The sky's the limit for father of pilot-in-training

Ray Boettner’s primary reason for wanting to lose weight was “loftier” than most — he wanted to be able to fit into the back seat of a Cessna 172. Ray’s 17-year-old daughter, Samantha, is a Civil Air Patrol cadet. Once she solos this year, father and daughter are looking forward to a cross-country flight. “Weighing what I did, I would never have been able to climb into that seat,” says Ray, who has lost 101 pounds so far.

Samantha, a student at a local high school, plans to major in aerospace engineering at Penn State. She has been with the Civil Air Patrol since age 12 and is looking forward to getting her pilot’s license.

Ray, an employee of UPMC Passavant in the Engineering and Maintenance Department, knew he needed to lose weight. He had developed arthritis in his knees and feet and was deemed too heavy for a prescribed treadmill stress test. After hearing other employees’ weight loss success stories, Ray decided it was time to seek assistance from a health coach at UPMC Health Plan.

“I started the UPMC Health Plan Weight Management Program in April of 2009 and, at the end of one year, I had met my 100-pound goal!” exclaims Ray. Ray credits his success to a combination of personalized weight loss tools and interaction with UPMC Health Plan health coach Kasey Danforth. “Kasey was lots of fun to work with,” he reports. “She kept me on track and provided me with tools that truly made this a life-changing process. I never realized how much I ate — especially the amount of fat — before working with her. I couldn’t have done it without her.”

One of the tools Kasey gave Ray was a daily food log. Ray is now very conscientious about keeping track of what he eats and tries not to go beyond the daily calorie limit he set with Kasey’s help.

“The number one thing is that you have to write down everything. No cheating! Overestimate calories, don’t underestimate — it keeps you on track,” Ray notes. He also closely monitors his weight and gets on the scale every day. “You have to buy a good scale and weigh yourself regularly,” he advises. And he’s started using the treadmill he’s owned for 10 years.

Ray counts many benefits from his weight loss. He feels better and has more energy. His family has been especially supportive, and now they eat healthier too. In addition, “My heart doesn’t pound the way it did even when I was sitting still, and I don’t get out of breath as easily. I can reach down to tie my shoes and I can climb a ladder — things I found difficult to do before,” says Ray.

But for Ray, the benefit he values most is that he now can get into the Cessna with Samantha. When she flies across the country for the first time, Ray will be right there with her.

ADHD treatment guidelines

If you have a child who has recently started on a medication for attention deficit hyperactivity disorder (ADHD), you are far from alone. ADHD is the most common behavioral health disorder among children, affecting 8% to 12% of children age 18 and under.

If your child recently started on a medication for ADHD, it’s important to visit the doctor who prescribed the medication within 30 days. It’s also important to schedule regular follow-up visits with the doctor to assess how well your child is responding to the medication and to manage any side effects.

The Clinical Practice Guidelines established by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry state:

1. The doctor should ask you and your child specific questions about any behaviors your child may have that are related to ADHD.
2. The doctor should evaluate your child based on the most current guidelines. The doctor should also examine your child for other health conditions and refer your child to a specialist, if necessary.
3. You and your doctor should establish a treatment plan specifically for ADHD. The doctor should work with you, your child, and the school to set goals and then build your child’s treatment plan to meet those goals. The goals should be ones that you and your child are able to accomplish, and the goals should be able to be measured.
4. The doctor should educate you about ADHD as well as about the possible benefits and risks of the treatment. You need to provide your OK to go ahead with treatment.
5. The doctor may recommend medication to improve your child’s symptoms. Your child should start on a low dose of medication and increase as needed.
6. The doctor should talk to you about behavior therapy, especially ADHD management training for parents. This can be very helpful if you are having difficulty coping with your child’s behavior and need emotional support and guidance.
7. Initially, your child should go to the pediatrician every month to make sure the medication is working as it should and to manage any side effects. After that, your child should go to the doctor every three to six months. During each visit, the doctor should check your child’s blood pressure, pulse, height, and weight.

Dispose of old medication the "green" way

When you think about ways to help the environment, how you throw away your old medication probably doesn’t come to mind … but it should. Disposing of medication safely and properly is very important. There are even federal safety guidelines on how to do so.

You may be able to avoid having to dispose of medication by getting only the medicines you need, storing them properly, and using them before they expire.

Federal guidelines for disposing of medication are as follows:

• Do not flush prescription drugs down the toilet or drain unless the label or accompanying patient information specifically instructs you to do so. For information on drugs that should be flushed according to the U.S. Food and Drug Administration, visit our eNewsletter Center online and select the article titled “Safe drug disposal.”

You may be able to dispose of medications through community drug take-back programs or household hazardous waste collection events, which collect drugs at a central location so they can be properly disposed of. Call your local trash and recycling service and ask if a drug take-back program is available in your community.

If a drug collection program is not available:

• Take your prescription drugs out of their original containers.
• Mix the drugs with an undesirable substance, such as cat litter or used coffee grounds.
• Put the mixture into a sealed bag and throw it away.
• To recycle your plastic drug vials: Black out all of the information on the label or scrape or soak off the label. Place the empty drug vials in your recycling container.
• If a recycling program is not available in your community, simply throw away the empty vial in the garbage.

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Facebook^©, Twitter^©, and YouTube are major social media sites that can help us communicate with you. These outlets are great ways for you to get information on the UPMC Health Plan benefits, programs, and initiatives that can help you and your family. If you are part of a social network, connect with us by liking our Facebook page, following our Twitter feeds, and watching and subscribing to our YouTube channel.

Here are the addresses:

www.facebook.com/upmchealthplan

www.twitter.com/upmchealthplan

http://www.youtube.com/user/upmchealthplan

Changes to health care could benefit your older child

You need to know about an important change to your health insurance. This change could have a very positive effect for your family! Young adults are among the fastest growing age group at risk for being uninsured. In the past, dependents covered on their parents’ or guardians’ health plans “aged out” of health care coverage at age 19 or when they graduated from college.

New health care reform laws now extend coverage to dependents until their 26th birthday, regardless of financial dependency, living arrangements, employment, or student or marital status. Coverage does not extend to children of dependents (grandchildren). This change was required of all health plans that renewed after September 23, 2010.

During your employer’s open enrollment period, you may request enrollment* for your older dependent child if:

• his or her coverage ended because of age limitations (your child “aged out”).
• he or she was denied coverage (or was not eligible for coverage) because your plan did not offer coverage for an older dependent child.

In some cases, enrollment may be predated to the beginning of the plan year, after September 23, 2010.

For more information on the date of your plan renewal or to enroll your dependent children, contact your employer.

Your employer may have already provided you with this or a similar notice and conducted a special open enrollment period for your adult dependents. This notice is not a guarantee that your dependent will be able to enroll in coverage now or in the future and does not modify your annual open enrollment period or other terms of coverage.

*Subject to the other applicable eligibility terms in your certificate of coverage/summary plan description.

Pharmacy updates

The goal at UPMC Health Plan is to improve the value and affordability of our health care benefits. Making the most of these benefits sometimes means that we have to change how we cover certain medications. The list of medications we cover and how we cover them is called our “formulary.” Every change we make to the formulary is made with the help of doctors and pharmacists. The table below shows a few recent changes to the formulary, which will be effective January 1, 2011. To see all of the changes to the formulary, visit our eNewsletter Center online and select the article titled “Recent formulary updates.”

Have you had your flu shot yet?

It’s not too late to get a flu shot. Getting a flu shot is the best way to prevent the flu. This year’s vaccination also protects against H1N1. The Centers for Disease Control and Prevention is recommending that all people age six months and older receive the flu vaccine this year.

Visit your doctor to get your free flu shot. Or get your flu shot at a designated location in your community.

We can help explain how health care reform will affect you

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (“Affordable Care Act” or ACA), commonly referred to as the new health care reform law. Nearly everyone will be impacted in some way by the changes this new law requires.

Many of the changes required by the ACA have already gone into effect for plan years that began in late 2010. Other changes will roll out over the coming months and years. UPMC Health Plan will be here to help you understand all of these changes.

We hope that over coming weeks, months, and years, you will turn to UPMC Health Plan as your trusted source for all the latest information. Visit the Health Care Reform section at www.upmchealthplan.com for more details. You’ll find easy-to-understand information about all of the new or expanded benefits as well as a Frequently Asked Questions section that covers a range of ACA-related topics.

Near-term reforms
No pre-existing condition exclusions for children under the age of 19 — Effective for plan years that began on or after September 23, 2010, health plans will no longer be able to limit benefits or deny coverage to children under age 19 who have pre-existing conditions. In the past, families of children with preexisting conditions have found it difficult to get health insurance and, in cases when they did, to afford it. Under the ACA, children with pre-existing conditions can no longer be denied coverage.

UPMC Health Plan has never excluded dependents on the basis of pre-existing conditions.

Coverage of dependents until age 26 — In the past, dependents covered on their parents’ or guardians’ health plan “aged out” of health care coverage at age 19 or upon graduation from college. The ACA extends coverage to dependents until their 26th birthday, regardless of financial dependency, living arrangements, employment, or student or marital status. Extending coverage to dependents up to age 26 is now required of all health plans, except grandfathered* plans, who can deny coverage to these dependents if other employer-sponsored coverage is available to the dependents (other than that through another parent).

No lifetime dollar limits — The ACA restricts health plans from putting lifetime limits on the dollar value of “essential health benefits.” Although the Department of Health and Human Services has not yet published a complete list of benefits that will be considered “essential health benefits,” the following categories will, at a minimum, be included on the list:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive/wellness services/chronic disease management
• Pediatric services, including oral and vision care

This ban on lifetime limits begins for all health plans when they renew on or after September 23, 2010.

Most UPMC Health Plan members will not see any change to their coverage based on this new provision, as most UPMC Health Plan coverage options do not impose lifetime limits on members.

Limited annual dollar limits — When plans renew on or after September 23, 2010, the ACA imposes restrictions on the amount of annual dollar limits that can be placed upon essential health benefits by health insurers. Effective January 1, 2014, there will be a complete ban on such annual limits. This restriction applies to all plans, including grandfathered plans.

No rescissions except in cases of fraud or intentional misrepresentation — A rescission is either a cancellation that treats coverage as void from the time of enrollment or a cancellation that voids benefits paid before the cancellation. Under the ACA, all health plans and insurers will be prohibited from rescinding the benefits of a covered individual absent fraud or intentional misrepresentation on the part of that individual. Plans and insurers that rescind coverage must give 30 days advance written notice to the affected individual(s) to allow time to appeal the rescission.

UPMC Health Plan’s policy has always been to only rescind coverage in cases of fraud or intentional misrepresentation.

Upon renewal on or after September 23, 2010, all plans, except grandfathered plans, must implement the changes below.

First-dollar coverage of preventive services — The ACA requires health insurers and self-funded plans to cover certain preventive services performed by in-network providers at no cost to covered individuals. Depending on a covered-individual’s age and gender, covered preventive services may include:

• Some vaccinations and flu shots
• Tobacco screening
• Obesity screening
• Some cancer screenings

Additionally, regular checkups for children and babies will be offered with no out-of-pocket expense.

Open choice of primary doctor/pediatrician — Under the Patient Protection provisions of the ACA, health plans that require members to choose or be assigned a PCP must allow each member to choose any in-network PCP (or pediatrician for covered children) who is available to accept new patients. UPMC Health Plan continues to be committed to making sure its members receive the best and most convenient care possible.

Our members will see no change with the new requirements because UPMC Health Plan members are not restricted to a subset of in-network doctors or pediatricians they may choose as their PCP. Also referrals and prior authorization for ob-gyn services are not required.

Matching cost-sharing for emergency care out-of-network — Under the ACA, health plans that cover emergency services must cover emergency services without requiring prior authorization, even when a member is treated at an out-of-network emergency facility. Additionally, the out-of-pocket costs (copayments and coinsurance) paid by a member must be the same for in-network and out-of-network emergency care.

UPMC Health Plan already covers emergency services without prior authorization whether they are received in- or out-of-network.

Ban on salary-based discrimination — Under the ACA, fully-insured group health plans will not be permitted to charge different premium rates, provide better benefit packages, or establish any eligibility rules for coverage that favor highly compensated individuals.

At times it may seem difficult or even impossible to read all the information being released about health care reform. UPMC Health Plan has an entire department dedicated to assist you in understanding how the changes will affect you. Please visit our website often to learn about health care reform.

*Grandfathering is the ACA term for allowing the continuation of certain health insurance coverage that was in effect before March 23, 2010. Employer groups that have grandfathered status are exempt from making some changes that would otherwise be required. To maintain grandfather status, a plan can only make very limited changes to their plan’s design or members’ cost-sharing. Members who have grandfathered coverage must receive a notice with their coverage enrollment or renewal materials that indicates they are members of a grandfathered plan.

Health care reform — What’s now? What’s next? What’s new every week?

Visit www.upmchealthplan.com and select the Health Care Reform Information icon. Learn more about near-term and long-term changes brought about by health care reform. We’ll keep you updated as new information from the government is released.

UPMC Health Plan Pittsburgh Half Marathon is May 15, 2011

UPMC Health Plan is proud to again sponsor the Pittsburgh Half Marathon for 2011. The half marathon, which is 13.1 miles, is the nation’s fastest growing race category.

The marathon offers runners and walkers an exciting course that crosses Pittsburgh’s three rivers.

To register and learn more about the UPMC Health Plan Pittsburgh Half Marathon, visit www.pittsburghmarathon.com.