U in NISON - uhccommunityplan.com NISON Working Together for ... watermelon, berries, apples, citrus...

OK, so you’re hungry. That’s normal. But before you just raid the refrigerator,consider the following facts and guidelines in choosing a healthier meal.

WHAT Should I Eat?

UNISONinWorking Together for Better Health South Carolina • Spring 2009

TThheessee ffooooddss hhaavvee ffeewweerr ccaalloorriieess..CChhoooossee tthheemm mmoorree oofftteenn……

TThheessee ffooooddss hhaavvee mmoorree ccaalloorriieess..CChhoooossee tthheemm lleessss oofftteenn……

FFrruuiittss aanndd VVeeggeettaabblleess((pprreeppaarreedd wwiitthhoouutt aaddddeedd ffaatt))Spinach, broccoli, tomato, carrots,watermelon, berries, apples, citrus fruits

FFrriieedd ffooooddssEggs fried in butter, fried vegetables,French fries

LLooww--ffaatt aanndd ffaatt--ffrreeee mmiillkk pprroodduuccttssLow-fat or fat-free milk, low or fat-freeyogurt, low-fat or fat-free cottagecheese

FFuullll--ffaatt mmiillkk pprroodduuccttssFull-fat cheese, full-fat ice cream,whole and 2% milk

BBrrootthh--bbaasseedd ssoouuppVegetable-based soups, soups withchicken or beef broth, tomato soups(without cream)

DDrryy ssnnaacckk ffooooddssCrackers or pretzels, cookies, chips,dried fruits

WWhhoollee ggrraaiinnss aanndd hhiigghh fifibbeerrBrown rice, whole wheat bread, wholewheat pastas, oatmeal

HHiigghheerr--ffaatt aanndd hhiigghheerr--ssuuggaarr ffooooddssCroissants, margarine, shortening,vegetable oil and butter, doughnuts,candy bars, cakes and pastries

LLeeaann mmeeaatt,, ppoouullttrryy aanndd fifisshhGrilled salmon, chicken breast, turkeyor fish without skin, ground beef (leanor extra lean)

FFaattttyy ccuuttss ooff mmeeaattBacon, brisket,

ground beef (regular)

LLeegguummeess ((bbeeaannss aanndd ppeeaass))Black, red kidney and pinto beans(without added fat), green peas, black-eyed peas 1

Being Overweight Can Cause:• Heart disease• Type 2 Diabetes• Cancer (endometrial, breast, colon)• Hypertension• Stroke• Liver and gall bladder disease• Breathing problems• Arthritis

Replace Bad Habitswith Healthy Ones:• Eat slowly• Eat only when hungry• Avoid skipping meals• Plan meals ahead of time• Be active• Split a meal or dessert with a friend• Ask for a to-go box when eating out• Choose calorie-free beverages(sparkling water or unsweetened tea)

Source: www.cdc.gov

inUNISON Spring 2009

If someone else uses your healthplan card to receive medicalcare, it is a crime. That person isstealing from your health plan.It could be taking money awayfrom programs you really need.It is called insurance fraud.

Here are a few tips to help stopinsurance fraud:• Keep your Unison ID card ina safe place

• Ask for a review of beneJtspaid for you all year

• Every so often check withyour doctor to see yourmedical records (providersmust keep track of who seesyour medical records)

• Tell us if you see somethingwrong on your medicalrecord

If you suspect fraud, waste orabuse, please contact our tollfree hotline at 1.877.766.3844.

You can also Jll out a form atwww.unisonhealthplan.com/_layouts/unison/fraudabusesubmit.aspx.

South Carolina also has ahotline (1.888.364.3224) and awebsite(www.dhhs.state.sc.us/dhhsnew/fraud.asp) to report suspectedMedicaid fraud and abuse. Youcan do this anonymously, too.THIS ISSUE

What Should I Eat?..........................................1Stop Insurance Fraud!......................................2When You Need a Prescription .....................3Remember Your Unison ID Card! ..................3A Healthy You Means A Healthy Baby.......4Get the Lead Out...............................................4Start Smart With Regular Check-Ups .........5Baby’s First Shots.............................................5Never Shake A Baby .......................................6Quality Counts....................................................7Coronary Heart Disease ..................................7Member Safety...................................................810 Safety Tips for Hospital Patients ..........9Why You Need A Mammogram......................9Questions for Surgeons....................................9Keep Your Finger on Asthma Triggers......10Teen Smoking - the Facts ............................10Put the Lid On High Blood Pressure ........11New Treatments...............................................11Utilization Management ................................11We Are Online ..................................................11Unison Health Plan Member Services .....12Language Support ...........................................12

STOP Insurance Fraud!

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inUNISONunisonhealthplan.com

You can go to any of ourparticipating drug stores tohave your prescription Jlled.

Unison uses a preferred druglist. It helps your doctor choosewhich drugs to order for you.Some prescription drugs mustbe approved before you can getthem Jlled.

This approval is called a priorauthorization. Always ask yourdoctor if a prescriptionrequires prior authorization. Ifit does, ask if there is adifferent drug that doesn’trequire approval.

If the medicine requires priorauthorization, your doctormust Jll out a request form andreturn it to Unison’s PharmacyDepartment before it can beJlled.

Our Pharmacy Department willreview the request and make adecision. If it is denied, youhave the right to appeal thedecision.

To learn more, go towww.unisonhealthplan.com.Click on “South Carolina.”Choose your plan. You willJnd:

• participating drug stores• a complete list of ourpreferred drugs • information on ourpreferred drugs process• how to appeal a decision ifa drug is not approved

If you would like a printed copyof this information, callMember Services at1.800.414.9025, hearingimpaired call 711.

When You Need a Prescription

REMEMBERyour UnisonID Card!Always take your Unison member IDcard with you when you go to thedoctor. Remember to take your IDcard to the pharmacy or drug store. Your Unison ID card shows you arepart of our plan, and you shouldhave your card with you:

• When you get refills or newprescriptions at the pharmacy ordrug store. (You may have troublegetting your prescription filled if youdon’t show your ID card).

• When you visit your health careproviders.

If you have not received your UnisonID card or have lost it, please callMember Services to get a new card.

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If you are expecting a baby, then check out Unison’s MiraclesProgram.

The healthier you are, the healthier your baby will be. Join theMiracles Program, and you get a Pregnancy Coach. Your Coach willhelp you with many things such as tips on eating right and takingcare of yourself. Your Coach will even help set up doctor visits.

A Gift For You - It’s In The CardsKeeping all doctor visits is important when you are pregnant. Moms-to-be can earn gift cards for making andkeeping doctor visits. If you keep alldoctor visits during and afterpregnancy and stay in touch with yourCoach, then you can earn gift cardrewards. Use your gift cards to buythings to help keep you and your babyhealthy.

The program starts as soon as you calland join the Miracles anytime duringpregnancy. The sooner you join theprogram the more rewards you canearn. To join, or get more information,call 1.800.414.6580 (hearing impairedcall 1.800.473.0989).

A HEALTHY You MeansA Healthy Baby


Get theLead OutWhy were millions of toys, toy boxes,books and children’s furniturerecalled last year? They were recalledbecause each contained lead.

Lead is very harmful, especially tosmall children. That’s because youngchildren like to put things in theirmouths. Lead can cause problemswith hearing, behavior, and learning.Lead poisoning can cause braindamage and even death.

Children with lead poisoning don’talways feel or act sick. That’s why itis so important to have them tested.A simple blood test will show if yourchild has been exposed to lead. Thisblood test is usually done duringwell-baby doctor visits at 9-12months and 24 months.

This is a covered benefit for all ourtoddler members. Plus if you getyour baby tested at 9-12 months,you can earn a gift card. Don’t wait.

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unisonhealthplan.com inUNISON

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Babies, who have regular well-care check-ups, get off to thebest start in life.

After your baby is born, you canearn gift cards to keep yourchild healthy! Take your babyfor regular preventive checkupsand immunizations (shots).Unison will send you a gift cardfor each visit at:

• 1 month • 12 months• 2 months • 15 months• 4 months • 18 months• 6 months • 24 months• 9 months

You’ll get an extra gift card afteryour baby gets a lead level bloodtest at 12 months.

Unison can help you set upthese important doctor visits. Wecan even get you a ride to thedoctor’s ofJce. All of yourchildren need to have well-carecheck-ups. These check-ups arenot just for the new baby. Wecan help you with these visits,too.

To learn more call our EPSDTTeam at 1.800.377.2142.

START SMARTWith Regular Check-Ups

BABY’SFirst ShotsBabies need six vaccines betweenbirth and six months old. Theyprotect your baby from eight seriousdiseases. These diseases haveinjured and killed many childrenthrough the years. These vaccinesmay be given together in the sameshot or separately. Getting severalvaccines at the same time will notharm your baby. Older children needto get at least one “booster” dose ofmost of these vaccines:

• DTaP (Diphtheria, Tetanus &Pertussis) Vaccine: 5 doses – 2months, 4 months, 6 months, 15-18 months, 4-6 years. Somechildren should not get pertussisvaccine. These children can get avaccine called DT, which does notcontain pertussis.

• Hepatitis B Vaccine: 3 doses –Birth, 1-2 months, 6-18 months.

• Polio Vaccine: 4 doses – 2 months,4 months, 6-18 months, 4-6 years.

• Hib (Haemophilus influenza type b)Vaccine: 4 doses – 2 months, 4months, 6 months, 12-15 months.Several Hib vaccines are available.With one type, the 6-month doseis not needed.

• Pneumococcal Vaccine: 4 doses –2 months, 4 months, 6 months,12-15 months. Older children withcertain diseases may also needthis vaccine.

• Rotavirus Vaccine: 3 doses – 2months, 4 months, 6 months.Rotavirus is an oral (swallowed)vaccine, not a shot.

Source: US Centers for Disease Control


It’s a fact that babies cry. Babies cry to let othersknow they need something. Babies need you, sobe a hero and not a villain. No matter howannoyed you become, never yell at or shake ababy.

Babies’ heads are larger than their bodies.Shaking a baby causes his or her head to snapback and forth. This can cause a variety ofphysical injuries that may lead to blindness,mental retardation, hearing loss, broken bonesor even death.

According to Childhelp.org, thefollowing advice should befollowed by parents andcaregivers.

If you are feeling angry orupset:• Put the baby down in a safeplace

• Walk away and get a grip

• Count to 10 or take slow, deep breaths untilyou calm down

• Call a friend or your health care provider forhelp. Or call the Childhelp National ChildAbuse Hotline at 1.800.422.4453. All calls arefree and conJdential.

It is OK if your baby keeps crying while you calmdown. The important thing is to calm down.

The National Center on Shaken Baby Syndromesays Shaken Baby Syndrome is preventable.

Parents should share the message of thedangers of shaking with all who care fortheir infant or child, including spouses,their own parents, siblings, day careproviders and others.

Parents must let those caring for theinfant know that it is OK to call for helpwhen needed.

Si desea recibir unacopia de estainformación enespañol, llame al

1.800.414.9025 (711para las personas condeAciencias auditivas).

NEVER Shake A Baby

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We work hard to improve ourservice to you. We want you toreceive the best possible care.Unison Quality Improvementwatches over and measures howwell we are doing. Then theylook for ways to make ourprograms better.

Please write to us if you want tolearn more about:

• How the Unison QualityImprovement program works

• How we are meeting our goals• How our practice guidelines help

to manage the health of ourmembers

UNISON HEALTH PLANQuality ImprovementUnison Plaza, 1001 Brinton RoadPittsburgh, PA 15221

QUALITYCOUNTS

Heart disease is caused bynarrowing of the coronaryarteries that take blood to theheart. Like any muscle, theheart needs a constant supply ofoxygen and nutrients, which arecarried to it by the blood in the

coronary arteries. When thecoronary arteries becomenarrowed or clogged by fat andcholesterol deposits and cannotsupply enough blood to theheart, the result is coronaryheart disease (CHD). If notenough oxygen-carrying bloodreaches the heart, you mayexperience chest pain calledangina. If the blood supply to a

portion of the heart iscompletely cut

off by ablockage of acoronary

artery, the result is aheart attack.

If you answer yes to any of thesequestions, you most probablyhave CHD: • Have you ever had a heart

attack?

• Do you suffer from chest pain thathas been diagnosed as angina?

• Have you had heart surgerysuch as a bypass operation or aballoon or angioplasty procedure?

• Have you ever had an angiogram(a special x-ray picture of theheart) that showed a blockage inyour coronary arteries?

Be sure to talk to your doctorabout cholesterol if you haveanswered yes to any of thesequestions. Even if you don’t have heartdisease, having diabetes or acombination of several riskfactors may put you at high riskfor developing heart disease inthe future. Check with yourdoctor about cholesterol andhow to lower your risk.

Source: National Institutes of Health

Coronary Heart Disease

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We want you and your family toreceive safe and effective healthcare. That is why we check onour providers each year. We arepleased to say that ourproviders scored high marks forsafety in 2008.

Doctors’ Of>cesWe visited 31 doctors’ ofJces tosee if the patient area was safe.We made sure all medicines weresafely out of reach. The resultsshow a strong commitment tosafety.

HospitalsWe sent a survey to ourhospitals. Eleven hospitalsresponded and the results wereexcellent. • 100% use two different ways to

identify patients when providingcare.

• 100% have programs to preventinfections.

• 100% check the patient’sregular medications with themedications ordered in thehospital.

Other AreasBehind the scenes, we work toprotect members’ safety withprescription drugs. Ourpharmacies help to Jnd drug-to-drug interactions before youpick up the medicine. We alsoshare safety tips with you in ournewsletters.

Your health and safety are veryimportant to us. We will keepworking to improve your healthcare services.

MEMBER SAFETY

Provider Of>ce Site Survey % Yes

Oxygen tank available . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100.00%Current CPR certiJcation . . . . . . . . . . . . . . . . . . . . . . . . . .100.00%Drugs are out of reach . . . . . . . . . . . . . . . . . . . . . . . . . . . .100.00%Emergency drugs on hand . . . . . . . . . . . . . . . . . . . . . . . . . .96.67%Prescription pads are controlled . . . . . . . . . . . . . . . . . . . .100.00%Refrigerated area for medications . . . . . . . . . . . . . . . . . . . .96.88%


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A mammogram can save yourlife. A mammogram, an x-raypicture of your breast, is one ofthe best ways to spot breastcancer early. It can Jnd breastcancer when a tumor is still toosmall for you to feel.

Women age 40 and older shouldhave a screening mammogramevery one to two years. You mayneed your Jrst mammogrambefore age 40 if you are at extrarisk of breast cancer. You are atgreater risk if:

• you had breast cancer.• your mother, sister or daughter

had breast cancer.• you are very overweight.

A mammogram takes about 15minutes. You don’t need areferral for a mammogram. Yourdoctor will give you aprescription for it. Call andschedule the test. There is nocost to you. So don’t wait. Takingaction can change your life.

Source: National Cancer Institute

QUESTIONS for SurgeonsIf you’re about to have surgery, thereare many things you should know.When discussing the procedure withyour doctor, ask the following: • What is the operation (procedure)that is recommended?

• What is the surgeon’s experiencewith this procedure?

• Why is this procedure necessary atthis time?

• What are the options if thisprocedure is not done?

• What is the anticipated outcome ofthe procedure?

• What kind of anesthesia is requiredfor the procedure?

• What are the specific risks that thisprocedure involves?

• What about a second opinion? • What is the recovery process afterthis procedure?

• Is this procedure covered by myinsurance plan?

Medicinenet.com

Why You Need AMAMMOGRAM

No one wants to go to the hospital, butsometimes it is necessary. Here are teneasy things you can do to make yourhospital stay safer:

1. Tell the hospital staff who you are.Your caregivers need to know yourname and what you like to becalled.

2. Be sure you understand what issaid and be sure hospital staffunderstands what you say. If youhave trouble understanding orspeaking English, ask for atranslator.

3. Ask questions! Patients that askquestions about their care have farfewer mistakes made and betteroutcomes in the hospital.

4. Check that youare receiving theright medicine.

5. Know how often you will receiveyour medicine.

6. Know what dose to take,particularly if it can be split.

7. Have a family member or friendhelp you get to and from thehospital.

8. Give your complete medicalhistory. That means everymedicine you take, any allergiesyou have and any prior illnesses orsurgeries.

9. Follow the rules. For example, nosmoking means no smoking.

10.Be considerate to other patientsand hospital staff.

10 SAFETY TIPSfor Hospital Patients

Source: The Joint Commission of Accreditation of Health Organizations (JCAHO)

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Spring can mean trouble forpeople with asthma. If you haveasthma, it is important to knowwhat triggers it. A trigger isanything that can lead to anasthma attack. Allergies to grassand pollen can trigger asthma.Weather changes, dust,cigarette smoke, and exercisecan also be triggers.

Everyone has their owntriggers. If you have asthma youcan reduce your symptoms byavoiding those things that

trigger your symptoms. Workwith your doctor to develop ahelpful management andtreatment plan. That way you’llkeep your Jnger on thosetriggers and have a greatspring!

Unison has health programs tohelp members with on-goingconditions like asthma. Tolearn how they can help you,call 1.800.508.2581.

Source: American Academy of Asthma,Allergy and Immunology

• Approximately 3,000kids under the age of 18start smoking everyday inthis country.• Teen smokers get sickmore often than thosewho don’t smoke. • Teen smokers havesmaller lungs and weakerhearts than those whodon’t smoke.• Spit tobacco, pipes andcigars are not safealternatives to cigarettes.• Parents have the mostinKuence over their kids.Let your kids knowsmoking is bad news.

TeenSmoking:THE FACTS

Keep Your Finger on

ASTHMATRIGGERS

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We Are OnlineLearn more about your health planon our website.

• What benefits and services arecovered and what’s not

• A list for doctors, dentists,specialists, drug stores, hospitalsand vision services

• Pharmacy Services

• How to get care - primary care,specialty care, after-hours care,behavioral health services andhospital services, and care whenyou are out of your service area

• What to do in an emergency

• Preventive health guidelines

• Your rights and responsibilities

• How to make a complaint

• How to appeal a decision

• What to do if your appeal is denied

• How we study and evaluate newtreatments and services

• Our privacy policy

Go to www.unisonhealthplan.com.Select South Carolina from the pulldown bar. Select your plan. Click onMembers. You will find thisinformation and more. Call MemberServices to get a printed copy ofinformation on our website.

Put the Lid OnHIGH BLOOD PRESSUREFollow these simple tips, andkeep your blood pressure undercontrol:1. Check your blood pressure

or get it checked regularly.2. Lose weight. Ask your doctor

what your weight should be.Try to get to that level.

3. Avoid salt. Stay away fromsalty food. Cut back on saltwhen cooking.

4. Read the label. Look forfoods low in saturated fats.

5. Limit alcohol. Keep it to onedrink a day for women, two

drinks a day for men.6. Take your medicine. Take all

medicines as directed andreJll them on time.

7. See your doctor. Make andkeep regular check-up visits.

8. Stop smoking. 9. Stay active. Regular physical

activity can lower bloodpressure. Talk with your doctorbefore starting any exercise.

10.Protect your loved ones.Make sure your family andfriends check their bloodpressure regularly.

NEW TREATMENTSUnison always looks for new medical treatments, behavioral health proceduresand services to improve your health and well-being. If your doctor requestssomething new to treat you, we study it and make a coverage decision. Anytreatment, drug, or device that is not experimental is reviewed. Then we tellyou and your doctor what the decision is. When new services and treatmentsbecome covered benefits you’ll get the news in a special mailing.

UtilizationManagementYour doctor must get approvalbefore you can receive certaintypes of services or care. OurUtilization Management team(UM) looks over your doctor’srequest. If it is an emergency,your doctor can reach a memberof the UM team anytime day ornight. There are three thingsyou need to know about UM:• UM doctors and nurses make

their decisions based on what youneed for your medical condition.

• Unison network doctors do notreceive extra money or rewards tolimit your care.

• We don’t pay our employeesextra for limiting your care.

Unison wants to help you staywell. If you’re sick, we want tohelp you get better. We makecoverage decisions based onwhat you need. We are here for you.

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South Carolina Member Newsletter

Presorted StandardU.S. Postage

PAIDPittsburgh, PA

Permit No. 4503

Unison Health Plan Member ServicesFor more information, we are available Monday through Friday from 8 a.m. to 5 p.m. You can reach us at 1.800.414.9025 or hearing impaired call 711

Interpretation and translation services are free tomembers. Please call Member Services for moreinformation.Please refer to your member handbook for bene1tcoverage. Si no habla inglés, llame al Departamento de Serviciospara Miembros.

Language SupportUnison helps members who need special services to understand their beneJts. These services includeTTY access, language line help for members who do not speak English and translated materials.If you or your family needs this kind of help, please call the Special Needs Unit at 1.877.844.8844 or theSpecial Needs Unit TTY at 711 .

Unison Administrative ServicesUnison Plaza, 1001 Brinton Road

Pittsburgh, PA 15221

www.unisonhealthplan.com

No person on the grounds of race, color, national origin, sex, age, religion or disability shall be excluded from participationin, be denied the benefits of, or be subject to discrimination under any program service provided by Unison Health Plan.

U in NISON - uhccommunityplan.com NISON Working Together for ... watermelon, berries, apples, citrus...

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