HealthBeat
Priority Health’s magazine for healthy living
Spring 2013
All members with a Medicaid plan
are assigned a primary care provider
(PCP). Your PCP is your family
doctor. Your doctor’s office is also
called your medical home. It’s the
place you go for “well visits” and
when you have a health problem.
If you don’t know who your PCP
is — or if you need to find a new
one — call Customer Service at
1.888.975.8102. We’ll help you
find a doctor.
Are you in the
BMI danger zone?
Your body mass index (BMI) tells you how much
body fat you have. If your BMI is 25 or over, you’re
at risk for diabetes, high blood pressure and more.
A BMI of between 18.5 and 24.9 is healthy for adults.
For your kids, it’s important for you to know their BMI percentile. Ask
about your child’s BMI percentile at their next doctor’s appointment.
Remember to always include healthy eating and exercise in your
family’s life.
Keyword: BMI
1231 East Beltline NE
Grand Rapids, MI 49525
Your doctor is your
key to good health
Remember your
kid’s well-child visits
and screenings
It’s important to take your child in for checkups at 2,
4, 6, 9, 12, 15, 18, 24 and 30 months of age so they
can grow up healthy. Kids also need a checkup once
a year from ages 3 - 6, at least every two years from
ages 7 - 10 (we’ll cover a check-up every year), and
one visit each year at ages 11 -18.
At well-child checkups, your doctor can:
• Measure your child’s height, weight and body mass index (BMI)
• Give a lead poisoning test or vaccines
• Find health and learning problems early
At the 9, 18 and 30-month checkups, your doctor will see if your
child is developing normally by checking how your child speaks,
plays and acts. This will tell your doctor if your child is learning
age-related basic skills or if there may be a problem.
Keyword: milestones
HealthBeat | Spring 2013
Important health reminders
Here are five things to do to help keep you and your
family healthy. You can find more health information at
priorityhealth.com. Just type the keyword(s) below in the
search box in the upper right-hand corner of the page.
Call your doctor if you have questions or concerns.
1. Keep your
heart healthy
2. Breathe easier –
control asthma
3. Learn about
chlamydia screenings
Adults, teens and even kids can have
high blood pressure, which is a big
factor in heart disease. Most doctors
recommend that blood pressure be
140/90 or lower. Stay healthy by eating
more fruits and vegetables, doing
family activities and not smoking.
If you have asthma, ask your doctor for an
asthma action plan to help you:
Get the facts about this sexually
transmitted infection.
Keywords: heart disease
• Get information about testing
To control asthma, take long-term
medicines even when you feel better. Take
Keyword: chlamydia
quick-relief medicines only when needed. If
• Recognize early warning signs
• Know when to take medicines
• Know when to call the doctor or get
immediate care
your child has asthma, you can enroll them
in asthma case management.
Keywords: asthma
HealthBeat | Spring 2013
• Learn why it’s important for sexually
active women to be tested
• Learn why parents need to be
prepared to talk with their teens
4. Fight cancer
The earlier cancer is found, the easier it is to
treat. That’s why it’s important to know if your
family is at risk for these common cancers
and when your family needs screenings.
Breast cancer
If your family has a history of breast
cancer, ask your doctor when to begin
screenings. Most women need a
mammogram after age 50. It can detect
changes in your breasts long before you
can see or feel anything. Remember, you
can get breast cancer even if there’s no
family history.
Keywords: breast cancer
Cervical cancer
Cervical cancer can be preventable if
you get a routine Pap test. This test finds
abnormal cells on the cervix that can often
be treated before cancer develops. Women
should get this screening starting at age 21
or the beginning of sexual activity. Women
under 30 should have a Pap test every year,
and those aged 30-65 should be checked
every two to three years.
Keywords: cervical cancer
Colon cancer
People aged 50+ need to get screened
for colon cancer because often there are
no symptoms. If you have a family history
of cancer or polyps, your doctor may
screen earlier. A colonoscopy is the best
option because it looks at your
entire colon.
Keywords: colorectal cancer
5. Plan for a
healthy baby
Before you become pregnant
Because many pregnancies are
unplanned, every woman of childbearing age should take a vitamin
with .4 to .8 mg of folic acid each
day to prevent brain and spinal cord
birth defects.
Pregnancy
See your doctor during the first 12
weeks of your pregnancy so you can
be enrolled in our maternity program.
You’ll receive an educational packet
about care you need.
Hospital
If you choose the minimum stay at
the hospital after your baby is born,
you can get a phone assessment and
home visit from a nurse.
Care for you after your baby is born
Visit your doctor for a checkup four to
six weeks after your baby is born. Your
doctor will make sure you’re back to
full health and that feeding your baby
is going well.
Get Priority Health for your baby
Call Priority Health to let us know
you had a baby. We’ll also need the
baby’s Medicaid ID number. Then, call
Michigan ENROLLS at 888.367.6557,
and select Priority Health when you
call. If you don’t call and choose
Priority Health, your baby may be
added to a different health plan.
Keyword: pregnancy
Customer Service is
here to help!
When you have questions about your
health care benefits, contact us! You
can also call us when you:
• Want to change your doctor
• Need a new ID card
• Get a medical bill by mistake
• Want to know how to get care
• Need to update your address
Call us
Our number is 888.975.8102 (TTY
users should call 888.551.6761).
Our hours are:
• Monday through Thursday,
7:30 a.m. to 7 p.m.
• Friday, 9 a.m. to 5 p.m.
• Saturday, 8:30 a.m. to noon
If you speak little or no English, we’ll work
with a translator so we can talk to you.
Email us
Go to priorityhealth.com and click on
“Contact Us” at the top right of the page.
Help fight fraud and abuse
Get free help to
stop smoking
Protect yourself and your family
Some people look for illegal ways to get
money from health insurance companies.
That’s called health care fraud and abuse,
and experts estimate that it costs you
and all U.S. taxpayers as much as $175
billion dollars each year.
If you’re ready to quit smoking,
we’re here to help. As a Priority
Health member, you can get free
products to help you quit tobacco,
like nicotine replacement therapy
gum, inhalers, patches and Zyban®
or Chantix®. Talk to your doctor to
see what might work best for you.
Health care fraud is when someone lies
to get money they aren’t entitled to.
Examples include:
• A doctor bills the insurance company
for a service that the doctor didn’t
provide
• A person receives health care services
under someone else’s name
Health care abuse is when a
doctor provides unnecessary
care or patients try to avoid
paying their share of the costs.
Health care abuse happens when,
for example:
• A person goes to the emergency
room for non-emergency
medical services
• A
doctor orders tests or
services you don’t need
Report fraud and abuse
If you think you know of this kind of
illegal activity, you should report it.
You won’t have to give your name,
address or phone number. You may
remain anonymous.
You can also get free help when
you call the Michigan Tobacco Quit
Line at 1.800.480.7848. You can
receive up to five 20-minute phone
calls with a trained coach to help
you quit (pregnant women receive
up to 10 calls).
Keyword: tobacco
Keywords: fraud and abuse
If you suspect fraud, you can:
1. Contact Priority Health
• Call Customer Service at 616.942.1221 or 1.888.975.8102.
• Write to Priority Health Fraud and Abuse Program
Mail Stop 3175
1231 East Beltline NE
Grand Rapids, MI 49525
2. Call the Compliance Helpline
The Compliance Helpline is a third-party organization where you can
report a concern 24 hours a day. You can remain anonymous, and the
call can be kept confidential. Call them at 800.560.7013.
3. Contact the State of Michigan
• Call toll-free 1.855.MI.FRAUD (1.855.643.7283)
• Go to michigan.gov/fraud and click on “Submit an online complaint.”
The site will provide examples and directions about how to report
fraud and abuse.
• Write to Office of Health Services Inspector General
P.O. Box 30479
Lansing, MI 48909
Our board
needs you
Interested in joining the Priority Health
Government Programs, Inc. Board of
Directors? We’re seeking candidates.
You must be a current Medicaid
member and able to attend at least
four meetings each year. Please send
a brief letter describing yourself, your
work history and your community
service to:
Priority Health
Mail Stop 1340
Attn: PHGP Board Member Request
1231 East Beltline NE
Grand Rapids, MI 49525
Understanding
your health plan
You can get information about how Priority
Health works.
Go to priorityhealth.com and type the keywords below in the search box.
For printed copies, call Customer Service at 1.888.975.8102.
Get your checkup
Call your doctor today
if you haven’t had a
physical exam in the
past year. At your
appointment, talk with
your doctor about all of
your health conditions.
Also, be sure to ask
if you’re up to date
on recommended
checkups, screenings
and immunizations. See
our preventive health
care guidelines to see
the care you may need.
Disease management programs
Learn what programs we have to help you
manage chronic illnesses. You can also
learn how you can get and use the services.
Keyword: preventive
Keyword: utilization
Keyword: programs
Benefit decisions
Our goal is to cover care that meets
high medical standards and is also
cost-effective. This is called utilization
management. If you have questions
regarding our utilization management
process and decisions, contact
Customer Service at 888.975.8102,
and they’ll contact a health management
staff member to help. Know that all
utilization management decisions are
based on appropriateness of care and
service, and that no financial incentives
exist for issuing denials.
Grievance procedure
Learn how our three-step grievance
procedure works.
Keyword: grievance
Plan basics
Your Certificate of Coverage and Member
Handbook have information about:
• Benefits
• Procedures
© 2013 Priority Health
• How to get care and services
• Doctors you can use
Keyword: coverage
Prescription drug updates
We review new drugs to help make
sure that you’re getting safe and
effective care. If you take prescription
drugs, be sure to read our approved
drug list for changes or updates.
Keyword: drugs
Privacy statement
Learn how we keep your health
information private.
Keyword: privacy
Quality performance
Review summary information
regarding Priority Health’s Quality
Improvement Program performance
and key quality results.
Keyword: accreditation
Rights and responsibilities
Know what you can expect from us
and what we expect from you.
Keywords: member rights
3001-05 Approved M 05012013 7547 5/13