IN thIS ISSue
helps you take charge of your health
• Can lack of
sleep make you gain weight?
• New Naturally
BlueSM vendor brings more services to you
Build a better body to fight illness—Page 22 A magazine for Blue Care Network members
table of Contents
Meet Jeanne Carlson: New Ceo makes time for health ...................2 Help set direction for your health plan ............................................3 MiBCN.com helps you take charge of your health ...........................4 The Blues family is growing ............................................................5 New Naturally Blue vendor brings more services to you ...................6 Formulary Quick Guide mailed .......................................................7 Save money on maintenance drugs .................................................7 Three new vaccines are covered for members ..................................7 How to pick the right drug .............................................................8 Treating sore throats without antibiotics ........................................8 Make exercise a family affair ..........................................................9 . When life gets out of step, get help ...............................................10 Healthy body means healthy baby ................................................11 Fighting cancer with the help of his friends and family ...................12 When someone you know has cancer ...........................................13 Become an ex ..............................................................................13 Guidelines to Good Health .....................................................14-15 Three cheers for breakfast ............................................................16 eat well with these menu ideas .....................................................17 Can lack of sleep make you gain weight? ......................................18 . learn more about alcohol and your health....................................18 Colon testing saves lives ...............................................................19 Five steps to safer health care .......................................................20 Fruits and veggies: Strive for five ...................................................21 adults who live with children tend to eat more fat .........................21 Build a better body to fight illness ...........................................22-23 Ten ways to fit in exercise .............................................................23 lose weight with Weigh to Go’s new six-month program ...............24 Using your benefits ......................................................................25 How we monitor member care .................................................25 . Use these tools to compare hospitals ........................................25 How BCN decides on new health services ..................................25 Your PCP coordinates all of your care ........................................26 Quality information available ...................................................26 resolving your concerns ...........................................................27 Blue goes with you when you’re away from home ......................28 Use these guidelines when scheduling appointments ..................29 Keep your coverage up to date .........................................back cover
Blue Care Network’s Web site is MiBCN.com. While Web site addresses for other organizations are provided throughout this publication for members to use for additional information, BCN does not control these sites and is not responsible for their content.
JeaNNe H. CarlSoN President and Chief Executive Officer JoaN M. MoreHeaD Vice President, Corporate Administration MarY elleN MoHN Manager, Member Communications lISa SMIGIel Senior Communications Specialist, Member Communications PaUla BaTCHelor Graphics Coordinator, Communications Design Services STeVe GraNT Graphic Designer, Communications Design Services
We welcome your letters. articles may be reprinted with permission. Please send your comments and requests for additional copies and reprints to: editor, Good Health — Mail Code C226 Blue Care Network P.o. Box 5043 Southfield, MI 48086-5043
Good Health is published semiannually for Blue Care Network and Blue elect Sro members. Good Health is meant to complement the advice of health care professionals and is not intended to take the place of professional medical care. Your specific contract may not cover every procedure or treatment recommended. Blue Care Network of Michigan is an independent, nonprofit affiliate of Blue Cross Blue Shield of Michigan, one of many individual Blue Cross® and Blue Shield® plans in the United States. Blue Care Network is controlled by a board of directors including private citizens, business, labor and health care professionals. The Blue Cross and Blue Shield association licenses Blue Care Network of Michigan to offer certain products and services under the Blue Cross and Blue Shield names. Blue Care Network of Michigan is an independent organization and solely responsible for its own debts and obligations. Neither the association nor any other organization using the Blue Cross and Blue Shield names acts as a guarantor of Blue Care Network of Michigan’s obligations.
Spring 2007/Good Health
Blue Care Network Board of Directors
Frank Garrison, Chair Gregory a. Sudderth, Vice Chair Julie angott Mark r. Bartlett William H. Black Charles Burkett Jeanne H. Carlson Shauna ryder Diggs, M.D. Janet Harden, Ph.D., r.N.* D. Bonta Hiscoe, M.D.* Valeriah ann Holmon, r.N.* Karen Marie Knapp, C.r.N.F.a.* Daniel J. loepp Donald oetman Diana l. Watson*
Blue Care Network important phone numbers and programs
Health education message line . . . . . . . . . . . . . . 800-637-2972 . request self-help guides Disease management programs . . . . . . . . . . . . . . .800-392-4247 asthma, congestive heart failure, chronic obstructive pulmonary disease, depression, diabetes, heart disease, kidney disease, low back pain and migraine Quit the Nic . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-811-1764 Phone-based smoking cessation program Weigh to GoTM . . . . . . . . . . . . . . . . . . . . . . . . . . 866-MITeaM5 Weight management program through the Michigan Institute for Health enhancement ValueOptions Behavioral health services . . . . . . . . . . . . . . . . . . 800-482-5982 TTY users . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-223-5822
Terri Brady, emily DuVall, Susan Huskey, Christine Karl, robert Klimek, M.D., Cynthia McDonald, Pamela reinert and Michelle Smith
Phone inquiries 800-662-6667 800-257-9980 (TTY users) Monday through Friday 8 a.m. to 5 p.m. after regular business hours, members can call Customer Service and leave a message about an existing referral or authorization of care. The call will be returned within two business days. Written inquiries Blue Care Network P.o. Box 68767 Grand rapids, MI 49516-8767
Spring 2007/Good Health
News Meet Jeanne Carlson: New CEO makes time for health
Everyone knows that eating right and exercising are key.
The trick is fitting it all into a busy day. “I fit in exercise where I can,” says Carlson, who became president and chief executive officer of Blue Care Network last September (previously she was chief operating officer). She has a demanding career (30-plus years with the Blues), and a family. So how does she do it? “I take the stairs up to my office each day. Knowing that I’m not going to exercise in the morning, I set time aside (usually at 9 p.m.) a few times a week to do the treadmill and some floor exercises.” Carlson prefers the treadmill because, for her, it’s easier to work out at home instead of going to a gym. When the weather gets warmer, you’ll find her outside walking to her favorite tunes. Eating well matters, too. “I eat out a lot because of my job. I did Weight Watchers® a while back and it really taught me how to eat and the importance of fruits and vegetables,” said Carlson. When dining out, she’ll double up on veggies and hold the starch. Desserts are out, as much as she loves them. At home, she tries to cook healthier by always including fruits and vegetables. Part of BCN’s company vision is “maintaining and promoting health.” For Jeanne, this starts with BCN employees. “As a health care company, our workplace should support employees’ efforts to get permanently fit,” said Carlson. A new program for BCN employees has healthier food choices in their cafeteria and fitness and weight-loss challenges. For members, this means continuing to offer innovative products like Healthy Blue LivingSM and programs like Weigh to Go™ and Naturally BlueSM.
Jeanne’s tips to better health
• Find what works for you. Are you a morning person? Get up a little earlier to get your activity • Work exercise into your day. Use the stairs instead in. Do you need to work out with others to stay of the elevator and park your car farther away motivated? Find a buddy to pair up with. than close to an entrance. • Fill up with fruits and vegetables at every meal. • Make time for exercise. Schedule time on your • Don’t keep snack food on hand — you’ll only calendar like you would any appointment. tempt yourself. • Get a good night’s sleep.
Spring 2007/Good Health
News Help set direction for your health plan
Applications available for BCN board of directors
The Blue Care Network board of directors includes representatives of the BCN membership. This year is an election year for those positions, and we’ll have six openings on our 18-member board. Board members attend board and committee meetings in which they help develop corporate policy, monitor BCN’s financial stability, oversee implementation of policy and ensure BCN’s compliance with the law. Board members are compensated. To be eligible, you must be: • A BCN member in good standing • A Michigan resident • At least 18 years old • Able to attend board and committee meetings You are not eligible if you are: • A Blue Care Network or Blue Cross Blue Shield of Michigan employee, an employee of the BCBSM subsidiaries Accident Fund Insurance Company of America, DenteMax and LifeSecure, or a relative of an employee of these organizations • Responsible for or have a financial interest in Blue Care Network’s business • A BCBSM member (BCBSM has a separate board) Applications must be submitted by May 31. You can download an application and get more information by going to MiBCN.com, filling out the reply card inside this magazine, or calling 800-482-1112. The applications will be reviewed and candidates selected for each of our four regions by a board committee. All subscribers will have the opportunity to vote for their regional board representative in the fall.
News MiBCN.com helps you take charge of your health
BlueHealthConnection®: your online health resource
Using the BlueHealthConnection Web site at MiBCN.com is a great way to help you achieve your health goals, change lifestyle behaviors and reduce your risks for developing chronic conditions like diabetes or heart disease. benefit you. Topics include: fitness, nutrition, smoking cessation, stress management, weight loss, walking programs, diabetes, asthma, heart disease, high blood pressure, high cholesterol and pregnancy. Learn as you go: Your online health coach will help you set goals and give you the tools to help you meet them. As you complete each level of the program, you can test your knowledge with a quiz. Make healthy changes: Use your online health coach to create nutritious meal plans, and get recipe ideas and shopping lists. Track your own progress: Record your exercise, weight, walking and stress level by logging your activities. You can even view graphs that chart your progress. Manage your health record: Organize your health information such as medicines, tests and doctor visits into an easy-to-print report.
When you visit MiBCN.com:
Select I am a Member on the home page. The Member Services page will appear. If you are a first-time user, click on Register and fill in the information. If you are already registered, type in your user ID and password, then click on OK. Click on the BlueHealthConnection section. Receive encouragement via e-mail: You’ll get emails from your online health coach to help keep you motivated.
New! Sign up for an online health coach — a program designed just for you
For even more help managing your health, sign up for the new online health coach at BlueHealthConnection. Take a few minutes to answer the questions and then the coach will suggest up to three programs that could most
Take a health risk appraisal
By answering questions about your health, lifestyle and family history, you’ll receive immediate results and suggestions on areas of focus to improve your overall health. Take the HRA every six months and track your progress!
Selecting a doctor just got easier
You can now select your primary care physician while using our online provider directory at MiBCN.com/find. Our advanced provider search lets you find a doctor by location, specialty, languages spoken and other criteria that matter to you.
Spring 2007/Good Health
News The Blues family is growing
With the Dec. 31, 2006, purchase of M-CARE, a health plan previously owned by the University of Michigan, Blue Care Network and Blue Cross Blue Shield of Michigan look forward to most M-CARE members selecting a Blue product when it’s time to renew their health care coverage. At the same time, Blue Cross and the University of Michigan Health System launched a separate joint venture involving efforts to improve health care across the state. Both the Blues and M-CARE are nonprofit organizations and share the mission of improving the health of Michigan citizens. BCN is committed to providing innovative and cost-effective health care for our growing membership. M-CARE members who transition to BCN coverage will benefit from our disease management and preventive services, and will join you in carrying the most recognized ID card in the nation.
How BCN helps
Over 130 primary care doctors at the UMHS have opened their practices to BCN members. These doctors practice in UMHS health centers in Ann Arbor, Canton, Livonia, Brighton, Dexter and Chelsea, and in physician offices elsewhere in southeast Michigan communities.
Spring 2007/Good Health
News New Naturally Blue vendor brings more services to you
You now have more choices, more services and more discounts available to you through our Naturally Blue program. Our new vendor Healthways WholeHealth Network Inc., a national leader in integrative health care, provides BCN and Blue Cross Blue Shield of Michigan members with an expanded national network (more than 25,000 practitioners) of discount health products and services. With the new Naturally Blue program, you can show your BCN ID card to receive discounts of up to 30 percent on: • Acupuncture • Exercise • Diet and supplement advisors • Fitness centers • Massage therapy And more…
Save money on vitamins and magazine subscriptions
Receive discounts of up to 25 percent on vitamins and natural health supplements. You can access an online catalog of products, and there are no shipping charges if you order online. You can also call 800-917-3690 to order vitamins and supplements. Use code AWH-6010 when ordering. There’s a $7 shipping and handling fee for phone orders. You can also receive great deals on select health and fitness magazine subscriptions. Go to MiBCN.com/natblue. Click on “magazine subscriptions.” Follow the instructions for ordering.
Did you know…
Members can find Naturally Blue information, directories and services by going to MiBCN.com/natblue or call BlueHealthConnection® at 800-637-2972.
Learn more about alternative medicine and lifestyles
Also, from the Naturally Blue section of BCN’s Web site you can find a link to WholeHealthMD.com. Besides getting the latest news about complementary and alternative medicines, you can: • Visit the Healing Kitchen for healthy recipes and nutritional information • Get opinions from the WholeHealthMD experts • Use the reference library to find out more about integrative therapies, supplements, food and more
Spring 2007/Good Health
Pharmacy Formulary Quick Guide mailed
Formulary Quick Guide for Members
Our drug formulary offers the best value
Our drug formulary lists medications that are available to Blue Care Network members who have a prescription drug rider. This list represents the clinical judgment of Michigan physicians, pharmacists and other health care experts. Medications are selected based on clinical effectiveness, safety and opportunity for cost savings. The formulary is categorized by tiers, indicating the level of copayment required. • Formulary Preferred (Tier 1): These drugs have a proven record of effectiveness and offer the best value for the member. Because they are Tier 1, they require the lowest copayment, making them the most cost-effective option for treatment. Most generics are Tier 1. Formulary Options (Tier 2): These drugs also have a record of safety and effectiveness. Since more costeffective therapy or a generic alternative is usually available for these drugs, Tier 2 medications require a higher copayment. Nonformulary (Tier 3): Nonformulary drugs are not on our list of approved drugs. These drugs may not have a proven record for safety or their clinical value may not be as high as the drugs in Tier 1 and Tier 2. Formulary alternatives are available. Most BCN members do not have coverage for nonformulary drugs unless the prescriber and BCN agree that the drug is medically necessary. These drugs are considered medically necessary only if none of the available formulary drugs would be effective or if use of the available BCN formulary drugs would pose an unnecessary risk to the member.
In January, we mailed all subscribers who have drug coverage a copy of the new BCN Formulary Quick Guide for Members. Besides listing medicines that are available to members, the Quick Guide also includes information on: • Brand-name vs. generic drugs • How your prescription drug benefit works • How to fill your prescription If you did not receive a copy, you can call Customer Service or go to our Web site at MiBCN.com/drugformulary.
Brand name versus generic
Prescription drugs can be costly. One way BCN works to keep costs down while maintaining high-quality care is to promote the use of generic drugs. There’s little difference between a brand-name drug and its generic equivalent. The U.S. Food and Drug Administration requires that generic drugs have the identical active ingredients as their brandname equivalents. They may differ from brand-name drugs only in color and shape. Since the major difference between brand name and generic drugs is price, your prescription will automatically be filled with the generic equivalent when medically appropriate. Brand-name drugs that physicians prescribe or members request to be dispensed as written (DAW), but are available as generics, are covered only when determined to be medically necessary by the physician and approved by BCN. If a DAW prescription is not authorized, you must pay the difference in cost between the brand-name product and the generic drug, in addition to your copayment for a brand-name medication.
Save money on maintenance drugs
If you take a prescription on a regular basis for a chronic condition like asthma, heart problems or diabetes, you can get more for your money. You said you wanted coverage for a larger supply of medicines without having to use the mail order service, and we listened. Members with a BCN drug rider can now receive a 90-day supply of most maintenance medications from nearly all participating retail pharmacies in Michigan. And, the copay is reduced from three copay amounts to two. Many members are already enjoying this new benefit; nearly 20 percent of members’ maintenance prescriptions are now being filled for 90-day supplies from retail pharmacies. Remember, if you’re being prescribed a new drug, you’ll need to get a one-month supply filled first to make sure the drug and dose are appropriate. Also, certain drugs are not included. Check with Customer Service. Note: Mail order is still a convenient option if you wish to use it.
Three new vaccines are covered for members
BCN recently approved coverage for three new vaccines. As with all vaccines, talk with your primary care physician about what’s right for you and your family. • Zostavax™ helps protect against painful shingles in adults age 60 and over. One shot protects for a lifetime. • Human papillomavirus vaccine is recommended for women under age 26, including teens (as early as age 11). This vaccine helps protect against HPV, which can lead to cervical cancer. • Rotavirus vaccine protects infants from this serious virus. See the Guidelines to Good Health on Pages 14-15 for the complete schedule.
Spring 2007/Good Health MiBCN.com
Pharmacy How to pick the right drug
You’re hit by advertisements every day — on the radio, in newspapers, in magazines, on TV and even over the Web. There are ads for sleeping drugs, impotence and insomnia. You’ve been told how to fight depression, how to increase your blood cells and how to decrease allergy symptoms or even arthritis. With everyone trying to sell you something, who should you listen to? Consumer Reports recommends that you ignore drug ads. In 2005, drug companies spent $4.2 billion in direct-to-consumer advertisements — and that amount is increasing by around 20 percent per year. The payoff for drug companies is worth it. Profits continue to rise. Doctors say they often hear from patients who’ve seen a drug ad and who ask for a specific drug they think might work for them. If you ask for a drug you saw advertised, but your doctor refuses to write you a prescription, don’t be offended. That’s because other drugs are usually just as effective, generally cost less and their risks are better known. Many advertised drugs aren’t included on BCN’s formulary. Have you noticed that none of the ads are for generic drugs, which are just as effective as their brandname counterparts? Once a drug becomes available as a generic, the pharmaceutical companies have no interest in promoting them to doctors or patients. But these generic alternatives offer the best value. And, for BCN members, they’re available for the lowest copay. Bottom line: Be an informed consumer. Talk with your physician about your condition and about the treatments he or she is considering. Use the Web to learn about your condition and your medication. For recommendations on the best, most cost-effective drugs for a range of conditions, try Consumer Reports’ Web site at bestbuydrugs.org or the Blues’ generic drug Web site at theunadvertisedbrand.com.
Treating sore throats without antibiotics
If your child is suffering from a sort throat, home remedies may be just an effective as an antibiotic. Treatment depends on whether it’s a bacterial or viral infection. Most sore throats are caused by viruses and do not need antibiotics. Your child’s doctor can decide what type of infection your child has by doing a throat culture. If needed, your physician can prescribe antibiotics. This helps to avoid using antibiotics to treat a virus (which will not work), but may cause resistance to the antibiotic in the future.
If your child needs antibiotics, make sure that he or she takes them correctly. Take it exactly as your child’s doctor prescribes and make sure your child takes all of Try these tips for treating viral infections: it, even if he or she feels better. Never give your child old or unused Give ibuprofen or acetaminophen antibiotics or antibiotics prescribed for pain and fever. Always check for someone else because they may with your child’s doctor on dosage. not be the right treatment or dose Increase fluids. Have your child for your child’s illness. drink lots of juice and water.
Have your child try popsicles, ice chips or gargling with salt water if he or she has problems swallowing.
Spring 2007/Good Health
Health Make exercise a family affair
A lot of kids get little exercise, but parental involvement can help get them moving again
Staying fit as a family can help your children improve their health — now and for the rest of their lives. “Parents can actively help their kids maintain a healthy weight by getting up, getting out and together making exercise fun,” says Colleen Greene, employee wellness program coordinator for the University of Michigan Health System in Ann Arbor. “Doing so can make the whole family healthier.” An estimated one in five American children weighs too much, according to the National Institutes of Health. Being obese increases a child’s risk for serious childhood medical problems, including diabetes, heart disease, sleep apnea and psychological disorders. Studies have found overweight kids are at greater risk of becoming obese adults. Experts blame childhood obesity in part on excessive “screen time” because it replaces physical activity, increases eating and reduces metabolism. “Limiting the amount of TV children watch, the number of video games they play or the amount of computer time they have is an important step parents can take to get their kids moving,” says Greene. Like adults, children should be physically active most, if not all, days of the week. Experts suggest at least 60 minutes of moderate physical activity daily for most children. Running, bicycling, jumping rope, dancing and playing basketball or soccer are good ways for them to be active. Here are some strategies to help you help your kids get a move on. • Don’t call it exercise. Instead, promote playtime and encourage activities that are fun and physical, such as hopscotch or jumping rope. • Find out what your children like to do and make this a focus of family activities. “Vary the activities, and let your children take turns choosing what the family will do,” says Greene. • Participate in community fitness events, such as charity walks or fun-runs. • Use family walks or bike rides as a time to do more than just exercise together. Talk about school and family issues when you’re taking a break. • Relive your childhood by playing the games you loved as a kid, such as tag or hide-andseek. • Plan outings that involve physical activity. Go skating, visit the zoo or play miniature golf. • Turn chores into games. Try raking leaves and jumping in the piles. Have a water fight while washing the car. • Invite neighborhood kids to play games that take more people, such as capture the flag or kickball. But the best way you can help children get more exercise is to join in. “If the whole family makes the conscious decision to be active, they all share the exercise benefits, and, most importantly, the family can enjoy the playtime together,” says Greene. “Being active as a family encourages children to choose an active lifestyle well into their adult years.”
Did you know…
Surveys show nearly half of Americans ages 12 to 21 aren’t physically active.
Spring 2007/Good Health
Health When life gets out of step, get help
It can happen to anyone. It’s much more common than people think. In fact, 70 percent of people with it are under age 45 and working. What is it? It’s depression. Depression is not a sign of weakness or something that can be willed or wished away. Without treatment, symptoms can last for weeks, months or years.
People with depression, even the most serious forms, can be helped. Treatment may include professional counseling and antidepressant medicines. Some people do well with counseling alone. Most do best with combined treatment: medicine for quick-relief of symptoms and counseling to learn ways to deal with life’s problems, including depression.
Some tips for dealing with depression
• Set realistic goals; take on what you can handle. • Break large tasks down; set priorities. • Be with other people; talk to someone. • Do activities that may make you feel better. Exercise can help. • Expect your mood to improve with time, not right away. • Don’t make big decisions until the depression has lifted, or talk with others who know you well and can be objective. • Let your family and friends help you.
Depression is real
It’s not just a bad mood. Depression is an illness that involves the body, mood and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself and the way one thinks about things. It can change behavior, physical health and appearance, work performance, social activity and the ability to handle everyday decisions and pressures.
How BCN helps
• Members can take a depression screening through BlueHealthConnection® at MiBCN.com. • You are covered for behavioral health services when you use ValueOptions. No referral is necessary. Call 800-482-5982, 24 hours-a-day, seven days a week or visit valueoptions.com. • Members taking antidepressant medicine or those diagnosed with depression will receive information on this condition through BCN’s depression program.
Spring 2007/Good Health
Health Healthy body means healthy baby
Having a baby or planning to become pregnant? Take care of yourself and your unborn baby with these tips. If you’re over 35 or your pregnancy is high-risk because of health problems (like diabetes or high blood pressure), you may need to see your doctor more often. You’re covered: Prenatal and postpartum visits are covered for members.
Take care of yourself before you get pregnant:
• Eat healthy foods, exercise regularly (30 minutes per day most days of the week is best) and get enough sleep. • Take 400 micrograms of folic acid (one of the B vitamins) every day. The best way to do this is to take a daily multivitamin with this amount of folic acid. Getting enough folic acid every day before you get pregnant and during early pregnancy can help prevent certain birth defects. • See your doctor for a physical exam. Make sure that you’ve had all your shots, especially for rubella (German measles). Rubella can cause serious birth defects. Chickenpox can also be dangerous during pregnancy. If you’ve had chickenpox and rubella in the past, you should be immune to them. If not, talk to your doctor about the vaccines. • Stop smoking cigarettes, drinking alcohol or taking drugs.
After your baby is born
Don’t forget to have a postpartum checkup. New moms should make an appointment 21 to 56 days after delivery so the doctor can check healing. You’ll also want to make sure to add your baby to your BCN contract. Contact your employer’s benefit representative soon after the baby is born to avoid any claims issues. If you have individual coverage, call Customer Service.
Get early prenatal care. If you know you’re pregnant, or think you might be, call your doctor to schedule a visit (before 14 weeks). Get regular prenatal and postpartum care. Your doctor will schedule you for many appointments over the course of your pregnancy. Don’t miss any — they are all important. Follow your doctor’s advice.
See your doctor once you are pregnant
Your doctor will give you a schedule of all the doctor visits you’ll need while pregnant. Doctors can spot health problems early when they see mothers regularly. As your pregnancy progresses, you’ll see the doctor more often. (For a schedule, see BCN’s Guidelines to Good Health on Pages 14-15).
Spring 2007/Good Health
Health Fighting cancer with the help of his friends and family
BCN member Don Campbell deals with health insurance all the time. Campbell, 51, of Livonia, works for Ford Motor Company and helps purchase the type of plans to offer employees. Never in his wildest dreams did he think he’d become even more involved with health care — from a patient’s point of view. That all changed last August when Campbell was diagnosed with throat cancer. Within a month of his diagnosis, Campbell got a call from BCN Nurse Case Manager Rose Gorzenski. She helped him understand his condition. She answered his questions, coordinated his care and sometimes just listened. “My job as a case manager is to support the patient any way I can,” said Gorzenski. “I like the fact that my job allows me to help people. BCN does more than just pay claims. There’s a human touch and I like that,” she said. Campbell had surgery and seven weeks of radiation and chemotherapy. “I made it through with lots of support from family and friends.” And even though
Did you know…
“I like the fact that my job allows me to help people.”
Campbell’s wife is a nurse, he found great value in talking to Gorzenski. Says Campbell, “My treatment has had its ups and downs. Rose helped talk me through what was going on. She’s a good reminder and safety check. My doctor would tell me things, but Rose would take even more time to explain in detail what it all meant.”
BCN has case managers who are registered nurses who understand all parts of the health care system. Many have training in managing specific diseases and are certified in case management. Case managers can help patients facing unusual medical challenges with things such as coordinating benefits, answering questions, going over care instructions and reminding them about appointments. They can also work with the patient’s doctor to create a treatment plan. For more information, contact BCN Customer Service.
Don Campbell, Rose Gorzenski and Don’s dog Snowball
Spring 2007/Good Health
Health When someone you know has cancer
A list of some basic dos and don’ts
• Take your cues from the person with cancer. Some people are very private while others will talk more about their illness. Respect the person’s need to share or their need to remain quiet. • Respect decisions about how the cancer will be treated, even if you disagree. • Include the person in usual work projects or social events. Let he or she be the one to tell you if the commitment is too much to manage. • Listen without always feeling that you have to respond. Sometimes a caring listener is what the person needs the most. • Expect the person with cancer to have good days and bad days, emotionally and physically.
• Offer unsolicited advice or be judgmental. • Take things too personally. It’s normal for the person with cancer to be quieter than usual, to need time alone, and to be angry at times. • Be afraid to talk about the illness. • Always feel you have to talk about cancer. The person with cancer may enjoy conversations that don’t involve the illness. • Be afraid to hug or touch your friend if that was a part of your friendship before the illness. • Tell the person with cancer, “I can imagine how you must feel,” because you really can’t. Adapted with the permission of the American Cancer Society, Inc. All rights reserved.
Become an ex
Nicotine, when delivered by a tobacco product, is just as addictive as many hard drugs. There isn’t anything wrong with you if you’ve tried to quit unsucessfully. Smoking is an addiction. Learn to live without smoking. Become free from cigarettes. Become an Ex. That’s the name of a campaign by the American Legacy Foundation to help people become nonsmokers by making a plan. For more information, call 800-QUIT-NOW or visit becomeanex.org
Here’s your plan:
1. 2. 3. 4. Set a quit date. Get the support of your family and friends. Visit your doctor. Choose a nicotine replacement medicine or other medicine to deal with withdrawal symptoms. 5. Find a quit-smoking coach. • Join Quit the Nic, BCN’s smoking cessation program, by calling 800-811-1764. If you enroll and have BCN prescription drug coverage, you can get nicotine patches, lozenges and gum covered for your usual copayment. (Normally over-the-counter medications are not a covered benefit.) 6. Create a stop-smoking notebook. 7. Identify your triggers — the things that make you want to smoke. 8. As the quit day nears, start separating smoking from your triggers. 9. Begin changing the times, places and ways you smoke. 10. Have a spring cleaning day right before your quit day. (Get rid of all smoking stuff like lighters and ashtrays.) 11. Quit. 12. Fight the urges to smoke with every trick you have. 13. Build new activities into your smoke-free life. 14. Start noticing all the good stuff that’s happening and reward yourself.
Source: American Legacy Foundation
Spring 2007/Good Health MiBCN.com
guidelines to good health
preventive care is the key to good health!
Blue Care Network encourages members to be active partners in maintaining good health. These health guidelines for all age groups are based on recommendations from national medical organizations and the most current medical and scientific literature. These guidelines are recommended by BCN for healthy adults and children. BCN guidelines are a resource for physicians and may not always apply to every individual. Please discuss questions you have about your health care with your primary care physician. Your primary care physician may recommend a different schedule based on your needs. Items in blue have been recently updated.
adult immunizations Name For
Age 19 – 39
Age 40 – 64
Td/Tdap Pneumococcal Zoster (shingles)
Tetanus/diphtheria Pneumococcal disease (meningitis and pneumonia) Shingles
Annually for certain Every year starting at age 50 chronic conditions — discuss with your physician Every 10 years Every 10 years Persons at high risk for pneumococcal disease — discuss with your physician Not applicable Age 60 and older
Every 10 years — Td only At age 65
adult Female Preventive health recommendations Name For Age 19 – 39
Health maintenance examination Health history, physical exam, Every 3 – 5 years preventive health and depression assessment, patient education on nutrition, weight mgt., alcohol/drug abuse, tobacco use and injury prevention Hypertension Every 2 years Cardiovascular disease and stroke Level of blood cholesterol Cervical cancer Cervical cancer Every 2 years
Age 40 – 64
Age 40 – 49, every 2 – 3 years Age 50 – 64, every 1 – 2 years
Blood pressure screening Cardiovascular disease and stroke risk assessment Cholesterol screening Pap smear
Age 40 – 49, every 2 years Age 50 – 64, every 1 – 2 years Every 2 years
Every year Every year Every 5 years Age 65 – 69 every year or every 2 – 3 years (after 3 negative results) Age 70+ discuss with your physician Every 1 – 3 years, discuss with your physician Every year
Every 5 years Every 5 years Beginning within 3 years ofsexual activity or Age 21 – 30 every year Age 31 – 64 every 2 – 3 years (after 3 negative results) Every 1 – 3 years Every 1-3 years Every year Discuss with your physician Not applicable Every year
Breast cancer Clinical breast exam and instruction for breast self-exam Breast cancer Mammography Sigmoidoscopy Fecal occult blood test Diabetes screening Pregnancy Colorectal cancer Colorectal cancer Diabetes Maternal and child health
Age 40 – 49, every 1 – 2 years; Every year; age 75+ at patient/ age 50 – 64, every year. physician discretion Every 5 years starting at age 50; or colonoscopy every 10 years; or double contrast barium enema every 5 years Not applicable Every year starting at age 50 Every year (not following colonoscopy) (not following colonoscopy) Not applicable Every 3 years starting at age 45 Every 3 years First visit before 14 weeks; visits every 4 weeks through 30 Not applicable weeks; every 2 weeks from 30 – 36 weeks; weekly visits after 36 weeks; once to twice per week after 40 weeks. Postnatal checkup 21 – 56 days after delivery.
Spring 2007/Good Health
adult male Preventive health recommendations Name For Age 19 – 39
Health maintenance examination assessment, patient education on nutrition, weight mgt., alcohol/ drug abuse, tobacco use and injury prevention Blood pressure screening Cardiovascular disease and stroke risk assessment Cholesterol screening Clinical testicular exam and instruction for testicular selfexamination Prostate screening Sigmoidoscopy Fecal occult blood test Diabetes screening Health history, physical exam, Every 3 – 5 years preventive health and depression
Age 40 – 64
Age 40 – 49, every 2 – 3 years Age 50-64, every 1 – 2 years
Every year Ages 65 – 75 men who are or have been smokers should have a one-time ultrasound to screen for abdominal aortic aneurysm Every year Every year Every 5 years Not applicable
Hypertension Cardiovascular disease and stroke Level of blood cholesterol Testicular cancer Prostate cancer Colorectal cancer Colorectal cancer Diabetes
Every 2 years Every 2 years Every 5 years As part of routine health assessment As recommended Not applicable Not applicable Not applicable
Age 40 – 49, every 2 years Age 50-64, every 1 – 2 years Every 2 years Every 5 years As part of routine health assessment
Age 45 based on race, nationality As recommended or family history Age 50+ as recommended Every 5 years starting at age 50; or colonoscopy every 10 years; or double contrast barium enema every 5 years Every year starting at age 50 Every year (not following colonoscopy) (not following colonoscopy) Every 3 years starting at age 45 Every 3 years
Pediatric immunizations Name For 0 – 12 months
IPV DTaP Polio At 2 and 4 months
12 – 18 months
3rd dose between 6 – 18 months 4th dose between 15 – 18 months
Diphtheria, tetanus and At 2, 4 and 6 months acellular pertussis Tetanus, diphtheria and Tdap acellular pertussis Haemophilus influenza At 2, 4 and 6 months 4th dose at HiB type B 12 – 15 months Hepatitis A Two doses at least six months apart from 12 to Hep A 23 months Hepatitis B At birth, 1 – 4 months and Discuss with your Hep B 6 – 18 months physician Rotavirus At 2, 4 and 6 months Rota Meningococcal Meningitis Measles, mumps and Not applicable rubella Human papillomavirus HPV Chickenpox Not applicable Varicella Flu Every year (start at 6 Influenza months) At 2, 4 and 6 months Pneumococcal Pneumonia conjugate* MMR 12 – 15 months
4th dose (usually at Not applicable school entry) 5th dose (usually at school entry) 11-12 years, then Td booster every 10 years Not applicable Not applicable Discuss with your physician Discuss with your physician Discuss with your physician Discuss with your physician
2nd dose (usually at school entry)
11-12 years (or age 15 if not had previously) Discuss with your physician
12 – 15 months Every year 4th dose at 12 – 15
11-12 years, 3 doses for females 2nd dose Discuss with your physician Every year up to age 5. Every year over age 5 for those with chronic illness. Discuss with your Not applicable physician
* catch up is recommended between 24 months and 5 years
Pediatric Preventive health recommendations Name For 0 – 15 months 16 months – 5 years
Well-child examination History, physical exam, immunization status, education
Spring 2007/Good Health
Total of 9 visits including 5 visits 5 visits Annually the initial visit A complete health maintenance examination is recommended for all members. At that time your physician will recommend a health maintenance examination schedule based on your child's health care needs.
Health Three cheers for breakfast
The first meal of the day offers a lot of benefits — and it doesn’t have to be ham and eggs. Does your day start like this? The alarm rings and you’re off, with no time for breakfast. Even if you’re not in a rush, breakfast foods may not appeal to you. Or you think skipping breakfast will help you lose weight. Whatever the reason, you may be missing out on more than a meal. There are at least three great reasons to have breakfast: • You need the energy. Imagine trying to start your car with no gas in the tank. That’s what it’s like when you begin your day without breakfast. When you eat something in the morning, your body converts the food to fuel, which gives you energy. • It’ll keep your mind sharp. A morning meal can help improve your mood, concentration and ability to solve problems. Studies show that students have higher test scores and pay attention better in class when they eat breakfast. That’s why many schools offer breakfast programs. • You may lose weight. In one study, people who ate breakfast consumed less fat and ate fewer snacks on impulse than those who didn’t eat anything in the morning. You can take some simple steps to make breakfast part of your routine: • Make something you enjoy. Breakfast can be cereal, fruit and milk, but it can also be a turkey sandwich or leftover spaghetti. • Make it easy but special. Set the table the night before and plan the menu with your family. Having breakfast yourself sets a good example. • Make it nourishing. Some people only consume fruit and milk at breakfast, which can make it the most important meal for vitamins C and D and for calcium. • Make small moves to start or improve your breakfast menu. Have some juice. Add some yogurt. Try half a bagel or a piece of toast. • Buy high-fiber, whole-grain cereals. Read the labels to learn serving sizes, calorie content, sweeteners and nutrients — including about 5 grams of fiber per serving. • Make it portable. If you don’t have time to sit down, take breakfast with you. Pack a homemade muffin and a container of milk. Try the recipe featured at right for a nutritious, portable breakfast.
1 cup quick oats 2 cups unbleached ﬂour 2 teaspoons baking powder ¼ teaspoon salt ¾ cup packed dark brown sugar 1 egg, lightly beaten 1 cup skim milk ¼ cup vegetable oil 2 grated carrots 1 cup raisins ½ cup chopped walnuts Line a regular mufﬁn pan with 12 paper liners. Preheat oven to 400 degrees. In a large bowl, combine oats, ﬂour, baking powder, salt and sugar. In a small bowl, beat egg lightly. Add milk, vegetable oil and grated carrots. Stir wet ingredients into large bowl of dry ingredients. Do not overmix. Stir in raisins and walnuts. Divide batter among 12 mufﬁn cups. Bake 20-25 minutes, or until tops are golden brown. Makes 12 mufﬁns. Each contains about 248 calories, 5 grams protein, 9 grams fat and 39 grams carbohydrate.
Spring 2007/Good Health
Eat well with these menu ideas
2 onions 1 red pepper 1 green pepper 4 whole carrots or 1 cup shredded carrots 1 tsp. minced garlic (2 cloves) 1 15 oz. can kidney beans 1 15 oz. can garbanzo beans 2 cans 15 oz. each black beans – 2 tbsp. cumin seed or 1 tbsp. ground cumin 1 tbsp. chili powder 1 tsp. oregano 2 jars 32 oz. each vegetable juice 1 14.5 oz. can stewed tomatoes Nonstick cooking spray Chop onions, peppers and carrots into small wedges. In large kettle, heat nonstick cooking spray and add garlic, chopped veggies and turkey. Sauté for 5 minutes. Toss kidney, garbanzo and black beans into colander. Rinse, drain and add to sauté. Add garlic, cumin, oregano and chili powder to sauté. Add V-8 juice and tomatoes. Bring to a simmer for 10 to 20 minutes. Serving size: 1½ cups including ground turkey. 250 calories, 2 grams fat, 36 grams carbohydrate, 6 grams ﬁber and 19 grams protein. For a meatier version, add 1 lb. extra lean ground turkey.
If you’re trying to eat better in 2007, here are a few tasty recipes to try
LIghT AND EASy ChICkEN STROgANOFF
5 oz. dried no-yolk egg noodles* 2 tsp. dried dillweed, crumbled 6 oz. sliced button mushrooms 2 cups diced cooked skinless chicken breasts (cooked without salt) 1 10.75 oz. can low fat, reduced sodium condense cream of chicken soup 2 medium green onions, finely chopped (green and white parts) 1 tsp. dijon mustard ¼ cup fat-free or low-fat plain yogurt or fat-free or light sour cream Vegetable cooking spray Prepare the noodles using the package directions, without the salt and oil. Add the dillweed. Drain well. Meanwhile, heat a 12-inch nonstick skillet over medium heat. Remove from the heat and lightly spray with vegetable oil spray. Cook the mushrooms for ﬁve minutes or until limp, stirring frequently. Stir in the chicken soup, green onions and mustard. Cook for two minutes or until thoroughly heated. Stir the noodles into the chicken mixture. Stir in the yogurt (or sour cream). Serving size: 1 ½ cups. 323 calories, 4.5 grams total fat, 1.5 grams saturated fat, 38 grams carbohydrates, 5 grams sugar, 3 grams ﬁber, 30 grams protein, 407 mg. sodium. Exchanges: 2 ½ starches, 3 grams protein. *Substitute whole wheat egg noodles to increase ﬁber
SwEET POTATO FRIES
3 lbs. sweet potatoes (about 6), cut into spears ½ cup of low-fat Italian dressing ¼ cup grated parmesan cheese 2 tsp. dried parsley Preheat oven to 375 degrees. Toss potatoes with dressing. Place on a lightly greased baking sheet. Bake for 30 minutes, then turn potatoes and cook for an additional 30 minutes. Sprinkle cheese on potatoes for last 5 minutes. Sprinkle with parsley and serve. Makes 8 servings. calories 170, total fat 3 grams, sodium 220 mg., cholesterol 5 mg., total carbohydrates 31 grams, ﬁber 5 grams and protein 5 grams.
Do you have a favorite recipe to share? E-mail us at MiBCN.com/ feedback and click on the Good Health link.
Chili with ground turkey
Menus on this page are compliments of the Michigan Institute for Health Enhancement
Spring 2007/Good Health MiBCN.com
News Health Can lack of sleep make you gain weight?
If you aren’t catching up on some zzz’s, obesity may be catching up to you. Lack of sleep can affect the processing of food, the function of your heart, whether or not you gain weight and even your chances for diabetes. We need eight hours of sleep at night for a reason. It keeps us alert and makes certain processes in our bodies work. Over time, a lack of sleep catches up with us, and people who don’t get enough sleep actually appear to age faster. A lack of sleep may affect your hormones. Levels of leptin, which tells your brain when you’re full, tend to fall off when you aren’t getting enough sleep. Scientists at Stanford University and University of Wisconsin studied 1,000 people and found that those who slept fewer than eight hours a night had higher body mass indexes than those functioning on a full night’s sleep. When low on sleep, you may turn to food for an energy boost. You crave that quick source of energy that junk food can provide. This rise in blood sugar may wake you up, but the extra calories are often stored as fat. Source: Health A to Z
How to get a good night’s sleep:
Go to bed and awaken at the same time every day, including weekends. Have a relaxing bedtime routine — take a hot bath and read a book or listen to music. Make sure your bedroom is dark, quiet, comfortable and cool. Use a sleeping mask and earplugs. Sleep on a comfortable mattress and pillows. Finish eating at least two to three hours before going to bed. Exercise regularly. Complete your workout at least a few hours before bed. Avoid caffeine and alcohol before bedtime. Don't smoke. Nicotine can interfere with sleep.
Learn more about alcohol and your health
Do you or someone you love have a drinking problem? It’s very common — nearly one-third of adults drink way too much and may not even know it. At-risk drinking is defined by the National Institute on Alcohol Abuse and Alcoholism as: • Women: More than seven drinks per week or more than three drinks per occasion • Men: More than 14 drinks per week or four drinks per occasion
How BCN helps
• Use BlueHealthConnection® online at MiBCN.com to take two screening tests or call 800-637-2972 for more information. • You are covered for behavioral health services when you use ValueOptions. No referral is necessary. Call 800-482-5982, 24 hours-a-day, seven days a week or visit valueoptions.com.
April 5 is National Alcohol Screening Day, a day on which organizations nationally provide free, anonymous screenings, alcohol education and prevention tips. You can even speak with a health professional. For more information about and to locate a confidential screening site, visit nationalalcoholscreeningday.org.
Spring 2007/Good Health
Health Colon testing saves lives
If you’re approaching your 50th birthday, it’s time to ask your doctor about colon cancer screening. Don’t be hesitant to be screened — it’s not as bad as it seems. The tests you should have depend on your age and whether you’re at greater risk of getting colon cancer because of your personal or family health history. Tests could save your life. You’re more at risk of developing colon cancer if you have: • A personal or family history of colon cancer. • A personal or family history of benign colon polyps. • A personal or family history of inflammatory bowel disease such as ulcerative colitis or Crohn’s disease. • Diabetes. People with diabetes have a 30 to 40 percent increased chance of getting colorectal cancer. When colorectal cancer is found and treated early, it can often be cured.
Get screened. It’s the single most important thing you can do to prevent colon cancer. For a schedule, see our Guidelines to Good Health on Pages 14-15. Screenings can also find polyps, which when removed can help prevent colorectal cancer. Eat your fruits and vegetables. Get at least five servings of each every day. Also, choose whole grains and limit fat in your diet. Exercise. Get at least 30 minutes of physical activity on most days. This could be walking, swimming or gardening. Lose weight if you are overweight or obese. Limit your alcohol intake. Don’t smoke.
• Covers screenings for colon cancer. • Mails reminder cards to members who have not had their screening. • You can request health information from the BlueHealthConnection® line at 800-637-2972 or go online at MiBCN.com. • Offers the Quit the Nic program.
How BCN helps
Sources: Centers for Disease Control and Prevention and Health A to Z
Spring 2007/Good Health MiBCN.com
Health Five steps to safer health care
It’s true — patients who are more involved with their care tend to get better results. BCN takes patient safety seriously and encourages you to talk to your doctor. He or she is your best source of health care help. Below are some tips for talking to your doctor.
Get the results for tests and screenings
Ask questions if you have doubts or concerns • Stay until all your questions are answered. If you forget something, don’t be afraid to call back later. • Take a friend or relative with you to your doctor visit. He or she can remind you what you and the doctor talked about. Keep a list of all the medicines you take (include nonprescription medicines and vitamins) • Bring the list to your doctor appointments to go over with your doctor. • For new prescriptions ask about side effects and tell your doctor about any allergies you have. • Always read the label when you get your medicine. Make sure it’s what the doctor ordered and that you know how to take it. If it looks different, ask before you leave the pharmacy.
• Ask when and how you will get the results. Call you doctor to ask for your results. • Ask what the results mean for your care. • Don’t assume the results are fine if you don’t hear back from the office. Talk to your doctor about which hospital is best for your health needs • Ask the doctor which hospital has the best care and results for your condition. • Call BCN for a list of hospitals that have earned our Centers of Excellence designation or go to MiBCN. com/coes. If you need surgery, make sure you understand what will happen • Make sure you, your doctor and your surgeon agree on exactly what will be done during the operation. Ask these questions: – How long will the surgery take? – What will happen after the surgery? – What can you expect during recovery?
How BCN helps
• You can find quality facilities for cardiac care, low back treatment and bariatric surgery by using BCN’s Centers of Excellence. Go to MiBCN.com/coes. • Use HealthCare Advisor™ at MiBCN. com to research a condition, learn about cost and treatment options, and compare hospitals using criteria that you choose. – Which doctor will manage your care while you are in the hospital? • At the hospital: – Tell hospital staff about any allergies. – Bring your list of medications for the hospital staff. – Understand the instructions you get about follow-up care before you leave the hospital.
Source: U.S. Department of Health and Human Services
Spring 2007/Good Health
Health Fruits and veggies: Strive for five
Does your diet include a healthy dose of fruits and vegetables? Only 20 to 30 percent of Americans are actually eating at least five a day. The rest of us are falling short. That’s no small matter. About 35 percent of cancers can be prevented by getting at least five servings of fruits and veggies a day. Eating healthy eating can also help prevent: • Heart disease • High blood pressure • Type 2 diabetes • Obesity The number of fruits and vegetables you need daily aren’t one size fits all. Children between the ages of 2 and 6 should get five. Older kids, teen girls and women need seven. Teen boys and men need at least nine. Adding fruits and veggies to your diet can be tough. Take it slow by introducing an extra serving of veggies in your dinner, until, ultimately, most of your plate is full of veggies.
Add steamed broccoli or cauliflower to pasta. Keep frozen veggies on hand to throw into soups. Drink a glass of orange juice or apple juice. Slice bananas or strawberries on cereal. Make your salads sing with dried fruit, like cranberries. Quick snack idea: Roast red peppers by cutting them in half and putting them under the broiler for 15 minutes. Place them in a plastic bag and allow them to cool for 20 minutes, then peel off the skins. Source: Health A to Z
Adults who live with children tend to eat more fat
Adults who live with children eat more saturated fat than adults who don’t live with children, says a study from the University of Iowa and University of Michigan Health System. The difference is equal to eating an additional small frozen pepperoni pizza each week. “The study doesn’t prove that the
Spring 2007/Good Health
presence of children causes adults to eat more fat,” says lead author Helena Laroche, M.D., of the University of Iowa. “However, an important implication of the study is that healthy changes in eating need to focus on the entire household, not just individuals.” Compared to adults living without
children, adults living with children ate an additional 4.9 grams of fat daily, including 1.7 grams of saturated fat (which is linked to heart disease). The finding was based on survey data from 6,600 adults.
Health Build a better body to fight illness
Conditions such as heart disease and diabetes are chronic (never go away) and can cause severe problems in major organs of the body. While family history plays a part, you can make a difference and avoid future health problems by adopting a healthy lifestyle and getting regular health screenings. Below are the most important things you can do to build a healthy body inside and out. • Eat oily fish (herring, sardines, mackerel, salmon, tuna, etc). Omega-3 fatty acids in the fish oil help reduce plaque buildup in your blood vessels. • Reduce your salt intake to lower blood pressure. • Don’t have more than one or two alcoholic drinks per day because that can raise your blood pressure.
Get physical activity
Besides trimming your waistline, regular physical activity helps control cholesterol and blood sugar levels. Aerobic activity such as brisk walking helps reduce blood pressure. • Get 30 minutes of moderateintense physical activity on most days of the week. • Incorporate exercise into your every day routine (see Jeanne Carlson’s tips on Page 2).
The higher your blood cholesterol levels, the more you’re at risk of developing heart disease. Target goals are: triglycerides below 150, HDL above 60 and LDL below 100 (below 70 if you have other heart risk factors). • Have a fasting cholesterol test as recommended by your doctor. • If lifestyle changes don’t reduce your cholesterol levels, your doctor can prescribe medicine to help.
Smoking wreaks havoc on the body and can even cause wrinkles! Once you stop smoking, your body begins to heal itself from the unhealthy effects of tobacco. Avoid exposure to secondhand smoke. It can be just as dangerous.
• Plan your meals around highfiber foods, vegetables and fruit, whole grains (brown rice, breads, oats) and legumes (dried peas, beans, lentils). • Cut down on fat, especially animal fat such as meat, butter and cheese. Limit saturated and trans-fat. Use olive and canola oils for cooking. Eat low-fat dairy products.
Watch your blood pressure
High blood pressure can damage arteries and strain your heart. A blood pressure of 140/90 (140 over 90 mm Hg) is high. • Have your blood pressure checked at least every two years, more often if you already have high blood pressure.
Watch your waistline
Being obese or even overweight can affect your health more than you think. People with extra fat around their waist are at more risk for heart disease than people who have extra weight around their hips or thighs. • Extra pounds can weigh down joints and lead to knee, hip or foot problems.
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• When you’re lighter, you’ll feel better and exercise more. • A weight loss as little as of 7 to 10 percent of your body weight can make a difference and lower your risk.
If you have diabetes . . .
If you have already have diabetes, you’re at higher risk for heart disease and stroke. Avoid problems by: • Keeping your blood sugar levels within range, which helps prevent or delay blood vessel damage. • Getting an A1c test at least twice a year to check your blood sugar control. • Watching your cholesterol levels. Diabetics generally have a high triglyceride level and low levels of the “good” HDL cholesterol. LDL (bad) cholesterol is more likely to block blood vessels, too.
How BCN helps
Say “no” to stress
Stress causes the release of adrenalin, which speeds up the heart, narrows the arteries, and raises blood pressure and blood sugar. • Practice stress management tips such as relaxation, meditation or guided imagery. • Exercise, even yoga, helps reduce stress. • Off load on someone – talk to a friend or family member.
• BCN covers preventive care including well-visits. See our Guidelines to Good Health on Pages 14-15. There you’ll find the recommendations for how often you should have blood pressure checked, cholesterol tested, etc. • BCN’s Quit the Nic program can help you say “goodbye” to cigarettes for good. • Our Weigh to Go program can help you learn about nutrition and exercise. • BCN offers a diabetes management program to help those with the disease live a healthier lifestyle. See Page 1 for more information.
Ten ways to fit in exercise
1 2 3 4 5
Get off the bus a stop or two early and walk the rest of the way. Use the stairs instead of the elevator whenever you can.
Go for bike rides with your children.
6 7 8
In bad weather, walk around inside the shopping mall a few times. Plan active outings, such as hiking, on weekends. Ride a stationary bike or use hand weights as you watch television.
Take family walks after dinner.
Do your own yard work and gardening.
9 0 1
Take the dog (or a neighbor’s dog) for a walk.
Wash and wax your car.
Source: American Medical Association Family Medical Guide
Spring 2007/Good Health MiBCN.com
Health Lose weight with Weigh to Go’s new six-month program
Effective Feb. 1, 2007, Weigh to Go™ will be offered as a six-month renewable program. It previously required a 12-month commitment. More than 2,000 BCN members have signed up for the Weigh to Go program to help them reach their weight and fitness goals. Weigh to Go helps members commit to lifestyle changes, which includes eating healthy food and choosing to be active. It doesn’t involve fad or extreme diets or other temporary interventions. Members are asked to pay $90 to enroll in the program offered through a partnership between BCN and the Michigan Institute for Health Enhancement. When the member participates in the program for six months and loses at least 20 pounds, the $90 fee is refunded. For members desiring a weight loss of more than 20 pounds, the six-month refund can be used to re-enroll in another six months of program services. Upon completing the program and successfully losing 20 pounds, the member is refunded the fee.
Weigh to Go has two tracks:
• BCN partners with the Michigan Institute for Health Enhancement to assist members who have a substantial amount of weight to lose (i.e., they have a body mass index of 30 or higher or 27 or higher if they have other health conditions). The MIHE track includes nutrition, exercise and counseling. Members can receive services at facilities in Lansing, Rochester, Trenton or Roseville. Coming soon to Warren and Woodhaven. • BCN also offers a mail-based educational and support track available to all members. There is no enrollment fee for this track. Both tracks help members learn how to maintain a healthy weight and use tools to help them reach their weight and fitness goals. To register for either track, call MIHE at 866-MITEAM5 or visit miteam.org.
Spring 2007/Good Health
Benefits News Using your benefits
How we monitor member care
We want you to get the right medical care from your physician and other providers. That’s why our medical review staff works closely with your physician to make sure you get the care needed within the benefit design of your certificate and in accordance with standard medical practice. We also sometimes review data to look for potential under use of health care services. We would like you to know: • By contract, BCN physicians are required to make decisions about your care based only on your personal health care needs. • BCN monitors members’ health care services to help physicians provide the most appropriate care for members’ conditions. • BCN does not advertise, market or promote specific products or services to you or your doctors when discussing a member’s health condition. In limited circumstances, BCN may contact you about new products or treatments. • BCN does not have financial ownership arrangements with others engaged in advertising, marketing or providing goods and services. • Health care providers, including physicians and hospitals, are never paid for denying services.
Use these tools to compare hospitals
Want to know how your area hospital rates? A new consumer tool can help you get a better understanding of the quality of care at hospitals and health systems in southeastern Michigan. Visit savelivessavedollars.org. Blue Cross Blue Shield of Michigan and Blue Care Network are members of “Save Lives, Save Dollars,” a campaign led by the Greater Detroit Area Health Council. Participation helps the Blues address concerns for health care cost and quality across Michigan. For outside southeast Michigan, go to the 2006 Michigan Health and Safety Coalition Consumer Report, mihealthandsafety.org or use the HealthCare Advisor at MiBCN. com/healthcareadvisor (You’ll need to log in or register if you’re a firsttime user).
How BCN decides on new health services
We keep up with changes in health care through an ongoing review of new services, procedures and drug treatments. Our goal is to make coverage decisions in the best interest of our members’ health. A committee of physicians, nurses and representatives from different areas of BCN review new technology requests and make recommendations. In our research we use a variety of resources, which may include the following: • Published scientific studies from the peer-reviewed medical literature or other comparable sources • The recommendation from the facility or physician who wants to perform the procedure or test • The U.S. Food and Drug Administration • The National Institutes of Health • The National Cancer Institute • Other medical sources as needed, including national and local Medicare and state Medicaid coverage guidelines • The Blue Cross and Blue Shield Association After reviewing the information, the committee makes a recommendation to BCN’s senior vice president and chief medical officer to include or not include the service, procedure or drug treatment as a covered benefit for BCN members. Updates are available on our Web site or available by calling Customer Service.
Spring 2007/Good Health
Your PCP coordinates all of your care
Your primary care physician is your health partner and provides most of your care. Choose a primary care physician for yourself and each family member. Parents may select a family/general practitioner doctor or pediatrician for their children. Our female members can also see an OB-GYN without a referral as part of our Woman’s Choice program. Here are some tips to use when choosing a primary care physician that is right for you and your family. 1. Find a physician who will meet your needs. • Many primary care physicians are affiliated with larger physician groups or subspecialty networks with which they have a professional relationship. Primary care physicians generally refer to specialists who are affiliated with their subspecialty network, who use the same hospital and with whose work they are familiar. • Are there any preferences you have for specialty care that you or family members are receiving or may receive in the future? Consider the primary care physician’s hospital affiliation because this is where he or she has permission to admit and care for you if you need hospital care. • Talk with any specialist who has treated you in the past to find out which primary care physicians refer to him or her. • Ask a friend or family member who they recommend. Other details that might be important about a physician: • Office hours and location and what’s closest to your home, work or child’s school • Medical school the physician attended or the facility where the physician completed his or her residency • Foreign languages the physician speaks • The physician’s partners and types of assistants • The range of ages and genders of patients the physician treats 2. Find a physician in BCN’s extensive network of over 3,700 primary care physicians. You can find a BCN primary care physician by: • Going online at MiBCN.com/ find • Looking in a BCN Provider Directory (for a copy, contact Customer Service at 800-662-6667) • Calling BCN’s dedicated PCP hotline at 888-656-8276 3. Notify BCN of your selection. • Once you’ve found a primary care physician for everyone on your contract, you must choose one and tell BCN. • Please do this when you enroll or immediately thereafter. • Not having a primary care physician can affect your access to your benefits. There are several ways you can notify us: – Complete a Physician Selection form (available in BCN’s Provider Directory or Member Handbook. – While searching at MiBCN.com/find, select “choose doctor as PCP” to submit the online form – Call BCN’s dedicated PCP hotline at 888-656-8276 4. Remember to make an appointment. • Once you’ve picked your primary care physician, make an appointment to meet with your physician. At this time you can discuss your medical history and any special needs you may have. • Also discuss if you are seeing a specialist for any care. Your new primary care physician must authorize any treatment you are receiving (or the treatment may not be covered).
Quality information available
BCN has quality improvement programs in place. Updates are available in this magazine and at MiBCN.com. You can also call the quality department at 248-455-3471 for more information.
Spring 2007/Good Health
Resolving your concerns
BCN and your primary care physician want you to be satisfied with the care and services you get. If you have a problem related to your care, we suggest you talk to your primary care physician first. You can also call Customer Service. We have a formal process if your concern is not resolved. You have two years from the date of discovery of a problem to file a grievance or appeal a decision we’ve made. There is no cost to you. Below is a brief summary of BCN’s grievance process. A complete explanation of the grievance program is available by: • Referring to your Member Handbook • Calling Customer Service to ask for a copy • Going to MiBCN.com/ resolveproblems Members are also told of their rights to appeal on the back of the Explanation of Benefits form.
step One: Review and decision by BCN
To start a grievance, you or someone approved by you in writing, must send a letter about the problem to Customer Service at: Appeals and Grievance Unit Blue Care Network P.O. Box 284 Southfield, MI 48037-0284 Fax: 888-458-0716 The Appeals and Grievance Unit will review your concern and give you a reply within 15 calendar days for preservice claims and within 20 calendar days for postservice claims. If you disagree with our decision, you may appeal to Step Two within 180 calendar days after receiving BCN’s decision.
• A physician confirms verbally or in writing that you have a medical condition for which the time frame for completing a standard grievance would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function, and • You believe we have wrongfully denied, terminated or reduced coverage for a health care service prior to your having received that health care service, or you believe we have failed to reply in a timely manner to a request for benefits or payment. You can submit your expedited request by calling us or sending a letter. Mail or fax your letter to the address listed above in Step One. Your physician’s confirmation that your condition qualifies for an expedited grievance can also be sent by phone. We’ll decide within 72 hours of receiving both your grievance and the physician’s confirmation. If we tell you our decision orally, we’ll provide a written confirmation within two business days. If you still do not agree, you may ask for an expedited external review from the Office of Financial and Insurance Services within 10 days of receiving our decision.
step two: Review and decision by BCN Grievance Panel
If you appeal from Step One, BCN’s Member Grievance Panel will review and consider the decision made at Step One. For preservice and postservice claims, you’ll be notified of the Step Two grievance decision within 15 calendar days.
Appeal: To have a previous decision reviewed. Grievance: A concern about your care or benefit coverage. Preservice claim: A claim that must be approved before a member can get access to that service. Postservice claim: Any claim for a benefit involving the payment or reimbursement of the cost for medical care that has already been provided.
external grievance process
If you do not agree with the decision at Step Two, you may appeal to the State of Michigan Office of Financial and Insurance Services no later than 60 days after you receive BCN’s final decision.
You may ask for an expedited (quick review) grievance when:
Spring 2007/Good Health
Blue goes with you when you’re away from home
As a BCN member, you’re covered when you’re away from home – whether you’re making a short trip or staying for an extended time, whether you’re traveling in Michigan or to other states. Always carry your ID card with you. You should not have to complete claim forms or pay upfront health care expenses, except for your usual out-of-pocket expenses (noncovered services, copayments and deductibles). You also have access to Blue plan physicians and hospitals nationwide through BlueCard®, a program of the Blue Cross and Blue Shield Association. Refer to the chart below for how to get care when you’re away from home. Kids away at college? They’re covered too. BCN members who are attending school outside of Michigan can use the BlueCard program by calling 800-810-2583 for routine, urgent and follow-up care. If the student is away at school but still in Michigan, he or she can be assigned to a primary care physician near the school. The student can also stay with his or her PCP back home and request referrals to be treated by doctors in the network while away at school. Relax: Urgent or emergency care is always covered no matter where you are in the world!
Did you know…
BCN covers those travel vaccines for trips out of the country? Yes, if you are going out of the U.S. and, for example, need a malaria vaccine, BCN will cover it. Ask your primary care physician where you can go (some clinics may have the vaccines) or call your local health department. You’ll have to pay upfront and then submit a reimbursement form to BCN. See your Member Handbook for details or call Customer Service.
If you’re traveling
In Michigan where BCN is offered
And you need
Emergency care (immediate medical attention needed) Urgent care (condition that requires a medical evaluation within 48 hours) Follow-up care (for a medical condition that started before you left home)
Here’s what you do
Call 911 or go to the nearest hospital room. Call Customer Service to help you locate a BCN participating urgent care center. Call 888-656-8276 to locate a physician at your destination. Call 911 or go to the nearest hospital emergency room. Call 911 or go to the nearest hospital emergency room. Call BlueCard at 800-810-BLUE (2583) to find a provider. Call BlueCard at 800-810-BLUE (2583) to find a provider. Members who plan to live out of state for a period of time should contact BlueCard for a Blues participating provider in the area where they will be located. Go to the nearest hospital emergency room. (You may have to pay for services and then seek reimbursement.)
In Michigan where BCN is not offered In the United States but outside Michigan
Emergency care Emergency care Urgent care Follow-up care
Extended stays out of state Outside the United States
Spring 2007/Good Health
Use these guidelines when scheduling appointments
Your partnership with your doctor includes scheduling appointments to get the best possible care. The table below lists the different types of appointments and BCN’s Medical health services standards for wait times. Unless it’s an emergency, you need to make an appointment to see your primary care physician.
Remember, you can call your primary care physician 24 hours a day, seven days a week.
Type of appointment with your PCP
Preventive care (routine, primary and specialty care) Routine primary care
A complete health history and physical exam including screenings and immunizations listed in the Guidelines to Good Health (see Pages 14–15 ) • Not acute or nonlife-threatening conditions such as a sore throat, cold • Recurrent symptoms such as rashes and joint/muscle pain • Members who were previously seen for a problem A previously diagnosed problem, such as an ear infection or high blood pressure Acute but nonlife-threatening conditions, such as fever over 101°F more than 24 hours, persistent vomiting, mild/persistent diarrhea or a new skin rash A condition that is life-threatening or requires rapid intervention to prevent deterioration of the member’s health
Standard wait times
30 calendar days 4 calendar days
Follow-up care Urgent care
14 calendar days 2 calendar days
Do not wait — go to the nearest emergency room or call 911
Behavorial health services Behavioral health and substance abuse counselors are available 24 hours a day, seven days a week. Call ValueOptions for an appointment with one of our affiliated providers or to get assistance during an emergency. You do not need a referral from your primary care physician. ValueOptions is BCN’s behavioral health vendor and coordinates your care with a behavioral health professional and your primary care physician. ValueOptions will help you find a specialist in behavioral health or substance abuse services. ValueOptions can be reached at 800-482-5982 or 800-223-5822 (TTY). If you are ever in the hospital for a behavioral health issue, continuing treatment is important to your care. Your aftercare visit should be made the same day you are discharged from the hospital. You should also make another appointment within seven days from your hospital discharge. For more information, call ValueOptions.
Type of appointment
Routine care Urgent care Emergency care (not life-threatening) Emergency care (life-threatening)
Standard wait times
Cases where no danger is detected and the member’s ability to cope is 10 working days not in jeopardy Conditions that are not life-threatening, but face-to-face contact is needed within a short period of time (for example, severe depression) Conditions that require rapid intervention to prevent deterioration of the member’s state of mind that left untreated could jeopardize the member’s safety Conditions that require immediate intervention to prevent death or serious harm to the member or others Within 48 hours Within 6 hours
Spring 2007/Good Health
Keep your coverage up to date
To make sure you are receiving all the benefits you are entitled to, please make sure to contact BCN within 30 days of any status change. If you have group coverage, contact your group benefits representative to make changes to your record. Some examples of changes we need to know about include:
3 3 3 3 3 3 3 3
Birth of a child Adoption or legal guardianship Marriage Divorce Death Name change New home address or telephone number Medicare eligibility
XYH 888888888 VALUED CUSTOMER
GROUP NUMBER SUBSCRIBER NAME
For more information, call Customer Service at 800-662-6667.
Mail Code C226 P.O. Box 5043 Southfield, MI 48086-5043
Presorted standard U.s. Postage Paid Blue Cross Blue shield of Michigan
CF 2865 Mar 07