2016 ISSUE 2 - passporthealthplan.com · • You may call Passport’s Compliance Hotline at...

WHAT’S INSIDE

2016 ISSUE 2

6

12Back-to-School Tips for Parents

Taking Care of Diabetes

8

Special Section

Just for Women

Pages 14-19

Enjoy Your Summer and Be Safe

Want to get a copy of our Preferred Drug List (PDL)?

Our PDL is a list of all the medicines we cover and any limits that apply. We also cover some over-the-counter (OTC) medicines when your doctor gives you a prescription.

We make changes to our PDL from time to time. To find the most up-to-date list, please visit www.passporthealthplan.com and click on Pharmacy, then click Pharmacy Portal:

• To view or print our PDL, click on Preferred Drug List.

• To view or print our Over-the-Counter drug list, click on Over-the-Counter Drug List.

• To see if a drug is covered using our online formulary, click on Drug Lookup Tool.

If you don’t use a computer and would like some help, just call Member Services at 1-800-578-0603.

Visit us online at www.passporthealthplan.com2

The key is to get a spirometry test as soon as you notice any signs of COPD. The earlier you get tested, the sooner you can be treated and slow down the disease. If you have COPD and don’t get tested, the disease could get worse quickly and be hard to control.

If you think you might have Chronic Obstructive Pulmonary Disease (COPD), the first step is to see your doctor. Your doctor may give you a spirometry test.

Spirometry tells you how well your lungs are working. Having this test can help your doctor treat your symptoms.

Spirometry is Simple! Spirometry is a simple and painless breathing test. During the test, all you need to do is blow out all of the air in your lungs into a mouthpiece.

When to Get TestedYou should have a spirometry test if your doctor has put you on an inhaler or nebulizer, or if you have any of the signs of COPD listed here:

Get a Spirometry Test to Find Out

Signs of COPD• Shortness of breath when you exercise• Shortness of breath even while resting• Coughing up mucus in the morning• Coughing that never really goes away• A chest infection that lasts more than 2 weeks• Wheezing

Think You Have COPD?

Source: www.copdfoundation.org, “The Importance of Spirometry in COPD and Asthma: Effect on Approach to Management,” Chest 117 (2000)

If you don’t use a computer and would like some help, just call Member Services at 1-800-578-0603.

3Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566

You Have a Right to Your Health InformationOur Notice of Privacy Practices (NPP) tells you about your privacy rights and how you can use them. The NPP also tells you how Passport may use and share your health information.

To find a copy of our NPP, please visit www.passporthealthplan.com:

• Click on Members• Click on Using Your Benefits• Click on Notice of Privacy

Practices

If you’d like us to mail you a copy of our NPP, please call us at 1-800-578-0603. TDD/TTY users may call 1-800-691-5566.

When fraud and abuse happens, it hurts you, your doctors and everybody in the health care system. If you see fraud or abuse happening, you should report it! When you report fraud or abuse, you’re helping make sure the health care system has the money to take care of members like you.

What is fraud?Fraud happens when someone does something on purpose to get benefits they don’t have the right to receive.

Examples of fraud by a doctor, dentist, chiropractor or other provider:• A doctor bills you for a service you did not receive.• A doctor bills you or the insurance company more than

once for the same service.

Examples of fraud by a person:• Someone lies about their income

to receive Medicaid benefits.• Someone uses a member ID card

that doesn’t belong to them.

What is abuse?Abuse can happen when a provider causes Passport to pay for something that was not needed or not done the right way.

1. If you think fraud or abuse is happening, report it!

• You may call Passport’s Compliance Hotline at 1-855-512-8500 and leave a message. When you call, you don’t have to give your name but it does help us get more information about the situation. Leave as much detail as possible so we can look into the matter.

• If you want to speak with someone, please call 1-800-578-0603 and ask for a Program Integrity Investigator.

2. If you get a health statement in the mail, look at it closely. Make sure you received the services listed on the statement.

3. Never let anyone else use your Passport or Medicaid ID cards. Do

n’t

Be

a “N

o S

ho

w”


Do

n’t

Be

a “N

o S

ho

w”

How to Avoid Being a "No Show"

✓Write down all of your appointments in one calendar. Keep your calendar in a place where you can see it every day. For example, you might keep your calendar on the refrigerator or near a coffee maker.

✓ If your cell phone has a calendar, set a reminder for the appointment. It’s best to set a reminder for the day before and the day of your appointment.

✓ If you rely on others (friends, family members, neighbors, Medicaid) to drive you to your appointment, check with them the day before to make sure they can still take you. Make sure your ride knows the time of your appointment and where you are going.

If you have to miss a scheduled doctor’s appointment, don’t be a “no show!” A “no show” is when you miss an appointment and you don’t call the office to tell them you cannot be there.

What’s so bad about being a “no show?”When you miss an appointment without calling to cancel, you miss a chance to get the care you need from a doctor. It could also take a while to get a new appointment and you could hurt your relationship with your doctor.

What To Do When You Have to Miss An Appointment

1. As soon as you know, call your doctor’s office and let them know if you cannot make your appointment. The sooner you call, the more likely the office can give your appointment time to someone who needs it. Reschedule your appointment for a day and time that works for you.

2. If your doctor schedules a lab test for you, be sure to get this done. If you cannot make it, call the lab and reschedule. Remember, your doctor ordered the lab test because he or she needs this information to treat you.

Call to Cancel Appointments!


Taking Care of Diabetes

Problems Diabetes Can Cause

High blood pressure

Have your blood pressure checked at each doctor’s visit. You want your reading to be below 140/90.

Having diabetes can cause problems to many parts of your body. But with good diabetes care, you can help avoid or “prevent” these problems. Take a look here at ways to prevent problems caused by diabetes.

Kidney disease also called “Nephropathy”

Have a urine test done to look for kidney disease. Finding kidney problems early is the key, because it can prevent or slow down the damage.

Heart disease also called “Cardiovascular Disease” or “CVD”

Have your blood lipid levels checked by doing blood work. Heart disease is the most common cause of death for people with type 1 and type 2 diabetes.

Diabetic eye disease also called “Retinopathy”

Get a diabetic retinal exam done by an eye doctor. This exam can catch diabetic eye disease early when it’s treatable. Retinopathy is the number 1 cause of blindness in U.S. adults.

Stroke Keep your blood sugar, blood pressure, and cholesterol under control to help lower your chances of stroke. If you smoke, quit. If you’re overweight, lose weight to lower your chances of stroke.

What You Can Do to Prevent It

Questions?If you have any questions about diabetes, you may call your primary care provider (PCP) or Passport at 1-877-903-0082.

Source: American Diabetes Association, American Association of Diabetes Educators, Centers for Disease Control and Prevention, National Institute of Health


Questions?If you have any questions about diabetes, you may call your primary care provider (PCP) or Passport at 1-877-903-0082.

Work It Out — As a Family!If you’ve got kids, you know how busy life can be. Lots of families have busy lives and still find the time for family exercise. Taking just a few minutes each day for exercise can make everyone feel better, lower stress and help your family have some fun! Exercise can also help you avoid heart disease, diabetes and some cancers.

How much exercise does my family need?Talk to your doctor about how much exercise is right for you. In general:

• Kids need to be active about 1 hour each day

• Adults need to be active about 2½ hours each week

If it’s too hard to find a full hour, break your activity into two 30-minute groups.

Set the Example!If you as a parent become active, your children are more likely to be active too! Ask your kids what they like to do. You might play games like soccer or tag, or go walking or biking. If your kids come up with several ideas, flip a coin for that night’s workout and go with it.

Great Places To Be Active:• Public parks• Swimming pools• Walking trails• Outdoor tracks at schools• Community centers• Outdoor sports stadiums with

plenty of steps for climbing

Source: www.wecan.nhlbi.nih.gov, American Heart Association


Sources: Center for Disease Control, Health in Aging Foundation, American Red Cross, www.sharecare.com, www.healthline.com

for Bug Bites and Stings• Remove any stingers.• Put an ice pack on the bite or sting for 15 to 20 minutes. Do this every

hour for the first 6 hours. • Elevate or prop up the area that has been bitten or stung. • Take medicines such as Benadryl® or hydrocortisone cream.

Use as directed to relieve the itching, redness and swelling.

ENJOY YOUR

SUM

MER

–And

Be Sa

fe!

There’s no better way to enjoy the summer than to spend time with your family and have some fun! Maybe you’ll go to the park or the swimming pool or take a road trip. Whatever you do, try to be safe and follow the tips on this page. These tips can help you avoid an unwanted trip to the emergency room (ER).

What to Do


What to Dofor a Minor Injury• Cut back on your daily activity and get some rest.

Avoid putting weight on the injured part of the body.• Put an ice pack on the injured area for 10 to 20 minutes at a time, 4 to 8

times per day. Apply a cloth between the ice pack and your skin.• Wrap the injured area with an elastic bandage or any other compression

brace your doctor recommends. Do not wrap it too tightly. • Use pillows or blankets to raise the injured part of the body above

the level of your heart. • Take Ibuprofen for pain as directed.

Remember-Bug bites, bee stings, sunburns and minor injuries don’t require a trip to the ER. If you have questions or need help deciding what to do, you may call your primary care provider (PCP) or our 24-hour Nurse Advice Line at 1-800-606-9880.

for a Sunburn• Put a cold, damp towel on your skin.• Use a moisturizer that contains aloe vera to soothe sunburned skin.• Take Ibuprofen for pain as directed.• Drink extra water.• Leave blisters alone.

What to Do


Building a Relationship

with Your Child

Using some of the tips listed on the next page is a great way to give your child a loving and caring home. When children grow up in this type of home, they are more likely to be loving and caring adults!

Do you want to be a good parent and raise a happy, healthy and well-behaved child? The secret is to create a close and loving relationship with your child. Building a relationship with your child takes a lot of hard work and patience, but the benefits are worth it!

Source: Prevent Child Abuse Kentucky


How to Build a Close Relationship

with Your Child:

Get prenatal care during pregnancy. It’s the best way to take care of your child before he or she is born.

Make sure your home is safe and that you or someone else is always watching your child.

Give your child healthy meals.

Take your child to routine medical and dental visits. This shows your child that you care about his or her health and well-being.

Make sure your child gets enough sleep and has a daily routine.

Spend time with your child doing activities you both enjoy.

Find ways to discipline your child so he or she can learn right from wrong. Instead of physical discipline, you might place your child in “time out” or take away something he or she likes to do.

Listen to your children and ask them what they think.

Tell your children you love them and are proud of them.

1

2

3

4

5

6

7

8

9


Source: American Academy of Pediatrics (AAP) Periodicity Schedule, Centers for Disease Control and Prevention, 907 KAR 17:020

Tips

For

Par

ents

q Make an appointment with your child’s primary care provider (PCP). Ask the PCP if your child is due for any immunizations (shots). Some schools may ask for a copy of your child’s immunization record.

q Make an appointment for a dental check-up.

q Make an appointment for an eye exam. In Kentucky, children ages 3 to 6 going to school for the first time must have an eye exam.

q Make sure your child is up-to-date and getting checkups at these ages:

1 month 9 months 24 months

2 months 12 months 30 months

4 months 15 months Every year from age 3 to 20

6 months 18 months

Earn Rewards!Children and teens can earn free gift cards for completing a dentalvisit and for visiting a PCP. For more details,

please call us at 1-877-903-0082.

You can help your child get healthy and ready for the new school year by getting up-to-date on important checkups and exams. Here are some ways you can make this happen:

Back

School

to


q If you have a pre-teen, teen or a young adult, ask his or her PCP about vaccines for meningitis, Human Papillomavirus (HPV) and Tetanus Booster. To learn more, please visit www.cdc.gov/vaccines/vpd-vac/vaccines-list.htm.

q Go to your child’s back-to-school events and learn about free resources available in the community. Be sure to look for the Passport table. We attend lots of back-to-school events and would be happy to see you!

q Assess or look at your child’s developmental milestones. These developmental milestones are things that most children can do by a certain age like taking a first step, smiling for the first time and waving “bye bye.”

- During a well-child visit, your child’s doctor will look for developmental milestones. That’s why it’s so important to take your child to each well-child visit even when he or she is not sick.

- If you think your child may be falling behind in meeting developmental milestones, talk to your child’s PCP and school. Your child could have a developmental delay. The PCP and school can help your child get the care he or she needs.

- Ask your child’s school about programs such as Early Head Start, Head Start or an Individual Education Plan (IEP).

q To learn more about school requirements for children, visit www.kde.state.ky.us.

Need Help?If you need help scheduling appointments or finding doctors, call us at 1-877-903-0082.


Ladies, we know you like to take care of everyone else. Maybe you’re a mom, a wife, a caretaker or all of these! Whatever role you play, you can only be your best when you take care of yourself! You can start looking out for your own health by getting a Pap test to check for cervical cancer.

What causes cervical cancer?Most cervical cancers are caused by the human papillomavirus or “HPV.” HPV is passed from one person to another during sex. Most of the time, you won’t even know you have it. Girls and women ages 9 to 26 can get an HPV vaccine to help avoid or prevent cervical cancer.

Get tested!The test you need is a Pap test. A Pap test checks for the HPV or abnormal cells. A Pap test can find problems early before they become cancer. This test could save your life!

Women need to start getting tested for cervical cancer at age 21 and sometimes sooner. Talk with your doctor or OB/GYN about how often you need a Pap test.

Get Tested EARLY for Cervical Cancer

Just

for

Wom

en •

Just

for

Wom

en •

Just

for

Wom

en

Source: www.cdc.gov/cancer/cervical/basic_info/screening.htm, www.cdc.gov/std/hpv/pap/

Earn

Rewards!


Just for Wom

en • Just for Wom

en • Just for Wom

en

Did you know you can earn a $20 gift card for getting a Pap test? For more information or to get help scheduling your appointment, call us at 1-877-903-0082.

Earn

Rewards!


Just

for

Wom

en •

Just

for

Wom

en •

Just

for

Wom

en

For all you mommies-to-be out there, here are the answers to some of your burning questions.

Mommies-to-Be Questions and Answers Just for You

Question Answer

How much weight should I gain during pregnancy?

Does it really matter how much weight I gain?

How many extra calories do I need a day during pregnancy?

What should I eat?

It depends on your weight before you got pregnant. Here’s a general guide:

Yes! • If you don’t gain enough weight, your

baby could have a low birthweight. • If you gain too much weight, you

have a higher chance of having a premature baby and getting high blood pressure or diabetes during pregnancy.

300 extra calories per day.

Eat all 5 food groups — vegetables, fruits, grains, dairy and protein. Fill half of your plate up with fruits and vegetables.

Normal weight 25 to 35 pounds

Underweight 28 to 40 pounds

Overweight 15 to 25 pounds

Obese 11 to 20 pounds

How Much You Need to Gain During Pregnancy

Your Weight Before You Got Pregnant


Source: www.choosemyplate.gov, March of Dimes, www.americanpregnancy.org, Mayo Clinic, La Leche League

Just for Wom

en • Just for Wom

en • Just for Wom

enMommies-to-Be Questions and Answers Just for You

Question AnswerWhat can I do to help with heartburn?

What should I avoid eating and drinking during pregnancy?

How many fluids do I need to drink?

I have really bad allergies. What kind of medicines can I take during pregnancy and while breastfeeding?

What should I do if I get pregnant and I am smoking, drinking alcohol or using street drugs?

Eat 4 to 6 small meals every day instead of 3 big meals. Sit up for a while after you eat. Going to sleep right after you eat can make heartburn worse.

Drink 6 to 8 glasses of water each day during pregnancy. Drink when you are thirsty while breastfeeding.

While pregnant or breastfeeding, always talk to your OB doctor before taking any medicine, vitamin or supplement. Many drugs, even over-the-counter drugs, are not safe during pregnancy and could cross into your milk.

Talk to your OB doctor right away. He or she can find resources to help you quit.

• No alcohol. There is no safe amount of alcohol while you’re pregnant. Alcohol can cause serious and long lasting defects to your baby.

• Limit caffeine to about 200 mg a day or one and a half 8 ounce cups of coffee. Remember that chocolate, tea and soft drinks have caffeine in them. Be sure to check the label and stay under 200 mg! Caffeine can raise your blood pressure, make you feel jittery and cause indigestion. Limit caffeine while breastfeeding, too.

• Heat up deli meat before eating it. Deli meat could have listeria which can cause a miscarriage or infection to the baby.

• Wash vegetables before eating them. They could have toxoplasmosis on them which can cause birth defects or premature birth.


If you’re a smoker who has become pregnant, there’s no better time than now to quit! It’s never too late to quit, because the fact is — smoking causes many diseases and deaths that can be avoided.

Quit Smoking for YouJu

st f

or W

omen

• Ju

st f

or W

omen

• Ju

st f

or W

omen

and Your Baby

Smoking Raises Your RisksAnyone who smokes has a higher chance of getting heart and lung disease along with other types of cancer. If you smoke during pregnancy, there are even more risks. You have a higher chance of having a:

• Miscarriage (losing your baby)

• Preterm labor or delivery (your baby is born too soon — before 37 weeks)

• Low-birthweight baby (your baby is born too small — less than 5 pounds, 8 ounces)

• Stillbirth (your baby dies before delivery)

• Baby being born with birth defects

• Sudden Infant Death Syndrome (SIDS) baby — (a healthy baby who dies during sleep)

• Baby who has lifelong health problems

Quitting Lowers Your Risk It’s NEVER too late to quit smoking! When you quit, you’ll see some great benefits. Here are just a few of them:

• Your blood pressure goes down

• Your chance of a heart attack goes down

• You have a lower chance of a having a preterm delivery or low-birthweight baby

• Your baby has a better chance of being healthy

Source: March of Dimes, Centers for Disease Control and Prevention, United States Department of Health and Human Services


If you need help with your pregnancy or have any questions, please call our Mommy Steps team at 1-877-903-0082.

Quit Smoking for YouJust for W

omen • Just for W

omen • Just for W

omen

and Your Baby

Do you want help?There are free programs available to help you quit smoking. Some programs can offer you a counselor and products to help you quit. You may even be eligible for free gifts! To find out more, please call 1-800-784-8669 (1-800-QUIT NOW)!


Marketing and Community Engagement Department5100 Commerce Crossings Dr.Louisville, KY 40229

Helping Kentuckians

Live Healthier Lives™

MARK-62355 APP_5/26/2016

Passport does not guarantee the availability or quality of care. We are not responsible for any act or omission of any provider.

All providers contracted with Passport are independent contractors and not employees or agents of Passport.

Any information included in this newsletter is not intended to replace medical care or advice from your doctor. Any

references to other companies or internet sites are not an endorsement or guarantee of the services, information or products

provided. Passport does not take responsibility for anything that may result from the use, misuse, interpretation or

application of the information in this newsletter.

Our Medical ReviewHere at Passport, we have a special team called Utilization Management (UM). Our UM team includes nurses and medical staff who want to make sure you get the care you need!

As a Passport member, you should know the following about how we make decisions:

We do not reward anyone for denying services to you.

We do not give anyone extra money for making decisions that stop you from getting the care you need.

We make sure you get the care and services you need.

If you have questions, please call us at 1-800-578-0603 between 7:00 a.m. and 7:00 p.m. TDD/TTY users may call 1-800-691-5566.

2016 ISSUE 2 - passporthealthplan.com · • You may call Passport’s Compliance Hotline at...

Documents

Transcript of 2016 ISSUE 2 - passporthealthplan.com · • You may call Passport’s Compliance Hotline at...