GPC_Fa14-1
http://www.coventry-medicare.com�
A COVENTRY HEALTH CARE NEWSLETTER FALL 2014
Times
Good
INSIDE
How care managers
can help
Heart
Matters
Tools to lower heart
attack and stroke risk
page 2
Possible changes
in coverage
page 5
page 6
Fall 2014 3
Influenza—better known as the flu— is a very serious disease. Estimates vary widely, but between 1976 and 2007 flu-related deaths could be as high as 49,000 people. And about 90 percent of deaths during flu season occur in people 65 and older.
Steer clear of the flu with these three tips:
1. Get the flu vaccine.Fluzone High-Dose is designed specifically for folks 65 years and older and has four times the amount of antigen contained in regular flu shots.
2. Avoid close contact with peoplewho are sick.
3. Wash your hands often.If soap and water aren’t handy, use an alcohol-based hand rub.
Women hear a lot about their health in the fall, and with good reason. September is Gynecologic Cancer Awareness Month and October is Breast Cancer Awareness Month.
What steps can you take to safeguard your health? Check if you’re due for a mammogram, Pap test or other screening. Then make an appointment if needed.
Also, talk about breast, cervical and ovar-ian cancer with the other women in your life. Encourage them to get any needed screenings. Discuss your family history of cancer with your mother or other close family members. Keep in mind that all women are at risk for breast and gynecologic cancers, and that risk increases with age.
For more on early detection and prevention, visit http://www.cdc.gov/cancer/gynecologic
and http://www.cdc.gov/cancer/breast.
A HEALTH CHECK
FOR WOMEN
When you think stress relief, you might picture yoga and meditation. But you don’t have to say “Om” to find inner peace.
Crafting can help soothe your nerves just as much as any yoga pose. In fact, a study of more than 3,500 knitters published in the British Journal of Occupational Therapy found that those who knit frequently felt calm and happy.
Activities like knitting, scrap-booking and painting are what experts call “cognitive distracters.” That means while you’re creating, you’re not thinking about your overblown to-do list. And, the sense of accomplishment upon completing your grandchildren’s photo album can help release chemicals in your body that make you feel better.
Craft Your Own Stress Relief
Avoid the Flu
This Season
PHI Use and Disclosure
�
Your health information is private. We call this protected health information or PHI. We use it to manage your benefits.
We collect your PHI from many sources. Keeping your PHI safe is one of our most important jobs. We make sure that only certain people can see and use your information.
We may use and share your PHI to: •
• • • •
Provide for your treatment or authorization. Pay for your health care.
Review the quality of the care you get. Tell you about your choices for care. Manage our health plan.
Also, we may access, use or share your PHI for other purposes as the law permits or requires.
These other uses are covered under state and federal laws. You can see our policies on PHI at http://www.coventry-medicare. coventryhealthcare.com. Once there, select the state you live in under “Plan Sites.” Then, go to “Members,” then to “Find Important Information,” and then to “Privacy Notice.” You can also call the number on your member ID card to ask for a copy.
Helping you get
the
care you need
Do you have a serious medical concern? Do you take care of someone who does? You may want to work with one of our case managers.
Case managers are registered nurses. They are trained to work with patients who have high-risk conditions or serious illnesses.
Our case managers will work with you and your doctor to:
• •
Help identify your needs. Coordinate resources.
To learn more, you can call the Customer Service number on your member ID card.
G
GoodoodTTiimmeses
2 2
GoodTimes
2 GoodTimes
2
Helping you get
the
care you need
Your health information is private. We call this protected health information or PHI. We use it to manage your benefits.
We collect your PHI from many sources. Keeping your PHI safe is one of our most important jobs. We make sure that only certain people can see and use your information.
We may use and share your PHI to:
• Provide for your treatment or authorization. •Pay for your health care.
•Review the quality of the care you get. • Tell you about your choices for care. • Manage our health plan.
Also, we may access, use or share your PHI for other purposes as the law permits or requires.
These other uses are covered under state and federal laws. You can see our policies on PHI at http://www.coventry-medicare. coventryhealthcare.com. Once there, select the state you live in under “Plan Sites.” Then, go to “Members,” then to “Find Important Information,” and then to “Privacy Notice.” You can also call the number on your member ID card to ask for a copy.
PHI Use and Disclosure
Do you have a serious medical concern? Do you take care of someone who does? You may want to work with one of our case managers.
Case managers are registered nurses. They are trained to work with patients who have high-risk conditions or serious illnesses.
Our case managers will work with you and your doctor to:
•Help identify your needs.
•Coordinate resources.
To learn more, you can call the Customer Service number on your member ID card.
Avoid the Flu
This Season
Influenza—better known as the flu— is a very serious disease. Estimates vary widely, but between 1976 and 2007 flu-related deaths could be as high as 49,000 people. And about 90 percent of deaths during flu season occur in people 65 and older.
Steer clear of the flu with these three tips:
1. Get the flu vaccine. Fluzone High-Dose is designed specifically for folks 65 years and older and has four times the amount of antigen contained in regular flu shots.
2. Avoid close contact with people who are sick.
3. Wash your hands often. If soap and water aren’t handy, use an alcohol-based hand rub.
Women hear a lot about their health in the fall, and with good reason. September is Gynecologic Cancer Awareness Month and October is Breast Cancer Awareness Month.
What steps can you take to safeguard your health? Check if you’re due for a mammogram, Pap test or other screening. Then make an appointment if needed.
Also, talk about breast, cervical and ovar-ian cancer with the other women in your life. Encourage them to get any needed screenings. Discuss your family history of cancer with your mother or other close family members. Keep in mind that all women are at risk for breast and gynecologic cancers, and that risk increases with age.
For more on early detection and prevention, visit http://www.cdc.gov/cancer/gynecologic and http://www.cdc.gov/cancer/breast.
A HEALTH CHECK
FOR WOMEN
Fall 2014 3 ’ ” -“ ” ’ ’ ’Craft Your Own Stress Relief
When you think stress relief, you might picture yoga and meditation. But you don’t have to say “Om” to find inner peace.
Crafting can help soothe your nerves just as much as any yoga pose. In fact, a study of more than 3,500 knitters published in the
British Journal of Occupational Therapy found that those who knit frequently felt calm and happy.
Activities like knitting, scrap-booking and painting are what experts call “cognitive distracters.” That means while you’re creating, you’re not thinking about your overblown to-do list. And, the sense of accomplishment upon completing your grandchildren’s photo album can help release chemicals in your body that make you feel better.
Fall 2014 5 UPDATES
T
he Centers for Medicare & Medicaid Services (CMS) sometimes change coverage rules for a benefit or service. When this happens, CMS issues a National Coverage Determination (NCD).NCDs tell us:
• What’s covered
• What’s changing
• What Medicare pays.
You can get the facts quickly. We post them within 30 days on http://coventry-medicare. coventryhealthcare.com/under “Medicare Coverage Changes.” You can also visit http://www. cms.gov and search “National
Coverage Determination” for more information.
RECENT CMS UPDATES
The dates show that the change affects services on or after that date.
• Percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis (LSS) (January 9, 2014)
• Aprepitant for chemotherapy induced emesis (May 29, 2013)
• Fluorodeoxyglucose (FDG) positron emission tomography (PET) for solid tumors (June 11, 2013)
• Single-chamber and
dual-chamber permanent cardiac pacemakers (August 13, 2013)
• Hospital beds (October 1, 2014)
• Beta amyloid (AB) positron emission tomography (PET) in dementia and neurodegenerative disease (September 27, 2013)
WE’RE HERE TO HELP YOU
Call us at the number on your member ID card(TTY: 711).
• 8 a.m. to 8 p.m., seven days a week, October 1–February 14
• 8 a.m. to 8 p.m., Monday –Friday, February 15– September 30.
A CMS CHANGE MAY AFFECT YOUR
MEDICARE COVERAGE
Thinkstock
Coventry Health Care* is a Coordinated Care plan with a Medicare contract. Enrollment in our plans depends on contract renewal. Coventry Health Care of Florida also has a contract with the Florida state Medicaid program. Coventry Health Care of Missouri and Coventry Health Care Kansas also have contracts with the Missouri state Medicaid program. HealthAmerica also has a con-tract with the Pennsylvania state Medicaid program. *Coventry Medicare Advantage plans are offered by Aetna’s licensed affili-ated companies, which include Altius Health Plans, Inc.; Coventry Health Care of Florida, Inc.; Coventry Health Plan of Florida, Inc.; Coventry Health Care of Georgia, Inc.; Coventry Health Care of Illinois, Inc.; Coventry Health Care of Iowa, Inc.; Coventry Health Care of Louisiana, Inc.; Coventry Health Care of Missouri, Inc.; Coventry Health Care of Nebraska, Inc.; Coventry Health and Life Insurance Company; Coventry Health Care of Kansas, Inc.; Coventry Health Care of Texas, Inc.; Coventry Health Care of West Virginia, Inc.; First Health Life & Health Insurance Company; HealthAmerica Pennsylvania, Inc.; and HealthAssurance Pennsylvania, Inc. First Health Part D is a Medicare-approved Part D sponsor. Enrollment in our plan(s) depends on contract renewal.
NR_0009_3433 (07/2014)
Protect Your
Medical Identity
Health care fraud is on the rise. Here’s
how to safeguard your information.
YOUR CARE
4
So You Think
You’re a Victim:
Now What?
If you see a mistake on your billing statements or Explanation of Benefits (EOBs), contact us right away. It’s a good idea to keep paper copies of everything, but you can always request them. Report errors to us and the health care providers involved, in writing, by certified mail.
If you file a police report about identity theft, send a copy to us and all three credit reporting agencies: Equifax, Experian and TransUnion. You should also check your credit report for any discrepancies. It’s smart to review your credit report at least once a year regardless. You can get a free copy from all three agencies every 12
months at http://www.
AnnualCreditReport.com.
T
hey say imitation is the sincerest form of flattery, but not when it comes to identity theft. You’ve undoubtedly heard about the recent rash of retail identity theft. Maybe your credit card company even issued you a new card and account number.But you may not know that medical identity theft is an increasing problem in the United States. Someone can steal your medical and health insurance information to fill prescriptions, receive benefit checks and get medical services—including expensive surgeries. Just like traditional identity theft, it can cost you money and time to clear your name and may have a negative impact on your credit rating. Medical identity theft may also wreak havoc on your medical records and insurance coverage.
WHAT YOU CAN DO
Review your medical and insurance statements. The Federal Trade Commission recommends doing this regularly, just like you’d check
your bank or credit card statements. Look for irregularities in the
provider name, date of service and service provided. If you see an error, contact us right away, along with your health care providers.
Be on the lookout for other signs of medical identity theft. These include bills for medical services you didn’t receive or calls from debt collectors or collection notices on your credit report about medical bills you don’t recognize.
Protect your medical identity. Keep a close watch on your
member ID card. Don’t give out your personal or insurance information to take advantage of an offer for free products or services—those can be scams. Never offer your medical or insurance information over the phone or by email, unless you’re the one who reached out to a company or provider you know. When in doubt, don’t give your personal or health insurance information to anyone other than your health care providers, pharmacy or insurance company.
a CMs Change May affeCt your
MediCare Coverage
updates
t
he Centers for Medicare & Medicaid Services (CMS) sometimes change coverage rules for a benefit or service. When this happens, CMS issues a National Coverage Determination (NCD).NCDs tell us:
• What’s covered What’s changing What Medicare pays.
• •
You can get the facts quickly. We post them within 30 days on http://coventry-medicare. coventryhealthcare.com/ under “Medicare Coverage Changes.” You can also visit http://www. cms.gov and search “National
Coverage Determination” for more information.
Recent cMS updateS
The dates show that the change affects services on or after that date.•
• •
•
Percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis (LSS) (January 9, 2014)
Aprepitant for chemotherapy induced emesis (May 29, 2013) Fluorodeoxyglucose
(FDG) positron emission tomography (PET) for solid tumors (June 11, 2013) Single-chamber and
dual-chamber permanent cardiac pacemakers (August 13, 2013) Hospital beds (October 1, 2014) Beta amyloid (AB) positron emission tomography (PET) in dementia and neurodegenerative disease (September 27, 2013)
• •
We’Re heRe to help you
Call us at the number on your member ID card (tty: 711).• •
8 a.m. to 8 p.m., seven days a week, October 1–February 14 8 a.m. to 8 p.m., Monday�
–Friday, February 15–�
September 30.�
Thinkstock
Coventry Health Care* is a Coordinated Care plan with a Medicare contract. Enrollment in our plans depends on contract renewal. Coventry Health Care of Florida also has a contract with the Florida state Medicaid program. Coventry Health Care of Missouri and Coventry Health Care Kansas also have contracts with the Missouri state Medicaid program. HealthAmerica also has a con-tract with the Pennsylvania state Medicaid program. *Coventry Medicare Advantage plans are offered by Aetna’s licensed affili-ated companies, which include Altius Health Plans, Inc.; Coventry Health Care of Florida, Inc.; Coventry Health Plan of Florida, Inc.; Coventry Health Care of Georgia, Inc.; Coventry Health Care of Illinois, Inc.; Coventry Health Care of Iowa, Inc.; Coventry Health Care of Louisiana, Inc.; Coventry Health Care of Missouri, Inc.; Coventry Health Care of Nebraska, Inc.; Coventry Health and Life Insurance Company; Coventry Health Care of Kansas, Inc.; Coventry Health Care of Texas, Inc.; Coventry Health Care of West Virginia, Inc.; First Health Life & Health Insurance Company; HealthAmerica Pennsylvania, Inc.; and HealthAssurance Pennsylvania, Inc. First Health Part D is a Medicare-approved Part D sponsor. Enrollment in our plan(s) depends on contract renewal.
NR_0009_3433 (07/2014)
Fall 2014
Why You
Shouldn’t
Share Meds
Although sharing
medications with friends may seem innocent, you should never take drugs prescribed for others. Not only is it illegal, it’s dangerous. Why?
• Drugs are prescribed for an individual, and dosing is based on age and weight. So the dosage could be totally wrong for you. • You might be allergic
to the drug.
• You might already be taking another drug that interferes.
• The drug could have side effects you’re unaware of. • The drug could be
contraindicated with another medical condition you have.
• Certain drugs interact poorly with certain foods and drinks and you won’t know which ones to avoid. • Taking a drug could mask
the symptoms of an underlying disease you have and actually make your condition worse.
CLEAR CARE
A
ntibiotics are frequently prescribed. Unfortunately, the prescription is often unnecessary. Antibiotics may seem like a quick fix for a sneeze, sore throat or flu bug, but the truth is they’re completely useless when viruses hits.Why? Antibiotics treat bacterial infections, not viruses. Even worse, antibiotics may make the situation worse. Every time you pop an antibiotic it kills off some bacteria. The ones that remain transform and multiply, becoming stronger—and more resistant—to antibiotics. Eventually certain bacteria will become so strong
that no antibiotic will be able to fight them off.
It’s a growing problem. Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections.
What can you do to help? The next time you feel under the weather, do not insist on an antibiotic. If you do get a prescription, take your medication exactly as directed. And finish all the medication even if you’re feeling better.
When Do You Need
an Antibiotic?
What seems like a quick fix could
damage your health.
7
HEALTHY LIVING
Million Hearts
The Million Hearts™ campaign is a U.S. Department of Health and Human Services initiative designed to prevent 1 million heart attacks and strokes over five years. Take the Million Hearts pledge at http:// millionhearts.hhs.gov. Their website has these tools:
•�H eart Attack Risk
Calculator: Enter your blood pressure, cholesterol and blood sugar results, weight and smoking status to calculate your 10-year risk of having a heart attack.
’
• �H eart 360: Sign up to record and track your health results online and access heart-health information. You can also share your results with your doctor. Also available are:
• A medication tracker wallet card, blood pressure journal, access to Facebook to receive daily tips, and community resources. • Links to information about
blood pressure, healthy diet, weight management, physical activity, limiting alcohol use and quitting smoking.
Lower Your Risk
for
Heart Attack and Stroke
H
eart disease and stroke are the first and third leading causes of death for men and women. Yet they’re also among the most preventable.Take control of your heart health by talking to your doctor about:
• •
•
• •
Y our risk factors—and those you can change and control. Y our medical treatment.
Ask questions to help you
understand.�
Y our medications. Tell your doctor if you are unable to fill prescriptions.
A heart healthy diet.
An exercise program that is right for you.
GET ACTIVE AND STAY STRONG
Find a way to fit 30 minutes of physical activity into your schedule. Talk to your doctor about what is best for you.
Eat a heart-healthy diet, high in fresh fruits and vegetables. Limit salt, saturated and trans fats, and cholesterol. Also, you should:
• •
• •
Achieve and maintain a �
healthy weight�
Monitor and control �
your blood pressure and �
cholesterol�
Limit alcohol intake Quit smoking.
GoodTimes
6 6
• My Life Check™: All the above information plus physical activity and diet is used to identify what you’re doing well and what you can change to improve your health.
GoodTimes
6 6
Lower Your Risk
for
Heart Attack and Stroke
Million Hearts
The Million Hearts™ campaign is a U.S. Department of Health and Human Services initiative designed to prevent 1 million heart attacks and strokes over five years. Take the Million Hearts pledge at http:// millionhearts.hhs.gov. Their website has these tools:
• Heart Attack Risk
Calculator: Enter your blood pressure, cholesterol and blood sugar results, weight and smoking status to calculate your 10-year risk of having a heart attack.
• My Life Check™: All the above information plus physical activity and diet is used to identify what you’re doing well and what you can change to improve your health.
• Heart 360:Sign up to record and track your health results online and access heart-health information. You can also share your results with your doctor. Also available are:
• A medication tracker wallet card, blood pressure journal, access to Facebook to receive daily tips, and community resources. • Links to informationabout
blood pressure, healthy diet, weight management, physical activity, limiting alcohol use and quitting smoking.
HEALTHY LIVING
H
eart disease and stroke are the first and third leading causes of death for men and women. Yet they’re also among the most preventable.Take control of your heart health by talking to your doctor about:
• Your risk factors—and those you can change and control. • Your medical treatment.
Ask questions to help you understand.
• Your medications. Tell your doctor if you are unable to fill prescriptions.
• A heart healthy diet.
• An exercise program that is right for you.
GET ACTIVE AND STAY STRONG
Find a way to fit 30 minutes of physical activity into your schedule. Talk to your doctor about what is best for you.
Eat a heart-healthy diet, high in fresh fruits and vegetables. Limit salt, saturated and trans fats, and cholesterol. Also, you should:
• Achieve and maintain a healthy weight
• Monitor and control your blood pressure and cholesterol
• Limit alcohol intake • Quit smoking.
CLEAR CARE
When Do You Need
an Antibiotic?
What seems like a quick fix could
damage your health.
A
ntibiotics are frequently prescribed. Unfortunately, the prescription is often unnecessary. Antibiotics may seem like a quick fix for a sneeze, sore throat or flu bug, but the truth is they’re completely useless when viruses hits.Why? Antibiotics treat bacterial infections, not viruses. Even worse, antibiotics may make the situation worse. Every time you pop an antibiotic it kills off some bacteria. The ones that remain transform and multiply, becoming stronger—and more resistant—to antibiotics. Eventually certain bacteria will become so strong
that no antibiotic will be able to fight them off.
It’s a growing problem. Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections.
What can you do to help? The next time you feel under the weather, do not insist on an antibiotic. If you do get a prescription, take your medication exactly as directed. And finish all the medication even if you’re feeling better. Fall 2014 • • • • • • •
Drugs are prescribed for an individual, and dosing is based on age and weight. So the dosage could be totally wrong for you. You might be allergic
to the drug.
Y ou might already be taking another drug that interferes.
The drug could have side effects you’’re unaware of. The drug could be
contraindicated with another medical condition you have.
Certain drugs interact poorly with certain foods and drinks and you won’’t know which ones to avoid. Taking a drug could mask
the symptoms of an underlying disease you have and actually make your condition worse. Although sharing
medications with friends may seem innocent, you should never take drugs prescribed for others. Not only is it illegal, it’s dangerous. Why?
Why You
Shouldn’t
Share Meds
http://www.coventry-medicare.com
Coventry Health Care of Illinois, Inc. is a Coordinated Care plan with a Medicare contract. Enrollment in our plan depends on contract renewal. NR_0009_3593 07/2014
Published by McMurry/TMG, LLC. ©2014. All rights reserved. No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not take the place of—the recommendations of your health care provider. Consult your physician before making major changes in your lifestyle or health care regimen. McMurry/TMG makes no endorsements or warranties regarding any of the products and services included in this publication or its articles.
Happy, Healthy Holidays
Eat and be merry—without doing damage.
It’s easy to go overboard at the holiday table, but a few simple swaps will let you enjoy your favorites without all the fat and calories.
Here are some healthy alternatives: •
• •
Instead of mashed potatoes, try sweet potatoes with cinnamon and winter spices like cloves and nutmeg.
In vegetable dishes, use olive oil instead of cream or cheese.
Skip the stuffing and serve a tasty rice dish instead. There are plenty of healthy holiday recipes out there—like this smart take on a classic dessert.
Peach Cobbler
•
•
•
•
•
•
•
•
•
•
•
•
•
1/2 tsp. ground cinnamon 1 Tbsp. vanilla extract 2 Tbsp. cornstarch 1 c. peach nectar 1/4 c. pineapple or peach juice (can use juice from canned peaches) 2 cans (16 oz. each) peaches, packed in juice, drained, (or 1 3/4 lb. fresh), sliced 1 Tbsp. tub margarine 1 c. dry pancake mix 2/3 c. all-purpose flour 1/2 c. sugar2/3 c. evaporated skim milk 1/2 tsp. nutmeg
1 Tbsp. brown sugar
DIRECTIONS:
COMBINEcinnamon, vanilla, cornstarch, peach nectar, and pineapple or peach juice in saucepan over medium heat. Stir constantly until mixture thickens and bubbles. ADD sliced peaches to mixture. REDUCE heat and simmer for 5-10 minutes. MELT margarine in another saucepan and set aside.
SPRAY 8-inch square glass dish with cooking spray. POUR in peach
mixture. COMBINE pancake mix,
flour, sugar and melted margarine in another bowl. STIR in milk then quickly spoon this mixture over
peach mixture. COMBINE nutmeg
and brown sugar then sprinkle mixture on top of batter.
BAKE at 400 F for 15-20 minutes or until golden brown. COOL AND CUT into 8 squares.
NUTRITION INFORMATION
PER SERVING:
CALORIES, 271; SA TURATED FAT, LESS THAN 1G; SODIUM, 263MG; PROTEIN, 4G; TOTAL FAT,
4G; CHOLESTEROL, LESS THAN
1MG; CARBOHYDRATES, 54G
