Preventive screenings can help you stay healthy

Sure … you know and try to follow the basics to stay healthy, like eating right, getting some exercise almost every day, and taking your medicines just as your doctor has directed. But did you also know that regular checkups and screenings can improve your health and possibly even extend your life?

A screening is another name for a test — it’s simply an exam to make sure that you don’t have a health condition. Regular screenings can catch health problems in the early stages, when they are easier to treat. Some people are at higher risk of developing health problems than others. These people should talk to their doctor about how often and when they should be screened. Factors that put people at higher risk typically include family history of the disease, lifestyle (e.g., tobacco, alcohol, lack of exercise, overeating), and other current health conditions.

The U.S. Preventive Services Task Force (USPSTF) recommends people age 50 or older receive the following screenings (the list does not include all the tests that are recommended):

Do a “good health” favor for yourself in 2010 — get regular checkups and screenings. For questions about preventive screenings, call UPMC for Life Member Services or our Health Care Concierge team toll-free at 1-877-539-3080. Representatives are available 8 a.m. to 8 p.m. seven days a week.* TTY users should call toll-free at 1-800-361-2629.

*From March 2 through November 14, you may receive a messaging service on weekends and holidays. Please leave a message and your call will be returned the next business day.

Source: Agency for Healthcare Research & Quality and USPSTF

UPMC Health Plan Pittsburgh Half Marathon — May 2, 2010

UPMC Health Plan is proud to sponsor the Pittsburgh Half Marathon for 2010. The half marathon, which is 13.1 miles, is the nation’s fastest growing race category. The UPMC Health Plan Pittsburgh Half Marathon offers runners and walkers an exciting course that crosses Pittsburgh’s three rivers before finishing at the David L. Lawrence Convention Center.

Visit www.upmchealthplan.com for training tips and more! To register or to learn more about the UPMC Health Plan Pittsburgh Half Marathon, visit www.pittsburghmarathon.com.

Fitness isn't just about your body anymore

NEW for 2010! Our InSight™ brain health and fitness program can help you exercise your brain and keep it healthy and fit. UPMC for Life members can now receive the InSight program from Posit Science® at no additional cost.^†

Brain health is an important part of healthy aging because it affects what matters most – emotional health, relationships, everyday tasks, work, and hobbies. Although one in four older adults experience confusion and forgetfulness, this is not considered a normal part of healthy aging. The InSight program, a series of brain fitness exercises that can be downloaded on your home computer, can help you improve your ability to visually process and store information.

UPMC for Life members can get the InSight program for no additional cost. When you sign up, you’ll get a software package to load onto your home computer. Prior computer experience is not required.

To order the InSight™ brain health and fitness program, call our Health Care Concierge team at 1-877-539-3080, 8 a.m. to 8 p.m., seven days a week.* TTY/TDD users should call 1-800-361-2629. You can also order by logging in to MyHealth OnLine at www.upmchealthplan.com and entering your user ID into the Secure Member Login box on the right. If you need help logging in, call our Health Care Concierge team at the number above.

The InSight program can help you improve your ability to visually process and store information. Increased visual processing speed can help you to:

React more quickly — avoid collisions while driving, read faster, improve your hand-eye coordination

Capture more visual details — when driving, house hunting, scanning a bookshelf, and other vision-dependent tasks

Retain sharper pictures of what you see — new faces, important landmarks, travel experiences

Resources for Life

Question: I’m living on a fixed income and I just found out that I won’t be receiving a cost of living increase in my Social Security check for 2010. Yet, all of my bills keep increasing! I don’t know what I will do this winter, and I am concerned about even turning on my heat. I’m really worried about how I will make ends meet. Can Resources for Life help me?

Answer: Resources for Life can help you by putting you in touch with agencies and programs that offer help to people who need it. For example, did you know there is a program called Low Income Home Energy Assistance Program (LIHEAP) that will help you pay your heating bill? Resources for Life can connect you with the agency that administers this program in your county. Once you complete and submit an application, you will receive a written notice that explains whether you are eligible and the amount of help you can get.

This is just one example of many programs that can help those in need. Resources for Life will search to see if there are other programs for which you qualify.

You are also eligible for a free 30- to 90-minute telephone call with a financial consultant who can show you ways to reduce and manage your debt, make a budget and stick to it, prevent foreclosure on your home, prevent bankruptcy, and set long-term goals. The consultant can also help with financial planning, reverse mortgages, and housing education and purchases.

UPMC Resources for Life is designed to help you meet the challenges of everyday living.† To access UPMC Resources for Life, call Member Services or our Health Care Concierge team toll-free at 1-877-539-3080, 8 a.m. to 8 p.m., seven days a week.* TTY/TDD users should call 1-800-361-2629.

Have you moved?

If you have recently moved or are planning to move, please let UPMC for Life know! Contact our Health Care Concierge team at 1-800-818-8762 or Member Services at 1-877-539-3080 with your new address and phone number. TTY users should call 1-800-361-2629.

If you don't understand what the doctor says ... ask again

Are you nervous or anxious when you go for a doctor visit? Do you sometimes have trouble understanding the words your doctor uses or the instructions he or she gives? Many people have the same kinds of problems. Here are some examples:

• Tim had a successful career as a salesman for an office supply company. Now that he’s retired, Tim regularly volunteers at his grandson’s school. When he went to his doctor for his regular diabetes checkup, the doctor told him he also had hypertension and gave him another prescription. Although Tim had heard the word hypertension before, he was not sure exactly what it was or whether it was related to his diabetes. But he thought he should know and felt too embarrassed to ask his doctor to explain.
• Julie recently retired from a long career teaching elementary school. Her last mammogram revealed a small growth on her right breast, and she was scheduled for surgery to have the lump removed. The nurse at her doctor’s office gave Julie a consent form to read and sign. Because she was nervous about the surgery, Julie had trouble focusing on the form. Although she could not understand everything it said, she signed the form anyway.
• Irina moved to the U.S. 20 years ago to live with her children and can speak and write English fairly well. But it is still sometimes hard for her to understand medical terms and information. She listened carefully when her doctor explained how to use her asthma inhaler. Then she talked with the doctor about two other health problems she was having. As the doctor was leaving the room, Irina realized she could not remember all the instructions for using the inhaler, but she did not want to ask the doctor again.

Don’t be afraid to ask the doctor or nurse to explain something a second – or even a third – time until you understand it. Make sure you understand what your doctor has told you before you leave the office. To learn about how you can make the most of your next doctor’s appointment, visit our eNewsletter Center online and select the story titled Get the most out of every doctor’s visit.

Ask the pharmacist

Question: I recently started taking an over-the-counter vitamin. Do I really need to tell my doctor?

Answer: Absolutely. You should always let all of your doctors know what other medicines you’re using, including herbs, vitamins, and over-the-counter (OTC) remedies such as cough or cold preparations, eye drops, and laxatives. Tell your doctor how often you take each. Describe any drug allergies or reactions you have had. Say which medicines work best for you.

In some cases, mixing medicines can be dangerous and even life threatening. When prescription medicines are combined with OTC drugs, home remedies, and herbal supplements, the chemicals in them can sometimes interact and produce a harmful effect.

For example, the prescription drug warfarin interacts with several herbal supplements, including saw palmetto and garlic. If you take saw palmetto or garlic with warfarin, it can cause an increased risk of bleeding. For more examples of harmful combinations, visit our eNewsletter Center online and select the story titled Common and dangerous drug interactions.

Before your doctor’s appointment, take a few moments to write down all the medicines, vitamins, and herbs you take, how much of each you take, and how often. It’s worth the extra time and will help you not to forget anything when you’re at the doctor’s office.

Important pharmacy updates

As health care costs continue to rise, the goal at UPMC for Life is to improve the value and affordability of the health care benefit for our members. Maximizing the value of the benefit sometimes involves removing or adding medications to the formulary. All changes to the formulary are made with the help of our local doctors and pharmacists. The table below describes changes to the formulary, which are effective January 1, 2010.

*Members who are currently filling this as a maintenance medication in 2009 through their UPMC for Life pharmacy benefit will be allowed to continue on this medication in 2010.

If you have any questions, call UPMC for Life Member Services at 1-877-539-3080. Member Services representatives are available from 8 a.m. to 8 p.m., 7 days a week. TTY/TDD users should call 1-800-361-2629.

Important notes:
Prior Authorization: Your doctor must consult with UPMC for Life before prescribing this drug for you. Drugs that require Prior Authorization are set on a drug-by-drug basis and may include newer drugs or those that UPMC Health Plan wants to monitor for side effects or patient safety.

Step Therapy: This means that you must try certain preferred medications first before other medications. The drug will be approved for coverage if there is a record that you have already tried the preferred medication.

Non-Covered: UPMC for Life no longer pays for this medication.

Tier 1: The first tier is for generic drugs, which have the lowest copayment.

Tier 2: The second tier is for preferred brand-name drugs, which have the middle level of copayment. UPMC Health Plan classifies these drugs as “preferred” because of their value and effectiveness.

Tier 3: The third tier is for non-preferred brand-name drugs, and it has the highest copayment level.

Ask the Health Care Concierge

Question: I take several medications routinely, and it is both costly and time-consuming to pick up my prescriptions each month. How can I get more than a month’s supply and what does it cost?

Answer: If you are taking a maintenance medication, you can get a 90-day supply of that medication at a participating retail pharmacy or through Express Scripts, Inc., which is our mail-order pharmacy. Getting a 90-day supply of your medication gives you the convenience of only having to go to the pharmacy once every three months. Using our mail-order service means you get your medication delivered right to your home. If you qualify for “extra help” or Low Income Subsidy for your Part D prescriptions, you will pay only one copayment for a 90-day supply. If you belong to the PACE or PACENET program, you should always get your medications from a retail pharmacy.^†

If you need more information about your pharmacy copayments, call our Health Care Concierge team. If you are a UPMC for Life member, call Member Services at 1-877-539-3080; TTY users should call 1-800-361-2629. If you are a UPMC for Life Specialty Plan member, call 1-800-606-8648; TTY users should call 1-866-407-8762. To find a participating pharmacy, check your pharmacy directory or contact our Health Care Concierge team.

Member discount on Chatham Baroque concerts

As a UPMC for Life member, you can receive a 40 percent discount off ticket prices to the Chatham Baroque’s Peanut Butter & Jam Sessions. The Chatham Baroque is a professional baroque ensemble that plays 17th and 18th century music using authentic period instruments. The group has traveled locally, nationally, and internationally to dazzle audiences with their intricate technique and lively musical interpretations.

Peanut Butter & Jam Sessions are designed for preschoolers and accompanying adults to encourage young children to become active and enthusiastic listeners through music, dance, and games. Hosted by a certified Kindermusik teacher, these informal concerts are fun, lively, and educational.

Tickets are normally $5 for children and $8 for adults. With a UPMC for Life discount, members will only pay $3 for children and $4.80 for adults. Tickets can be purchased at the door and members must show their UPMC for Life member ID card to get the discount.

All shows are held on Saturdays at the Calvary Episcopal Church, 315 Shady Ave., Pittsburgh, PA 15206. Two shows occur on each of the dates listed below. Session 1 starts at 10 a.m. and Session 2 starts at 11:30 a.m.

Show dates:
January 30, 2010 – “Delicious Double Stops”
February 20, 2010 – “Open Wide: Discover Your Voice!”
March 13, 2010 – “May I Have This Dance?”
April 10, 2010 – “Hello Cello”

Peanut Butter & Jam Sessions are most appropriate for children ages 12 months to 5 years.

Network provider update

Dr. Dean E. Kross was mistakenly omitted from our Provider Directory. Dr. Kross specializes in cardiology and internal medicine. His practice information is as follows:

Dr. Dean E. Kross
Heart Care Medical Associates
The Schenley House Suite 110
155 North Craig Street
Pittsburgh, PA 15213
412-687-7666

Network hospital change

The UPMC for Life regional hospital network includes 90 hospitals. New to our network this year is Corry Memorial Hospital, located in Corry, PA. UPMC Braddock Hospital, located in Braddock, PA, has closed.

UPMC for Life calendar correction

We would like to apologize to Michael Einodshofer for misspelling his name in some of the picture captions in the 2010 member calendar. Mr. Einodshofer contributed several pictures that helped make this year’s calendar better than ever.

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Don't forget to re-apply

In order to protect your membership in UPMC for Life Specialty Plan, you must keep your enrollment in both the Medicare and Medical Assistance programs (dual status). You do not need to do anything to maintain your Medicare status, but the Medical Assistance program in which you are enrolled typically requires you to reapply for coverage annually.

If you do not re-apply for your Medical Assistance program in time, your membership in UPMC for Life Specialty Plan will end.

To ensure that your membership is not at risk, UPMC for Life Specialty Plan has hired PremiumAssist to help you with the re-application process.

You can call PremiumAssist immediately toll-free at 1-888-378-5257 to talk with them about starting the application process.

UPMC for Life Specialty Plan and PremiumAssist want you to know these important facts:

• PremiumAssist will ask you information about your income and resources (assets) in order to verify your ongoing eligibility for the Medical Assistance program you are now enrolled in.
• PremiumAssist will keep ALL information you provide private and will use it ONLY to help you apply for these programs.
• You are NOT required to respond to any calls you may receive from PremiumAssist.

For the fastest way to get help with your application and to ensure that you keep your dual status, call PremiumAssist immediately at 1-888-378-5257. (If you have a hearing or speech impairment, call the Pennsylvania Relay Service on TTY at 1-800-654-5984.)

PremiumAssist is ready to talk with you between the hours of 9 a.m. and 7 p.m. Monday through Friday.

Surveys help us help you

If you are a new member of the UPMC for Life Specialty Plan, you may be feeling overwhelmed by the amount of information you need to learn regarding your own or your loved one’s health condition. We want to help. Your Welcome Kit contains a Health Assessment Survey. Please complete the survey based on your needs and return it to us. We will use your survey responses to tailor programs and services to meet your needs.

Your response will tell us if a health coach could help you:

• Learn about certain health conditions and how to manage them
• Find the assistance you need to stay in your home
• Lose weight, stop smoking, or become more active

If you are not a new UPMC for Life Specialty Plan member, you will receive a Health Reassessment Survey. This survey is your chance to tell us anything new about your health and what you need us to provide for you. Please fill it out as soon as you receive it.

If you need help filling out either survey, call Member Services at 1-800-606-8648. If we do not receive your Health Assessment Survey or your Health Reassessment Survey, a Member Services representative will call you. Your health is very important to us and we want to do everything we can to make sure we meet your needs.

Specialty Plan members — remember to show both of your cards

UPMC for Life Specialty Plan is your primary insurer and provides coverage for the majority of medical and pharmacy services you receive throughout the year. The amount UPMC for Life Specialty Plan does not pay for is submitted to Medical Assistance for consideration. Therefore, it is important that you provide both your UPMC for Life Specialty Plan card and your Medical Assistance (ACCESS) ID card any time you receive care or fill a prescription. Showing both ID cards will enable providers and pharmacies to correctly bill UPMC for Life Specialty Plan and Medical Assistance for their services. It should also stop providers from billing you by mistake.

Caring for caregivers

UPMC for Life offers a series of six classes, called Powerful Tools for Caregivers, that helps family caregivers increase their self-care skills and confidence. Each 90-minute class offers a wealth of tools to help you reduce your stress level, tell other family members and health care personnel what you need, and deal with difficult feelings — plus help you make tough caregiving decisions. The second class in the series focuses on managing stress.

The class presents four basic steps for effectively managing stress: identifying early warning signs, identifying things that cause you stress, changing what you can change and accepting what you cannot change, and taking action.

You will learn about different ways to reduce stress and find out how to practice the stress reduction techniques that work best for you. One of these techniques is deep breathing, which is easy for almost anyone to add to their life. The class leader will discuss the importance of your attitude and how you see things as you provide care to your loved one and face difficult situations.

You will receive information in the mail when classes are available in your area.

Important reminder for UPMC for Life Specialty Plan members

As a Specialty Plan member, you are not responsible for paying out of pocket for premiums, deductibles, copayments, or coinsurance. These costs are considered by your Medical Assistance benefits. However, you are responsible for any prescription drug copayments and any Medical Assistance copayments that apply.