Autumn 1999

Take care

of yourself.

Someone’s

depending

on You.

~Women’s Health Information Inside~

Take care

of yourself.

Someone’s

depending

on You.

~Women’s Health Information Inside~

Want Healthy Kids? Join the Club! — p. 10Want Healthy Kids? Join the Club! — p. 10

3

is published four times a year by theArkansas Blue Cross and Blue ShieldAdvertising and CommunicationsDivision for the company’s mem-bers, health care professionals andother persons interested in health

care and wellness. Opinions expressed herein do not necessar-ily reflect the views of Arkansas Blue Cross and Blue Shield orany of its publics.

Vice President of Advertising and CommunicationsPatrick O’Sullivan

EditorKelly Whitehorn

DesignerGio Bruno

ContributorsMark Carter, Damona Fisher, Kathy Luzietti and Greg Russell

Customer Service Numbers

Little Rock Toll-freeCategory Number (501) Number

State/Public School Employees 378-2437 1-800-482-8416

e-mail: publicschoolemployees@arkbluecross.comstateemployees@arkbluecross.com

Medi-Pak (Medicare supplement) 378-3062 1-800-338-2312

Medicare (for beneficiaries only): Part A (hospital benefits) 378-2173 1-800-482-5525 Part B (physician’s benefits) 378-2320 1-800-482-5525

UniqueCare, UniqueCare Blue, Blue Select® (individual products) 378-2010 1-800-238-8379

Group Services 378-2157 1-800-421-1112

BlueCard® 378-2127 1-800-880-0918

Federal Employee Program (FEP) 378-2531 1-800-482-6655

Health Advantage 221-3733 1-800-843-1329

Medi-Pak HMO (Health Advantage) 954-5200 1-800-354-9904

USAble Administrators 378-3600 1-800-522-9878

Numbers to call for information about obtainingcoverage:

Little Rock Toll-freeCategory Number (501) Number

Medi-Pak (Medicare supplement) 378-2937 1-800-392-2583

UniqueCare Blue, Blue Select® (individual products) 378-2937 1-800-392-2583

Medi-Pak HMO (Health Advantage) 378-6987 1-800-588-5706

Regional Office locations:Central Little RockNortheast JonesboroNorthwest FayettevilleSouth Central Hot SpringsSoutheast Pine BluffSouthwest TexarkanaWest Central Fort Smith

Customers who live in these regions may contact theregional offices or call the appropriate toll-free telephonenumber listed above.

INSIDETHIS ISSUE

~AUTUMN 1999~

Breast Health ............................................ 4-5Down but not out (depression information) .......... 6Are you depressed? Find out withThe Wakefield Scale ........................................... 7Flu & You .................................................. 8-9Do you want healthy kids? Join theBlueAnn Club! ............................................ 10-11Focus on Women’s Health (information aboutosteoporosis, menopause and PMS) ...................... 12Diabetes and You ....................................... 13How to file a Health Advantage claim ........ 14Health Advantage members, take note!(what you need to know about prescriptions, utilizationguidelines and the new Health Management Programs) ... 15Leading the Way(get to know some of Arkansas’ legislators) ....... 16-17Ageless Heroes honorees........................... 18Blue & Your Community ............................. 19Clearly Blue(a guide to health insurance terminology) ............... 20

4 Breast

Step 2 includes an annual physical examination by a physician or nurse practitioner. Women donot need to see a gynecologist if their family physicians are including breast and cervical exams in theannual physical.

Step 3 is a baseline screening mammogram which should be done sometime before the age of 40.Then, once a woman reaches 40, screening mammograms should be done on an annual basis. Mammog-raphy is about 90 percent effective and can detect tiny lumps before they can be felt. If the familyphysician or gynecologist is not recommending annual mammograms, then once again, it is recom-mended that women request this test.

The sooner a breast health program is begun and consistently followed, the greater the chancesof detection, diagnosis, treatment and survival.

Know the Facts.

I t’s important to know the risks and the facts about breast cancer and you. Did you know...• By the end of the decade, about 1.8 million women and 12,000 men will be diagnosed with invasive

breast cancer?• Approximately 44,000 women and 300 men will die of this disease each year?• Breast cancer is the leading cancer among American women and is second only to lung cancer in

cancer deaths? (For women ages 35-54, breast cancer is the leading cause of death.)• Breast cancer accounts for 30 percent of all new cancer cases in women?• When breast cancer is confined to the breast, the five-year survival rate is higher than 95 percent?

Know the Facts.

Three Steps to Breast HealthThree Steps to Breast HealthThree Steps to Breast HealthThree Steps to Breast HealthThree Steps to Breast HealthThree Steps to Breast HealthThree Steps to Breast HealthThree Steps to Breast HealthThree Steps to Breast HealthThree Steps to Breast Health

B reast Cancer is the leading cause of death in women 35-54.Every three minutes, a woman is diagnosed, and every 12 minutes,a woman dies from this disease in this nation. While there is nocure at this time, and there are no prevention techniques ortherapies, the best defense is a good offense — to use a well-known phrase.

There are three tried-and-true steps to follow:1) Monthly breast self-examination (BSE).2) Annual clinical exam by a physician or nurse practitioner.3) Annual mammograms starting at age 40.

Step 1 in good breast health is to perform a monthly breastself-examination — a commitment women make to themselvesand to the ones who love them. Starting at age 20, the monthlyexam should be done approximately one week following the startof the menstrual period. For women who have reached meno-pause, the BSE should be done on the same day each month. It issuggested that women select a day that has meaning, such as abirth date or anniversary date, so that the day is easily remembered.

5

Health

Q. Who is at risk for breast cancer?A. All women are at risk. Women with either a mother, sister or daughter with breast cancer, particularly if it

occurred before menopause or in both breasts, are at higher risk. However, only 5 percent to 10 percent ofbreast cancers are due to heredity.

Q. When should breast self-examination be performed?A. Breast self-examination (BSE) should be performed at the same time each month. A good time to examine

yourself is just as your menstrual period is ending, when the breasts are least sensitive.

Q. What role does diet and nutrition play in reducing one’s breast-cancer risk?A. There is an increasing body of knowledge suggesting that a low-fat, high-fiber diet may play a role in

lowering breast-cancer risk. However, there is no conclusive evidence.

Q. Will drinking alcohol increase one’s risk for breast cancer?A. Some research studies have shown an association between alcohol consumption and an increased risk

of breast cancer.

Q. Are women who have fibrocystic changes in their breast at higher risk for breast cancer?A. For the majority of women, fibrocystic changes are not associated with an increased risk of breast cancer.

Q. Are women who use birth control pills at an increased risk for breast cancer?A. Most research studies have not found an increased risk of breast cancer in women who use birth control pills.

Q. Is obesity a risk factor for breast cancer?A. Obesity itself is not a risk factor. Weight gain is a much greater risk factor, espe-

cially if the weight gain occurs after menopause.

This information is reprinted from the Susan G. Komen Breast CancerFoundation’s “Breast Health Basics” literature. For printed copies of this or otherinformation or to schedule a breast education class for a civic, church or businessgroup, please call the Arkansas Affiliate Office at (501) 202-4009.

Breast Cancer Q & A

Know the Risks.

What is your risk of developing breast cancer?By age 25 — 1 in 19,608By age 30 — 1 in 2,525By age 35 — 1 in 622By age 40 — 1 in 217By age 45 — 1 in 93By age 50 — 1 in 50By age 55 — 1 in 33

Source: Susan G. Komen Breast Cancer Foundation

By age 60 — 1 in 24By age 65 — 1 in 17By age 70 — 1 in 14By age 75 — 1 in 11By age 80 — 1 in 10By age 85 — 1 in 9Ever — 1 in 8

Know the Risks.

Recognition is the key to beating depression

6 Everyone feels a little “down in the dumps” now and then. It’s just part of being

human. But for some people, major depression is aclinical condition with a huge impact.

It is estimated that one out of every eightpeople needs treatment for depression, but only

one-third to one-half of that number actually gethelp. Sadly, many cases of depression simplyaren’t recognized. Often, people are reluctant toadmit that they are depressed because of thestigma associated with the disorder. Also, thesymptoms of depression aren’t always easy toidentify because they can appear to stem fromsome other physical problem.

Major depressive disorders can strike at anyage, but generally speaking, they occur mostcommonly between the ages of 20 and 40. Onecommon misconception is that depression is causedby some mental defect. Psychiatric disorders maymake a person more susceptible to depression, butin reality, depression can be triggered by a numberof nonpsychiatric factors: major or chronic healthproblems, the use of certain medications, etc.

Illness can be a significant contributor. Overall,it is believed that from 25 percent to 33 percent ofpeople who suffer from chronic illnesses experiencedepression. One survey found the following rates ofdepression among patients in several categories ofserious illness:

• Recent heart attack victims — 45 percent.• Hospitalized cancer patients — 42 percent.• Recent stroke survivors — 40 percent.• Multiple sclerosis victims — 40 percent.• Parkinson’s disease sufferers — 40 percent.• People with diabetes — 33 percent.

Down but not outRecognition is the key to beating depression

Other factors such as gender and age also canplay a part. For instance, women are up to twice aslikely as men to experience depression. And the agefactor is particularly problematic (more than 15percent of seniors experience depression) becauseof influences including deteriorating health and

cognitive abilities, adverse drug interactions andpersonal losses (loss of occupation; death of aspouse, relative or friend; etc.). Also, older adultsare less likely to believe they are depressed, so theytend to focus on physical complaints that actually

mightstemfromdepres-sion(insom-nia,weightloss,fatigue,etc.).Becauseof theseand other

“atypical” factors associated with aging, seniorsmay not fit the usual criteria or measurement toolsused to determine whether a person is clinicallydepressed.

And the cost of depression is high. The disordertakes an incalculable emotional toll, and theestimated annual monetary impact on the nation is$43 billion in medications, professional care andmissed time at school and work.

But the news about this condition isn’t alldepressing. In fact, once major depression isrecognized, it almost always can be treated success-fully with medication or psychotherapy — or both.Not everyone responds to the same therapy, but if aperson doesn’t respond to the first treatment used,he or she is likely to respond to another approach.

Health Advantage recently issued Major Depres-sion Guidelines to its primary care physicians andbehavioral health specialists. This information isprovided as a resource to assist physicians inidentifying the symptoms of depression so they cansee that patients get the help they need.

... once major

depression

is recog-

nized, it

can almost

always be

treated

success-

fully ...

... once major

depression

is recog-

nized, it

can almost

always be

treated

success-

fully ...

7The Wakefield ScaleDetection is the key to successfully dealing with depression. The Wakefield Scale is one easy-to-use

screening tool that can help you determine whether you need to contact your primary care physician todiscuss possible treatment. Just answer the following 12 questions, circling your response, and add up thecircled numbers. If your score is 15 or higher, show the test to your primary care physician.

And even if you do not score highly on the test but suspect you are depressed, talk to your doctor. Somepeople with normal scores on depression questionnaires actually are depressed and can benefit from treat-ment. And please, if you develop thoughts of harming yourself or others, seek help right away.

A. I feel miserable and sad. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely

B. I find it easy to do the things I used to do. (0) Yes, definitely (1) Yes, sometimes (2) No, not much (3) No, not at all

C. I get very frightened or panicky feelingsfor apparently no reason at all. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely

D. I have weeping spells, or feel like it. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely

E. I still enjoy the things I used to. (0) Yes, definitely (1) Yes, sometimes (2) No, not much (3) No, not at all

F. I am restless and can’t keep still. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely

G. I get off to sleep easily, without sleeping tablets. (0) Yes, definitely (1) Yes, sometimes (2) No, not much (3) No, not at all

H.I feel anxious when I go out of the house on my own. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely

I. I have lost interest in things. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely

J. I get tired for no reason. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely

K. I am more irritable than usual. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely

L. I wake early and then sleep badly for the restof the night. (0) No, not at all (1) No, not much (2) Yes, sometimes (3) Yes, definitely

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FLU & YOU ¥ FLU & YOU ¥ FLU & YOU ¥

Risk Factorsfor flu and pneumonia

Y ou may be at risk for the flu and/or pneu-monia if you are in one of the following catego-ries. Take preventive measures and get your fluand pneumococcal vaccines. People at risk include:

• Persons aged 65 or older.• Persons aged 2 to 64 who have chronic

illnesses such as cardiovascular disease(including congestive heart failure (CHF),cardiomyopathies and chronic obstructivepulmonary disease (COPD), recurrentbronchitis, emphysema, diabetes mellitus,alcoholism, chronic liver disease, cirrhosis,cystic fibrosis, functional or anatomicasplenia, sickle cell disease and splenectomy.

• Smokers.• Persons who are in special environments

such as nursing homes or other long-termcare facilities.

• Persons aged 2 and older who have func-tional or anatomic asplenia (including sicklecell disease and splenectomy), Hodgkin’sdisease, lymphoma, leukemia, multiplemyeloma, chronic renal failure and othersituations such as organ transplantation,cancer treatments and drug regimens causingimmunosuppression and HIV infection.

If you are pregnant, contact your health careprovider for more information.

If you are in one of the above risk categories,you will be receiving a reminder card from HealthAdvantage encouraging you to get your vaccines.Both vaccines may be taken at the same time atthe onset of the flu season (October through mid-November). See your primary care physician withquestions or for more information.

8

Information for the articles concerning the fluand pneumonia was obtained from “Preventionand Control of Influenza: Recommendations forthe Advisory Committee on ImmunizationPractices”; “Prevention of Pneumococcal Disease:Recommendation of the Advisory Committee onImmunization Practices”; and the ArkansasHealth Department.

Fast flu and

pneumonia facts

• In 1997, the Arkansas Health Department reported

that influenza and pneumonia were the sixth-

leading cause of death among Arkansans, with the

senior population accounting for more than 90

percent of the deaths.

• Each year in the United States, pneumococcal

disease accounts for an estimated 3,000 cases of

meningitis, 50,000 cases of bacteremia, 500,000

cases of pneumonia and 7 million cases of otitis

media (ear infection).

• Influenza is a significant cause of death. Between

1977 and 1987, at least 10,000 deaths occurred in

seven separate influenza epidemics, with 80

percent to 90 percent of the deaths occurring in

individuals age 65 and older.

• The influenza vaccine is 80 percent effective in

preventing death in the at-risk population, but only

40 percent of non-institutionalized older adults

receive the immunization annually.

• Only 20 percent of at-risk patients receive the

vaccine for pneumococcus.

• Penicillin-resistant and multi-drug-resistant strains

of streptococcus pneumoniae have increased.

9 FLU & YOU ¥ FLU & YOU ¥ FLU & YOU ¥

What causes pneumonia?Pneumonia can affect anyone at any age. Pneumonia

is an inflammation of the lungs caused by an infection. It isa common, serious illness that affects approximately oneout of 100 people each year. It is caused by many differenttypes of organisms and may range from a mild to a life-threatening illness.

Pneumonia symptoms include: cough, chills withshaking, fever, fatigue, chest pain, headache, loss ofappetite, nausea, vomiting and general discomfort.

Additional symptoms that may be associated with thisdisease include: shortness of breath, excessive sweating,clammy skin, rapid breathing, coughing up blood and ab-dominal pain.

Supportive therapy includes oxygen and respiratorytreatments. Most patients will respond to the treatment andimprove within two weeks.

If you are at high risk (see risk factors on Page 8), it isimportant that you get vaccinated to prevent the illness andany further complications. The vaccine has a protectiveefficacy of approximately 60 percent. Most people will needone shot that will immunize them for the rest of their lives.However, some people may need to have another vaccineafter five years.

Get your flu shotI f you have ever had influenza (better known asthe flu), you know it is no fun. So, to improve yourchances of having a flu-free fall and winter, takepreventive measures and get your flu shot.The flu is a viral infection of the respiratory tractthat causes fever, headache, muscle aches andweakness. It is spread from person to person byinhaling infected droplets from the air. Flu symptomsinclude: fever, cough, nasal discharge, headache,muscle aches and weakness, shortness of breath,chills, sweating, fatigue and appetite loss.Antibiotics are not effective against viral infec-tions. Bed rest, painkillers and warm fluids may helprelieve the symptoms. Symptoms usually go awaywithin seven to 10 days.To prevent the flu, get a flu shot. The vaccinehas a 70 percent to 90 percent success rate inpreventing illness in a healthy person under age 65.

10Parents and teachers, now there’s a new way to

teach your kids how to be healthy and encourage themto practice what they learn. BlueAnn Ewe, ambassador ofhealth and wellness for Arkansas Blue Cross and BlueShield, is looking for boys and girls throughout the statewho want to have fun ... and stay healthy.

Arkansas Blue Cross’ favorite sheep, BlueAnn Ewe, isat the center of her own clubs for kids focused on healthand wellness. The BlueAnn Health Club and the BlueAnnClass Club now areavailable forelementary school-aged children inhomes andclassroomsthroughoutthe state.

The BlueAnnclubs are part of theBlue & Youth HealthProgram, which seek to improve thehealth status of our communities, starting with the youngpeople of our state. In three years, the Blue & YouthHealth Program has reached more than 139,000 studentsthrough three educational components: 1) the BlueAnnEwe Elementary School Education lesson; 2) High SchoolHeroes; and 3) the Wildwood musical tour.

Now the Blue & Youth Health Program has expandedto include two new components:

A) The BlueAnn Health Club — a free club geared toindividual children.

B) The BlueAnn Class Club — a free club for class-room use.

The BlueAnn Health Club and the BlueAnn ClassClub will provide children with opportunities to learnabout healthy habits and participate in activities toencourage overall healthy behaviors or practices.

“The clubs will be offered free to participants andwill be designed to include incentives for participating inhealthy activities,” said Patrick O’Sullivan, Arkansas BlueCross vice president of Advertising and Communications.“We want the BlueAnn clubs to make learning abouthealth fun for kids. We hope that the club activities willhelp Arkansas children learn about and practice healthybehaviors now — while they are young — so that whenthey are older, they can be their healthy best.”

The BlueAnn Health Club is geared to elementary-school-aged children (approximately 5-10 years old). TheBlueAnn Class Club is geared to first-grade students,although kindergartners may participate.

Parents enroll their children for the BlueAnn HealthClub, and teachers enroll their classes for the BlueAnnClass Club. Both clubs will provide a membershipwelcome packet. Once a child becomes a member of theBlueAnn Health Club, he or she will receive quarterlymailings from Arkansas Blue Cross for two years. Partici-pation in the BlueAnn Class Club will be for the schoolyear, during which the class will receive three mailings.

The goals of both clubs are to:1. Teach children about health and wellness, and provideideas and activities for healthier behavior.

2. Involve parents/teachers in the educationalprocess.

3. Encourage and reward healthy behav-iors in club members.

“We have been teaching childrenabout health and wellness now for threeyears in classrooms and communitysettings,” said Damona Fisher, ArkansasBlue Cross public relations coordinatorand club coordinator. “The BlueAnn

clubs now will provide an avenue for thatinformation to translate into healthy behaviors. We want

to help kids understand how to be healthier and thenencourage them to practice what they learn.”

To do that, the club materials include a month-longactivity project (Healthy Habits Activity Calendar) thatrecords healthy behaviors. When the activity project iscomplete, club members/classes send in their finishedproduct to Arkansas Blue Cross, and their names aresubmitted for an opportunity to win some great prizes.Subsequent packets also will contain a new activity sheetto complete and return (if the member desires) for morechances to win prizes.BlueAnn Health Club — for individuals

Each child who joins the BlueAnn Health Clubwill receive an initial membershippacket and seven subsequentpackets of health information andactivities. The membershipwelcome packet will besent first and will

11contain a Healthy Habits Activity Calendar — a one-month activity chart and stickers to help kids recordhealthy behaviors they do each day — and several funitems for the member.

As an immediate reward for completing and return-ing the monthlong project, each child will receive aBlueAnn poster. Plus, the child’s name goes into adrawing for a chance to win some fun prizes, includingthe grand prize of a bicycle and safety helmet.

Each subsequent club packet will contain a fun-filled health newsletter — Ewe News — as well as awellness activity project to be completed and returned toArkansas Blue Cross (if desired), and a small gift itemrelated to the packet health topic. Club members will beencouraged to read the newsletter and complete thehealthy habits games. Each time an activity project iscompleted and returned, the child’s name is added to theprize bank for more chances to win prizes. Members’names will be maintained in the prize bank, and theywill be eligible for prize drawings held throughout thetwo-year membership.

Prize drawings will be held twice a year.At the end of the two-year membership period,

members will receive a BlueAnn Health Club GraduationCertificate congratulating them on learning health habitsand working hard to be a healthy kid.BlueAnn Class Club — for first-grade classes

Each class that joins the BlueAnn Class Club willreceive an initial membership

packet and two subsequentpackets of health informa-

tion and activities, as wellas small gift items for

their enjoyment. Themembership welcomepacket will be sentfirst and will containthe Healthy Habits

Activity Calendar andseveral fun items for the

class. The two subse-quent club packets

will contain a

health newsletter, a group wellness activity project sheetand gift items related to the packet health topic.

Class Club members will be encouraged to read thenewsletter and complete the healthy habits games. To beeligible for the prize associated with the Class Club, theteacher/class must complete the Health Habits ActivityCalendar and return it to be included in the drawing. Foreach subsequent Group Wellness Activity project com-pleted and returned, the class receives another chance towin a prize.

Class prizes will be given away in each ArkansasBlue Cross region of the state at the end of the schoolyear. The grand prize is a “Build a Healthy Sundae” partyfor the class with BlueAnn Ewe. The winning classroomteacher receives a special gift.

At the end of the school year, each class member willreceive a BlueAnn “Blue Ribbon Class” ribbon congratu-lating them on their efforts to be healthier. All teacherswho sign their class up for the program will receive aBlueAnn Ewe canvas bag.Signing up

Parents and teachers interested in enrolling theirchildren or class for one of the BlueAnn clubs should call1-800-515-BLUE, toll-free, and ask for the BlueAnn Club.

Information will be processed immediately and member-ship welcome packets will be mailed within 24 hours.Allow two weeks for delivery.

BlueAnn Health Club members then will receivepackets every three months for two years. BlueAnn ClassClub classes will receive two subsequent packets duringthe school year.

“We hope the BlueAnn Clubs will be an exciting,interactive way for kids to learn about health with theirparents or teachers and begin to take small, achievablesteps toward healthy habits for life,” said Fisher. “Afterall, the Arkansas Blue Cross mission states that we wantour members to be healthy. Through the BlueAnn Clubs,we hope to promote that mission to our young membersas well.”

W O M E N ’ S

Menopause, also known as the change of life, is aword that may strike dread, fear or relief in the hearts ofmany women. However, knowing the meaning ofmenopause and its symptoms and treatment options canhelp women better prepare for this natural part of life.

Menopause is the transition period when the ovariesstop producing eggs, menstruation decreases (eventuallyending) and the body decreases its production of femalehormones — estrogen and progesterone. Menopauseusually occurs between the ages of 40 and 55.

Symptoms may include hot flashes and skin“flushing,” mood changes, decreased sex drive, irregularmenstrual periods and vaginal dryness.

Natural menopause usually requires no treatment.Surgical menopause that occurs prior to naturalmenopause may require estrogen replacement therapy(ERT). Physicians may recommend ERT to reduce theundesirable symptoms of menopause, help decreasevaginal drying and prevent osteoporosis (see article thispage) after menopause.

If you have questions or concerns about menopause,please contact your primary care physician.

Researchers estimate that 23 percent of Americanwomen age 50 and older have osteoporosis.

Osteoporosis is the progressive loss of bone densityand thinning of bone tissue. The leading cause ofosteoporosis is hormone deficiencies, so women who aremenopausal may be at risk.

There are no symptoms of osteoporosis in its earlieststages. However, symptoms occurring late in the diseaseinclude: fractures of the vertebrae, wrists or hips; lowback pain; neck pain; bone pain or tenderness; loss ofheight over time; and stooped posture.

Treatment options should be discussed with yourprimary care physician. They may include medications(such as estrogen replacement therapy), lifestyle changessuch as regular exercise and a diet that includes calcium,vitamin D and protein.

Prevention of this disease is a lifelong commitment.It should start with regular exercise and a proper diet.

Menopause — a natural part of life

Prevention of osteoporosis —a lifelong commitment

Feeling a little cranky or “on edge” a few dayseach month? You may be suffering from premenstrualsyndrome (PMS).

Premenstrual syndrome is a symptom or collection ofsymptoms that occurs regularly in relation to the menstrualcycle, usually beginning five to 11 days prior to the onset ofthe cycle. An exact cause has not been identified, but it maybe related to social, cultural, biological and psychologicalfactors. From 70 percent to 90 percent of women areaffected by this syndrome during childbearing years.

Physical symptoms may include headache; swelling ofankles, feet or hands; backache; abdominal cramps(heaviness, fullness or pain); muscle spasms; breasttenderness; weight gain; cold sores; acne flare-up; nausea,

Feeling cranky? It’s not you — it’s PMS!bloating, bowel changes; decreased coordination; foodcravings; decreased tolerance to sensory input (noise orlight); and painful menstruation.

Other symptoms may include: anxiety or panic;confusion; difficulty in concentrating; forgetfulness; poorjudgment; depression; irritability, hostility or aggressivebehavior; increased guilt feelings; fatigue; decreased self-image; sex drive changes; paranoia or increased fears; slow,lethargic movement; low self-esteem; and overreaction tosensory changes (noise or light).

Treatment options include regular exercise and abalanced diet (with increased intake of whole grains,vegetables, fruit and a decreased intake of salt, sugar,alcohol and caffeine).

Diabetes and Youknow the facts 13Diabetes and Youknow the facts

Chances are, you or some-one you know either has diabetesor knows someone who does.

Roughly 16 million Americansare afflicted with the sometimesdeadly disease, according to a1995 estimate; half of them areundiagnosed.

There are two types ofdiabetes:• Insulin-dependent diabetes, alsoreferred to as type I or juvenile-onset diabetes.• Noninsulin-dependent diabetes, also known as type IIor adult-onset diabetes.

Diabetes occurs when a person’s body does notproduce insulin, doesn’t produce enough insulin or can’tproperly use the insulin that is produced. Insulin, pro-duced in the pancreas, is used to break down glucose(sugar) once it enters the bloodstream. It enables cells toabsorb the glucose.

Insulin-dependent diabetics either produce no insulinat all or not enough to be used. This type of diabetesusually occurs in children or adults below age 40 andrequires insulin injections.

Noninsulin-dependent diabetics produce insulin, buttheir cells are unable to break down the sugar that entersthe bloodstream. This type of diabetes usually occurs inadults age 40 or older and can be treated with insulininjections, oral medications, a combination of injectionsand oral agents or by a strictly modified diet and exercise

Arkansas Blue Cross and Blue Shield is a corpo-rate sponsor of the 1999 Walk To Cure Diabetessponsored by the Greater Arkansas Chapter of theJuvenile Diabetes Foundation. The event will be heldon Saturday, Oct. 2. If you would like more informa-tion about juvenile diabetes or the Walk To CureDiabetes, call (501) 372-7515.

Arkansas Blue Cross also is a corporate sponsorof America’s WALK for Diabetes sponsored by theAmerican Diabetes Association. The walk will beheld Saturday, Oct. 16. For more information aboutdiabetes, call 1-800-DIABETES. For more informationabout the walk, call (501) 221-7444.

regimen. Of the 16 million estimated Americans with thedisease, 7 million to 7.5 million are type II diabetics.

Common symptoms of diabetes include:• Fatigue, lethargy.• Increased thirst.• Increased urination.• Blurred vision.• Weight loss.• Hunger.• Infections or cuts that don’t heal.

Long-term complications of diabetes include blind-ness, heart disease, risk of stroke, high blood pressure,kidney disease, amputations, dental disease, pregnancycomplications and nerve damage.

As there is no cure for the disease, treatment ofdiabetes is an ongoing process consisting of oral medica-tion or insulin injections, blood glucose level monitoring,exercise, meal planning and special attention to medicaland other social factors such as stress.

Don’t hesitate to consult yourprimary care physician if you or aloved one exhibit the symptomsof diabetes. Working closelywith your primary carephysician will go a longway in ensuringpeople with diabe-tes a longer lifewith fewerproblemsrelated to thedisease.

People with diabetesuse glucometers tomeasure bloodglucose levels.

14Health Advantage members usuallydon’t have to worry about filingclaims because health care providersordinarily handle that task. Butoccasionally, situations arise thatrequire members to file claims.

In such instances, here’s how theprocess works.

Filing a claim for out-of-service area medical services

Members must present their HealthAdvantage identification card eachtime health services are received. Mostproviders will file a claim for servicesrendered. If the hospital or physicianwill not file a claim, the member mayfile the claim on behalf of the provider.

In such cases, the member shouldsubmit Standard Form 1500, with acopy of the bill for services received, toHealth Advantage. The claim must besubmitted within 180 days of the dateon which expenses first were incurred.

The claim form and a copy of thebill must be sent to:

ClaimsHealth AdvantageP.O. Box 8069Little Rock, AR 72203-8069

Reimbursement for coveredmedical services

If a member makes payment, otherthan required co-payments/co-insur-ance, for services covered by HealthAdvantage, a claim for reimbursementmay be filed. The request must bemade within 180 days of the date onwhich expenses first were incurred.

The request for reimbursement(with a copy of receipt for payment forservices received and a copy of the billattached) must be sent to:

ClaimsHealth AdvantageP.O. Box 8069Little Rock, AR 72203-8069

Pharmacy ServicesReimbursement for pharmacy

charges may be requested by submit-ting the Prescription Claim Form,#API-079 (with a copy of the salesreceipt) to:

Advance Paradigm, Inc.P.O. Box 853901Richardson, TX 75085-3901

(NOTE: Prescription medications purchased

from “out-of-network” pharmacies within the

service area are not covered.)

15Health Advantage

members —

take note!

UM GUIDELINESHealth Advantage provides

utilization management (UM)services to our members usingnationally accepted utilizationmanagement guidelines and inter-nally developed medical policy.

For Medi-Pak HMO members,Health Advantage uses UM guide-lines developed by the federalHealth Care Financing Administra-tion (HCFA) and local intermediarymedical policy.

Health Advantage appliescriteria on a case-by-case basisconsidering the individual medicalneeds of the member and resourcesavailable through the health caredelivery system. Medical decisionsare made based on informationprovided by the member’s primarycare physician, any specialist(s)involved in the care and themember’s medical records.

Authorizations for “Out of Plan”care must be requested by thephysician before the service isprovided, except in an emergency.The member’s physician mayrequest a review of the criteria usedfor decision-making, either inwriting or by telephone. A HealthAdvantage physician reviewer isavailable to discuss the criteria withthe member’s physician duringbusiness hours.

DRUG COVERAGE DETERMINATIONIf you are a Health Advantage

member with a drug card benefit,remember that coverage for anyprescription medication is subject tothe Health Advantage formulary.

The formulary is a specific listof covered medications. It wasdeveloped, and is maintained, bythe Arkansas Blue Cross and BlueShield Pharmacy and TherapeuticsCommittee, which includesArkansas pharmacists andconsulting physicians.

Medications in the HealthAdvantage formulary reflect thoseprescriptions that usually areprescribed by the Health Advantagenetwork of physicians. The criteriaused to determine formulary statusfor particular medications includesafety, uniqueness, effectivenessand cost.

Occasionally, a HealthAdvantage member may have anadverse or harmful reaction to aformulary medication or determinethat a medication is ineffective inthe treatment of a particular diseaseor condition. In these cases,members may be able to obtaincoverage for a non-formularymedication through the PriorAuthorization process. This willrequire a letter of medical necessityfrom the prescribing doctor.Additionally, medical records orfurther documentation from themember’s physician may berequested. For more information onauthorization of a non-formularymedication, Health Advantagemembers may call (501) 221-3733 or1-800-843-1329.

NEW HEALTHMANAGEMENT PROGRAMS

Health Advantage members withchronic diseases will benefit fromnew Health Management Programs.

Certain diseases or conditionsmay require long-term or continualcare. For example, people withdiabetes are monitored by theirphysicians throughout theirlifetimes. However, a person withan ear infection may need to see

his or her physician only once forproper treatment.

The new Health ManagementPrograms offered by Health Advan-tage are focused on those memberswho have chronic conditions(such as diabetes, coronary arterydisease, etc.) or those who arepregnant and may be at a higherrisk for complications.

Health Advantage identifiesmember needs in the populationand places those members in aHealth Management Program. Forexample, members in the DiabetesHealth Management Programreceived educational materials inMay 1999. In November 1998, everyprimary care physician and endocri-nologist in the Health Advantagenetwork received a BlueGuide,which contains clinical practiceguidelines for diabetes adapted fromthe American Diabetes Association(ADA). In April, they receivedadditional helpful materials, includ-ing profiles summarizing their careof diabetic patients.

Health Advantage is measuringphysician performance against theguidelines and is monitoring howour diabetes patients are faring.The outcome of the tracking maylead to more member education,case management for high-riskpatients (coordinated through themember’s physician), home healthcare or other options. HealthAdvantage also is attempting toeliminate barriers to care in order topromote the best care possible formembers who have diabetes.

Sen. Dave Bisbee (R)(Dist. 33) RogersCommittee on Committees;Public Health, Welfare &Labor; Transportation, Agingand Legislative Affairs(O/H) 501-636-2516

Sen. Cliff Hoofman (D)(Dist. 18) North Little RockVice chairman, JointPerformance Review;Insurance and Commerce;Joint Budget; Public Health,Welfare and Labor; Rules,Resolutions & Memorials(O) 501-371-9224(H) 501-758-9692

Sen. Kevin Smith (D)(Dist. 7) StuttgartChairman, Joint AdvancedCommunications &Information Technology;Children & Youth;Committee on Committees;Insurance & Commerce; JointBudget; Revenue & Taxation(O) 870-673-3573(H) 870-673-3422

Sen. William L. “Bill”Walker Jr. (D)(Dist. 17) Little RockCity, County & Local Affairs;Joint Retirement & SocialSecurity; Public Health,Welfare & Labor; Rules,Resolutions & Memorials(O) 501-375-8683(H) 501-375-5275

Rep. Mike Creekmore (D)(Dist. 51) HensleyJoint Performance Review;Public Health, Welfare &Labor; State Agencies &Governmental Affairs(H) 501-888-1966

Rep. John Eason (D)(Dist. 97) MariannaAging, Children & Youth,Legislative & Military Affairs;Public Health, Welfare & LaborNo phone

Rep. Danny Ferguson (D)(Dist. 91) Forrest CityEnergy; Insurance & Commerce;Revenue & Taxation(H) 870-633-8256

Rep. Jeff Gillespie (D)(Dist. 27) DanvilleVice chairman, HouseManagement; Insurance &Commerce; Joint PerformanceReview; Public Transportation(O) 501-495-9388(H) 501-495-7912

Rep. Bobby Glover (D)(Dist. 81) CarlisleInsurance & Commerce; JointBudget; Joint PerformanceReview; Revenue & Taxation(O) 870-552-7150(H) 870-552-3140

Rep. Brenda Gullett (D)(Dist. 75) Pine BluffVice chairman, Joint AdvancedCommunications & InformationTechnology; City, County & LocalAffairs; Public Health, Welfare &Labor(O) 870-535-3050(H) 870-541-0620

Rep. David Haak (R)(Dist. 21) TexarkanaPublic Health, Welfare & Labor;State Agencies & GovernmentalAffairs(O) 870-772-7931(H) 870-772-1774

LeadingPerhaps no other issue affects as many people as health care. In light ofthis fact, Arkansas Blue Cross and Blue Shield thought our customersmight want to get to know some of the many state senators and represen-

16

Rep. David Hausam (R)(Dist. 2) BentonvilleVice chairman, JointRetirement & SocialSecurity; Insurance &Commerce; Revenue &Taxation(O) 501-444-4009(H) 501-273-7050

Rep. Don House (D)(Dist. 78) Walnut RidgeInsurance & Commerce;Public Transportation(H) 870-886-3532

Rep. Jim Lendall (D)(Dist. 52) MabelvaleAgriculture & EconomicDevelopment; Joint AdvancedCommunications &Information Technology;Public Health, Welfare &Labor(H) 562-0011

Rep. Jim Magnus (R)(Dist. 55) Little RockChairman, Joint AdvancedCommunications &Information Technology;Insurance & Commerce;Revenue & Taxation(O) 501-220-5243(H) 501-227-0464

Rep. Randy Minton (R)(Dist. 69) WardPublic Health, Welfare &Labor; State Agencies &Governmental Affairs(O/H) 501-843-3147

Rep. David Rackley (R)(Dist. 63) SherwoodCity, County & Local Affairs;Public Health, Welfare & Labor(O) 501-416-0357(H) 501-834-1626

Rep. Marvin Steele (D)(Dist. 96) West MemphisAgriculture & EconomicDevelopment; Public Health,Welfare & Labor; Rules(O) 870-735-2850(H) 870-735-3922

Rep. Tracy Steele (D)(Dist. 59) North Little RockAging, Children & Youth,Legislative & Military Affairs; JointAdvanced Communications &Information Technology; PublicHealth, Welfare & Labor(O) 501-324-9333(W) 501-376-9466

Rep. Chaney Taylor, Jr. (R)(Dist. 41) BatesvilleAging, Children & Youth,Legislative & Military Affairs;Public Health, Welfare & Labor(O) 870-793-5297(H) 870-793-3545

Rep. Shawn Womack (R)(Dist. 40) Mountain HomePublic Health, Welfare & Labor;State Agencies & GovernmentalAffairs(O) 870-424-5000(H) 870-424-4422

the Waytatives of the Arkansas General Assembly who spend numerous hoursworking on health care issues. (Upcoming issues of Blue & You willfeature additional profiles of our legislators.)

17

Little Rock(Left to right): Carr,Hayman, Studdard,

Sellers, Rife andSimmons.

Texarkana(Left to right): Elam, Kipple, Coulter, Clemens,

McGraw and Cayce.

Jonesboro(Left to right, seated): Delaney, Shannon andBarton; (standing) King, Cannady and Jones.

Hot Springs(Left to right,

seated): McDougaland Smith;(standing) Petruk,Burton, Kiburasand Flint.

From teachers to tap dancers, those honored asArkansas’ Ageless HeroesSM represented the best examplesof good health, vigor and vitality.

The 1999 Ageless Heroes continue to be honoredthroughout the state by Arkansas Blue Cross and BlueShield, local hospital partners and Health AdvantageMedi-Pak HMO. The Ageless Heroes Awards program is apart of the Blue Cross and Blue Shield Association’scommitment to healthy aging.

Ageless Heroes categories are: Vigor and Vitality —demonstration of extraordinary physical or mental abili-ties; Community Involvement — commitment to a com-munity and its members; Love of Learning — pursuit ofknowledge by study or experience; Creative Expressions— unique expressions of talents; Bridging the Generations— grandchild’s expression of admiration for grandparent;Against the Odds — overcoming the challenges of adisability.

The 1999 Ageless Heroes winners honored to date arelisted by region and in the following order: Vigor andVitality, Community Involvement, Love of Learning,Creative Expressions, Bridging the Generations andAgainst the Odds.

NORTHWEST REGION — Ulis Morrison, 89, of Marshall; CarlTompkins, 77, of Bella Vista; Bob E. Hall, 69, of Fayetteville;Ree Mills, 83, of Springdale; Elizabeth “Daisy” Henry, 73,of Booneville; and Carmon Brown, 68, of Henderson.

SOUTHWEST REGION (Southwest Arkansas and NortheastTexas) — Aubrey “Shine” Elam, 74, of Waldo; CharlesDowns, 69, of Hope, and Joann Cayce, 66, of Thornton;Oscar Coulter, 68, of Nashville and Louise CarltonClemens, 81, of Texarkana, Texas; Charles Kipple, 96, ofTexarkana, Ark.; Myrtle Haggard, 87, of Hooks, Texas;and Frances McGraw, 85, of Ashdown.

NORTHEAST REGION — Mary Etta West, 75, of Bald Knob;Flo Jones, 69, and Demetra Parrish Barton, 103, both ofJonesboro; Doyle Cannady, 68, of Corning; Mary Eliza-beth King, 73, of Cotton Plant; Percy Shannon, 77, ofNewport and Ray Knight, 71, of Forrest City; and MildredDelaney, 81, of Batesville.

CENTRAL REGION — Ione Studdard, 80, of North Little Rock;James F. Carr Jr., 85, of Searcy; Truett Goatcher, 74, ofLittle Rock, and Bernice S. Hayman, 82, of Little Rock;Robert Rife, 89, of Little Rock; Hubert Sellers, 80, ofJudsonia; and Ginny Simmons, 80, of Benton.

SOUTH CENTRAL REGION — Len Burton, 69, of Hot SpringsVillage; Joe Petruk, 66, of Hot Springs; Ora R. Flint, 78,of Hot Springs; Joe Kiburas, 76, of Hot Springs and JoeSedlon, 90, of Mount Ida; and Frances Smith, 83, andJim McDougal, 62, both of Malvern.

18Fayetteville

(Left to right): Hall,Washington Regional

President and CEOPatrick Flynn, Brown,

Tompkins, Arkansas Blue

Cross Regional ExecutiveMel Blackwood, Mills,

Morrison and St. Mary’sHospital Vice President

Sister Janice Greenwood.

BlueAnn Ewe with better readersand bikes.

Back-to-schoolers toss bean bagsfor healthy prizes.

Christus St. Michael and Arkansas Blue Cross staff memberspulled together to help meet immediate needs. Christus St.Michael donated blankets and sheets, and Arkansas BlueCross, with the help of a local vendor, provided numerousfirst-aid items. When all was boxed, about 17 cases of supplieswere shipped to help out Cayce’s Charities.

Healthy Start Back-to-schoolOur Children First coalition presented its second

annual “Wild About Wellness” Back-to-School HealthFair sponsored by Arkansas Blue Cross, Christus St.Michael and KKYR Radio 102.5, among other localbusinesses, on Aug. 6-7 at the Four States Fair-grounds in Texarkana. More than 2,000 children andtheir parents attended the two-day event. Morethan 1,100 children received health screenings. Staffmembers from the Arkansas Blue Cross SouthwestRegional Office inTexarkanacoached kidsin playingBlueAnn’s BeanBag Toss for achance to winfun and healthyprizes. BlueAnneven stopped byto encourage thekids to be theirhealthy best.

High School HeroesAbout 20 High School Heroes and BlueAnn Ewe took

their message of how to resist pressure to smoke to morethan 150 fifth-graders at Hillcrest Elementary School inJonesboro. During the second semester, junior and seniorstudents from Jonesboro High School taught the youngerset about the deceptive appeals of tobacco advertisingand how to resist smoking. High School Heroes wasdeveloped by the Arkansas Lung Association and cur-rently is active in 21 counties in Arkansas. Arkansas BlueCross serves as the statewide title sponsor of the student-to-student teaching program.

19Arkansas Blue Cross and Blue Shield is a good

corporate citizen. Our employees raise money and spendmany hours helping those causes near and dear to thehearts of Arkansans.

Recognizing ReadersSt. Edward Mercy Medical Center in Fort Smith

concluded its second “Read to Succeed” program forstudents in kindergarten through sixth grade in the FortSmith public schools and at Christ the King schoolrecently. The reading program encourages students to readas well as encourages parents to read to small children.An awardsceremony washeld on May 16.BlueAnn Eweattended theceremony to helpaward bicyclesand helmets tothe top readers ineach grade level.Arkansas BlueCross provided asafety helmet foreach student whoreceived a bike. This was the second year for the WestCentral Regional Office to partner with St. Edward inrewarding the students for participation in the program.

Prevention ConventionArkansas Blue Cross and Blue Shield’s Northeast

Regional Office staff participated in St. Bernards RegionalMedical Center’s 1999 Prevention Convention recently.BlueAnn Ewe greeted young people who attended theevent to learn about farm safety.

Helping the Helper’s HandsJoann Cayce is known by thousands of people who have

been touched by her giving spirit and hard work getting peopleback on their feet after a tragedy. Cayce, of Thornton, one ofthe Southwest Arkansas 1999 Ageless HeroesSM and founder ofCayce’s Charities (a non-profit organization which helps theneedy), shared her stories with those attending the AgelessHeroes reception in Texarkana. Following the reception,

Arkansas Blue Cross and Blue ShieldP.O. Box 2181Little Rock, AR 72203-2181

disclosing the amount of time that individual had coverage. Theinformation included in this form will enable an individual toestablish his or her prior creditable coverage for purposes ofreducing any pre-existing condition exclusion imposed on theindividual by any subsequent group health plan coverage.Certificates of Creditable Coverage may be issued by:

Other group health plans (including COBRA)Individual Major Medical coverageMedicare, Part A or BMedicaidCHAMPUSFederal Employees Health Benefit Plan (FEHBP)Medical care programs of Indian Health Services of

Tribal OrganizationsState health benefits risk poolsPublic health plansPeace Corps

CSR (customer service representative) — Arkansas BlueCross staff member who helps external and internal customerswith questions or problems.

EOB (Explanation of Benefits) — A document sent tomembers describing the handling of charges submitted toArkansas Blue Cross for services provided.

HMO (health maintenance organization) — A health caresystem that assumes or shares both the financial risks and thedelivery risks associated with providing comprehensivemedical services to a voluntarily enrolled population in aparticular geographic area, usually in return for a fixed,prepaid fee.

— a guide to health insurance terminology

IIf your head is spinning after reading all the healthcare terminology (including abbreviations and acronyms) onan insurance form or in a health care article from your localnewspaper, never fear … Arkansas Blue Cross and BlueShield is here to help. We want you to be an informedcustomer, so in each issue of this quarterly publication,Blue & You, we will explain the meaning behind those healthinsurance words, acronyms and abbreviations you mayencounter when reading health care-related information.

Co-insurance — A method of cost-sharing in a health insur-ance policy that requires a group member to pay a statedpercentage of all remaining eligible medical expenses after thedeductible amount has been paid.

Co-payment — A specified dollar amount that a member mustpay out-of-pocket for a specified service at the time the serviceis rendered.

Deductible — A flat amount a group member must pay beforethe insurer will make any benefit payments.

Network — The group of physicians, hospitals and othermedical care providers that a specific managed care plan hascontracted with to deliver medical services to its members.

Pended — A claims term that refers to a situation in which itis not known whether an authorization has or will be issuedfor delivery of a healthcare service, and the case has been setaside for review.

Premium — A prepaid payment or series of payments made toa health plan by purchasers, and often plan members, formedical benefits.

Underwriting — The process of identifying and classifying theinsurance risk represented by an individual or group.

COB (Coordination of Benefits) — The internal claimsprocedures established so that Arkansas Blue Cross claimsinvolving worker’s compensation, subrogation or the non-duplication of benefits clause can be pended and handledthrough common correspondence when additional informationis needed from the policyholder, physician, hospital or acommercial insurance company.

COC/COCC (Certificate of Creditable Coverage) — A Certifi-cate of Creditable Coverage is a form issued by the group healthplan or the health insurance carrier to insured individuals,