VOLTEE PARA ESPAÑOL! FALL 2014 THE KEY TO A GOOD LIFE IS A GREAT PLAN Health TALK DID YOU KNOW? The flu virus can travel six feet from a person who sneezes or coughs. 6' Is it the flu? Know the symptoms. Colds and the flu share some symptoms. But people usually feel much worse with the flu. And the flu can come on quickly. Flu symptoms include: fever and chills headache and body aches fatigue cough Some people may also get an upset stomach or a runny or stuffy nose. The flu can be very dangerous. It can cause severe illness or even death, even in healthy people. Flu season is coming. Protect yourself and your family. Get vaccinated every fall. Everyone 6 months of age or older should get a flu shot. A nasal mist is also an option for some people. Flu vaccines are a covered benefit. PRSRT STD U.S. Postage PAID United Health Group UnitedHealthcare Community Plan 6095 Marshalee Drive, Ste. 200 Elkridge, MD 21075 AMC-032-MD-CHIP
Quality matters UnitedHealthcare Community Plan has a Quality Improvement program. It works to give our members better care and services. Each year we report how well we are providing health care services to our members. Many of the things we report on are major public health issues. In 2013, our goals included increasing the number of members who had: infant, child, teen and adult well visits. pap smears. childhood and adolescent immunizations. lead screening. diabetic lab and eye exams. routine well visits. In 2014, we found that more babies were getting well visits. Also, more women were getting mammograms. Plus, many more members were having their BMI measured. (BMI is part of screening for obesity.) However, we found that many teenagers were not having annual well visits. In 2014 2015, we will keep encouraging our members to get needed services. We want more members to have: annual well visits for teenagers and adults. routine mammograms and pap smears. annual eye exams, blood pressure screenings and HbA1c testing for diabetic members. We also do member surveys each year. They show how well we are meeting our members needs. Our 2014 surveys showed improvement in several measures. These include how our members rated their specialists, their health care and their health plan. We are trying to improve our customer service. We now have specific people who help members who call more than once about a problem. We are looking at new ways that we can better address all of our members needs. Get it all. If you would like to know more about our Quality Improvement, health education or outreach programs and our progress toward meeting goals, please call 1-877-813-4345 (TTY 711). Back to school Is your child having trouble in class? Sometimes, a teacher is the first to notice the signs of ADHD in a child. ADHD stands for attention-deficit/hyperactivity disorder. The child may be having trouble learning. He or she may be disrupting the class. There are many different signs of ADHD. All children sometimes have some of them. But children with ADHD have several symptoms most of the time. Their symptoms are more severe than in other children. Symptoms last for at least six months. They include: easily distracted a hard time finishing tasks trouble focusing or following often losing or forgetting things directions trouble sitting still not listening talking too much What next? If your child s teacher thinks there may be a problem, the first step is to take your child to his or her primary care provider (PCP). The PCP may evaluate your child or send you to a specialist. Need to find a provider? Visit MyUHC.com/CommunityPlan. 2 HEALTH TALK
The waiting game How long should you wait for an appointment? We want your child to get the right services at the right time and at the right place. When you call to make an appointment, it s important to tell the office why your child needs to be seen. This will help them know how soon they need to make the appointment. You should be able to get appointments in the following time frames. Emergency: immediate Urgent PCP visit: the same day Routine PCP visit: within 14 days Specialist visit: within 30 days of referral Post-hospital discharge visit: within 7 days Need help? If you are having trouble getting an appointment with a provider or need a ride to an appointment, let us know. Call Member Services toll-free at 1-800-318-8821 (TTY 711). UNDERSTANDING UM UnitedHealthcare Community Plan does utilization management (UM). All managed care health plans do. It s how we make sure our members are getting the right care at the right time and in the right place. A doctor reviews all requests when the care does not seem to meet guidelines. Decisions are based on care and service as well as your benefits. The decisions are not made because of financial or other rewards. Members and doctors also have the right to appeal denial decisions. This information will be in the denial letter. The appeal request must be submitted within 90 days of the denial. Preteen vaccines When your child turns 11 or 12, it s time for another round of shots. They are given at your preteen s annual checkup. These vaccines help protect your children, their friends and your family members from serious diseases. Next time you take your middle-schooler to the doctor, ask about the following shots: HPV: Prevents human papillomavirus MENINGOCOCCAL CONJUGATE: Prevents bacterial meningitis TDAP: Prevents tetanus, diphtheria and pertussis If your child missed any of these shots, it s not too late to make them up. It s your best shot. Learn more about vaccines for every member of your family at CDC.gov/vaccines. Questions? You can talk to our special needs coordinator. Just call 410-379-3434 toll-free. They are available during normal business hours, eight hours per day, Monday Friday. If you need to leave a message, someone will call you back. FALL 2014 3
Are you positive? You can avoid giving your baby HIV. Without treatment, one out of four pregnant women with HIV will give the virus to their babies. HIV is the virus that causes AIDS. Fortunately, there is a treatment that works very well. Pregnant women who take certain drugs very rarely give their babies HIV. The drugs are called antiretrovirals. Babies take the drugs for a short time after they are born. Also, it s important for women with HIV to not breastfeed their babies. This can reduce the number of babies with HIV. Today, because of prevention and treatment, only a small number of babies are born with HIV in the United States each year. Pregnant? Planning to get pregnant? Make sure you get tested for HIV. Need a woman s health care provider? Visit MyUHC.com/CommunityPlan. We care UnitedHealthcare Community Plan provides care management services. These services help members with special needs, such as physical or cognitive disabilities pregnancy complex health problems substance abuse HIV/AIDS sickle cell disease We also have disease management programs. These programs help members with chronic illnesses, such as: diabetes CHF asthma COPD Care managers work with the health plan, members physicians and outside agencies. They help members get the special services and care they need. Help is here. If you have special needs or need help managing a chronic illness, call 1-800-318-8821 (TTY 711). 4 HEALTH TALK
Around the clock You can reach your PCP 24/7. Your HealthChoice PCP serves as the entry point for your health care. Your PCP will coordinate all your medical care. Your PCP will provide telephone coverage 24 hours per day, seven days per week. He or she will provide most of the covered services you need. For services your PCP can t provide, he or she will refer you to a specialist. To help make sure you get the health care services you need, your PCP will work with: UnitedHealthcare specialty care providers the Administrative Care Coordination Units (ACCU) at your local health department If you miss appointments with your PCP, UnitedHealthcare may contact you to find out how to help you get to your appointments in the future. We will work with your PCP to make sure you get the care you need. You have the right to get certain services without a referral or authorization by your PCP. This includes certain self-referred services and emergency services. You are not required to contact your PCP in emergent or urgent situations. If you go to an urgent care facility, the staff will perform triage. This means they will determine whether you have an emergency condition. If you are found to have a non-emergency condition, you may be sent to your PCP. Or, you may be treated and then told to contact your PCP for follow-up. Questions? Want to know more about how your PCP and UnitedHealthcare work together? Call 1-877-813-4345 (TTY 711). Warm and safe Winter is coming. When there s a chill in the air, you might be tempted to warm up with a space heater. Don t! Space heaters can be dangerous. It s best not to use space heaters. But if you must, follow these safety tips. 1. READ AND FOLLOW ALL INSTRUCTIONS. Make sure everyone in your family knows how to use the heater safely. 2. NEVER LEAVE A SPACE HEATER ON WHILE YOU SLEEP or leave the room. 3. MAKE SURE THE SPACE HEATER IS AT LEAST THREE FEET AWAY from furniture, bedding, drapes or curtains. 4. NEVER USE A SPACE HEATER TO DRY CLOTHING OR SHOES. 5. WARN CHILDREN NOT TO TOUCH A SPACE HEATER. Do not let pets in the same room as a space heater. 6. MAKE SURE THE SPACE HEATER IS ON A HARD, EVEN SURFACE. Do not put it on a rug or carpet. Be safe. Learn more about using space heaters safely from the U.S. Consumer Product Safety Commission at cpsc.gov. For other safety tips, see the National Safety Council Web site at nsc.org. CONNECT TO QUIT Are you ready to quit smoking? Support can help you be successful. The Maryland Tobacco Quitline can help you. The Quitline offers four free telephone-based counseling sessions. They can also provide a free fourweek supply of nicotine replacement therapy. Help is also available online or through text messaging. Are you ready? Call the Maryland Tobacco Quitline at 1-800-QUIT- NOW (1-800-784-8669). They are available 24 hours a day, seven days a week. You can also visit Smoking StopsHere.com for more information. FALL 2014 5
Resource corner UnitedHealthcare Member Services: 1-800-318-8821 24/7 NurseLine: 1-877-440-0251 United Behavioral Health: 1-888-291-2507 Public Mental Health System (MAPS-MD): 1-800-888-1965 Transportation: 1-800-318-8821 UnitedHealthcare Outreach: 1-800-860-5257 UnitedHealthcare Health Education: 1-855-817-5624 Healthy First Steps: 1-800-599-5985 Department of Social Services: 1-800-332-6347 Maryland Health Connection: MarylandHealthConnection.gov 1-855-642-8572 Maryland Medical Assistance Help Line: 1-800-284-4510 Stay safe together! UnitedHealthcare has partnered with Sesame Workshop to create home safety tips. They provide tools and strategies for a safe environment. Your home is where your family learns and plays together. There are lots of simple things you can do to keep your home as safe as it can be. Explore safety with your child during your daily routines. IN THE BATHROOM Stay close at bath time. Together, play a game of I Spy or try an experiment to see which toys sink or float. Keep medicines, cleaners, beauty products and sharp items out of children s reach, or secured with child safety locks. Step safely by placing non-slip bath mats inside and outside of the tub. IN THE BEDROOM Stay safe and sound by placing smoke alarms on every floor and in each bedroom. Change the batteries at least once a year. Mark the special day on the calendar. Scoot furniture away from windows and use window guards to make a safe space to play and dream. To keep lead away, clean toys regularly and get rid of chipped or worn items. Get more. For more tips, visit sesamestreet.org/ toolkits. Here you will find tools and resources to help your family play and grow together. Maryland Healthy Smiles Dental Program: 1-888-696-9596 UnitedHealth Group fraud hotline: 1-866-242-7727 HealthChoice fraud hotline: 1-866-770-7175 Clinical practice guidelines: UHCCommunityPlan.com/healthprofessionals/md/clinicalpractice-guidelines.html Interpretation Services: If English is not your native language, please call Member Services to request interpretation services for your medical visits. TM/ 2014 Sesame Workshop 6 HEALTH TALK