Plan for a healthy baby. Protect yourself and your family. Know the signs of health care fraud and abuse. page 3

Transcription

1 Fall/Winter 2015 Protect yourself and your family. Know the signs of health care fraud and abuse. page 3 Save time and money with virtual visits page 5 Plan for a healthy baby page 6 Health Journal Fall

2 CONTACT US When you have questions about your health care benefits, contact us! You can also call us when: You want to change your doctor You need a new membership card You get a medical bill by mistake You want to know how to get care CALL US Our number is (TTY users should call 711). Our hours are Mon. through Thurs., 7:30 a.m. to 7 p.m., Fri. from 9 a.m. to 5 p.m. and Sat. from 8:30 a.m. to noon. If you speak little or no English, we ll work with a translator so we can talk to you. Get big savings with member perks As a Priority Health member, you can save big on products and services that help you be your healthiest. From health clubs and fitness gear to sporting goods and computers, Priority Health Member Perks will save you money wherever you live, travel or play! Priority Health Member Perks help you earn up to 20% cash back on every purchase when you shop using the Benefit Mobile, Inc. app. Here s how it works: Download the Benefit Mobile, Inc. app Buy your digital gift cards and have them delivered to your phone within seconds choose from hundreds of national retailers Redeem online or right at checkout Use your cash back to support a healthy lifestyle US Go to priorityhealth.com and click on Contact Us at the top right of the page. Every dollar you spend earns you money back. And you can use your savings toward your health care expenses. How great is that? Healthy Michigan Plan members: Earn your reward and complete your health risk assessment We want to reward you for staying healthy. You could earn a $50 gift card or get a reduction on your monthly payments if you choose at least one healthy behavior to work on over the next year. As your partner in health, we want to make sure you know about the things you should do in your first 150 days of joining our plan: Contact your primary care provider (PCP) within the first 60 days of enrollment to schedule an appointment that falls within the first 150 days of enrollment. If you don t have a PCP, you can: -- Use our online Find a Doctor tool to find a list of PCPs in your area. -- Open, save and/or print the provider directory. It s located online at priorityhealth.com, click on the Medicaid box. -- Call Customer Service at Our hours are listed at the top of this page. Complete a health risk assessment with your doctor during your PCP visit. The Healthy Michigan Plan Health Risk Assessment and instructions to fill it out are in your new member packet. The HRA is also available online: Visit priorityhealth.com, search health risk assessment. Answer questions in sections 1 3 as best as you can. Bring this form with you to your yearly check-up. Your doctor will fill out section 4 and send your results to your health plan. 2 Health Journal Fall 2015

3 Protect yourself and your family. Know the signs of health care fraud and abuse. Some people look for illegal ways to get money from REPORT FRAUD AND ABUSE health insurance companies. That s called health care If you think you know of this kind of activity, you should fraud and abuse. Experts estimate that it costs report it. You won t have to give your name, address or you and all U.S. taxpayers as much as $175 billion dollars each year. phone number. You can: 1 Contact Priority Health Call Customer Service at or FRAUD Health care fraud is when someone lies to get money they Write Priority Health Fraud and Abuse Program aren t entitled to. Examples include: A doctor bills the insurance company for a service that the doctor did not provide MS 3175, 1231 East Beltline NE Grand Rapids, MI Call the Compliance Helpline The Compliance Helpline is a third-party organization where A person receives health care services under someone else s name you can report a concern 24 hours a day. Call them at ABUSE 3 Contact the State of Michigan Health care abuse is when a doctor provides unnecessary Call toll-free 855.MI.FRAUD ( ) care or patients try to avoid paying their share of the costs. Write Office of Health Services Inspector General Health care abuse happens when, for example: A person goes to the emergency room for nonemergency services P.O. Box Lansing, MI Visit Michigan.gov/fraud and click on Submit an online complaint. The site will provide examples and directions A doctor orders tests or services you don t need about how to report fraud and abuse. Register your member center account Visit priorityhealth.com and click on the login button on the top right of your screen to register for your member center account. In your member center, you ll have: Access to your plan information The ability to order prescription refills A digital view of your membership card The option to change your primary care provider (PCP) Personal health plan information Plus so much more! Health Journal Fall

4 Important health reminders These tips can help keep you healthy. Call your doctor if you have questions or concerns. IMMUNIZATIONS DEPRESSION Immunizations (shots) help you and your family avoid getting and spreading serious diseases. Ask your doctor if your children are up to date on these shots. Many adults and children have depression. It can be caused by low self-esteem, job loss, medical conditions, divorce and moving. Call our Behavioral Health department at for help or a referral to a behavioral health specialist. Your call will be private. Influenza helps protect against the flu, which can be serious for people with chronic illness or for young children. Hepatitis B protects against a liver disease that could be deadly. Human papillomavirus (HPV) protects against HPV, a very common virus that is spread through sexual contact. Some types of HPV can cause cervical cancer. Measles-mumps-rubella (MMR) protects against measles, mumps and rubella. Pneumococcal protects against pneumococcal pneumonia, a lung infection that can be fatal. Tetanus-diphtheria-pertussis booster protects against diphtheria, a bacterial infection that can be fatal; lockjaw, a jaw disorder; and whooping cough. Varicella protects against chickenpox, which can be fatal in adults. 4 Health Journal Fall 2015 KNOW THE ABC S OF DIABETES CARE Many people don t even know they have diabetes, yet it can cause serious health problems like heart disease, blindness and kidney failure. Signs of diabetes may include extreme thirst, frequent urination, blurred vision and tiredness, but the only way to know for sure if you have it is to be tested. If you have diabetes, pay close attention to your ABCs: A1C Blood pressure Check your urine

5 Save time and money with virtual visits We want to help our members get the best care anytime, anywhere. Now, when you re sick and your doctor isn t available, you may not need to go to an urgent care or emergency room to get treatment. You can get 24/7 access to doctors via video chat or secure messaging on your computer through our virtual visits. Why virtual visits? Fast and reliable care for non-emergency conditions, like a sore throat, allergies, sinus infections and more Access to doctors anytime, anywhere Avoid unnecessary and costly emergency and urgent care visits Need a ride? We will help you get a ride to your medical appointments. Call us for help if: You do not have a way to get to and from a doctor visit; or You do not have a way to get medical items or services covered by us Remember: For rides you need to be approved in advance. For routine appointments, such as a doctor s appointment that is not an emergency, please ask for a ride at least 3 days before your appointment date. You must have no other way to get to your medical appointment. Call or for more information or help arranging a ride. To get a virtual visit call toll-free or log in to your member center. Get free help to quit smoking Ready to quit smoking? We re here to help. As a Priority Health member, you can get free products to help you quit tobacco, like nicotine replacement therapy, gum, inhalers, patches and Zyban or Chantix. Group and/or individual counseling is also available. Talk to your doctor to see what might work best for you. You can also get free help when you call the Michigan Tobacco Quit Line at You can receive up to five 20-minute phone calls with a trained coach to help you quit (pregnant women can receive up to ten calls). Health Journal Fall

6 PLAN FOR A HEALTHY BABY Stay on track throughout your pregnancy: Before you become pregnant Because many pregnancies are unplanned, every woman of child-bearing age should take a vitamin with.4 to.8 mg of folic acid each day to prevent brain and spinal cord birth defects. Hospital If you choose the minimum stay at the hospital after your baby is born, you can get a phone assessment and home visit from a nurse. Get Priority Health for your baby Call Priority Health to let us know you had a baby. We ll also need the baby s Medicaid ID number. Then, call MIEnrolls at , and choose Priority Health when you call. If you don t call and choose, your baby may be added to a different health plan. Pregnancy See your doctor during the first 12 weeks of your pregnancy so you can be enrolled in our maternity program. You ll receive an educational packet about care you need. Care for you after your baby is born Visit your doctor for a checkup four to six weeks after your baby is born. Your doctor will make sure you re back to full health and feeding your baby is going well. 6 Health Journal Fall 2015

7 STAY ELIGIBLE If you have a child covered under the Children s Special Health Care Services program, they need to be seen by a specialist more than once per year. If you need help with renewing the coverage, or call your CSHCS case manager at , prompt 1, then enter their 5-digit extension: Jennie B., MSW, CDE: ext jennie.b@priorityhealth.com Lisa C., RN: ext lisa.c@priorityhealth.com Gina L., MA: ext gina.l@priorityhealth.com Maternal Infant Health Program (MIHP) MIHP is a home visiting program for pregnant women and infants with Medicaid. MIHP provides support service to women and to parents so they have healthy pregnancies, good birth outcomes, and healthy infants. FREE access to transportation to medical appointments, WIC, and childbirth or parent education classes Help getting prenatal care and answers to questions about your pregnancy or care of your baby Help managing health problems that could affect your pregnancy Get referred to the program Call us at , Monday through Thursday, 7:30 a.m. 7 p.m., Friday 9 a.m. 5 p.m. and Saturday 8:30 a.m. noon. (Eastern Time) Did you know Priority Health participates with MIChild? The MIChild health program can help children in Michigan by covering checkups, pharmacy, shots, emergency and dental care. The cost is $10 per family each month. To qualify, a child must: Be a U.S. citizen Live in Michigan Be under age 19 Have no other comprehensive health insurance Parents must also meet income requirements. You can apply online at healthcare4mi.com and find out if you and your children qualify for coverage. For more information, you can call: The MIChild help line at (questions about the MIChild program and eligibility) Priority Health Customer Service at (questions about Priority Health, and coverage and benefits) Health Journal Fall

8 1231 East Beltline Ave. NE Grand Rapids, MI Connect with us! Health and wellness or prevention information Health Journal is presented by Priority Health, 1231 East Beltline NE, Grand Rapids, MI All rights reserved. Health Journal and its graphic representation are trademarks. Reproduction without permission is strictly prohibited. No material in this issue may be reproduced without written permission. The publishers do not assume responsibility for unsolicited editorial material. Health Journal is an information newsletter for the customers of Priority Health. The information provided in this newsletter is intended to be used as a general guideline and should not replace the advice of your physician. Always consult your physician for individualized care. If you have any questions, please call the number on the back of your membership card. Priority Health encourages physicians to discuss all treatment options with their patients regardless of benefit level or coverage. LEAD POISONING Lead is found in lead-based paint on toys, furniture and in old houses. Children can get lead dust from their hands into their mouths. Even a small amount of lead can cause learning, hearing and behavioral problems. Kids with lead poisoning may not look or act sick. Only a simple blood test can tell for sure. Ask your doctor to test your child at 12 and 24 months. Test kids ages 3 6 once a year. CARE MANAGEMENT SERVICE Our care managers can help you make good health choices. They provide free educational materials and work with your doctors to help you and your family get the best care. For more information, call , prompt 1, and then choose the extension of your care manager. UPPER RESPIRATORY INFECTIONS (COLDS) A cold is a viral infection with severe symptoms. Antibiotics won t help you feel better, but drinking lots of fluids and extra rest will. To prevent colds and other illnesses, wash your hands often and keep your hands away from your face. Coughs and sneezes spread germs, too. Use a tissue or the crease of your elbow to cover your nose and mouth when you cough or sneeze. REVIEW YOUR HEALTH MICHIGAN ACCOUNT WITH MAXIMUS Call the Beneficiary Help Line at , TTY for questions about your MI Health Account (Healthy Michigan) balance, money owed or your account information. DO WE HAVE YOUR CORRECT ADDRESS? Please check that your address is accurate. How? By calling your DHS case worker or by using the self-service website at mibridges.michigan.gov. HAVE YOU KEPT UP TO DATE ON YOUR ENROLLMENT INFORMATION? Change of address isn t the only thing we need to know about. You must notify us and your DHS caseworker of any changes that may affect your Medicaid coverage, including: Change in status of a dependent (such as if your child gets married); Eligibility for Medicare; or Enrollment, disenrollment or coverage by any other insurance or health plan Prevention: a little goes a long way Are you up-to-date on recommended checkups, screenings and immunizations? It s important to get to your doctor regularly to get preventive care. Preventive care lets your doctor find health problems before you feel sick. Preventive care includes: Immunizations Physical Exams Lab tests Prescriptions When completed by an in-network doctor, these preventive services are completely free. Questions about preventive care? Find more information at priorityhealth.com/preventive or call customer service at the number on the back of your membership card. 8 Health Journal Fall Approved MH Priority Health 8855D 12/15