GoodHealth
A MAGAZINE FOR BLUE CARE NETWORK MEMBERS | SPRING/SUMMER 2017
INSIDE THIS ISSUE
Health screenings
every man should have
See Page 14
9tips
for a healthy summer
See Page 17
BLUES
CROS APP:
LE
MOBI HAT'S
W
SEE EW,
N
28.
PAGE
Cover photo: Farmer’s Market at the Capitol
Courtesy: Michigan Department of Agriculture & Rural Development
Confidence comes wit
h every card.®
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations
and independent licensees of the Blue Cross and Blue Shield Association.
bcbsm.com
Dear valued reader:
Good Health
Editorial Board
Belinda Bolton
Terri Brady
Kellee Cornell
Michele Della-Moretta
Kristie Hand
Moira Horne
Shannon McCarthy
William Pompos,
L.M.S.W., A.C.S.W.
Sue Sims
Michelle Smith
Heidi Watson
Hashim Yar, M.D.
Kevin Zywiol
Editors
Tammie S. Nagridge
Mintzi Schramm
Emily M. Martinez
We want to hear from you!
Fill out the feedback postcard in this
issue, or address your comments to:
Good Health — Mail Code C403
Blue Care Network
P.O. Box 5043
Southfield, MI 48086-5043
With every issue of Good Health, we receive numerous responses to our
feedback card. Thank you for sending us your thoughts, whether to critique or
praise the magazine. To comment on this issue, see the feedback card in the
center of the magazine.
Sometimes readers ask, “Why are you sending me this?” And it got me
thinking about other ways we communicate with you — whether an email,
postcard, letter or even a phone call. Which led me to an even bigger question
that some of you are probably wondering: “Why are you contacting me at all?”
At Blue Care Network, we’re committed to educating our members — so you
can stay healthy and, when needed, receive the quality of care you deserve.
Every communication goes through extensive planning to ensure that we’re
delivering useful information to you in a manner that’s easy to understand.
For every issue of this magazine, we work hard to put together articles that we
think are important to you and your health. This is especially important as we
welcome new members to Blue Care Network in 2017.
As always, I hope you take advantage of the health information that we
provide you. If you’d like to see more in-between issues of the magazine, our
Good Health eNews includes articles on living healthy and provides access to
online tools. To subscribe, visit bcbsm.com/enewsletters.
At the end of the day, we have the same goal as you: keeping you healthy.
Here’s to your health.
Shannon McCarthy
Managing Editor
Good Health is published twice a year for Blue Care
Network. Good Health is meant to complement
the advice of health care professionals and is not
intended to take the place of professional medical
care. Your specific contract may not cover every
procedure or treatment recommended.
Blue Care Network and BCN in this publication
refer to all Blue Care Network of Michigan
commercial products, except where noted
otherwise.
Blue Care Network of Michigan is an
independent, nonprofit affiliate of Blue Cross
Blue Shield of Michigan, one of many individual
Blue Cross and Blue Shield plans in the United
States. Blue Care Network is controlled by a
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business, labor and health care professionals.
The Blue Cross and Blue Shield Association
licenses Blue Care Network of Michigan to offer
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Cross and Blue Shield names. Blue Care Network
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and solely responsible for its own debts and
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organization using the Blue Cross and Blue Shield
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2 | GoodHealth
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In the drop-down menu, select
Good Health magazine.
About us To share health information and help you understand your Blue
Care Network coverage, we mail Good Health twice a year to your home. We
include wellness tips, recipes, health guidelines, pharmacy news and more. And
who better to bring all of this to you than us? We’re Michigan’s largest HMO
network, with more than 5,800 primary care physicians, over 22,000 specialists
and most of our state’s leading hospitals. And, since 2000, we’ve received a
special stamp of approval from the National Committee for
Quality Assurance, which measures the quality of health care and
health care plans.
Learn more about us at bcbsm.com.
Blue Care Network’s website is bcbsm.com. While website addresses for other organizations are
provided throughout this publication for members to use for additional information, BCN doesn’t
control these sites and isn’t responsible for their content.
The XY
factor:
Checkups
for men
14
In this issue
Health
6 | Reader responses: You asked.
We answered.
8 | Ask our health coach
9 | Prediabetes: The facts
10 | What to expect at a colonoscopy
11 | The best way to relieve back pain
12 | Healthy lungs
14 | The XY factor: Checkups for men
16 | Are you at risk for adult allergies?
17 | 9 tips for a healthy summer
18 | Vaccinations: Make sure your children
are protected
19 | Understanding your baby’s stats
20 | Guidelines to good health
22 | Talk with your kids about drinking
23 | Living with cancer: The emotional side
Individual and family coverage
4 | HMO 101: What you need to know
5 | A guide to your health care costs
Pharmacy
24 | We all need to be concerned about
opioid abuse
25 | Ask the pharmacist
Need to know
26 | Understanding prior authorizations
27 | Online health care: See a doctor anytime,
anywhere
28 | Estimate the cost of health care
services — from your mobile phone
Visit bcbsm.com for detailed information
about our policies and procedures.
See Page 29.
Clarification regarding referrals
29 | Get answers at bcbsm.com
30 | Your Summary of Benefits and Coverage
document has been updated
30 | We’re available to talk about our
utilization management activities
30 | How we manage care
In our last issue, we featured an article on “Understanding referrals: Coordinating
care with your doctor.” The article should have noted that referral requirements
work differently in some regions within Michigan and don’t always need to be
submitted to BCN. If you have questions about how referrals work in your area,
call the Customer Service number on the back of your BCN ID card.
bcbsm.com
Spring/Summer 2017 | 3
Individual and family coverage
HMO 101
What you need to know to make the most of your coverage
The basics
With Blue Care Network, you’re part of a
health maintenance organization. As an
HMO member, you’re required to select
a primary care physician who provides
or coordinates your care with specialists.
It’s important to select a doctor who
participates in your plan’s network.
Your primary care physician
Your PCP is your partner in health care.
He or she is responsible for the care
you receive, from preventive health care
services to the treatment of an illness. To
find one in your plan’s network, log in to
your account at bcbsm.com. Or call the
Customer Service number on the back
of your BCN ID card.
Referrals
To see a specialist in some Michigan
regions, you may need a referral from
your PCP. You may also need special approval from BCN for certain services
and to see specialists who aren’t part
of your plan’s network. See Page 26,
“Understanding prior authorizations.”
For specifics about your plan and region requirements, call the Customer
Service number on the back of your
BCN ID card. If the service requires a
referral and your PCP doesn’t refer you,
you’re responsible for the charges.
Know your benefits
You can get details about your
coverage, including your deductible,
coinsurance and copayment amounts,
at bcbsm.com by:
1. Logging in to your account.
4 | GoodHealth
2. Clicking My Coverage in the blue bar
at the top of the page.
3. Selecting What's Covered from the drop-down menu.
You can also view your plan documents (Certificate of Coverage and riders) from the Blue Cross mobile app. See Page 28.
To request a paper copy of your plan
documents, call the Customer
Service number on the back of your
BCN ID card.
CUSTOMER
SERVICE
EXTENDED HOURS
Monday through Friday
8 a.m. to 8 p.m.
1-888-227-2345
(our dedicated Customer
Service number for
members who purchase
their own coverage)
Save time. Pay your bill online.
Signing up for online bill pay not only saves paper,
it also saves time.
Here’s a rundown of
all the online bill pay
features:
• Make onetime or
recurring payments
through your online
account, and pay
with your debit card,
credit card or bank
account.
• See your billing and
payment history.
• Create and download
reports.
• Get email reminders
about your bill.
• Pay for more than
one Blue Cross plan
at the same time,
such as health and
dental coverage.
Signing up for online
bill pay is easy. Using
your computer, log
in at bcbsm.com. If
you’re eligible, you’ll
see Pay My Bill in the
right-hand column.
Click the link and follow
the instructions to get
started.
Or pay your bill using
the mobile app.
Individual and family coverage
A GUIDE TO
YOUR HEALTH CARE COSTS
Knowing what you’ll pay for a health care service before you get care is important in understanding how your plan works.
Member: Jill
Age: 35
Deductible: $1,000
MONTH
OF SERVICE
SERVICE
Plan: BCN HMOSM
Coinsurance: 20%
Out-of-pocket maximum: $6,600
COST
JILL PAYS
BCN PAYS
JANUARY
Jill visits her primary care physician
for her annual wellness visit
$40
$0
As a preventive service*, the annual wellness
visit is fully covered. No copay required.
Nothing applied to the deductible.
$40
MARCH
Visit to PCP for a cold
$85
$20 copay
Jill is responsible for the copay.
Deductible doesn’t apply.
$65 $150 ER copay plus
$1,000 for X-rays and other tests
Jill has to pay $1,000 deductible first.
Once the deductible is met, she pays the
$150 copay of the remaining amount.
Jill pays a total of $1,150 for the visit.
APRIL
Trip to ER after falling
MAY
Trip to urgent care for difficulty
breathing
$120
$50 urgent care copay
Deductible doesn’t apply.
$70
MAY
Prescription antibiotics for
sinus infection
$50
$15 drug copay for generic
$1,000 deductible already met.
$35
AUGUST
With a referral** from her PCP,
Jill visits dermatologist
$100
$40 specialist visit copay
$1,000 deductible already met.
$60
AUGUST
Wrist X-ray (outpatient procedure)
$600
20% coinsurance = $120
Deductible already met.
$480
SEPTEMBER
Surgery on her wrist
(inpatient admission)
$6,000
20% coinsurance = $1,200
Deductible already met.
$4,800
TOTAL COSTS
$1,200
$8,195
$2,595
The total amount Jill has paid goes
to her $6,600 out-of-pocket maximum.
$50
$5,600
Jill's costs are based on the BCN HMO plan with a $1,000 deductible and 20% coinsurance and copayments for various services. These payments may change according to different
health plans. The costs for services are estimates.
TERMS TO KNOW
Deductible
Copay
Coinsurance
Out-of-pocket maximum
Premium
The amount you owe
for covered health
care services before
BCN pays.
A fixed amount you
pay for a covered
health care service,
usually when you get
the service.
Your share of the cost of a
covered health care service,
usually a percentage (for
example, 20%) of the allowed
amount for the service.
The most you’ll pay for
deductible, copay and
coinsurance during the year.
The monthly amount
you or your employer
pays to BCN to keep
your coverage.
*For a list of preventive services, visit https://www.healthcare.gov/coverage/preventive-care-benefits/.
**To see a specialist, you may need a referral from your primary care physician. See Page 26.
bcbsm.com
Spring/Summer 2017 | 5
Health
YOU ASKED:
How do I get started with the Blue
Cross mobile app?
Kirk K., Macomb, Michigan
Search BCBSM in the App Store® or on
Google Play™. Once you download the
app, you can look up your plan information
anytime, anywhere. For more about the
features of our mobile app, see Page 28.
We love hearing from you
We base much of what you see in this
magazine on your input. If we publish
your comment in Good Health, we’ll
send you a free cookbook of healthy
recipes. To give your feedback,
complete and return the enclosed
postage-paid reply card, or visit us at
bcbsm.com/bcnfeedback.
READER RESPONSES
You asked. We answered.
6 | GoodHealth
Health
YOU ASKED:
Why do we need certain tests and procedures
at certain times? For example, you suggest
mammograms every two years and a shingles
vaccine starting at age 60.
Diana K., Bay City, Michigan
Preventive care starts with screenings and
checkups that can either prevent illnesses,
disease and other health problems, or
detect illness at an early stage when
treatment is likely to work best.
Generally, screenings are calculated
for healthy people, taking into account
age, gender and known risk factors for
disease. Their timing is designed to
provide the best protection with the least
amount of inconvenience. Because they
may not always apply to you and your
physical condition, you should always
discuss guidelines and other health care
questions with your primary care physician
who may recommend a different schedule
based on your needs.
Our guidelines to preventive care
(see Pages 20 to 21) are based on
recommendations from the Michigan
Quality Improvement Consortium, which
reviews data from national medical
organizations as well as the latest medical
and scientific research.
YOU ASKED:
How can I be prepared for my annual physical? How do
I know what tests and procedures will be done?
J.C., Dearborn Heights, Michigan
We recommend a health exam that
covers height and weight assessment,
body mass index evaluation, obesity
counseling, and alcohol and tobacco use
discussion. A good doctor will spend
time listening to your concerns as he or
she updates your medical history. During
the exam, your primary care physician
also gathers information about you and
your health by watching and talking to
you. How is your memory and mental
quickness? Does your skin appear
healthy? Can you easily stand and walk?
Your doctor uses this exam to check
your vital signs, including your heart
and lungs:
bcbsm.com
• Blood pressure: Less than 120 over 80 is
a normal blood pressure. Doctors define
high blood pressure (hypertension) as
140 over 90 or higher.
• Heart rate: Values between 60 and 100
are considered normal.
• Respiration rate: From 12 to 16 breaths
per minute is normal for a healthy adult.
• Temperature: 98.6 degrees Fahrenheit
is the average, but healthy people can
have temperatures slightly higher
or lower.
• Heart exam: Listening to your heart with
a stethoscope, your doctor might detect
an irregular heartbeat, a heart murmur or
other clues to heart disease.
• Lung exam: Using a stethoscope, your
doctor listens for crackles, wheezes or
decreased breath sounds. These are
clues to the presence of heart or lung
disease.
Spring/Summer 2017 | 7
Health
Ask our health c ach
Michele DellaMoretta, BCN
health coach
Our certified health coach can help you make healthy choices.
Q:
A:
Do you have any recommendations for skin care
in the summer?
Belinda B., Detroit, Michigan
Summer’s harsh sun can damage your skin. When
the beach and pools call, protect yourself. While
sunscreen is part of the beach experience, it’s less likely to
be used when running errands. But even a short walk to
lunch can put you at risk for too much sun exposure. Try
adding a lotion or makeup that contains sunscreen to your
morning routine. Be sure to protect your lips, too. Choose a
lip balm with an SPF of at least 15. Also, be sure to use a lip
balm, not a lip gloss, in the summer. A balm tends to
hydrate more and stays on longer.
Q:
A:
Why is quinoa so popular these days?
Emily M., South Lyon, Michigan
This healthy whole grain is high in protein, a great
source of fiber and has a high level of heart-healthy
fats. It cooks up in 20 minutes and has a nutty taste. Red
quinoa holds its shape best after cooking, so it’s especially
good for salads.
ASIAN QUINOA CHOP SALAD
Ingredients
½ cup dry quinoa
1 cup water
½ cup diced red bell
pepper (about ½
medium red bell
pepper)
½ cup diced carrots
(about 2 medium-sized
carrots)
½ cup chopped pea pods
(about 8 to 10)
¼ cup chopped green
onions (about 2 to 3)
2 tablespoons rice vinegar
1 tablespoon sesame oil
1 tablespoon tamari
soy sauce
1 tablespoon honey
½ teaspoon grated
fresh ginger
1 garlic clove, minced
2 tablespoons minced
cilantro
6 large leaves romaine
lettuce or 6 cups
mixed greens
Directions
1. In a medium saucepan over high heat, bring water
to a boil. Add quinoa, stir, cover and reduce heat to
medium-low. Simmer for about 30 minutes or until
quinoa is soft and water is absorbed.
2. Meanwhile, in a large bowl, combine red pepper,
carrots, pea pods and green onions. In a second
medium bowl, whisk together rice vinegar, sesame oil,
soy sauce, honey, ginger, garlic and cilantro. Set aside.
3. Pour cooked quinoa into a large bowl and let cool
for at least 10 to 15 minutes (it chills faster in the
refrigerator). When the quinoa is no longer steaming,
mix in chopped vegetables and then stir in dressing.
4. To serve, place one large romaine lettuce leaf or
1 cup of mixed greens on a plate, then top with
½ cup of salad.
Per serving
Serves six. Each ½ cup of quinoa and lettuce leaf contains:
100 calories, 3 g total fat, 0 g saturated fat, 0 mg cholesterol,
178 mg sodium, 15 g carbohydrates, 4 g sugar, 2 g dietary fiber
and 3 g protein.
8 | GoodHealth
F
L
For more healthy
recipes, subscribe to
Good Health eNews,
the online edition of
Good Health at
bcbsm.com/enewsletters.
)
m
bcbsm.com
Health
Prediabetes:
The facts
Prediabetes — when your blood sugar is higher than normal — is
the first step toward diabetes. Here’s what you need to know to
stop this condition from progressing.
Fact 1:
More than one in three adults in the United States has
prediabetes, according to the Centers for Disease Control and
Prevention.
Without lifestyle changes, says the CDC, many people with
prediabetes will develop Type 2 diabetes. A healthy lifestyle can
help the body become better at using glucose so it doesn’t build
up in the blood. Research, reported by the American Medical
Association, shows that people with prediabetes can reduce their
risk for full diabetes by more than half when they lose 5 to
7 percent of their body weight by exercising and eating right.
Fact 2:
Prediabetes puts the heart at risk.
According to the National Institute of Diabetes and Digestive
and Kidney Diseases, people with prediabetes have a higher risk
for heart disease. Your risk increases even more if you develop
diabetes.
Fact 3:
People with prediabetes rarely have symptoms.
It’s a good idea to see your doctor and get your blood sugar
tested if you’re 45 or older. Younger people may want to ask their
doctors about testing if they’re overweight and have at least one
other risk factor for diabetes, such as:
• Not exercising regularly
• Being African-American, Asian-American or Latino
• Having low HDL (good) cholesterol or high triglyceride levels
Spring/Summer 2017 | 9
Health
What to expect at
a colonoscopy
A colonoscopy is one of the most important
health screenings because it can detect
colon cancer in its early stages.
When to be screened
If you have no symptoms of colorectal cancer or no family history of the disease,
you should get your first screening at age 50. If you have a history of the disease,
you should get your first test at age 40. Regardless of symptoms or family history,
African-Americans should have their first test at age 45.
Undergoing a colonoscopy
You’ll receive sedation to relax you. Then, your doctor will insert a tube with a
camera through your rectum to look for polyps in your colon. If any are found, the
doctor will remove them and send them to a lab for testing.
The procedure takes 30 to 60 minutes. Afterward, you may experience
cramping, bloating and bleeding. Your doctor can tell you the results
immediately unless additional testing is needed.
For the test to be most effective, follow your doctor’s instructions before the
screening.
DEEP OR MODERATE
SEDATION?
There are two types
of anesthesia used for
colonoscopies: deep
sedation or moderate
sedation. Both are given
with varying frequency, and
each has advantages and
disadvantages. Talk with your
doctor about what type of
anesthesia is right for you.
Deep sedation
• Requires an anesthesiologist.
• Patient is unconscious, but
can breathe on his or her
own and is more difficult to
awaken.
• May result in a higher
number of serious side
effects.
Moderate sedation
• Doesn’t require an
anesthesiologist.
• Patient is usually asleep, but
is easily awakened and can
respond to commands.
• May result in a fewer number
of serious side effects.
10 | GoodHealth
Health
The best way to relieve back pain
There are many ways to cope
with back pain, but exercise
works best.
Researchers reported in
JAMA Internal Medicine that
people who exercised had
a 35 percent lower risk for a
repeat attack of back pain.
Yoga offers moves that
stretch and strengthen your
back muscles while improving
posture and flexibility. You’ll
find that these stretches also
prevent pain in the area.
We’ve provided a couple of
classic yoga moves to get you
started.
Warrior II Pose
1. Standing on your mat, step out to
a wide-legged position. Your feet
should be about 3 feet apart, and you
should feel stable.
2. Turn your right foot slightly to the
right and your left foot to the left 90
degrees. Turn your left thigh out so
that the center of the left knee cap is in
line with the center of the left ankle.
3. Exhale and bend your left knee
over the left ankle, so the shin is
perpendicular to the floor. Anchor this
movement of the left knee by pressing
the outer right heel firmly to the floor.
4. Stretch your arms, and turn your head to the left, looking over your fingers.
5. Hold for 30 seconds to 1 minute. Inhale to a standing position. Reverse the feet
and repeat to the left.
Cat Pose
1. Start on your hands and knees in a
“tabletop” position. Set your knees
directly below your hips, and your
wrists, elbows and shoulders in line
and perpendicular to the floor. Center
your head, eyes looking at the floor.
2. As you exhale, round your spine
toward the ceiling. Release your head
toward the floor, but don’t force your
chin to your chest.
3. Inhale, coming back to the tabletop
position on your hands and knees.
What’s the role of imaging in diagnosing back pain?
Imaging for strained muscles and ligaments, the most common cause of low back pain and stiffness, may not be
very helpful. In fact, according to the American College of Physicians and the American Pain Society, much of
what shows up in imaging (X-rays, MRIs and CTs) is likely part of normal aging.
Blue Care Network works with the Greater Detroit Area Health Council on its Choosing Wisely website,
choosingwisely.org, which lists appropriate medical tests and treatments for conditions such as low back
pain. Developed by the American Board of Internal Medicine Foundation, the website is designed to promote
conversations between physicians and patients.
bcbsm.com
Spring/Summer 2017 | 11
Health
HEALTHY
LUNGS
12 | GoodHealth
Health
Health
THE FAR-REACHING EFFECTS
OF BREATHING PROBLEMS
Common disorders such as asthma, pneumonia and chronic obstructive
pulmonary disease affect more than your lungs. They also cause problems
throughout your body.
CHEST
Excess fluid from
pneumonia between the wall of
your chest and your lungs can raise
the risk for infection and worsen
breathing problems.
BRAIN
Pneumonia can cause
deafness and brain swelling,
as well as slower mental
processing.
BLOODSTREAM
HEART
COPD can
double or even triple
your odds for heart
disease. Asthma may
also increase your risk
for heart disease and
heart failure.
Pneumonia can send bacteria
into your bloodstream,
raising the risk for infections
elsewhere in your body.
MUSCLES Inflammation and
low blood oxygen levels can weaken
muscles throughout your body,
making you feel tired all the time.
EMOTIONS
Lung disease
is stressful, leading to feelings
of fear, worry and depression.
KEEP YOUR LUNGS
HEALTHY
Talk with your doctor about how
to keep your lungs in shape.
Some possible suggestions:
• Quit smoking. According to
the American Lung Association
(ALA), if you quit now, your lung
function will improve in as little
as two weeks.
• Get an annual flu shot. The
flu causes one-third of all
pneumonia cases, says the ALA.
If you have COPD, getting a flu
shot every year is a must.
• Get your pneumonia vaccine.
If you’re age 65 or older, you
should be vaccinated against
pneumonia.
• Control your asthma. If you
have asthma, create an action
plan with your doctor that
includes daily medications
(usually inhaled corticosteroids)
for long-term control, as well as
medicines for quick relief when
symptoms flare.
Note: Pages 20 and 21 tell you
when to get the flu shot and
pneumonia vaccination.
Free tools to help you quit
Tobacco use is the leading cause of preventable death in
the United States, according to the Centers for Disease
Control and Prevention.
At no extra cost to you, Blue Care Network’s Tobacco
Cessation Coaching program, powered by WebMD®,
includes access to many online tools. Log in to your
member account through your computer or mobile app,
and click the Health & Wellness tab.
Call 1-855-326-5102 to schedule your first Tobacco
Cessation Coaching call.
For more information on strategies, medicine and other
support resources:
• Talk with your doctor.
• Read our Quit Guide at bcbsm.com/bcnquit.
• Watch a short video by going to youtube.com and
searching “A doctor’s advice on smoking — Blue Care
Network.”
WebMD Health Services is an independent company supporting Blue Care Network by providing health and wellness services.
bcbsm.com
Spring/Summer 2017 | 13
Health
We’re devoting a special two-page section in honor of June being Men’s Health Month.
Look for a special section on women’s health in the fall 2017 issue.
The XY factor
Checkups for men
An annual health checkup can help you —
and your primary care physician — spot
health problems early. Here’s what you need
to know about tests and exams for men:
Prostate cancer screening:
An important conversation with your doctor
One in seven men — including one in three African-American men —
will develop prostate cancer in his lifetime, according to the American
Cancer Society. Prostate cancer kills more than 26,000 men each year in
this country.
Finding prostate cancer early can allow for lifesaving treatment. Your
doctor will start discussing screenings with you when you’re 50. If you’re
African-American or have a first-degree relative (father, brother or son)
who had prostate cancer before age 65, the discussion may come earlier,
according to the Centers for Disease Control and Prevention.
WHAT WILL HAPPEN AT YOUR CHECKUP: Your doctor will perform a rectal
exam to check the size and condition of your prostate gland. You may also
have a blood test that measures levels of prostate-specific antigen (PSA),
which may be elevated if you have prostate cancer.
WHAT HAPPENS NEXT: If your PSA levels seem high, your doctor may
order additional tests.
14 | GoodHealth
Health
Aortic aneurysm:
The lifesaving, onetime check
As wide as a garden hose, your aorta is the big blood vessel that
carries blood from your heart to the network of arteries that feeds
cells throughout your body. If the wall of the aorta balloons out — an
aortic aneurysm — it may fray or rupture, which leads to nearly 10,000
deaths per year, according to the CDC.
The U.S. Preventive Services Task Force recommends that men ages
65 who have smoked at some time in their lives get screened for an
aortic aneurysm, even if they don’t have any symptoms.
WHAT WILL HAPPEN AT YOUR CHECKUP: Your doctor will
recommend an ultrasound exam. The test, which uses sound waves to
measure the size of the aorta, is painless.
WHAT HAPPENS NEXT: If your aorta is extremely enlarged, you may
need surgery to strengthen the weakened area. If enlargement is less
severe, you may just need repeat checkups to monitor it.
Testicular cancer:
Early detection leads to early treatment
Experts aren’t sure what causes testicular cancer. Each year, 8,720
cases are diagnosed, and 380 men die, according to the CDC. You
may be at higher risk if you had an undescended testicle at birth, are
Caucasian or have a close family member with this type of cancer. The
good news: It’s typically caught early, and more than 95 percent of
men diagnosed with testicular cancer survive, the CDC reports.
WHAT WILL HAPPEN AT YOUR CHECKUP: Your doctor will examine
your testes for swelling, lumps or hard nodules, and to see if either
one is larger than normal. You can also perform monthly self-exams.
Contact your doctor right away if you notice the signs listed above.
WHAT HAPPENS NEXT: If your doctor notices a warning sign, he or
she will look for other health conditions that can cause lumps and
swelling, such as extra fluid or enlarged veins. Ultrasound scans and
blood tests are used to diagnose testicular cancer.
bcbsm.com
Spring/Summer 2017 | 15
Health
ARE YOU AT RISK
FOR ADULT ALLERGIES?
Perhaps you sailed through childhood allergy-free. Or
maybe you had some allergies as a child but seemed
to have outgrown them. In either case, you could be
in for a surprise as you get older. Allergies aren’t just a
childhood ailment. They can crop up in your 20s, 30s
and beyond, creating new problems as an adult.
All grown up with allergies
The immune system’s job is to fend off harmful invaders
within the body, such as viruses and bacteria. With
allergies, this process goes awry, causing:
• Runny or stuffy nose
• Sneezing
• Itchy nose, ears or mouth
• Red, watery, itchy eyes
• Coughing, wheezing, chest tightness or shortness of
breath in those with asthma
Be aware of your risk factors
Researchers are studying why some people develop
allergies and others don’t. Here are some factors that
may increase your risk for adult allergies:
• Being a Michigander. Michigan has one of the most
active allergy seasons in the country. Track the pollen
count in your area on sites such as pollen.com.
• Switching up your environment. Getting a dog or cat
might set off a pet allergy that you never knew you
had. Or moving into a new home might bring you
into contact with an allergy-causing mold.
• Changing your workspace. Have you changed floors
or buildings at work? Common workplace triggers
include cleaning products and some types of dust.
Don’t let allergies fool you
Many allergy symptoms are easy to mistake for a cold.
Itchiness is one clue that an allergy might be the true
cause. Another sign is if your symptoms stick around
for more than two weeks.
Talk with your primary care physician if your
symptoms are long-lasting or bothersome. Your
doctor can help pinpoint the cause and recommend a
treatment plan or a specialist.
Whatever you do, don’t ignore your allergies.
Want more information about allergies? Sign up for the
digital monthly edition of Good Health eNews at bcbsm.com/enewsletters.
16 | GoodHealth
9
Health
tips for a healthy summer
Long, warm summer days invite kicking back and having fun. Follow these tips
so you can make the most of the sunshine season while staying active.
1. Go outside and play.
Spending time in nature can reduce
stress, anxiety and depression. Plus,
it may help restore your ability to
pay attention when you’re feeling
mentally drained.
2. Hike, bike, swim. There are
many ways to get your 150 minutes
per week of moderately intense
physical activity. If it’s too hot
outside, hit the gym, walk at the
mall or visit an indoor basketball
court.
3. Slather on sunscreen.
Protect your skin from the sun’s
ultraviolet rays. Use a sunscreen
with an SPF of 15 or higher. Apply
liberally, even on cloudy days. And
wear a wide-brimmed hat and UV
blocking shades.
4. Stay cool. Wear light-colored,
lightweight, loose-fitting clothes.
Stay inside during the hottest part
of the day — usually about noon
to 3 p.m.
5. Drink more water. Your
body needs extra fluids in hot
weather, especially if you’re
exercising or working in the heat.
Avoid drinks with alcohol or lots of
sugar, which can be dehydrating.
6. Fire up the grill. Throw
on some fish, chicken, turkey
burgers or veggie kabobs. But
avoid cooking meat, poultry or fish
directly over an open flame or on
a hot metal grill to avoid creating
compounds that are linked to
certain cancers. Instead, cover the
grill with foil that has holes poked
in it. Remove any charred bits
before eating.
7. Visit a farmers market.
Summer is prime time for a host
of nutritious fruits and veggies,
including blueberries, green beans,
strawberries, tomatoes, watermelon
and zucchini. Or grow your own
food garden and get some bonus
physical activity.
8. Pack a safe picnic. To fend
off food poisoning, store cold food in
a cooler at 40 degrees or lower. Open
the lid as little as possible to keep
things cold inside.
9. Shoo away the bugs.
At best, bug bites are irritating. At
worst, ticks and mosquitoes can
carry diseases. To reduce the risk,
apply insect repellent to exposed
skin and clothing. Wash it off
when you come inside, and check
your skin, clothing and gear for
hitchhiking ticks.
June is Safety Awareness Month
Prescription drug overdose is the leading
cause of unintentional injury-related death
at home, according to the National Safety
Council. For helpful advice about managing
your medications, visit bcbsm.com:
• Click For Members.
• Click Health and Wellness, and scroll
down to Staying Healthy.
• Click Learn More.
• Click Using Medication Wisely.
bcbsm.com
Spring/Summer 2017 | 17
Health
4 reasons why
you should get
vaccinated
Vaccinations: Make
sure your children
are protected
Immunizations not only protect your child from getting sick but
also those around him or her. This includes babies who are too
young to be fully vaccinated and those with weakened immune
systems.
For the most protection, children need to get the right shots
at the right times.
Your children will need to get some shots more than once.
Talk with their primary care physician about what vaccinations
they should have and when.
Other things to consider
If you’re pregnant, you can protect your newborn from whooping
cough by getting a Tdap (tetanus-diphtheria-pertussis) shot
during your pregnancy, between weeks 27 and 36.
Facebook “f ” Logo
Don’t wait until one of you is sick to think about the health of
your family. For a recommended list of child and adult vaccinations,
see Pages 20 and 21. Or use the Immunization Reminder at
facebook.com/MiBCN.
CMYK / .eps
Facebook “f ” Logo
18 | GoodHealth
CMYK / .eps
1
Preventable diseases have
not gone away. The viruses and
bacteria that cause illness and
death still exist.
2 When you get sick, your
children are at risk, too. A
vaccine-preventable disease
that might make you sick for
a week or two could be much
worse for your children if it
spreads to them.
3 Infants and older adults
are at greater risk for serious
infections and complications.
Young and healthy people can
get very sick, too.
4 Vaccines help keep you
healthy. The Centers for
Disease Control and Prevention
recommends vaccinations
throughout your life to protect
against many infections. When
you skip vaccines, you leave
yourself and your loved ones
vulnerable to illnesses.
Health
Understanding
your baby’s stats
When you take your baby to the
pediatrician, you’ll learn that your little
bundle is in a specific percentile for his
or her age. But what does that mean?
For one thing, it’s some of the most
important information your pediatrician
will give you about your growing baby.
Percentiles help clarify how your baby
compares to others his or her age and
gender in physical growth milestones,
and whether your baby is growing at a
healthy pace.
To track the percentiles of babies up
to age 2, pediatricians use the WHO
Growth Charts, which measure length,
weight and head circumference. The
World Health Organization developed
these charts using growth data of
breastfed infants in six countries.
bcbsm.com
At a checkup, your pediatrician will
measure your baby’s weight and length
(or height) and track the measurements
to assess your baby’s growth over time.
Your doctor is monitoring:
• Weight for age
• Length for age
• Weight for length
• Brain growth
In other words, your pediatrician
wants to determine whether your
baby’s weight and brain growth is
normal for his or her age. So, if an
8-month-old boy’s weight is at the 25th
percentile, that means he weighs the
same or more than 25 percent of other
8-month-old boys.
While some parents may focus on
the exact percentile in which their
baby falls, the American Academy of
Pediatrics recommends concentrating
on whether your child is generally
consistent with normal trends over
time. Your baby’s personal trend can
provide a clue to your doctor as to
whether your baby is on a healthy
growing pace or whether there may be
a potential health concern.
Spring/Summer 2017 | 19
Health
GUIDELINES TO GOOD HEALTH FOR CHILDREN*
Regular well-child visits and scheduled immunizations for childhood diseases can help keep your child healthy. Ask your
child’s doctor about what schedule is right for him or her.
SCREENINGS FOR BOYS AND GIRLS
AGE
HOW OFTEN
Annual health, developmental screening
and risk assessments
0 to 24 months
11 visits
2 to 21 years
Every year
Neonatal and hearing screening
Birth (after 24 hours)
Once
Cholesterol screening
2+ years
Ask your doctor
Lead screening
9 months and 18 months
Once at 9 months and once at 18 months
Developmental screening
9 months
Once
18 months
Once
30 months
Once
Autism screening
18 months
Once
Vision screening
2 to 6 years
Before starting school
7 to 12 years
Every two years
Preconception and pregnancy (prevention and counseling)
13 to 21 years
Every three years
12+ years or earlier if sexually active
Every year
Chlamydia and sexually transmitted infection screening
11+ years
Every year, if sexually active
HIV screening
13 to 21 years
Screen
IMMUNIZATIONS FOR BOYS AND GIRLS
AGE
HOW OFTEN
HPV (human papillomavirus)
9 to 26 years
Three doses
DTaP
2, 4 and 6 months
First, second and third dose
15 to 18 months
Fourth dose
4 to 6 years
Fifth dose
Rotavirus
2 to 6 months
Complete series
Tdap
11 to 12 years
One dose
Hepatitis A
12 months
First dose
18 months
Second dose
Birth
First dose
1 to 2 months
Second dose
6 to 18 months
Third dose
2 months
First dose
4 months
Second dose
6 to 18 months
Third dose
4 to 6 years
Fourth dose
Hib-haemophilus
2 to 15 months
Complete series
Flu
6 months to 8 years
Two doses one month apart the first year
vaccinated, then one dose every year after
9 to 21 years
Every year
12 to 15 months
First dose
4 to 6 years
Second dose
12 to 15 months
First dose
4 to 6 years
Second dose
11 to 12 years
One dose
16 years
Booster
2 months
First dose
4 months
Second dose
6 months
Third dose
12 to 15 months
Fourth dose
Hepatitis B
IPV (polio)
MMR (measles, mumps and rubella)
Varicella (chickenpox)
Meningococcal (MCV4)
Pneumococcal conjugate (pneumonia)
For an updated immunization schedule, visit cdc.gov/vaccines/schedules/index.html.
20 | GoodHealth
Health
GUIDELINES TO GOOD
HEALTH FOR ADULTS*
Blue Care Network encourages you to be an active
partner in maintaining good health. These health
guidelines are based on recommendations from national
medical organizations and the most current medical and
scientific literature. While these guidelines are BCN’s
recommendations for healthy adults, they may not always
apply to you and your physical condition. Please discuss
questions you have about your health care with your primary
care physician. He or she may recommend a different
schedule based on your needs.
SCREENING FOR
MEN AND WOMEN
AGE
HOW OFTEN
Health exam including
height and weight
assessment; body mass
index; evaluation and
obesity counseling; alcohol
and tobacco use discussion
18 to 49
Every one to five years
50 to 65+
Every one to three years
Blood pressure screening
18+
Screen at each visit
Diabetes screening
18 to 65+
Every three years with
blood pressure above
135/80
Colon cancer screening
18 to 49
50 to 75
HIV screening
Hepatitis C screening
Lung cancer screening
If high risk, ask your
doctor
Screening intervals:
Fecal occult blood test
every year
AND
Sigmoidoscopy every
five years with fecal occult
blood test every three
years
OR
Colonoscopy every
10 years
AGE
HOW OFTEN
Cholesterol and
lipid screening
20 to 45+
Ask your doctor
Osteoporosis
screening with
DXA screening
50 to 64
Ask your doctor
65+
Test
Cervical cancer
and Pap test
21 to 65
Every three years
30 to 65
Every five years with Pap test
combined with HPV test
66+
Ask your doctor
18 to 49
Ask your doctor
50 to 74
Every two years
75+
Ask your doctor
Under 24
(sexually active)
Every year
25+ (if high risk)
Every year
Pregnant women
Screen
Pregnancy
(prenatal visits)
Childbearing
Weeks six to eight: first visit
Weeks 14 to 16: one visit
Weeks 24 to 28: one visit
Week 32: one visit
Week 36: one visit
Weeks 38 to 41: every week
Pregnancy
(postnatal visits)
Childbearing
Once 21 to 56 days after
delivery
Intimate
partner violence
screening
18+
Screen every year
Aspirin use
55 to 79
Ask your doctor
Mammography
Chlamydia and
gonorrhea
screening
IMMUNIZATIONS
FOR MEN AND
WOMEN
AGE
HOW OFTEN
HPV (human
papillomavirus)
9 to 26
Three doses
Tdap
After age 12
One dose
Pregnant
women
One dose during weeks 27
to 36 of pregnancy
76+
Ask your doctor
15 to 65
One test for everyone
Tetanus/Td
18 to 65+
Once every 10 years
15 to 65+
Every year for high risk
Flu
18 to 65+
Every year
50+
If high risk, screen.
Recommend onetime
screening for adults born
between 1945 and 1965
and those at high risk
MMR (measles,
mumps and rubella)
18 to 49
One to two doses if needed
Varicella (chickenpox)
18 to 65+
Two doses if needed
Hepatitis A, Hepatitis
B, Meningococcal,
Hib
18 to 65+
If high risk
Pneumococcal
(pneumonia)
18 to 64
If high risk
65+
Vaccinate, ask your doctor
for dosing schedule
Zoster (shingles)
60+
One dose
55 to 80
If high risk, screen every
year
SCREENING FOR MEN
AGE
HOW OFTEN
Cholesterol and lipid
screening
35+
Every five years; more
often with risk factors
Prostate cancer screening
50+
Ask your doctor
Aspirin use
45 to 79
Ask your doctor
bcbsm.com
SCREENING
FOR WOMEN
*These guidelines are based on recommendations provided by the
Michigan Quality Improvement Consortium and are updated by the
MQIC every two years, unless new research reveals findings that
affect the current recommendations.
Spring/Summer 2017 | 21
Health
Talk with your kids
about drinking
Alcohol can cause serious problems in the lives of young
people. That’s why it’s important to talk to your children
about the risks of using alcohol. Here are some effective
measures you can take:
• Start early and often: The National Institute on Alcohol
Abuse and Alcoholism reports that children as young as
age 9 begin to make decisions about drinking. Many
talks at different times may be more effective than one
sit-down.
• Show you care: Emphasize that not drinking is for their
own health and well-being, not simply because you say so.
• Have good information: The more you know, the more
credibility you have and the better you’ll be at countering
peer pressure arguments.
• Be a role model: Kids do what you do, not what you say.
Set a good example with your drinking patterns.
22 | GoodHealth
Pay attention
Alcohol may be a problem hidden in plain sight. Look for
signs of alcohol dependence:
• Sudden change in mood or attitude
• Change in attendance or performance at school
• Alcohol disappearing from your home
If you’re concerned about your child, you can reach a
BCN behavioral health care manager 24 hours a day,
seven days a week at 1-800-482-5982 (TTY users call
711). You don’t need a referral from your primary care
physician.
Health
LIVING WITH CANCER:
THE EMOTIONAL SIDE
Extra support is
available to members
who have a chronic
illness such as
depression. To learn
more about this
chronic condition
management program,
visit bcbsm.com:
• Click For
Members.
• Click Health and
Wellness, and
scroll down to
Chronic Condition
Management.
• Click Learn More.
bcbsm.com
Having cancer is emotionally as well as
physically challenging. While you’re going
through treatment, you may feel fear, denial
and anxiety. Depression and anxiety also go
hand in hand with a cancer diagnosis. That’s
why managing your emotions is an important
part of your treatment.
There’s help in hope
Many believe hope is an important element
in the recovery process. Keep in mind
that many cancer survivors live full and
productive lives. And more people today
survive cancer than ever before, according
to the American Cancer Society.
Lean on support groups
A support group can help increase quality
of life because it gives you the freedom to
do the following:
• Express emotions honestly, without
worrying about upsetting the listeners
• Reduce fear through shared knowledge
and experience
• Increase your success in managing
relationships with your family members
and doctor
Be proactive
You’ll feel better emotionally if you take
part in making treatment decisions.
Research published in the Annals of
Behavioral Medicine shows that breast
cancer survivors who were involved in
decisions about their follow-up tests had
higher quality-of-life measures than those
who didn’t. They experienced less pain and
greater energy.
Get creative
Write down your thoughts and feelings in
a journal. Not only is this an outlet for your
emotions, the practice can also help you
make sense of them.
Art therapy is another way to express your
feelings about your treatment or illness,
or it takes you away to a beautiful place in
your mind.
Humor helps
Humor can help manage pain and enhance
the body’s immune system. By laughing, your
body releases endorphins, special substances
in your brain that help control pain.
Spring/Summer 2017 | 23
Pharmacy
We all need to be concerned about opioid abuse
You’ve probably heard about or know
someone affected by the opioiduse epidemic that has gripped the
United States in the past several
years. Opioids can be very effective
in relieving pain, but these narcotics
also carry the risk that a patient may
develop a drug-use disorder.
The use of opioid pain medications
has quadrupled in the past 10 years,
according to the Centers for Disease
Control and Prevention. Easy access
to street narcotics hasn’t helped the
problem.
The CDC recommends doctors treat
chronic, long-term pain with nondrug
options and with nonopioids when
drugs are needed. The CDC also
encourages doctors to talk with their
patients about realistic treatment goals
for pain and function, as well as the
risks when taking opioids.
Dealing with pain is challenging. But
there are options other than opioids:
• Pain relievers (also known as
analgesics) such as acetaminophen,
ibuprofen and aspirin treat pain
and may reduce inflammation.
24 | GoodHealth
• Sleep goes a long way toward
helping patients tolerate a greater
degree of pain while awake.
• Physical therapy and therapeutic
massage can help alleviate pain
and may improve function.
• Yoga, meditation and other
relaxation techniques help reduce
anxiety, which can increase sensitivity
to pain. There are also nonopioid
medications that reduce anxiety.
• Psychotherapy, especially cognitive
behavioral therapy, can be very
helpful when managing chronic pain
and stress.
Opioid policy change
To support our members in effectively
treating pain and reducing the risk for
opioid overuse, we’ve changed our
opioid management policies. These
changes don’t apply to members
who have cancer or are receiving
end-of-life care.
• All fills of opioid pain relievers are
limited to a 30-day supply.
• Members who haven’t recently
filled a prescription for opioid
therapy are limited to a 15-day
supply for first fills of short-acting
opioids, such as Vicodin, Tylenol #3
and oxycodone immediate-release.
For questions about your coverage,
call Customer Service using the
number on the back of your BCN
ID card.
Yoga and meditation might be
better ways to deal with your pain.
Pharmacy
Q:
Where can I find drug
lists on the go?
Want to know whether a drug is
covered, how much you’ll pay and
how much you can save with a generic
option?
Download the BCBSM mobile app
from the App Store® and Google
Play™.
The mobile app connects you
securely to your account at
bcbsm.com, which includes
information about your pharmacy plan
if you have one.
Q:
Ask the
PHARMACIST
In each issue of Good Health,
our pharmacists provide useful
information about your drug plan.
How can I coordinate
delivery of my medications
to get them on the same schedule?
If you usually fill your heart
medication on the first of the month,
but your arthritis medication comes
due on the eighth, ask your pharmacist
to coordinate your refills. You’ll pay a
prorated copay based on the number
of days of medication you receive. And
the next time you go to the pharmacy,
you can fill both 30-day prescriptions at
the same time.
Note: Controlled substances and
some prepackaged medications aren’t
eligible for this coordination.
Q:
Where can I get information about generic versus brand-name drugs?
To learn about generics and their advantages as well as how to save
money on prescription drugs, go to bcbsm.com and search for “generic drugs.”
Your account at bcbsm.com is also a good place to start when you want
to research a drug, including what it’s used for, as well as find out possible
interactions and side effects.
The U.S. Food and Drug Administration website, www.fda.gov/drugs, offers
information about drug safety, including the side effects of many over-the­
counter and prescription medications.
bcbsm.com
Spring/Summer 2017 | 25
Need to know
Understanding
prior authorizations
Do you ever wonder why some procedures or drugs
require prior authorization and others don’t? Here’s a
summary of the process.
When is prior authorization necessary?
Blue Care Network requires prior authorization to
make sure certain treatments are appropriate for your
condition and are medically necessary.
Who’s responsible for submitting a prior
authorization request?
Your health care provider is responsible for submitting
the request to us with all the documents needed. Once
we receive the request, we begin the review process.
What if your prior authorization request
is denied?
If your prior authorization request is denied, you have
the right to appeal the decision. You’ll receive a letter
that tells you why your request was denied and what
you can do next.
Some important information to
remember
• If your doctor doesn’t get a prior authorization, your
health care service may cost you more, or it may not
be covered at all.
• Even though it’s your doctor’s responsibility to
submit a prior authorization request, talk with him or
her before receiving any health care services to see if
prior authorization is required.
If you have questions or concerns about services that
may require prior authorization, call Customer Service
at the number on the back of your BCN ID card to ask
about your coverage.
26 | GoodHealth
Need to know
Online health care:
See a doctor anytime,
anywhere
It’s 3 a.m., and your child isn’t feeling well. Is it a cold or something worse?
Find out immediately by talking face-to-face with a doctor online, using
24/7 online health care, powered by American Well®.
No appointment needed
Online health care is available to you 24 hours a day, seven days a week.
It’s as simple as using your smartphone, tablet or computer. There’s
no cost to sign up on bcbsm.amwell.com and no monthly fee. Take
advantage of this service when:
• Your primary care physician
• You’re on vacation or traveling
isn’t available
for work
• You can’t leave home or
• You’re looking for affordable
your workplace
after-hours care
Use 24/7 online health care for minor illnesses, such as:
• Sinus and respiratory infections
• Colds, flu and seasonal allergies
• Eye irritation or redness
• Rashes
• Earache
Note: In a life-threatening emergency,
always call 911 or go to the nearest
emergency room. Online health
care doesn’t replace primary doctor
relationships.
BE READY ANYTIME
Sign up for online health care:
Mobile: Download the Amwell app.
Web: Go to bcbsm.amwell.com.
Phone: Call 1-844-733-3627.
• Add your BCN health care plan
information.
• Use the service key BCBSM.
Important: You may be charged
incorrectly if you don’t enter your
plan information and the service
key: BCBSM. If you already have
an account, update your plan
information and enter the
service key.
Seeing a doctor is easy
Once you’re registered, all you
have to do is:
1. Log in at bcbsm.amwell.com
from your computer, or launch
the Amwell app on your
mobile device.
2. Choose an available doctor
who’s right for you.
3. Talk with the doctor and get a
prescription, if needed. Some
states have visit and prescribing
restrictions.
At the end of your visit, get a full
report to share with your primary
care physician.
American Well® is an independent company that provides online health care,
in the United States only, for Blue Care Network members.
bcbsm.com
Spring/Summer 2017 | 27
Need to know
ESTIMATE THE COST OF
HEALTH CARE SERVICES —
FROM YOUR MOBILE PHONE
Our mobile app now gives you estimated
costs for 1,600 health care services.
:
w
Why does that matter? Having
Ne
s
te
a
im
an estimate of what a provider may
Cost est
for health
charge can help you understand your
es
care servic
out-of-pocket costs when you need
Try it!
specialist care.
You and your doctor can talk about options
when getting your referral to see a specialist, so you can
make more informed choices about using your benefits.
Tap into our other new features:
•
•
•
•
Select, change and confirm your primary care physician.
Look up cost estimates for health care services.
Share your BCN ID card with your doctor’s office.
Look up your Blue365® member discounts.
And because everything is in one place on the app, you
can also check your claims, explanation of benefits
statements,deductible, plan information and health records
at any time.
Don’t have the app?
Search BCBSM on:
The Blue365 program is brought to you by the Blue
Cross and Blue Shield Association. The Blue Cross and
Blue Shield Association is an association of independent,
locally operated Blue Cross and Blue Shield Plans.
Blue365 offers access to savings on items that members
may purchase directly from independent vendors, which
are different from items that are covered under health
plan policies with Blue Cross Blue Shield of Michigan
or Blue Care Network, its contracts with Medicare,
or any other applicable federal health care program.
Neither Blue Cross Blue Shield of Michigan, Blue Care
Network nor the Blue Cross and Blue Shield Association
recommends, endorses, warrants or guarantees any
specific vendor or item.
28 | GoodHealth
See everything you can do
at bcbsm.com/app.
Need to know
Get answers at bcbsm.com
Blue Care Network policies are available online at bcbsm.com. Here’s how to find the policies
that affect your care:
I
Enter HMO care in the search box to find out:
• How you can get primary care, specialty and behavioral health services whenever you need care,
both during and after business hours
• How to submit a claim for covered services, if you ever need to
• How to obtain care and coverage when you’re out of our service area and what benefit restrictions
may apply
• How your pharmacy plan works if you have prescription drug coverage
Enter Emergency care in the search box to find out:
• How to use emergency or urgent care services and when to call 911
Enter BCN policies in the search box and scroll the left-hand column to find out:
• What your rights and responsibilities are
• How you can resolve problems, including sending us a complaint or appealing a coverage decision
that you don’t agree with
Enter Important information in the search box to find out:
• How we protect your health information
• How we base care decisions on appropriateness of care and service, and don’t provide financial
incentives for decisions that result in less care
• How we evaluate new technology and covered benefits
• How to obtain hospital services
Enter Continuing care with a doctor in the search box to find out:
• How you can continue treatment with a doctor not in your plan’s network
Log in to your account to find out:
• What benefits and services are included in, and excluded from, your coverage
• What copayments and other charges you’re responsible for
Click on Find a Doctor to find out:
• How to locate practitioners who participate with us, including their credentials and where they practice
You can also find these policies in your Member Handbook, sent to all new members. To order a copy customized to your
plan, call Customer Service at the phone number on the back of your Blue Care Network ID card. Or send a letter to:
Blue Care Network
P.O. Box 68767
Grand Rapids, MI 49516-8767
bcbsm.com
Spring/Summer 2017 | 29
Need to know
Your Summary of Benefits and Coverage
document has been updated
To help you better understand your health care coverage, the federal government has enhanced the Summary
of Benefits and Coverage template and Glossary. Some of the improvements include:
• An additional coverage example
• More detailed language to improve your understanding
To view your SBC, log in to your account at bcbsm.com and search “Summary of Benefits and Coverage.”
To receive a print copy, call the Customer Service number on the back of your BCN ID card.
We’re available
to talk about
our utilization
management activities
Did you know we have a comprehensive
Utilization Management program that promotes
cost-effective and medically appropriate services
for our members? Some of our key
efforts include:
• Referral management
• Prior authorization
• Inpatient services management
• Behavioral health services
We’re available to discuss these
activities during and after normal
business hours. Our staff identify
themselves by name, title and
organization when receiving or
returning calls. We also provide
language assistance. Call the
Customer Service number on the back
of your BCN ID card for information
about our Utilization Management
program (TTY users call 711).
30 | GoodHealth
How we
manage care
Decisions about services provided to a member
are based solely on the appropriateness of care
prescribed, as determined by the member’s coverage
and medical condition. Medical need is based
on criteria that are developed from sound clinical
evidence. Our clinical reviewers don’t have financial
arrangements that encourage denial of coverage or
service. Nurses and doctors employed by Blue Care
Network don’t receive bonuses or incentives based
on their review decisions.
Multi-language Interpreter Services
We speak your language
If you, or someone you’re helping, needs assistance, you have the
right to get help and information in your language at no cost. To
talk to an interpreter, call the Customer Service number on the
back of your card, or 877-469-2583, TTY: 711 if you are not
already a member.
Si usted, o alguien a quien usted está ayudando, necesita
asistencia, tiene derecho a obtener ayuda e información en su
idioma sin costo alguno. Para hablar con un intérprete, llame al
número telefónico de Servicio al cliente, que aparece en la parte
trasera de su tarjeta, o 877-469-2583, TTY: 711 si usted todavía no
es un miembro.
‫ ﻓﻠﺪﯾﻚ اﻟﺤﻖ ﻓﻲ اﻟﺤﺼﻮل ﻋﻠﻰ‬،‫إذا ﻛﻨﺖ أﻧﺖ أو ﺷﺨﺺ آﺧﺮ ﺗﺴﺎﻋﺪه ﺑﺤﺎﺟﺔ ﻟﻤﺴﺎﻋﺪة‬
‫ ﻟﻠﺘﺤﺪث إﻟﻰ ﻣﺘﺮﺟﻢ اﺗﺼﻞ ﺑﺮﻗﻢ‬.‫اﻟﻤﺴﺎﻋﺪة واﻟﻤﻌﻠﻮﻣﺎت اﻟﻀﺮورﯾﺔ ﺑﻠﻐﺘﻚ دون أﯾﺔ ﺗﻜﻠﻔﺔ‬
‫ إذا‬،877-469-2583 TTY:711 ‫ أو ﺑﺮﻗﻢ‬،‫ﺧﺪﻣﺔ اﻟﻌﻤﻼء اﻟﻤﻮﺟﻮد ﻋﻠﻰ ظﮭﺮ ﺑﻄﺎﻗﺘﻚ‬
.‫ﻟﻢ ﺗﻜﻦ ﻣﺸﺘﺮﻛﺎ ﺑﺎﻟﻔﻌﻞ‬
如果您，或是您正在協助的對象，需要協助，您有權利免費
以您的母語得到幫助和訊息。要洽詢一位翻譯員，請撥在您
的卡背面的客戶服務電話；如果您還不是會員，請撥電話
877-469-2583, TTY: 711。
ܿ
ܵ ‫ܣܢ ܝܩ ܝ ܝܬ ܿܘܢ ܿܗ ܿܝ‬، ‫ܬܘܢ‬
ܵ ܿ
ܿ ‫ܕܗ ܝܘܪܘ‬
ܿ ‫ܐܢ‬
ܿ
‫ ܿ ܼܝ‬،‫ܐܚܬ ܿܘܢ‬
،‫ܪܬܐ‬
ܼ ‫ܢ ܿ ܼܚܕ‬
ܼ
ܼ ܼ ܼ ‫ܦܪܨܘܦܐ‬
ܼ ܼ
ܸ
ܼ ܼ ܵ
ܵ
ܵ
ܵ
ܿ
ܿ
ܿ
ܿ
ܿ
ܵ
ܿ
ܿ
ܿ
ܵ
ܿ
ܵ
ܿ
‫ܘܟ ܘܢ‬
‫ܒܠܫ‬
݂ ‫ܐܝܬܠ‬
݂ ‫ܢ‬
ܼ ‫ܩܘܬܐ‬
ܼ ‫ܘܟ ܘܢ ܼܗ‬
ܼ ‫ܼܐܚܬܘܢ‬
ܼ ‫ܕܩܒܠ ܼܝܬܘܢ ܼܗ ܼܝܪܬܐ ܘܼܡ ܘܕܥ‬
ܸ ‫ܢܘܬܐ‬
ܵ
ܿ
ܵ
ܿ
ܿ
ܿ
ܵ
ܵ
ܿ
ܵ
ܵ
ܿ
ܿ
ܿ
ܵ
‫ܥ ܡ ܼܚܕ ܡ ܼܬܪܓܡ‬
‫ܕ‬
‫ܢܐ‬
‫ܢܝ‬
‫ܠܝܦܘܢ ܡ‬
ܼ
ܼ ‫ܥܠ ܹܬ‬
ܼ .‫ܛܝܡܐ‬
ܼ ‫ ܩܪܘܢ‬،‫ܢܐ‬
ܼ ‫ܡܙ ܡܬܐ‬
ܼ ‫ܠܗ‬
ܵ ܸܵ
ܿ ‫ܥܠ ܵܚ ܵܨܐ ܕܦܬ‬
ܵ
ܿ
ܿ
‫ܐܢ ܗ‬
‫ܢ‬
‫ܘ‬
‫ܟ‬
‫ܝ‬
‫ܢ‬
‫ܩܘ‬
877-469-2583
TTY:711
‫ܐ‬
‫ܐܝ‬
‫ܢ‬
ܸ
ܼ ܼ ݂
ܼ
ܼ ‫ܕ‬
ܸ
.‫ܬܘܢ ܼܿܗ ܵܕ ܹ̈ܡܐ‬
ܼ
ܼ ‫ܠܝ‬
Nếu quý vị, hay người mà quý vị đang giúp đỡ, cần trợ giúp, quý vị
sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi số
Dịch vụ Khách hàng ở mặt sau thẻ của quý vị, hoặc 877-469-2583,
TTY: 711 nếu quý vị chưa phải là một thành viên.
Nëse ju, ose dikush që po ndihmoni, ka nevojë për asistencë, keni
të drejtë të merrni ndihmë dhe informacion falas në gjuhën tuaj.
Për të folur me një përkthyes, telefononi numrin e Shërbimit të Klientit në anën e pasme të kartës tuaj, ose 877-469-2583,
TTY: 711 nëse nuk jeni ende një anëtar.
만약 귀하 또는 귀하가 돕고 있는 사람이 지원이 필요하다면,
귀하는 도움과 정보를 귀하의 언어로 비용 부담 없이 얻을 수
있는 권리가 있습니다. 통역사와 대화하려면 귀하의 카드
뒷면에 있는 고객 서비스 번호로 전화하거나, 이미 회원이
아닌 경우 877-469-2583, TTY: 711로 전화하십시오.
যিদ আপনার, বা আপিন সাহাযয্ করেছন এমন কােরা, সাহাযয্ েয়াজন হয়,
তাহেল আপনার ভাষায় িবনামূেলয্ সাহাযয্ ও তথয্ পাওয়ার অিধকার আপনার
রেয়েছ। েকােনা একজন েদাভাষীর সােথ কথা বলেত, আপনার কােডর্র েপছেন
েদওয়া াহক সহায়তা ন ের কল কর‍ন বা 877-469-2583, TTY: 711
যিদ ইেতামেধয্ আপিন সদসয্ না হেয় থােকন।
Jeśli Ty lub osoba, której pomagasz, potrzebujecie pomocy, masz
prawo do uzyskania bezpłatnej informacji i pomocy we własnym
języku. Aby porozmawiać z tłumaczem, zadzwoń pod numer
działu obsługi klienta, wskazanym na odwrocie Twojej karty lub
pod numer 877-469-2583, TTY: 711, jeżeli jeszcze nie masz
członkostwa.
Falls Sie oder jemand, dem Sie helfen, Unterstützung benötigt,
haben Sie das Recht, kostenlose Hilfe und Informationen in Ihrer
Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen,
rufen Sie bitte die Nummer des Kundendienstes auf der Rückseite
Ihrer Karte an oder 877-469-2583, TTY: 711, wenn Sie noch kein
Mitglied sind.
bcbsm.com
Need to know
Se tu o qualcuno che stai aiutando avete bisogno di assistenza, hai
il diritto di ottenere aiuto e informazioni nella tua lingua
gratuitamente. Per parlare con un interprete, rivolgiti al Servizio
Assistenza al numero indicato sul retro della tua scheda o chiama
il 877-469-2583, TTY: 711 se non sei ancora membro.
ご本人様、またはお客様の身の回りの方で支援を必要とさ
れる方でご質問がございましたら、ご希望の言語でサポー
トを受けたり、情報を入手したりすることができます。料
金はかかりません。通訳とお話される場合はお持ちのカー
ドの裏面に記載されたカスタマーサービスの電話番号
(メンバーでない方は877-469-2583, TTY: 711)
までお電話ください。
Если вам или лицу, которому вы помогаете, нужна помощь, то
вы имеете право на бесплатное получение помощи и
информации на вашем языке. Для разговора с переводчиком
позвоните по номеру телефона отдела обслуживания
клиентов, указанному на обратной стороне вашей карты, или
по номеру 877-469-2583, TTY: 711, если у вас нет членства.
Ukoliko Vama ili nekome kome Vi pomažete treba pomoć, imate
pravo da besplatno dobijete pomoć i informacije na svom jeziku.
Da biste razgovarali sa prevodiocem, pozovite broj korisničke
službe sa zadnje strane kartice ili 877-469-2583, TTY: 711 ako već
niste član.
Kung ikaw, o ang iyong tinutulungan, ay nangangailangan ng
tulong, may karapatan ka na makakuha ng tulong at impormasyon
sa iyong wika ng walang gastos. Upang makausap ang isang
tagasalin, tumawag sa numero ng Customer Service sa likod ng
iyong tarheta, o 877-469-2583, TTY: 711 kung ikaw ay hindi pa
isang miyembro.
Important disclosure
Blue Cross Blue Shield of Michigan and Blue Care Network comply
with Federal civil rights laws and do not discriminate on the basis
of race, color, national origin, age, disability, or sex. Blue Cross
Blue Shield of Michigan and Blue Care Network provide free
auxiliary aids and services to people with disabilities to
communicate effectively with us, such as qualified sign language
interpreters and information in other formats. If you need these
services, call the Customer Service number on the back of your
card, or 877-469-2583, TTY: 711 if you are not already a member.
If you believe that Blue Cross Blue Shield of Michigan or Blue Care
Network has failed to provide services or discriminated in another
way on the basis of race, color, national origin, age, disability, or
sex, you can file a grievance in person, by mail, fax, or email with:
Office of Civil Rights Coordinator, 600 E. Lafayette Blvd., MC 1302,
Detroit, MI 48226, phone: 888-605-6461, TTY: 711,
fax: 866-559-0578, email: [email protected]. If you need
help filing a grievance, the Office of Civil Rights Coordinator is
available to help you.
You can also file a civil rights complaint with the U.S. Department
of Health & Human Services Office for Civil Rights electronically
through the Office for Civil Rights Complaint Portal available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail, phone,
or email at: U.S. Department of Health & Human Services,
200 Independence Ave, S.W., Washington, D.C. 20201,
phone: 800-368-1019, TTD: 800-537-7697,
email: [email protected]. Complaint forms are
available at http://www.hhs.gov/ocr/office/file/index.html.
Spring/Summer 2017 | 31
Prsrt Std
U.S. Postage
PAID
Blue Cross
Blue Shield
of Michigan
Mail Code C403
P.O. Box 5043
Southfield, MI 48086-5043
Developed by StayWell
CF 2865 APRIL 2017
10228MA
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Your story can inspire other members with similar issues to make
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If your story is selected, you may be featured in a future issue of
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Discounts with Blue365 on the right side of the home page.
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