk about it with your family, your PCP and others who might help you with your health care. Handbook Highlights: Questions About Your PCP? Your Handbook Has Answers Your Member Handbook has a lot of helpful information about working with your primary care provider (PCP). Your PCP is your personal doctor or advanced practice registered nurse. He or she will treat you for most of your health care needs. You may have already selected a PCP. If not, we may have selected one for you, based on things like: Where you may have received care in the past Where you live Your language preference When you need to see a specialist, your PCP can give you a referral. The name and phone number of your PCP is on your member ID card. Call your PCP to schedule checkups and other care visits you need. Did you know you can change your PCP? Just call Customer Service toll-free at the number on the front page of this newsletter. You can also change your PCP online. Just go to www.ohanahealthplan.com. Get to know your PCP and the useful information you ll find in your Member Handbook. 6 Member Newsletter
Find What You Need in the Member Handbook Your Member Handbook is a great resource. It s also available 24/7 online at www.ohanahealthplan.com. Inside, you ll find all this and more: Benefits and services Exclusions from coverage Co-payments and other charges you might be responsible for Benefit restrictions about out-of-network and out-of-service area Language assistance Filing claims Information about doctors who are in our network Primary care services Specialty, behavioral health and hospital services After hours care Emergency care when to use 911 or go to the emergency room Getting coverage when out of the service area Filing complaints Filing appeals How we evaluate new technology You can ask us for a hard copy of the handbook. We can also send you member educational materials and other information. You can also ask us for materials in another format. This includes different languages, large print and audio tapes. There is no charge for this service. For any of these items, just call Customer Service. Our toll-free number is on the front page of this newsletter. 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. It does not imply that these are benefits covered by Ohana. Also, Ohana does not guarantee any health results. 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
949 Kamokila Blvd., 3rd Floor Suite 350 Kapolei, HI 96707 HI028790_CAD_NEW_ENG State Approved 07012015 WellCare 2015 HI_01_15 64396 This document has important information from Ohana Health Plan. You can request this written document to be provided to you only in Ilocano, Vietnamese, Chinese (Traditional) and Korean. If you need it in another language you can request to have it read to you in any language. There is no charge. We also offer large print, braille, sign language and audio. Call us toll-free at 1-888-846-4262. (TTY/TDD: 1-877-247-6272). Daytoy a dokumento ket naglaon iti napateg nga impormasyon manipud iti Ohana Health Plan. Mabalinyo a kiddawen a maisurat daytoy a dokumento iti Ilocano. Awan ti bayadanyo. Mabalinyo a kiddawen a maibasa daytoy kadakayo. Idiaya mi pay ti dadakkel a letra, braille, senyas a pagsasao ken audio. Tawagandakami iti awanbayadna nga 1-888-846-4262. (TTY/TDD: 1-877-247-6272). OH15-003 Language Block State Approved 10242014 59613