A Magazine For Blue Cross Complete Of Michigan Members
FALL 2016
IN THIS ISSUE:
MiBlueCrossComplete.com
Kids never
outgrow regular
checkups
Flu facts: Spot
the signs and
beat the bug!
>In this issue
Health
Heidi Chan
Market President
Donald S. Beam, M.D.
Chief Medical Officer
Laura J. Mutz
Editor, Communications and Marketing
Editorial Board
Mary Dooley
Julia Griffith, L.L.P., L.P.C.
Ramia Kaji
Paul A. Loffreda
Michele Lundberg
Carl E. Pate Jr., M.S.F., J.D.
Miriam Twardon-Bielski
Contact us
Blue Cross Complete of Michigan
Suite 210
100 Galleria Officentre
Southfield, MI 48034
1-800-228-8554
TTY users: 1-888-987-5832
24 hours a day, seven days a week
We welcome your letters
Editor, Blue Cross Complete of Michigan
My Blue Health
Suite 210
100 Galleria Officentre
Southfield, MI 48034
4 |
6 |
8 |
9 |
10 |
11 |
12 |
14 |
15 |
24 |
reventing common respiratory infections
P
Know the signs of depression and anxiety
Don’t add risk to winter driving
Stay safe when the weather turns frightful
Kids never outgrow regular checkups
Blue Cross Complete employees give back
Protect yourself from chlamydia with regular screening
Guidelines to good health for children
Guidelines to good health for adults
Flu facts: Spot the signs and beat the bug!
Benefits
17 | Dental program covers more kids
18 | H
elp fight Medicaid fraud, waste and abuse
19 | Quality improvement program gives our members better
care and service
21 | Keeping moms and babies healthy
22 | Discrimination is against the law
23 | Multi-language interpreter services
We want to hear from you!
Your opinion counts! At My Blue Health, we think there’s no better
way to inspire our readers than by having other members share
their real stories. Is there a benefit that has helped you and your
family be healthier? What motivates
you to live a healthier life?
Send us your story by writing
to My Blue Health at the
editor’s address on this
page. You can also
contact us online at
MiBlueCrossComplete.com.
Our website is MiBlueCrossComplete.com. While website addresses for
other organizations are provided in My Blue Health for reference, Blue Cross
Complete does not control these sites and is not responsible for their content.
The Healthy Michigan Plan is a health care program from the Michigan
Department of Health and Human Services. Blue Cross Complete
administers Healthy Michigan Plan benefits to eligible members.
Checkup
with Dr. Beam
This story is more common than you think. A young man has an accident and
breaks his leg. Following orthopedic surgery, he is placed in a cast with no
walking for eight weeks. His doctor prescribes a narcotic with hydrocodone,
often known as Vicodin or Norco. The pain is controlled and helps the man to
sleep at night. He likes the feeling that he gets from the pills, so he asks for
a refill. The doctor does not want to be bothered and gives him a couple of
refills to last him 90 days. The patient has the cast taken off, but now it hurts a
little when he starts to walk and during therapy. So, again, he asks for some more
hydrocodone and the doctor gives him a couple of months’ worth.
The man is now walking, but he really likes the pain pills; his doctor wants to wean
him off of them with only small refills. When the man reduces his intake, he starts to feel
muscle cramps, nausea and sweats. He begins to frequent the emergency room and
visit other doctors, asking for pain medicine. When that tactic no longer works, he finds
out that those pain pills are also available on the street — but they are quite costly, and
he soon runs short of money. Heroin is cheap, however, and is much stronger than the
hydrocodone, which now has very little effect on him. He is now shooting up heroin on
a daily basis. Thus, another heroin addict is born.
According to the report from the Michigan Prescription Drug and Opioid Abuse Task
Force, prescription drug abuse has reached an epidemic in the U.S. and in Michigan.
The number of overdose deaths from drugs has tripled since 1999. Recreational use of
prescription drugs now is more common with teens than all other street drugs except
for marijuana. Every day, 44 Americans die from an overdose of prescription drugs.
That is more than heroin and cocaine together. Heroin use in women has grown
100 percent in the past 10 years. This can lead to withdrawal problems in a newborn
baby. As you can see, the impact of prescription drug abuse is immense. In my next
column, I will detail some of the recommendations that were made by the task force.
Donald S. Beam, M.D.
Dr. Beam is the Chief Medical Officer for Blue Cross Complete.
He spent nearly 15 years in family practice in the west part
of the state and has been a medical director for more
than 20 years in managed care. He received his medical
degree from Michigan State University and his master’s in
Public Health from the University of Michigan. He has spent
the majority of his life in Michigan.
MiBlueCrossComplete.com
Fall 2016 | 3
Health
Got asthma?
Get a flu shot
People with asthma are
Preventing common
respiratory infections
among the groups at high
risk for flu complications.
But, according to the
Centers for Disease
Control and Prevention,
most adults with asthma do
not receive an annual flu
vaccination. The Centers
for Disease Control and
Prevention recommends
that everyone ages
6 months and older get
a yearly flu vaccine.
Vaccine can prevent
flu, lessen symptoms
The flu can make your
asthma symptoms worse.
Other possible complications
include dehydration and
pneumonia.
Don’t put yourself at
unnecessary risk. Get a flu
shot each year. October
and November are the best
times to be vaccinated.
But you can still have the
vaccine anytime during flu
Respiratory infections such as colds and flu are common in winter. These
infections are often caused by viruses. They may share some symptoms, but not
all respiratory infections are the same. Some are more serious than others. You
can take steps to prevent common respiratory infections. And if you get sick,
you can take care of yourself to keep the infection from getting worse.
What is a cold?
• Symptoms include runny nose, coughing,
sneezing and sore throat. Cold symptoms
tend to be milder than flu symptoms.
• Symptoms tend to come on slowly. They
last from a few days to about a week.
• With a cold, you can still do most of the
things you usually do.
What is the flu?
• Symptoms include fever, headache,
fatigue, cough, sore throat, runny nose
and muscle aches. Children may have
upset stomach and vomiting, but adults
usually don’t.
• Symptoms tend to come on quickly.
Some, such as fatigue and cough, can
last a few weeks.
• With the flu, you may feel worn out and
not able to do normal activities.
• It’s most likely not the flu if an adult has
vomiting or diarrhea for a day or two.
It’s probably a gastrointestinal infection,
commonly referred to as the stomach flu.
season, which runs from
October to May.
Keep in mind, you can
still get the virus after
you’ve had the vaccine.
However, people who have
been immunized will likely
get a milder case.
4 | MyBlueHealth
Get a flu vaccination
A flu vaccination protects you from
influenza (but not other colds or infections).
Get a vaccination each fall before flu
season starts. This can be done at a clinic,
doctor’s office, drugstore, senior center or
through your workplace.
Get pneumococcal vaccinations
Pneumonia can be a complication of
influenza. There are two vaccines that
protect against many types of pneumococcal
pneumonia. Talk with your health care
provider about these important vaccines.
Keep germs from spreading
No one likes getting sick. To protect yourself
and others from cold and flu germs:
• Wash your hands often. Use alcoholbased hand sanitizer when you don’t have
access to soap and water.
• Don’t touch your eyes, nose and mouth.
This may help you keep germs out
of your body.
• Avoid people with respiratory infections.
You may want to stay out of crowds during
peak flu season (winter).
• Ask your health care provider if you should
get a pneumonia vaccination.
Handwashing 101
Follow these steps to wash your hands the
right way:
• Use warm water and plenty of soap.
Work up a good lather.
• Clean your whole hand, under your nails,
between your fingers and up your wrists.
Wash for at least 15 to 20 seconds.
Don’t just wipe — rub well.
• Rinse. Let the water run down your
fingertips, not up your wrists.
• In a public restroom, use a paper towel
to turn off the faucet and open the door.
Health

Health
checks
Adults need regular medical care.
Members who get regular tests and
screenings, and discuss the results
with their doctor, are taking proactive
steps to manage their health.
Keeping track of these results can
help you and your doctor make sure
you stay healthy. You can get most
tests, screenings and vaccines during
your annual well visit. Each year,
adults should have:
When the infection gets worse
Without proper care, a respiratory infection can lead to
serious complications and death. If you aren’t getting better,
call your health care provider. Complications can include:
• Bronchitis (infection of the airways that leads to shortness
of breath and coughing up thick yellow or green mucus)
• Pneumonia (infection in which fluid and mucus settle in the
lungs, making breathing difficult)
• Worsening of chronic conditions such as heart failure,
chronic lung disease, asthma or diabetes
• Severe dehydration (loss of fluids)
• Sinus problems
• Ear infections
MiBlueCrossComplete.com
■ Annual well visit – date:_________
■ Height and weight check
Height __________ft. _________ in.
Weight ____________________ lbs.
■ Body mass index – BMI:_________
■ Blood pressure
____________ /__________ mm/Hg
■ Total cholesterol
Cholesterol______________ mg/dL
LDL ____________________ mg/dL
HDL ____________________ mg/dL
Triglycerides_____________ mg/dL
■ A1C ________________________ %
■ Flu shot – date:________________
■ Pneumonia shot – date:_________
Children need regular medical
care, too. For a list of the tests
and screenings children need, see
Page 14. Talk with your doctor about
which tests are right for your family
and when they are needed.
If you use tobacco and have
thought about quitting, call our free
Tobacco Quit program. To enroll, call
1-800-480-7848 from 8 a.m. to 1 a.m.
seven days a week.
Fall 2016 | 5
Health
Know the signs
of depression
and anxiety
Talking with your doctor
is the first step to
feeling better.
6 | MyBlueHealth
Health
Some days you just don’t feel your best. For some people, those days turn into weeks
or months. You might feel down all the time or worry constantly. Or you might notice
strong mood swings.
If this sounds familiar, you might have a treatable mental
health condition, such as depression or anxiety.
Talk with your doctor if you think you may have one of these
common mental health concerns.
DEPRESSION: More than just the blues
Feeling sad from time to time is a part of life. For people with
depression, these feelings interfere with daily living. Work,
friendships and self-care may suffer.
Extreme sadness is one symptom of depression, but there
are many others. Talk with your doctor if you have any of these
signs for more than two weeks:
• You don’t enjoy the things and activities that you
used to like
• You feel empty, worthless or helpless
• You have trouble concentrating or making decisions
• You’re fatigued nearly all the time
• You think about hurting yourself
Even people with severe depression can recover. Treatment
may involve medicine, counseling or a combination of
both. Remember, medicine works best when it is taken
as prescribed. Do not skip doses.
ANXIETY DISORDERS: When worrying goes overboard
Are you always worrying? Do you worry even though
everything is fine? You may have an anxiety disorder.
Short-term anxiety is normal. But sometimes anxiety
won’t go away and can interfere with your daily life.
There are several types of anxiety disorders. Common
ones include:
• Generalized anxiety disorder. People with GAD worry
excessively. They also have physical symptoms such
as sweating or trouble sleeping.
• Panic disorder. Panic attacks, or sudden bouts of extreme
fear and anxiety, are a key symptom of panic disorder.
• Social anxiety disorder. People with social anxiety have
a strong fear of embarrassment or judgment in social
settings.
Never hesitate to talk with your doctor at any time, but
especially if symptoms of strong anxiety last for six months
or longer.
BIPOLAR DISORDER: Extreme moods
Bipolar disorder is also called manic-depressive illness.
People with bipolar disorder have unusual mood changes
and intense emotions. During a manic episode, they feel
very “up” and have a lot of energy. They may also have
bouts of depression.
Talk with your doctor if you think you might have a mental
health condition. Mental health conditions are treatable. Your
doctor may suggest medicine or counseling. Many people
benefit from both.
Seasonal sadness: More than a phase
Do you start to feel depressed around November or
December every year? You may suffer from seasonal
affective disorder.
SAD is a type of depression that comes and goes
with the seasons. It’s usually worse in winter.
Talk with your doctor if you feel depressed in the
winter months. Bright light and vitamin D can help you
feel better. Medicine and counseling are also options.
If you take depression medicine, don’t skip doses.
Medicine works best when you take it as prescribed.
MiBlueCrossComplete.com
Fall 2016 | 7
Don’t add risk to winter driving
Even if you love winter, you probably don’t enjoy driving in winter weather. Ice, snow or rain can make
roads slick and hazardous. Add texting to that mix and you could be putting yourself — and others —
in real danger.
The risks of texting
You may think that sending or reading a text only takes a moment
— not long enough to cause a problem. Think again. It takes
five seconds to send or read just one text. If you’re going 55 miles
per hour, that’s like traveling the length of a football field while
blindfolded. It’s no wonder that texting increases your risk of
crashing by 23 times. And an accident can affect your health and
your ability to function in all areas of your life:
• You could miss work while you recover from your injuries
• You may be sidelined from some of your favorite activities
such as playing sports, dancing or exercising
• You may need help with common tasks such as making
dinner, doing chores, taking care of the kids or climbing stairs
• Pain from your injuries may cause problems sleeping
• You may not be able to drive for a period of time
depending on your injuries or possible legal action
Learn how to stay safe
Take these steps to stay safe as you’re traveling this winter —
and all year round.
• Turn off your phone. The sound of a text is hard to resist.
To avoid temptation, turn off your phone or put it on silent
whenever you get behind the wheel. Then store it out
of reach.
• Record a message. If you’re worried about missed calls,
record a message that lets callers know you’re driving
and will return their call when you’ve stopped.
• Make a pit stop. If you need to text or make a call,
pull over and stop somewhere safe.
• Enlist help. Ask passengers to text or make calls for you.
• Speak up. Don’t let other drivers text. Let them
know about the risks and offer to text or
call for them.
We’ll pick you up
Need to get to the doctor for a covered medical service, but
don’t want to drive in the snow? Blue Cross Complete will pick
you up and get you there safely and on time. At no charge.
We also provide gas reimbursement.
Schedule at least 48 hours in advance to make sure your
ride will be available. Call 1-888-803-4947 from 8 a.m. to
5:30 p.m. Monday through Friday. TTY users can call 711.
8 | MyBlueHealth
To cancel a ride, please call at least four
hours in advance. If this happens often
and you don’t cancel your rides, your ride
services may be temporarily suspended.
To give feedback about your ride, you can call either the ride
service or Blue Cross Complete Customer Service. To reach us,
call 1-800-228-8554.
Health
Stay safe when the weather turns frightful
Winter. They say it’s the most wonderful
time of the year. And with parties for
hosting and marshmallows for toasting,
who could disagree? But when it comes
time for any activity in wintry weather,
you need to be prepared.
outside. Or wear boots and then change
into your work shoes at the office.
No matter what environment you
work in, remember to dry your shoes to
avoid tracking snow inside. Wet floors
can be a risk for slipping as well.
At home
If snowy conditions are a part of winter
where you live, make sure you’re doing
all you can to prevent slips, trips and
falls at home. Start the season by
collecting these items on your winter
weather safety checklist:
• Shovel to remove snow
• Rock salt to melt icy sidewalks
• Sand to improve traction
At play
Winter activities such as sledding and iceskating can be fun for the whole family.
But if you’re playing outside, play safe.
Your heart works extra hard to keep
you warm when it’s cold out. So do it a
favor and avoid exerting yourself too
much — especially if you already have
a condition such as heart disease or
high blood pressure.
Even with the appropriate outdoor
clothing — hat, scarf, mittens, layers
of loose clothing, coat and boots —
hypothermia can still set in. Be on the
lookout for:
•Shivering
• Fumbling hands
• Exhaustion or drowsiness
• Slurred speech
• Confusion or memory loss
Ornaments and lights are a part of
many people’s holiday season. If you
decide to deck the halls — and the
bushes, porch, roof and garage — do
it safely by following these steps:
• Use lights designed for outdoors
• When using a ladder, have another
person help you
• Never stand on the top rung
of a ladder
• Don’t lean too far over when trying
to hang a light
On the road
No matter where you’re going, make
sure you travel safely when the weather
turns bad.
Get your car tuned up before winter
to make sure it’s in peak condition.
And always check the weather report
before hitting the road. Winter storms
can make conditions too dangerous for
travel. If you must go out, make sure
you have some safety items on hand:
• Spare tire and jack
•Shovel
• Jumper cables
• Salt or cat litter for traction
•Flashlight
•Flares
•Blanket
• First aid kit
With winter road conditions already
treacherous, don’t add to the risk by
texting while driving. According to the
Federal Communications Commission,
the Virginia Tech Transportation
Institute found that your risk of
crashing is 23 times greater than if you
leave the cell phone in your pocket.
At work
The shoes you normally wear to work
may not be ideal for crossing an icy
parking lot. Many dress shoes have
smooth, hard soles or high, narrow
heels, neither of which provides
traction in the slippery snow. Good
winter footwear should have:
• Nonslip rubber soles
• Deep grooves or treads
• Good insulation
Get a pair of rubber overshoes to slip
on over your work shoes when you go
MiBlueCrossComplete.com
Fall 2016
| 9
Health
Kids never outgrow
regular checkups
Babies need to see the doctor often — even when they are
not sick. Your child should have 12 well visits by age 3. Older
children need fewer exams but well visits are still important
each year as children grow. The American Academy of Pediatrics
suggests annual well visits from ages 3 to 21.
A good reminder is to make the appointment during your child’s birthday week every
year. If you need help finding a pediatrician in your area, visit MiBlueCrossComplete.
com and click on the Find a Doctor tab at the top of the page.
At each well visit, the doctor will make sure your child’s shots are up to date.
But well visits are not just for shots. The doctor also looks at how your child is
growing. He or she may check your child’s:
• Height
• Blood lead level
• Weight
• Cholesterol
• Blood pressure
The AAP and the National Heart, Lung and Blood
Institute suggest that all children be screened for high
cholesterol between ages 9 and 11 and again between
ages 17 and 21.
10 | MyBlueHealth
CLIP AND
SAVE THIS
SCREENING
REMINDER
For children ages 3 and
older and adolescents,
schedule their doctor
visit the same week as
their birthday every
year. This ensures they
will have important
screenings such as:
• Annual well child and
adolescent visit
• Urine test
• Lead test (ages 0 – 2)
•Immunizations
• Cholesterol check
• Vision and hearing check
• Height and weight
Health
Blue Cross
Complete
employees
give back
Staff helped clean up three blocks on Detroit’s east
side as part of the Life Remodeled program.
➋
It has been a busy year for Blue Cross Complete staff.
Outside of work, many of us volunteer our time to help the
communities we serve. These are just three examples of
events where you might have seen us recently:
Many Communities, One Heart
United Way campaign
We made personal donations to the United Way to
strengthen communities and improve lives where we
live and work.
➊
Cleaning up the Denby community
We teamed up with the nonprofit program Life
Remodeled, which aims to remodel lives along with
neighborhoods, schools and homes in and around Detroit.
More than 50 volunteers from Blue Cross Complete
donated their time, money, materials and equipment to
help with this special project. The Blue Cross Complete
staff spent two days cleaning three neighborhood blocks.
Since launching, the program has remodeled 80 homes
and cleaned more than 300 blocks on Detroit’s east side.
➋
➌
Playing hoops and being healthy
On October 22, 2016, we hosted our free Healthy
Hoops® event at Ypsilanti High School where kids ages 3
to 16 and adults joined us for:
• Health screenings, including asthma and
blood pressure checks
• Boxed lunches, refreshments and
special entertainment
• Basketball clinics and activities with coaches
and players
• Cooking demonstrations
• A family workshop with asthma and health experts
➌
Healthy Hoops is a registered trademark of
AmeriHealth Caritas.
MiBlueCrossComplete.com
Happy Blue Cross Complete associate Donulae Knuckles
teams up with former Detroit Pistons player Jermaine
Jackson at Healthy Hoops.
Fall 2016
| 11
Health
Protect yourself
from chlamydia with
regular screening
Chlamydia is the most common bacterial
sexually transmitted disease in the U.S., infecting
about 2.86 million people annually. It can affect
anyone, but young people ages 15 to 24 are
most at risk because they are less likely to use
condoms during sexual intercourse and more
likely to have multiple sexual partners.
Who should get screened?
The CDC recommends a yearly chlamydia
screening for all sexually active women
younger than 25. The CDC also recommends
screening for older women with certain risk
factors, including new or multiple partners or
a partner who has an STD. Pregnant women
should also be screened for chlamydia.
There is no regular screening guideline for
men. But it’s still a good idea for guys to get
tested, too. Especially if they are younger, are
more sexually active or have sex with other men.
How is chlamydia detected?
Doctors can detect chlamydia with a simple
urine test.
How is it treated?
Fortunately, it’s quick and easy to treat
chlamydia. Your doctor may give you
a seven-day course of antibiotics or a
single shot of a powerful antibiotic called
?
DID YOU
KNOW
Doctors can help people who have been exposed to certain
sexually transmitted diseases get treated without a trip to the clinic.
Chlamydia is now part of the “Expedited Partner Therapy” act.
This allows doctors to give patients medicine or a prescription to
pass along to their partners without an extra visit. This helps prevent
repeat infection and ensures partners at risk are also treated.
12 | MyBlueHealth
Health
azithromycin. It is recommended that you abstain
from sex for at least a week after starting treatment.
It’s easy to get infected again. The CDC
recommends you get tested again about three
months after you finish your treatment.
Chlamydia symptoms
Many people don’t know they have chlamydia in
its early stages because there are no symptoms.
In later stages, symptoms include:
Women:
• Mucous-like vaginal discharge
• Pain or burning when urinating
• Abnormal vaginal discharge
• Pain in the lower abdomen or lower back
•Nausea
•Fever
• Bleeding between menstrual periods
• Painful intercourse
Men:
• Discharge from the penis
• Frequent urination
• Pain or burning when urinating
• Painful, swollen testicles
Lower your risk for infection
You can reduce your risk for chlamydia by
abstaining from sex. If you’re sexually active,
latex condoms can greatly reduce your risk.
You may also be safer in a long-term relationship
with just one person who has tested negatively
for chlamydia.
Talk with your doctor about other ways you can
protect yourself from chlamydia and other STDs.
Your doctor can help you find information to help
you practice safe sex.
MiBlueCrossComplete.com
Chlamydia
and pregnancy
Chlamydia is a special concern for pregnant women.
It can cause problems such as conjunctivitis (pink eye)
or pneumonia in newborn babies.
Screening is the best way to prevent these problems.
All pregnant women should be screened for chlamydia
at their first prenatal visit. Pregnant women younger than
age 25 and those at greater risk for chlamydia should be
tested again in the third trimester.
Pregnant women who test positive for chlamydia should
get treated right away. To guard against re-infection,
the CDC recommends getting tested three weeks after
treatment, and three months after that.
Fall 2016
| 13
Health
Guidelines to
good health
for children
Regular well-child visits and scheduled immunizations
for childhood diseases can help keep your child on track.
Talk with your child’s doctor about what schedule is right
for him or her.
Seeing a doctor regularly helps make sure your kids
grow up health and stay healthy. Well visits, shots and
lead testing are all part of your benefits. Your child can
see a Blue Cross Complete pediatrician without a referral.
Your child can do this even if his or her pediatrician isn’t
his or her primary care doctor.
Immunizations for
boys and girls
For boys and girls
Age
How often
Well-child exam
Parental education:
nutrition, development,
injury and poison
prevention, SIDS,
coping skills, tobacco
use screening,
secondhand smoke,
height, weight and
body mass index
0 – 24 months
11 visits
2 – 18 years
Every year
Neonatal and hearing
screening
Birth (after
24 hours)
Once at birth
Cholesterol screening
2+ years
Ask your doctor
Blood lead testing
12 and 24 months
Twice
Vision screening
2 – 6 years
Before starting
school
Every 2 years
Every 3 years
7 – 12 years
13 – 21 years
Preconception
and pregnancy
Prevention and
counseling
12+ years
or earlier if sexually
active
Every year
Chlamydia screening
Females 16 – 24 years
Males 16 – 18 years
Every year if
sexually active
For girls
Age
How often
Cervical cancer
Pap test
13 – 21 years
Every 3 years if
sexually active
Sexually transmitted
infection screening,
including HIV screening
13 – 21 years
Every year if
sexually active
14 | MyBlueHealth
Age
How often
9 – 14 years
Females 9 – 26
Males 9 – 21
2 doses, at least
6 months apart
3 doses
3 doses
DTaP
2, 4 and 6 months
15 – 18 months
4 – 6 years
1st, 2nd, 3rd dose
4th dose
5th dose
Rotavirus
2 – 6 months
Complete series
Tdap
11 – 12 years
1 dose
Hepatitis A
12 months
18 – 24 months
1st dose
2nd dose
Hepatitis B
Birth
1 – 2 months
6 – 18 months
1st dose
2nd dose
3rd dose
IPV – polio
2 months
4 months
6 – 18 months
4 – 6 years
1st dose
2nd dose
3rd dose
4th dose
HIB – Haemophilus
2 – 15 months
Complete series
Flu
6 months – 8 years
HPV (human
papillomavirus)
9 – 21 years
2 doses first year, then
every year
Every year
MMR
12 – 15 months
4 – 6 years
1st dose
2nd dose
Varicella
(chickenpox)
12 – 15 months
4 – 6 years
1st dose
2nd dose
Meningococcal
11 – 12 years
16 – 18 years
1 dose
Booster
Pneumococcal
conjugate –
pneumonia
2 months
4 months
6 months
12 – 15 months
1st dose
2nd dose
3rd dose
4th dose
Health
Guidelines to good health for adults
Men and women
Age
How often
Men
Age
How often
Health exam (includes
height and weight
assessment, body mass
index evaluation and
obesity counseling,
alcohol and drug abuse,
tobacco use and injury)
18 – 49 years
Every 1 to 5 years
Cholesterol and
lipid screening
35+ years
Every 5 years;
more often with risk factors
50 – 65+
Every 1 to 3 years
Prostate cancer
(digital rectal exam
or prostate-specific
antigen test)
50 – 74
Ask your doctor.
Blood pressure
screening
18+
Every two years if blood
pressure is at or less than
120/80
Women
Age
How often
Cholesterol and
lipid screening
20 – 45+ Ask your doctor.
Osteoporosis
screening
50 – 64
Ask your doctor.
65+
Test
Mammogram
(with or without
clinical breast exam)
18 – 39
Ask your doctor.
40 – 74
Every 2 years
75+
Ask your doctor.
Cervical cancer/
Pap test screening
18 – 64
Every 3 years after becoming
sexually active
65+
Ask your doctor.
Pregnancy
(prenatal visits)
Childbearing
Weeks 6 – 8: first visit
Weeks 14 –16: 1 visit
Weeks 24 – 28: 1 visit
Week 32: 1 visit
Week 36: 1 visit
Weeks 38 – 41: every week
Pregnancy
(postpartum visits)
Childbearing
Once 21 – 56 days
after delivery
Immunizations for
men and women
Age
How often
HPV (human
papillomavirus)
Females
9 – 26
3 doses
Males 9 – 21
3 doses
Tdap
After age 12
1 dose
Tetanus
18 – 65+
Once every 10 years
Flu
18 – 65+
Every year
MMR
18 – 49
1 – 2 doses if needed
Varicella (chickenpox)
18 – 65+
2 doses if needed
Hepatitis A, hepatitis B,
meningococcal
18 – 65+
If high risk
Pneumococcal
(meningitis and
pneumonia)
18 – 64
If high risk
65+
1 dose for everyone 65 and
older; revaccinate at age 65
if first vaccine was received
before age 65 and 5 years or
more have passed since that
first dose was given.
Zoster (shingles)
60+
1 dose
Every year if blood pressure is
higher than 120 – 139/80 – 89.
Screen more frequently if
needed.
Diabetes screening
Colorectal cancer
screening
18 – 65+
18 – 49
50 – 75
Every 3 years with blood
pressure at or more than
135/80
If at high risk, ask your doctor.
Fecal occult blood test
OR
Sigmoidoscopy every 5 years
with fecal occult blood test
every 3 years
OR
Colonoscopy every 10 years
76+
Ask your doctor.
Glaucoma screening
18 – 64
If at high risk, ask your doctor.
HIV screening
18 – 64
One test for everyone
65+
Every year if high risk
Females
16 – 24
Every year if sexually active
Chlamydia screening
Females 25+
Every year if high risk
Pregnant
women
Screen
Males 16 – 18
MiBlueCrossComplete.com
Every year if sexually active
Fall 2016
| 15
Benefits
New Blue Cross Complete
mobile app
Help for
translations
and other
special needs
Download our free mobile app
The new Blue Cross Complete mobile app
keeps you up to date on your health care
information.
Here’s what you can do with the app:
• See your virtual member ID card
• Find doctors and hospitals
• Call Customer Service and our 24-hour
Nurse Helpline
• Get directions to doctors’ offices
• Keep your account information updated
Please call Customer Service if
you need free help in another
language or format. If you’d like
to speak in another language,
or need help reading or
understanding a document,
we can help. We can even
help you in another language
when you’re at your doctor’s
office. Written materials may be
available in other formats. You
can reach Customer Service at
1-800-228-8554, 24 hours a
day, seven days a week.
Download the app today
The mobile app is available for iPhone and
Android smartphones. Visit GoogleTM Play or
the Apple App® Store to get it now. It’s free
to download. Simply type “BCCMI” in the
search bar.
If you use an iPhone, make sure it runs iOS
7.1.2 or better. For Android users, your phone
needs to run version 5.0 or better.
*Standard messaging and data fees apply.
For more information, please call Blue Cross Complete Customer Service
at 1-800-228-8554, 24 hours a day, seven days a week. TTY users should
call 1-888-987-5832.
Member portal: Access your account anytime
>
Visit our website at MiBlueCrossComplete.com and log in to your online account. Be sure to
register for quick access to all of your health plan information. As a member, you can:
• See a snapshot of your recent
medical visits
• See if you’re due for any health
screenings, vaccines or office visits
• Take our health risk assessment
• See a list of your medicines
• Find a pharmacy in your area
• See a list of Blue 365® discounts
available to you
Access your account anytime, anywhere with your mobile device.
16 | MyBlueHealth
• Get the name, address and phone
number for your primary care doctor
• Request a member handbook or
ID card
Benefits
News for our Healthy Michigan Plan members
Blue Cross
Complete
protects
your privacy
Dental program
covers more kids
Blue Cross Complete’s Notice of Privacy Practice is our policy for how
we handle your private information, including your protected health
information. We are allowed to use and disclose your protected
health information only as stated in our Notice. We’ve updated our
policy, effective Sept. 3, 2015.
Visit MiBlueCrossComplete.com to read our privacy policy. You can
also ask Customer Service for a copy. We value your membership.
We take our responsibility to protect the privacy and security of your
health information very seriously.
Starting October 1, 2016,
the Healthy Kids Dental
program is available
statewide to all members
up to age 20. Enrollment
is automatic. Those
enrolled will get a
permanent Delta Dental
identification card that has
a Medicaid ID number.
Call us at 1-800-642-3915
with questions.
Attention Healthy Michigan Plan members:
Update your HRA once each year
Remember to work with your doctor to update your health risk assessment.
You can earn rewards such as a $50 Target® gift card or a 50 to 100 percent
discount on your cost-sharing contribution, depending on your income.
Just complete a Health Risk Assessment form with your doctor. Then, commit
to making healthy choices such as quitting smoking, losing weight or lowering
your blood pressure or cholesterol.
We mail the form to our members annually. It’s also on our website at
MiBlueCrossComplete.com. Learn more by calling Customer Service
at 1-800-228-8554, 24 hours a day, seven days a week.
MiBlueCrossComplete.com
Fall 2016 | 17
Benefits
Help us identify
health care fraud
Health care fraud, waste and
abuse affect everyone, even
you. Anyone who unfairly uses
Medicaid resources leaves less
money to help other people who
also need help and care.
If you notice any problems or
want to report fraud or abuse:
Write: Blue Cross Complete
Anti-fraud Unit
P.O. Box 018
Essington, PA 19029
Call toll free: 1-855-232-7640
(TTY users call 711.)
Email: FraudTip@
MiBlueCrossComplete.com
You may also report or get more
information about health care
fraud by writing:
Michigan Department of Health
and Human Services
Office of Inspector General
P.O. Box 30062
Lansing, MI 48909
Or calling toll free:
1-855-MI-FRAUD
(1-855-643-7283)
Or emailing:
[email protected]
You don’t have to leave your
name. Information may be left
anonymously.
@
18 | MyBlueHealth
Help fight Medicaid
fraud, waste and abuse
Fraud, waste and abuse take money
away from adults and children in
Michigan who need health care. Fraud,
waste and abuse describe misuse of
Medicaid resources.
Fraud is purposefully misrepresenting
facts. Waste is carelessly or ineffectively
using resources. Abuse is excessively or
improperly using those resources. Help us
fight fraud, waste and abuse.
Blue Cross Complete works to detect,
investigate and prevent health care fraud.
You can help. Know what to look for when
you receive health care services.
• Take a close look at your explanation
of benefits statements. Look for
charges for services or items you
didn’t get or that your doctor didn’t
order. Make sure you haven’t been
billed twice for the same service.
• Call your health care provider if you
don’t understand the charges. Also call
if you think a service wasn’t needed.
• Contact Blue Cross Complete to
report a concern via phone
at 1-855-MI-FRAUD
(1-855-232-7640) or email at
[email protected]
To do your part in preventing fraud,
waste and abuse:
• Never give personal information,
such as your Blue Cross Complete or
mihealth card number, to someone
you don’t know.
Minimizing fraud, waste and abuse
means Michigan can provide more
care to more people and make the
Medicaid program even stronger.
Together, all of us can work to find,
report and end fraud, waste and abuse.
Quality improvement
program gives our
members better care
and service
As part of our accreditation with the National Committee
for Quality Assurance, we report our CAHPS®* survey results.
Each year, Blue Cross Complete sends the CAHPS survey
to a random selection of members. This year’s survey asked
members about their health plan and care for the previous
year. Members rate their experiences with their plan. They
also rate the care and service they get from their doctors.
Here are some of the results:
• Rating of Health Plan was in the top 10 percent. This
means members had a good experience with the service
Blue Cross Complete provided.
• Rating of Personal Doctor was in the top 25 percent. This
means members had good relationships with their doctors.
For more information about the CAHPS survey,
visit cahps.ahrq.gov.
Blue Cross Complete also uses the Healthcare Effectiveness
Data and Information Set.* This measures how well
we provide care to members. HEDIS® compares the
performances of health plans across the country. We scored in
the top 10 percent of health plans this year for the following:
• Chlamydia screening
• Monitoring for nephropathy
• Medicine management for people with asthma
• Child body mass index
This year, our focus is on increasing access to care for children
and adults. We also aim to improve access to prenatal and
postpartum care for women.
Participating health plans receive a star rating from the
NCQA every year. This year Blue Cross Complete received
four out of five stars. This means that Blue Cross Complete
provided better care than most health plans across the country.
For more information about these programs, call
1-888-288-1722 from 8 a.m. to 6:30 p.m. Monday through
Friday. We also provide information in this magazine and
online at MiBlueCrossComplete.com. To learn about our
clinical practice guidelines, visit our website and mqic.org.
*2016 CAHPS Adult Medicaid Member Satisfaction Survey. CAHPS stands for Consumer Assessment of Healthcare
Providers and Systems. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). CAHPS®
is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
DRUG UPDATES: Visit our website at MiBlueCrossComplete.com and click
on the Pharmacy tab to find:
•Preferred Drug List updates
•New prior authorization criteria and procedures for submitting
a prior authorization
•Pharmacy benefit restrictions or limitations
MiBlueCrossComplete.com
Fall 2016 | 19
Benefits
Healthy Michigan
Plan members:
Remember to pay
your cost sharing
Save money and live
healthier with Blue365®
Membership has its benefits
Blue Cross Complete of Michigan
members can receive savings on healthy
products and services from many
businesses in Michigan and across the
United States.
Here’s how:
1.Log in to your account at
MiBlueCrossComplete.com
2.Click Member Discounts with
Blue 365 on the right side of your
home page
3.Search, review and redeem deals
Member discounts with Blue365
offers deals on things like:
• Fitness and wellness: health
magazines, fitness gear and gym
memberships
• Healthy eating: cookbooks, cooking
classes and weight-loss programs
20 | MyBlueHealth
You’ll receive your MI Health
Account statement every three
months. This tells you your costsharing amounts. These include
copays and contributions, if you
have them. If you need to pay, you
will also get a payment coupon.
Be sure to make your payments
before the due date shown on
your statement. If you fall behind
in your payments, you may not
be able to qualify for healthy
behavior incentives. Keep in
mind, you don’t pay cost sharing
to your health care provider or
Blue Cross Complete. If you have
questions about your
MI Health Account, call the
Michigan Beneficiary Help Line
at 1-800-642-3195.
• Travel and recreation: family activities
like skiing and trips to the zoo
• Personal care: LASIK and eye care
services, dental care and hearing aids
Cash in on discounts
You can show your Blue Cross Complete
ID card at participating local retailers.
Or, use an offer code online to take
advantage of these savings.
For a full list of discount offers, visit
MiBlueCrossComplete.com and log
in to your account. Click Member
Discounts with Blue365 on the right side
of your home page.
Get monthly updates and details
about new offers delivered directly
to your email inbox. You can choose
to receive emails through Paperless
Options under Account Settings from
your member account.
> Need a ride
to your covered
medical service
appointments? Call
1-888-803-4947 from
8 a.m. to 5:30 p.m.
Monday through
Friday. TTY users
should call 711.
Benefits
Keeping moms and babies healthy
The Maternal Infant Health Program is a covered benefit starting
January 1, 2017.
The Maternal Infant Health Program is for pregnant women and infants who are
enrolled in a Medicaid health plan. It can help you and your baby stay healthy
during pregnancy and after you deliver.
Once you join, you can get free rides to medical visits and childbirth or
parenting classes. During visits to your home, a health professional will answer your
questions about being pregnant, caring for your baby and birth control. The health
professional can also help you:
• Get health care while you are pregnant (prenatal care)
• Get food or a place to live, if needed
• Address concerns about abuse or violence
The health professional will also help you with health matters that may affect
your pregnancy. These include:
• Asthma
• Depression and anxiety
• High blood pressure
• High blood sugar
• Smoking
• Alcohol or drug use
To find out more about MIHP, call Customer Service at 1-800-228-8554
(TTY : 1-888-987-5832).
Postpartum
rewards
Every new mother needs to see
a doctor regularly after her baby
is born. These visits are just as
important as prenatal visits. A
postpartum visit should occur 21 to
56 days after you deliver your baby.
Your body changes after
pregnancy. Your doctor will help
if you’re not sleeping well or
having any pain. He or she can
help if you are worried or feeling
sad. This is also a great time to
ask any questions, even if you
feel well.
Blue Cross Complete will send
you a $50 Target® gift card if
you have your postpartum visit
within three to eight weeks after
delivery. And did you know? Blue
Cross Complete now covers
breast pumps for all new moms.
Plus, you may also qualify for
free diapers. We’ll send a free
pack of Cuties™ diapers to
women and children who have
these services this year:
• Postpartum visit. New moms
must have this visit 21 to 56
days after the delivery date.
• Well visits for children 0 to
15 months. Take your child for
six well visits before he or she
is 15 months old.
Once you have these visits, we’ll
send you an order form for your
diapers. Simply pick the diaper
size you want and return the
card. Call our Outreach Team
at 1-888-288-1722 for more
information about rewards for
postpartum visits.
MiBlueCrossComplete.com
Fall 2016
| 21
Benefits
Discrimination is against
the law
Blue Cross Complete of Michigan complies with applicable
federal civil rights laws and does not discriminate on the
basis of race, color, national origin, age, disability or sex. Blue
Cross Complete of Michigan does not exclude people or
treat them differently because of race, color, national origin,
age, disability or sex.
Blue Cross Complete of Michigan:
• Provides free aids and services to people with disabilities
to communicate effectively with us, such as:
oQualified sign language interpreters
oInformation in other formats (large print,
audio, accessible electronic formats)
• Provides free (no cost) language services to people
whose primary language is not English, such as:
oQualified interpreters
oInformation written in other languages
If you need these services, call Blue Cross Complete
of Michigan 24 hours a day, seven days a week, at
1-800-228-8554. TTY users can call 1-888-987-5832.
If you believe that Blue Cross Complete of Michigan has
failed to provide these services or discriminated in another
way on the basis of race, color, national origin, age, disability
or sex, you can file a grievance with:
• Blue Cross Complete of Michigan Member Grievances
P.O. Box 41789, North Charleston, SC 29423
1-800-228-8554 (TTY 1-888-987-5832)
• If you need help filing a grievance, Blue Cross Complete of
Michigan Customer Service is available to help you.
You can also file a civil rights complaint with the U.S.
Department of Health and Human Services, Office for Civil
Rights, through the Office for Civil Rights Complaint Portal,
available at ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by
mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 1-800-537-7697 (TTY)
Complaint forms are available at:
hhs.gov/ocr/office/file/index.html.
Getting care and appointments
When and where you get care matters.
That’s because your doctor’s office, urgent
care centers and emergency rooms have
different resources for specific kinds of care.
Don’t forget that regular visits with your
doctor help you get the best care. These
charts show how soon you should be able
to get an appointment for certain kinds
of care. Unless it’s an emergency, make
appointments with your primary care doctor.
22 | MyBlueHealth
Appointment type
Standard
Urgent care
Within 48 hours of
member’s request
Preventive care (primary care/
pediatrician only)
Within 30 business days
Routine care
Within 10 business days
Emergent care
Immediately or send to ER
Non-life-threatening emergent
(behavioral health only)
Within 6 hours or send
to ER
Wait time in office
30 minutes or less
Benefits
Multi-language
interpreter services
Multi-language interpreter services
Seeking care elsewhere
Planning to get medical care in another state? Be sure your doctor gets prior authorization
from the health plan for treatment. Always follow up with us to make sure the authorization
was granted. And keep in mind that medical care outside of the country is not covered.
BCC-16214
www.mibluecrosscomplete.com
MiBlueCrossComplete.com
Fall 2016
| 23
PRSRT STD
U.S. POSTAGE
PAID
PERMIT NO. 372
LONG PRAIRIE, MN
Suite 210
100 Galleria Officentre
Southfield, MI 48034
Flu facts: Spot the signs and beat the bug!
The flu can knock you off your feet.
But knowing how to take care of yourself
can help you feel better faster.
Flu symptoms
The following symptoms pack a powerful
punch but usually clear up within two
weeks. If symptoms linger or worsen,
call your doctor.
• A fever between 102 and 104 degrees
Fahrenheit that lasts three days
• Muscle aches and pains
• Extreme fatigue
• Headache
• Chest discomfort
Other symptoms include a cough, stuffy
nose, sore throat and sneezing. Children
may experience nausea and vomiting.
Comfort measures
The best thing you can do when you
have the flu is take good care of yourself.
Try these comfort measures:
• Eat well and drink lots of fluids such as
water, soup and caffeine-free beverages.
CC-04/Rev10/18/16
CE-09262016-0171
NOV 16
11037M
• Get plenty of rest.
• Consider over-the-counter medicines.
For example, nasal decongestants
can help unclog a stuffy nose,
and antihistamines stop sneezing.
Acetaminophen can tackle a fever
and minor aches.
A shot in the arm
An annual flu shot can greatly lower your
chance of getting the flu. And, if you get
the flu despite vaccination, it’s often a
milder case.
There were typically two options
for the flu vaccine: the traditional flu shot
and a nasal spray. But according to the
August 26, 2016 report from
the Advisory Committee on
Immunization Practices, the CDC
has deemed the nasal spray
ineffective for the 2016–2017 flu
season. Your best bet is to get
the traditional flu shot.
The CDC recommends an
annual flu vaccine for all people
ages 6 months and older.
The National
Committee for Quality
Assurance is a private,
nonprofit organization
dedicated to improving
health care quality.