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healthy mind
healthy body
FALL 2005
YOUR OXFORD
®
GUIDE TO LIVING WELL
Pillow talk:
sleep and your health
Managing arthritis
Fending off flu
MS-05-1184
More choice for you:
Oxford’s expanded regional network
Did you know?
Preliminary data from researchers at Tufts University suggests that
the leading source of calories in the average American diet may not
come from any one food, but from
soda and sweet
drinks. In the recent National Health and Nutrition
Examination Survey, over two-thirds of the respondents reported
consuming more daily calories from soda and sweet drinks than
from any other food. Incidentally, these same respondents had
higher rates of obesity. So if you are looking to cut calories in your
diet, the answer may be at the bottom of a tall glass of water.
Common foods may someday play a role in
O
pain
management. Researchers from The Johns Hopkins
Hospital conducted a study recently to investigate unsubstantiated
reports that tart cherries could reduce pain in certain chronic medical
conditions. The study, which used laboratory rats, found that extracts
from tart cherries, called anthocyanins, did reduce pain and swelling
related to inflammation. In fact, the extracts were as effective as
medications commonly used to treat pain and swelling. While the
link between diet and pain management is just beginning to be
investigated, future research may open the door to additional
treatment options for people living with chronic pain.
O
According to a Yale School of Medicine study, listening to your
favorite music during surgery may decrease the amount
of sedation you need. Although previous studies had shown the link
between listening to music and a decreased need for anesthesia,
Yale researchers wanted to test if the decrease resulted from listening
to music or from simply blocking the noise of the operating room.
In the new study, surgery patients were randomly selected to wear
headphones and hear either their favorite music or white noise. A
control group was given no headphones and heard normal operating
room noises. The need for sedation during surgery was not reduced
in the test subjects listening to white noise, but was greatly reduced
in patients listening to music they liked.
O
CONTENTS
healthy mind
healthy body
FALL 2005
CEO, Northeast Region Kevin Hill
Chief Medical Officer and EVP Alan M. Muney, MD, MHA
Vice President, Marketing Chuck Green
Vice President, Marketing Communications Rebecca Madsen
Senior Marketing Manager Meg Dedman
Copy Editor Starlet Coleman
Editor Justin Colby
Healthy Mind Healthy Body® is published exclusively
for Oxford Health Plans by:
Onward Publishing, Inc.
10 Lewis Road, Northport, NY 11768
Phone 631-757-3030
Publisher Jeffrey Barasch
Creative Director Melissa Barasch
Editorial Director Wendy Murphy
Art Director Bruce McGowin
Designer Lisanne Schnell
Associate Creative Director Tamyra Zieran
Project Director Bret Barasch
Business Manager Liz Lynch
Oxford Health Plans, LLC and Onward Publishing, Inc.,
are not responsible for typographical errors.
This magazine provides general health information and,
as such, is neither intended to replace the advice of your
physician nor to imply coverage of referenced treatments
or medications. Please consult with your physician
regarding any treatment or medication that could impact
your health before proceeding with it, and refer to your
benefit documents for specific coverage information.
YOUR OXFORD
®
GUIDE TO LIVING WELL
4
COVER STORY
8
PREVENTION
9
Pillow talk: sleep and your health
Fending off flu
4
M E R G E R U P D AT E
More choice for you:
expanded regional network
10
SPECIAL TOPIC
12
WEB NEWS
13
O F VA L U E
14
MAKING PROGRESS
Managing arthritis
8
The new oxfordhealth.com
Dollars and sense
Coping with cancer:
Oxford lends a hand
16
NEWS YOU CAN USE
23
LIVING WELL
23
Oxford benefits update
Take a hike!
© 2005 Onward Publishing, Inc. All rights reserved.
Healthy Mind Healthy Body, which is designed to give you the latest information on a wide range of
health topics and your plan benefits, is available on our web site. Simply log in to your personalized account page at
www.oxfordhealth.com. As always, we encourage you to e-mail your comments to us at [email protected],
or write to: Oxford Health Plans, c/o Member Publications, 55 Corporate Drive, Trumbull, CT 06611.
4
COVER STORY
Pillow talk:
sleep and your health
Did you sleep well last night? How about the night
before? If your answer is “yes”, we’ve got great
news — getting a good night’s sleep is one way that
you can help your body to stay healthy and happy.
The work of sleep
Sleep may not seem like work for most people, but during sleep your brain and body are busy keeping your
nervous and immune systems running smoothly. Sleep is a time when nerves carry out cellular repairs —
giving new meaning to the phrase “beauty sleep.” And in children and young adults, sleep is the time when
growth hormones are released. But all sleep is not the same — sleep’s many functions are carried out at
different times during your slumber. Brain researchers track five phases of sleep that mark different depths
of sleep and brain activities. A complete cycle takes about 100 minutes, and, as anyone who has been
wakened suddenly knows, becoming alert out of a deep stage of sleep can be very difficult. The phase
during which dreams occur is the rapid eye movement or REM phase. REM sleep seems to play an
important role in learning and certain other mental skills.
5
The two fundamental processes that regulate
It doesn’t take long for your sleep debt to add up.
sleepiness are circadian rhythm (see You’ve got
In a study of sleep deprivation at the University of
rhythm on page 6) and the body’s physiological needs
Pennsylvania, investigators discovered that the effects
to restore its depleted reserves of energy. Circadian
of sleeping between four to six hours a night for 14
(which translates as “around a day”) rhythm is the
consecutive nights were equivalent to going without
body’s natural time-keeper; it’s tied primarily to the
sleep for up to three nights in a row.
cycle of sunlight and darkness. Most of us are naturally
inclined to spend our days awake and our nights asleep
because of two pinhead-sized structures in the brain
linked to light receptors in our eyes. When light intensity
drops, the body’s level of the hormone melatonin rises,
causing us to feel increasingly sleepy. Typically, there
are two predictable peaks of sleepiness each day — one
Sleep deprivation (lack of sleep) causes drowsiness,
impairs memory and makes it difficult to concentrate
and carry out complex thinking; it can affect your mood,
your job performance, even your ability to drive an
automobile. In fact, the National Highway Traffic
Safety Association estimates that 100,000 motor
vehicle accidents a year are sleep-related.
about mid-afternoon, the second just before bedtime.
Not getting enough sleep can also impact your
How much is enough?
The amount of sleep each person needs depends on
long-term physical health. Recent studies, as reported
by the NIH, suggest that disrupted sleep patterns
many factors; on average, infants require about 16 hours
may contribute to the onset of metabolic syndrome
a day, teenagers about nine, and most adults seven to
and excess weight gain in some people, particularly
eight, although extremes of as little as five hours and as
when combined with a high fat diet. Metabolic
many as 10 hours work for some people. The National
syndrome — defined as the presence of at least three
Sleep Foundation’s 2005 Sleep in America Poll found
of the following risk factors: high blood pressure, high
that, on average, American adults sleep 6.8 hours on
glucose levels (which can indicate a risk for diabetes),
weeknights. And, according to the National Institutes
high triglyceride levels, low levels of good cholesterol,
of Health (NIH), at least 40 million Americans have a
or large waistline — can increase a person’s risk for
chronic sleep problem, with an additional 20 million
heart disease and stroke.
experiencing occasional sleep difficulties. The reasons
why many Americans don’t get the nightly seven to
eight hours they may need are as varied as too much
Help is on the way
Fortunately, more and more research is being
late night television, a hectic schedule or, in some cases,
done on sleep deprivation, making it possible for all
a sleep disorder, such as sleep apnea (see Common sleep
of us to become better informed about sleep behaviors
disorders on page 7). International travelers, shift
and their effect on our health and well being.
workers and others who must adapt to schedules that
work against natural circadian rhythms are particularly
If you believe you may have a sleep problem,
talk to your primary care physician (PCP). He or
vulnerable to sleep disruption.
she may be able to make suggestions on how to
The effects of sleep debt
change your sleep habits (see our suggestions on
page 6), or offer treatment options in cases of
When you don’t get enough sleep, you begin to
more serious sleep disorders.
accumulate a “sleep debt,” the balance of which will
continue to increase until you get the sleep you need.
6
COVER STORY
Stimulants and sleep
Sleep tips
Any substance defined as a stimulant is best avoided for four to six
For routine sleep problems, a change in your sleep habits may
bring some relief. Here are some time-proven measures to try:
hours before bedtime, especially if you have difficulties going to sleep
and staying asleep. Stimulants act on the part of the brain involved in
regulating mental activity, raising the level of alertness and increasing
heart rate, blood pressure and breathing rate, all of which counteract
the body’s natural tendency to slow down at night. The most widelyused stimulant is caffeine. Caffeine is found in coffee, as well as in
tea, chocolate, many carbonated drinks, and some over-the-counter
medicines. Stronger prescription stimulants in the form of amphetamines
or “uppers” are occasionally used by people who drive long distances
without adequate sleep, students who are cramming for exams, and
exhausted shift workers. These practices can lead to serious health
and safety problems.
• Avoid stimulants and depressants such as alcohol
before bedtime
• Set a schedule for sleeping; try and make it to bed at a set
time each night and get up the same time each morning,
even on weekends
• Expose yourself to sunlight or very bright lights on wakening
to help your biological clock reset itself each day
• If you have trouble sleeping at night, resist the temptation
to nap during the day
• Get 30 minutes of exercise daily, preferably five hours or
more before bedtime.
• Allow yourself an hour to unwind before bedtime; set the
mood for relaxation by taking a warm bath and brushing
your teeth well before bedtime; stop watching late evening
news or other stimulating TV shows
• Don’t drink anything after 8 PM to reduce nighttime wake-up
calls to the bathroom
• Minimize noise, light and excessive hot or cold temperatures
in the bedroom
• Reserve your bedroom for sleep; do not use it to watch TV,
read a book or do paperwork
You’ve got rhythm
Below are some of the highs and lows that are synchronized
with the body’s natural circadian sleep-wake patterns:
• Body temperature goes from its highest in the late afternoon
to its lowest between 4 AM and 6 AM, a differential often
noticeable when running a fever
• Pain tolerance is highest from 8 AM to 10 AM
• Manual dexterity and hand-eye coordination are best
between 3 PM and 6 PM
• Blood platelets are stickiest in the early morning, which
relates to the heightened risk for blood clots and strokes
in the early morning
• Immune resistance is most active in the morning
7
A pinched back nerve may also be to blame. Less common causes
are diabetes, Parkinson’s disease, thyroid and endocrine disorders,
and use of some medications. If you suffer from these cramps,
self-treatment may help: drink plenty of water during the day, do
stretching exercises several times daily including before bedtime,
wear proper footwear, and keep blankets loose at the foot of the
bed to prevent toes and feet from turning downward. If cramps
continue to disrupt sleep, consult your doctor. Muscle relaxants
and other medications may be advised.
Insomnia Almost everyone has occasional bouts of short-term
insomnia, which is marked by the prolonged inability to obtain
adequate amounts of sleep. Insomnia can be caused by jet lag,
illness or injury, indigestion, a stressful or traumatic event, or even
sheer excitement. If your insomnia goes away in a few nights,
there’s probably no harm done. However, longer bouts of insomnia
can be taxing, making you jittery and inattentive during waking
hours, and leaving you more susceptible to illnesses such as colds
and headaches. Chronic insomnia can impact your long-term health
(see page 5).
Common sleep disorders
Snoring About one in three older adults snores, and most of the
time it’s medically harmless to the snorer. Snoring can, however,
interfere with others getting a good night’s sleep and create tension
within the household. Snoring occurs when air flowing over relaxed
throat muscles causes the tissue to vibrate noisily. Snoring can be
caused by drinking too much alcohol late in the evening, chronic
nasal congestion or a deviated septum in the nostrils. Loud snoring
accompanied by interrupted breathing can signal the more serious
condition of sleep apnea (at right). If snoring is a concern, ask your
primary care physician (PCP) for advice. You may be advised to
lose weight, sleep on your side rather than your back, take a nasal
decongestant, or try some other simple solution. For severe snoring,
you may be referred to an otolaryngologist (an ear-nose-throat
specialist) for further treatment.
Nocturnal leg cramps Roughly 70 percent of adults older than age
50 experience these painful nighttime sensations. Muscles in the
calf or feet cramp up for no apparent reason and awaken the
individual with a sudden very painful contraction. Common causes
vary from daytime overexertion and prolonged sitting in positions
that stress the legs to wearing high heels and becoming dehydrated.
Sleep apnea Sleep apnea, second only to insomnia as a common
sleep disorder, is marked by interrupted breathing during sleep.
An estimated 18 million Americans are believed to have some
degree of sleep apnea, but besides feeling tired during the day,
few suspect that anything is wrong. The cause of sleep apnea is a
physical obstruction of the breathing mechanism — often due to fat
build-up associated with obesity or to loss of muscle tone in the
upper chest muscles. The latter is a condition often related to aging,
although high blood pressure, coronary heart disease, pulmonary
hypertension, stroke, and other conditions may also co-exist. This
may occur hundreds of times a night. Each apneic episode begins
as the effort to inhale creates suction that collapses the windpipe for
10 seconds to as long as 60 seconds. As oxygen levels fall, the brain
sends out signals that awaken the person enough to allow him or her
to tighten the muscles that open the windpipe: however, occasional
deaths do occur. The only reliable way to diagnose sleep apnea is
with an overnight stay in a sleep disorder laboratory where brain
waves, heart beat and breathing can be monitored for an entire sleep
cycle. Treatment may include weight loss, a change in sleep position,
and/or corrective surgery in rare instances. People with sleep apnea
should never take sleeping pills or other sedatives that may inhibit the
process of waking to refill their lungs after each apneic episode. O
8
PREVENTION
Fending off flu
Winter colds and coughs can
be irritating, but they are rarely
life-threatening. Flu is something
else altogether.
Influenza is hard on the body, causing fever, chills,
muscle aches, profound fatigue, intense headache,
coughing, sore throat, and nausea. And it can last
two weeks or more. Along the way, this virus can
set the stage for more serious secondary diseases
such as pneumonia, bronchitis or inflammation of
the heart and brain. According to the Centers for
Disease Control and Prevention (CDC), each year
the flu sends an estimated 200,000 people to the
hospital and is blamed for some 36,000 deaths.
Fortunately, flu vaccines are extremely effective in
At Oxford, we believe that it is important for at-risk
Members to be protected from influenza each year.
providing several months of immunity if taken before
For most plans, the Member copayment is waived
the onset of the flu season in early winter. Unlike many
when the vaccination is the only service received during
other kinds of vaccines, the flu shot must be updated
an office visit with your primary care physician (PCP).
yearly because the virus it combats changes slightly
Call your PCP to find out if, and when, you should get
from year to year. If you received a vaccination last
your shot (see the box below). While at your doctor’s
fall, it was most likely highly effective, but it may not
office, ask if you are up-to-date on your protection for
be a match for the strain of influenza predicted for this
bacterial pneumonia. Pneumococcal disease usually
flu season. Incidentally, the vaccine is safe for nearly
gets its start after a severe upper respiratory infection
all patients with very few exceptions (see the box
like flu, or sometimes after a bad cold. The bacterial
below), and rarely does anyone experience symptoms
pneumonia vaccine, which is also covered under most
greater than a headache or temporary sore arm.
plans, typically provides protection for 10 years.
Who should get the vaccine?
Unless a flu vaccine shortage develops again this year, the CDC
recommends an annual vaccination for roughly 60 percent of
Americans. People who fall into this broad group include the following:
• People age 65 years and older
• Young children ages six months to 23 months
• Children and teenagers, ages six months to 18 years, who take
aspirin daily
• Residents of nursing homes and other chronic care facilities
• Household members and other caregivers of infants under the age of
six months (children under the age of six months cannot be vaccinated)
• Healthcare workers who provide direct, hands-on care to patients
• Adults and children age two and older with chronic lung
or heart disorders including heart disease and asthma
People who may not be able to tolerate flu
vaccine include:
• Adults and children age two and older with chronic metabolic
diseases including diabetes, kidney diseases, blood disorders
such as sickle cell anemia, or with weakened immune systems
including persons with HIV/AIDS
• Anyone allergic to eggs
• Pregnant women
O
• Anyone who has had a severe reaction to flu vaccine in the past
• Anyone with a history of Guillain-Barre Syndrome
• Anyone who has a fever or is severely ill
• Any child under six months of age
M E R G E R U P D AT E
More choice
for you:
Oxford’s expanded regional network
We are happy to bring you news about one of the ways Oxford Members
can benefit from our merger with UnitedHealthcare. On July 1, 2005,
we integrated the majority of the tri-state (New York, New Jersey and
Connecticut) UnitedHealthcare and Oxford Health Plans commercial
physician networks. Combining the networks leverages the best of both
companies to give you more choice and more options.
How many physicians are
being added?
• Hospital and ancillary-based providers
(e.g., anesthesiologists)
• Behavioral health providers
The integration of Oxford Health Plans and
UnitedHealthcare commercial physician networks
has resulted in a total tri-state network of over
65,000 providers.*
• Connecticut: Added ~ 500 physicians to
the Oxford Freedom Network
• New Jersey: Added ~ 1,400 physicians to
the Oxford Freedom Network
• New York: Added ~ 2,000 physicians to
the Oxford Freedom Network
• Chiropractors
• Complementary and alternative medicine providers
• Physical and occupational therapists
• Providers outside of the tri-state service area
• Providers with special contractual arrangements
By 2007, we hope to have the entire tri-state
network integrated.
What does this mean for you?
In addition to Oxford’s already broad existing network,
Is the entire tri-state physician
network being integrated?
Approximately 65 to 70 percent of the
UnitedHealthcare/Oxford Health Plans commercial
tri-state networks are being integrated at this time.
The following categories of facilities and specialties
are not integrated at this time:
you can now access additional providers in the tri-state
area who used to participate only with UnitedHealthcare.
To locate participating providers, please go to
www.oxfordhealth.com and click on Members,
and then the Search tab. New rosters will be available
soon. To request a copy of our Roster of Participating
Physicians and Providers, please call Oxford’s Customer
Service Department at 1-800-444-6222, or at the number
• Hospitals and ancillaries (radiology providers,
urgent care facilities, etc.)
on your Oxford ID card.
Please note: Oxford policies and procedures, including
* Oxford’s Liberty Network remains unchanged and continues to support
Oxford’s Liberty products.
referrals and precertification, will continue to apply.
O
9
10
SPECIAL TOPIC
Managing
arthritis
Arthritis is a term that describes a group of more than 100 diseases that can cause pain,
stiffness and swelling chiefly in the bony joints, but also in long bones, tendons, ligaments,
muscles, and occasionally some organs. Despite the number of conditions classified as
arthritis, just two forms account for the vast majority of arthritic conditions — osteoarthritis
(osteo referring to bone) and rheumatoid arthritis (rheumatoid indicating inflammation).
Osteoarthritis
Known as degenerative arthritis, osteoarthritis (OA) is a chronic disease affecting an
estimated 21 million adults in the United States. Although often associated with the elderly,
nearly two-thirds of people with arthritis develop a degree of the disease well before age 65;
in fact, by the time most people reach age 40 an examination of their skeletal frame will
show early signs of arthritis. By age 70, virtually no one escapes OA entirely, although women
are more likely overall to develop OA and at a younger age.
OA’s underlying cause is the gradual erosion of cartilage, a thin layer of tissue that cushions
the ends of bones at the joints. As this cartilage becomes frayed and thin, the bearing surfaces
of the bones rub together. Microscopic bits of cartilage and bone flake off and create a gritty,
grinding friction, which causes the bones beneath to become pitted and rough. Irritating
chemicals are released to cause further pain and swelling, and additional small bone spurs
may develop. Not all parts of the body suffer equally. Many people may have only one
or two areas that produce intermittent mild pain, while others may develop degenerative
arthritis in a number of areas. Joints that receive repeated stress or injury — typically the
hips, knees, elbows, spine, fingers, and toes — are the most likely targets, so people who
engage in bone-crunching sports or repetitive, stressful action on the job are likely to pay
a price later. Excess weight, which stresses the body’s structural support system, is also
a contributing factor in osteoarthritis.
Rheumatoid arthritis
Rheumatoid arthritis (RA) affects roughly one percent of the population, with women
accounting for three of every four cases. RA differs from osteoarthritis in that it is a form
of autoimmune disease, in which the body’s own immune system turns against itself,
specifically inflaming the synovial membrane covering the ends of each bone in the joint.
The synovial membrane produces excess fluid that swells the joint to cause severe pain and
stiffness. RA characteristically settles first in the small joints of the hands and feet, and tends to
be symmetrical — occurring with equal pain and swelling on both sides of the body. About one
in 10 people later develop RA in other areas and experience the disease in a disabling form.
11
Oh, the pain of it
• In advanced cases of OA, where major joints become
deformed, arthroplastic surgery — to make surfaces
Diagnosing arthritis can be difficult because some signs
and symptoms are common to many different diseases.
smooth again or to replace damaged bones with
artificial parts — is a remarkably effective option
But in most cases, your primary care physician (PCP) will
be able to diagnose your particular disorder on the basis
Treating rheumatoid arthritis
of a medical history, physical exam and laboratory tests
(if necessary). During the history, you will be asked
Because the underlying causes of RA are not yet known,
how long you have had the pain, whether the pain is
there is no strategy to bring about a cure. Early and
in the joints or elsewhere, what it feels like and when
aggressive treatment that includes drugs, physical therapy
it occurs, and how severe it is at its worst. You will also
and other modalities is regarded as the best means to
be asked if you have a family history of arthritis and
reduce the otherwise inevitable damage to cartilage and
about past illnesses or accidents, as well as if there are
bone. During periods of remission — when stiffness,
any medications you may be taking that might account
pain and swelling may disappear for a time — treatment
for your pain. Keeping a daily pain journal in the days
must continue in 95 percent of cases because it is the
before your first appointment is a good way to gather
best means of reducing or delaying flare-ups.
accurate information.
Your PCP will also examine your joints for tenderness,
Treatment of RA often includes:
• Combinations of NSAIDs, disease-modifying anti-
redness, swelling, ease of movement, and any deformities.
rheumatic drugs (DMARDs) such as methotrexate
If something other than osteoarthritis is suspected, your
and/or corticosteroids, and in some cases, new
doctor may also do a full body examination and run
drugs that are promising additions to the current
some laboratory tests including several kinds of blood
treatment options available
tests, urinalysis and possibly a test of synovial fluid,
which involves using a needle to withdraw a small
amount to fluid from around your joints. Your doctor
• Heat and cold therapies, water therapy, mobilization
therapy (traction and massage), and relaxation therapy
to aid in maintaining mobility and reducing pain
may also order x-rays or other imaging procedures.
• Exercise to maintain and increase flexibility and
Treatment of OA in its early stages can usually limit
symptoms, but if your condition is advanced or if there
are complications, your PCP may refer you to a team
strength, as well as endurance (aerobic) exercise
to improve cardiovascular fitness and improve
overall well-being
of specialists led by a rheumatologist (an internist who
has specialized training in arthritis treatment).
• Assistive devices such as splints and braces
support weakened joints, but only when they
Treatments for osteoarthritis
are fitted professionally and the wearer is trained
in proper usage
Treatment of OA focuses on reducing symptoms,
starting conservatively:
• Stress management techniques ranging from
biofeedback and relaxation techniques to family
• Anti-inflammatory drugs such as aspirin and
counseling therapy
non-steroidal anti-inflammatory drugs (NSAIDs)
are usually adequate to manage mild arthritis;
several new drugs actually mimic synovial fluid
when injected into painful joints
• Nutritional supplements including glucosamine
and chondroitin sulfate may be recommended
• Liniments and ointments offer short-term relief, but
direct application of heat generally gives better results
• Surgery to repair or replace a damaged joint, restore
function or reduce pain
• In severe cases where mobility is limited or pain
excessive, extensive physical and occupational therapy
The best long-term program for maintaining an
active and productive life with RA must also include
patient education to gain a realistic understanding
of how to best manage the disease.
• Massage and mild exercise focused on the arthritic
joints can reduce stiffness
O
12
WEB NEWS
The new
oxfordhealth.com
Your satisfaction is important to us.
That’s why we are continually looking for ways to
make your experience with Oxford a positive one.
To help make your web transactions with Oxford even
more convenient, we have updated the look and feel
of our web site. Our new site is more visually pleasing,
and we’ve reorganized some of the tools, features and
resources to make them easier for you to find.
If you are an Oxford Member and you have not
visited our site, register today. As a registered user
of www.oxfordhealth.com you can:
• Check your benefits and review the status of
claims and referrals
• Learn more about how to save money on
health-related products with our Healthy Bonus®
Member discount program, learn about offers
and how to redeem them*
• Notify us about a pregnancy or new arrival
• Make informed healthcare decisions using the
Subimo® Healthcare Advisor™ to compare
prescription medications, treatments and hospitals
• Search for participating physicians, facilities and
complementary and alternative medicine providers
• Download important forms including the
Student Verification Form and Coordination
of Benefits Form
• Access ConsumerLab.com, which offers
independent test results of vitamins, minerals
and supplements based on criteria including
strength, purity and consistency
Whether you are new to www.oxfordhealth.com,
or just haven’t logged in lately, visit today and see all
our Member web site has to offer to make doing business
with us even easier. The tools and resources available
on www.oxfordhealth.com will assist you in managing
your healthcare at your convenience. O
* Healthy Bonus offers are valid through December 31, 2005. These offers are
not insured benefits and are in addition to, and separate from, your benefit
coverage through Oxford Health Plans. These arrangements have been made
for the benefit of Members, and do not represent an endorsement or guarantee
on the part of Oxford. Discounts may change from time to time and without
notice and are applicable to the items referenced only. Offers are subject to
the terms and conditions imposed by the vendor. Oxford Health Plans cannot
assume any responsibility for the products or services provided by vendors
or the failure of vendors referenced to make available discounts negotiated
with Oxford; however, any failure to receive discounts should be reported to
Oxford Customer Service by calling the number on your Oxford ID card.
O F VA L U E
Dollars and$ense
It is an undeniable fact: Medical care is expensive and costs continue to grow. Routine
medical procedures are becoming more sophisticated, involving technologies and
equipment that was not even dreamed of a few years ago. Doctors can now
prescribe a host of pharmaceutical drugs to treat many once untreatable
conditions. All of us celebrate these medical advances, but they are costly.
Rising healthcare costs nationwide have impacted both
Members and employers. As costs rise overall, many
employers are opting for plans that give their employees
more control, and conversely, more responsibility for
managing the costs of their healthcare.
There are steps you can take to keep your out-of-pocket
costs in check. To start, be a savvy consumer. Here are
some tips to help you to save money and to become a
more educated healthcare consumer, using the resources
available through your Oxford plan:
Become well-informed about the medications you
take. Ask whether your prescription drugs may be
available in a less expensive over-the-counter or generic
version before you and your doctor choose an expensive
brand name drug. Oxford Members can find a wealth
of information about medications with the Subimo®
Heathcare Advisor, available by logging into
www.oxfordhealth.com, and clicking on Tools
For non-emergent healthcare
guidance, take advantage of
Oxford On-Call ®, which permits
you to speak to a registered nurse
any time of the day or night.
Also, take a hard look at
your health risk behaviors.
Pay attention to your blood
pressure, cholesterol profile, sleep needs, and diet. Do what
good sense and your doctor recommend to keep yourself in
optimum health. Make it your goal to change behaviors
that put you at higher risk of illness, accident or disability.
For example:
• If excess weight puts you at risk for developing diabetes
or heart disease, ask your physician for information
about reasonable, sustainable programs to help you
lower those risks
• If you exercise less than 30 minutes a day three
times a week, join an exercise program
and Resources.
Take advantage of the wellness checkups, screenings
and vaccinations your plan offers at no out-of-pocket
cost. Preventive care is a good defense against developing
costly, debilitating illnesses, impacting not only how
much you spend on care, but also your quality of life.
Treat yourself to a Healthy Bonus®. With our
innovative program, you can save money on weight loss
programs from LA Weight Loss and Weight Watchers,®
select stress-relieving products from Brookstone® or
smoking cessation programs from Quitnet. For more
®
information, log on to www.oxfordhealth.com and
click on Healthy Bonus Member Discounts under
Tools and Resources.
Avoid using the emergency room for non-emergent
situations. You will save money with the lower out-ofpocket cost usually associated with an office visit, and
in most cases, receive care from a provider who has a
more complete picture of your medical history.
• If you abuse alcohol or smoke, enroll yourself in a
program that will give you the support you need to
change these habits
• If you have a chronic disorder like kidney or heart
disease that requires daily management, become an
expert on how to eat properly, take your drugs according
to plan, and monitor and report your symptoms
• If you experience frequent stress, find a relaxation
program that helps you get it under control; too much
stress simply wears out every part of your body faster
• If you have mood disorders including depression and
anxiety, recognize that you can get help
The rising cost of healthcare is an issue that affects
all of us. Being an informed patient and consumer of
healthcare is more important than ever. Luckily, as
an Oxford Member, you have access to many resources
to help you along the way. O
13
14
MAKING PROGRESS
Coping with cancer:
Oxford lends a hand
A diagnosis of cancer can be terrifying, both for the patient and his or
her loved ones. Few of us are prepared for the consequences of treating
this difficult disease.
Yet according to the American Cancer Society, over one
Together they offer customized support to the Member,
million Americans get cancer every year. Many, if not the
his or her physicians and family caregivers, providing a
majority of cancer patients, become survivors thanks to
wealth of services that support medical treatment.
recent advances in early detection and treatment options,
The Oncology Program focuses primarily on assisting
as well as a better understanding of what causes cancer
Members with a potential to develop complications
and how to confront the disease.
associated with cancer treatment and is offered to Members
Oxford is here to help Members confronted with a
diagnosis of cancer. Through our extensive Oncology
that are over the age of 18 and in active treatment.
One of the key services Oxford provides is a proactive
Program, we reach out to high-risk cancer patients
approach to symptom management. Cancer treatment
when they are undergoing active treatment. Patients
often involves aggressive therapies, such as radiation
entering the program are assigned a case management
and chemotherapy, which may cause the patient physical
team consisting of a registered nurse and a social worker.
stress and, at the same time, compromise his or her
15
immune system. Access to knowledgeable, reassuring
Many added that Oxford’s caring exceeded their
case managers can make a tremendous difference in
expectations. Nothing could please us more.
how well patients and their families feel about what’s
If you think that you or a covered family member
happening to them. The case management team is
may be may be eligible for this program, please call the
also able to complement the physician’s treatment
Oxford Oncology Program directly at 1-800-835-8021.
O
program and can coordinate additional services such
as home nursing if needed.
In the more than two years that Oxford has been
offering its comprehensive Oncology Program, Members
have overwhelmingly voiced their appreciation. In a
survey conducted in 2004, 94 percent of Members said
that the program was either “extremely helpful” or
“helpful” in managing their health more effectively.
O
OX F O R D I N F O
Oxford Members have access to eCancerAnswers.com,
an online source of reliable and timely information on cancer
risk, diagnosis and care solutions. To access these resources,
log in to the newly redesigned www.oxfordhealth.com and
click Tools and Resources. Under Manage Your Health,
click Managing Disease.
Patients’ voices
In the past year, Oxford Health Plans’ Oncology Program has touched the lives of almost 3,500 Members and their families.
Each of these Members received individual case management from one of our case managers and social workers with special
training in cancer care. Frequently, we get calls and letters letting us know how much the program is appreciated by those
who use it. We’d like to share some of the comments we’ve received:
“As soon as I came home from the hospital, Anqi, my nurse, and Sheryl, my social worker, were there for me, calling often
to see how I was doing, if I needed any special help. I live alone so those calls are especially appreciated, and here it is a
year later and they are still there. I think they’re great!”
A Member coping with lung cancer
“If I’m not feeling well, Donna and Renee seem to know even before I do, and they’re on the phone to ask what’s going on.
They always have ideas to help me when I’m not tolerating the medicine so well. I’ve gotten so I think of them as personal
friends, and they tell me I can call just to talk any time. That’s important because my friends and family really don’t know
how to relate to what I’m feeling sometimes, so I keep my problems to myself until I can speak to Donna or Renee.
Then I can let my hair down.”
A Member coping with breast cancer
“You can’t believe how much it helps mentally to know that someone cares about you when you’re feeling low. Oxford put
me in touch with Gail, one of the program’s nurses. Gail began calling me, even before my surgery, to tell me what to expect
and what I would need when I came home. It made a difficult situation a lot more bearable.”
A Member coping with colon cancer
“I count my blessings really. I live alone but I’m still managing very well, and I give a lot of the credit to my nurse, Kathy. I call her
a ‘perfect’ nurse — intelligent, full of useful information and kind enough to listen to my complaints when I need to tell someone.
One time when I fell and it seemed as though I might have to go into some kind of home, she worked out some home care
until I was able to take care of myself again. Oxford has also put Vivian, a social worker, on my case. Vivian has helped me
think about long-term planning. It’s all a lot more help and comfort than I had counted on. Thank you, Oxford.”
A Member coping with lung cancer
“Laurise, my husband’s case manager, is an angel from heaven. She’s been with us every step of the way, and even though
she and I have never met face to face, I feel as though I know her like an old friend. Sometimes, there are things about this
cancer experience that I can’t talk to my husband about; but even though I’m not the patient, I get the same kind of attention
and caring from Laurise that he does. I can tell you, it makes a big, big difference in keeping me going. She’s also great in
helping with all the paper work and forms — she’s very patient explaining what I need to do. Laurise is great, but then I’ve
never met anyone at Oxford who wasn’t ready to help.”
The wife of a Member with pancreatic cancer
16
NEWS YOU CAN USE
O
OXF OR D | B E N E F I T S U P D AT E
“It just makes sense for our
You: The Owner’s Manual
company to be involved in the Heart
You: The Owner’s Manual is a fun and
Walk,” said Alan Muney, MD, Chief
informative guide to the intricate workings
Medical Officer at Oxford. “Through
of the human machine. Recently featured on
our work with organizations like the
The Oprah Winfrey Show, this New York
AHA, our direct collaboration with
Times bestselling book is based on information
gathered from over 30,000 articles from a variety of
sources. You: The Owner’s Manual offers not only facts
about the body, but more importantly, steps that you can
take today to improve your health and well-being. For
more information, visit www.youtheownersmanual.com.
Heart Walk: “Change Tomorrow.
Today.”
Members and physicians, and our
wellness and outreach initiatives,
we strive to improve the health of our Members and
communities.” In its history, Heart Walk has raised
more than $406 million for research and education. Last
year through the Heritage Affiliate alone, 35,000 walkers
participated in 14 walks raising more than $4.7 million.
This year’s Heart Walk will take place in towns and
cities across the country. If you are interested in joining
Oxford Health Plans is teaming up with the Heritage
a Heart Walk or starting a company walk team, visit
Affiliate of the American Heart Association (AHA) as the
www.americanheart.org or call 1-800-AHA-USA1.
presenting sponsor for this year’s tri-state Heart Walk to
help the AHA’s fight against heart disease and stroke.
The Heritage Affiliate is made up of the New York,
New Jersey and Connecticut chapters of the AHA.
“We are very happy for Oxford’s support of the
New health management
tool for Oxford Members
As an Oxford Member, you now have access to
even more information on health and well-being
American Heart Association’s efforts to help improve
at www.oxfordhealth.com. Our newest tool,
the cardiovascular health of residents in the tri-state
HealthForums®, offers Members a range of features,
area,” said Richard M. Hodosh, MD, president of the
including online discussion boards, symptom guides,
Heritage Affiliate’s Board of Directors and Medical
an audio library, and articles about living with acute
Director of the Atlantic Brain and Spine Institute at
and chronic diseases.
Overlook Hospital in Summit, New Jersey.
Major cardiovascular diseases are the country’s
In addition, HealthForums offers a host of assessment
tools to help you track measures such as cholesterol
leading cause of death, with heart disease and stroke
and blood pressure over time, and help pinpoint areas
the nation’s number one and number three causes
in which you and your doctor may want to discuss
respectively. However, AHA-funded research has
making changes.
yielded many important discoveries, such as cardio-
To explore all of the features of HealthForums, log
pulmonary resuscitation (CPR), life-extending drugs,
on to www.oxfordhealth.com today, click on Tools &
pacemakers, bypass surgery, the heart-lung machine,
Resources, find Manage Your Health, and then click
and surgical techniques to repair heart defects.
on HealthForums.
17
One more incentive to make it
to the gym
jeopardy, or in the case of a behavioral condition, placing
the health of such Member or others in serious jeopardy;
(b) serious impairment to the Member’s bodily functions;
At Oxford, we believe that preventive care is vital to
staying in good health. And one of the best things we
(c) serious dysfunction of any bodily organ or part of such
Member; or (d) serious disfigurement of such Member.
think you can do to promote good health is to exercise
on a regular basis. That’s why Oxford makes it easy and
affordable to reap the healthy benefits of regular exercise,
Non-emergent emergency room utilization
We have recently identified an overuse of the ER for
through our Exercise Facility Reimbursement program,
non-emergent matters. When ER services are used
where available.*
inappropriately, there may be a number of unfavorable
Active people know that exercise is an important part
of preventive care and that it can help lower risks for
outcomes, including:
Higher out-of-pocket costs Generally, the copayment
a number of conditions. But did you know that with
required for ER care is considerably higher than the
many Oxford plans, Members can receive up to $200
copayment required for an office visit. Also, non-emergent
back every six months, just for verifying that they have
care received in the emergency room is not covered.
completed 50 visits to an eligible exercise facility?
To determine if you are eligible for exercise facility
Rising costs of healthcare Non-emergent ER visits
contribute to the rising costs of healthcare. The total
reimbursement, please refer to your Certificate of
cost of an ER visit far exceeds the costs of being seen
Coverage or contact your benefits administrator.
by your PCP in an office setting. Because only your
To obtain an Exercise Facility Reimbursement Form,
PCP and specialists will know your full health history,
log on to www.oxfordhealth.com and click on Tools
non-urgent tests and treatments received in ER settings
and Resources. Then select Download Forms under
can be costly and unnecessary.
Practical Resources.
* The gym reimbursement benefit is not available
to Members enrolled in Connecticut plans.
Member Satisfaction Survey Results
The results of the 2005 National Committee for Quality
Assurance (NCQA) 2004 Member Satisfaction Survey
How to obtain emergency care
At Oxford, we strive to make accessing care as simple
as possible. Members who seek emergency room (ER) care
for medical emergencies do not need to contact Oxford
have been reported. Members’ opinions of Oxford have
continued to improve especially in overall health plan
rating, placing Oxford above the national average.
Members continue to be satisfied with Oxford’s
prior to receiving treatment and are not required to notify
network of doctors and specialists especially in New
Oxford of the visit if they are treated and released. If the
Jersey and Connecticut. In addition, results show a
Member is released, it is his or her responsibility to pay
marked improvement in Members’ experiences with
the applicable out-of-pocket cost at the time of the ER
providers and office staff. This reflects Oxford’s
visit. However, if the Member is admitted to the hospital
continued commitment to provider outreach in order
through the ER, the ER copayment will be waived.
to enhance and improve provider-member relationships.
Areas of notable improvement include claims processing,
Medical emergency
A medical emergency is generally defined as a medical
or behavioral condition for which the onset is sudden.
especially in the New Jersey and Connecticut areas,
while Members in New York have rated Oxford above
the national average in customer service.
The condition manifests itself by symptoms of sufficient
severity, including severe pain, that a prudent layperson,
possessing an average knowledge of medicine and health,
could reasonably expect the absence of immediate
medical attention to result in (a) placing the health of
the afflicted Member with such a condition in serious
Oxford has already implemented initiatives for
improvement in Customer Service, Claims and Appeals,
and will continue to work to improve your satisfaction.
If you have recommendations, please contact us at
[email protected].
18
NEWS YOU CAN USE
Student verification process
These possibilities also make it necessary and important
for providers and patients to keep each other informed.
This year, Oxford’s student verification process will be
conducted via telephone by Silverlink Communications®.
In October, parents of children who have reached the
student age outlined in their Certificate of Coverage
will receive an automated phone call with a series of
“yes” or “no” questions to help verify the student status
of their dependents. Parents may verify the information
immediately or call a specified number to verify the
information at their convenience. This process was
Please note: The Behavioral Health Department, in
conjunction with a panel of participating behavioral
health specialists, has developed a Release of
Information Form that allows BEH specialists and
PCPs to share treatment information. This form
can be signed by you in the presence of your
behavioral health provider (but is not mandatory),
and gives him or her permission to contact your PCP.
Oxford’s grievance procedures
used in November of last year in order to confirm
outstanding verifications.
Although Oxford strives to offer Members programs
and services to make their healthcare experience a
Dependents who have reached the student age and
are not full-time students will no longer be eligible
for coverage and will be terminated from the plan on
December 31, 2005. During the first week of December,
a final termination letter will be sent to the subscriber
confirming the student’s upcoming termination
from the plan.
Coordination of care
positive one, we understand that from time-to-time a
Member may wish to formally report a complaint. That
is why Oxford has developed a meaningful, dignified
and confidential grievance procedure to hear and resolve
Member grievances. If a Member has followed the
required grievance procedure and is not satisfied with
Oxford’s final decision, the Member may be entitled
to appeal the decision with an independent, external
agent of the appropriate state. Information on how to
It is important that all providers rendering your care
share treatment information. It is equally important
for you to be an active partner in your care. You can
do this by maintaining an open dialogue with your
providers about all forms of treatment you receive.
Failure to maintain an open dialogue with your
providers can result in fragmented care. Fragmented
submit an external appeal is outlined in your Certificate
of Coverage and Member Handbook, as well as in the
initial denial letter and all subsequent appeal decision
letters. For information about grievances and external
appeal procedures, please call Oxford’s Customer Service
Department at the number on your Oxford ID card or
at 1-800-444-6222.
care occurs when primary care physicians (PCPs) and
specialists treat you at the same time, but are not aware
of the other providers’ treatment or involvement. PCPs
and specialists capture different information when
determining your treatment plan, and combining this
information is essential to forming a complete picture
of your health status.
At Oxford, we understand that behavioral health (BEH)
Important news for heart
attack survivors
The American Heart Association and the American
College of Cardiology recommend that nearly all
heart attack survivors remain on a combination of
medications to reduce the risk of another heart attack.
For most heart attack survivors, the recommended
is a sensitive and important issue. That said, it is
combination of medications includes aspirin, a beta-
especially important that BEH care be coordinated
blocker, an ACE-inhibitor, and a statin medication.
with traditional care, as well as complementary and
alternative medicine (CAM) care. A BEH provider may
be treating a disorder with a medical basis that affects
your physical health. Likewise, a PCP may be treating
a medical illness that can lead to BEH conditions, such
as depression. CAM providers can be used to assist in the
treatment of both medical and behavioral health problems.
It is important to consult your doctor before making
any changes to your medication. Stopping prescribed
medication suddenly or taking a prescription intended
for someone else can be unsafe. If it is necessary for you
to discontinue a particular medication, there are usually
alternatives that your doctor can prescribe that will
provide similar heart-healthy benefits.
19
Reminder: Roster of Participating
Physicians and Providers
The information contained in our Roster of
Reducing hospital infection
Hospital infections are a growing concern among
many healthcare professionals and their patients. Largely
Participating Physicians and Providers is available
preventable, these infections not only contribute an
online and is updated regularly. Simply log on to
estimated $4.5 billion a year to already rising healthcare
www.oxfordhealth.com and use the doctor search
costs, but in some cases, they can be fatal.
tool. To request a hard copy of the Roster of
Many hospitals and their staff are making efforts
Participating Physicians and Providers specific
to reduce patient infections. In addition, many states
to your network, click on Request Materials under
are developing legislation that will require hospitals
Tools and Resources, or contact Oxford’s Customer
to publicly report infection rates as a means of
Service Department at 1-800-444-6222 or at the
motivating even more hospitals to take action.
number on your Oxford ID card.
While these developments are promising, there are
ways that you, as a patient, can help reduce the rate
Reminder: reconstructive breast
surgery law
Federal law requires that all health plan Members
be notified of The Women’s Health and Cancer Rights
Act of 1998 on an annual basis. This Act applies to all
commercial policies that started or have been renewed
since October 21, 1998. The Women’s Health and
Cancer Rights Act, which amended existing federal
law (ERISA and the Public Health Service Act), requires
health insurance carriers of group and individual policies
that cover mastectomies to cover reconstructive surgery
or related services following a mastectomy. Oxford offers
of hospital infection.
What can you do to help prevent infection?
You can help reduce hospital infections by following
these recommendations prior to and during your next
hospital stay:
• Before any surgery, research your hospital’s
infection rate
• Shower frequently with antibacterial soap beginning
the week before your surgery
• When you have visitors, ask them to clean their hands
and avoid sitting on your bed
this benefit in all commercial products. Essentially, the
Act guarantees coverage for any plan Member who is
receiving services in connection with a mastectomy
and who elects breast reconstruction in connection with
• Ask your provider about the precautions that your
healthcare team may take to reduce the likelihood
of a hospital infection; these precautions may include:
that mastectomy. The health insurance company that
• Hand washing or use of gloves, when appropriate
issues the policy is required to provide coverage for:
• Preparation of the surgical site
• Reconstruction of the breast on which the
mastectomy has been performed
• Surgery and reconstruction of the other breast
to produce a symmetrical appearance
• Prostheses
• Treatment for physical complications arising at
any stage of mastectomy, including lymphedema
If you have any questions about this benefit, please
• Use of catheters and intravenous equipment only
when medically necessary
While it is impossible to eliminate hospital infections,
there are steps that we can all take to reduce infections
and their impact.
For additional information on patient safety and
hospital infections — including a link to the Subimo®
Hospital Advisor™, where you can compare hospitals
refer to your Certificate of Coverage or call Oxford’s
based on criteria such as clinical quality and
Customer Service Department at the number on your
experience — log in to www.oxfordhealth.com and
Oxford ID card or at 1-800-444-6222.
click on Patient Safety under Tools and Resources.
20
NEWS YOU CAN USE
2005 Adult Preventive Screening Guidelines
Procedures
Ages 18-39
Ages 40-49
Every 5 years
Every 2 years
Ages 50-64
Ages 65+
Health Screenings
Routine Preventive Health Assessment
Annually
At least every 2 years
Blood Pressure
C
Serum Cholesterol
Annually
Every 5 years
E
Hemoglobin
Age 20 or older, at least once every 5 years
B
UrinalysisB
At clinician’s discretion
Tuberculin Skin Test (PPD)B
For all those in high-risk groups
Under age 25 &
sexually active,
regular screening
Chlamydial Infection G ▲
Cancer Detection
Clinical Breast ExamA,I ▲
Mammography D,G ▲
Pelvic Exam and Pap Smear H ▲
Every 3 years or
at clinician’s
discretion
Annually
At clinician’s
discretion
Every 1 to 2 years
Pelvic exam: annually starting at age 19, regardless of the frequency
of cervical cancer screening. Pap smear: 3 years after first sexual
intercourse or by age 21, whichever comes first. Up to age 30,
annually. Age 30 and older, every 2-3 years after negative pap
smears on three consecutive annual tests, or no more frequently
than every 3 years after one negative combined Pap and HPV test.
Prostate Specific Antigen (PSA)D,G ■
At clinician’s discretion
Digital Rectal ExamD,G
At clinician’s discretion
Fecal Occult Blood (FOB) Test A,I
At clinician’s discretion
Annually
Sigmoidoscopy/Colonoscopy
At clinician’s discretion
Flexible sigmoidoscopy every
5 years OR Double contrast
barium enema every
5 years OR Colonoscopy
every 10 years
A
Immunizations
Diptheria and Tetanus Booster F
Every 10 years
Hepatitis B Vaccine F
One series for persons with medical, behavioral,
occupational, or other indications
Hepatitis A Vaccine F
One series for persons with medical, behavioral,
occupational, or other indications
Influenza Vaccine F
Annually with chronic
disease/high-risk
Pneumococcal Vaccine*,F
▲
Women Only
■
Men Only
Initial dose for those at high risk
Annually
One dose for
unvaccinated.
Revaccinate
after 5 years
for high-risk
* Revaccinate if less than age 65 when initial dose was received and if received more than five years ago.
Sources for information presented in guidelines above:
A. American Cancer Society, 2004. www.cancer.org
B. Centers for Disease Control and Prevention, 2003
C. Joint National Committee on Detection, Evaluation, and Treatment of
High Blood Pressure, 7th report, 2004
D. National Cancer Institute. Cancernet.nci.nih.gov/clinpdq 2002, 2003
E. National Cholesterol Education Program Adult Treatment Panel III, 2001
F. Summary of Adult Immunization Recommendations, Centers for
Disease Control and Prevention, 2004-2005
G. U. S. Preventive Services Task Force, 2nd Edition.
www.Hstat.nlm.nih.gov 2002
H. American College of Obstetrics and Gynecology, 2003
I. American Medical Association, 2004
21
Recommendations for Preventive Pediatric Healthcare
Each child and family is unique. Therefore, Recommendations for Preventive Pediatric Healthcare are designed for
the care of children who are receiving competent parenting, have no manifestations of any important health problems,
and are growing and developing in satisfactory fashion. Additional visits may become necessary if circumstances
suggest variations from the norm.
These guidelines represent a consensus by the Committee on Practice and Ambulatory Medicine in consultation
with national committees and sections of the American Academy of Pediatrics (AAP). The Committee emphasizes the
importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care.
O
Recommendations for Preventive Pediatric Healthcare
Infancy
Age
Prenatal
Newborn
Early Childhood
2-4d
By 1mo
2mo
4mo
6mo
9mo
12mo
15mo 18mo
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
24mo
3y
4y
•
•
•
•
•
•
•
•
•
•
•
•
History
Initial/Interval
•
Measurements
Height and Weight
Head Circumference
Blood Pressure
Sensory Screening
Hearing
s
o
s
s
s
s
s
s
s
s
s
s
s
s
s
s
s
s
s
s
s
s
o
s
o
o
Developmental/
Behavioral Assessment
•
•
•
•
•
•
•
•
•
•
•
•
•
Physical Examination
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
✦
✦
✦
✦
✦
✦
Vision
Procedures — General
Hereditary/Metabolic Screening
Immunization
Hematocrit or Hemoglobin
Urinalysis
Procedures — Patients at Risk
✦
Lead Screening
✦
✦
Tuberculin Test
✦
✦
Cholesterol Screening
STD Screening
Pelvic Exam
Anticipatory Guidance
Injury Prevention
Violence Prevention
Sleep Positioning Counseling
Nutrition Counseling
Dental Referral
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
(continued)
22
NEWS YOU CAN USE
Recommendations for Preventive Pediatric Healthcare (continued)
Middle Childhood
Age
Adolescence
5y
6y
8y
10y
11y
12y
13y
14y
15y
16y
17y
18y
19y
20y
21y
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Vision
o
o
o
o
s
o
s
s
o
s
s
o
s
s
s
Hearing
o
o
o
o
s
o
s
s
o
s
s
o
s
s
s
Developmental/
Behavioral Assessment
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Physical Examination
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
✦
✦
✦
✦
✦
History
Initial/Interval
Measurements
Height and Weight
Head Circumference
Blood Pressure
Sensory Screening
Procedures — General
Hereditary/Metabolic Screening
Immunization
•
Hematocrit or Hemoglobin
Urinalysis
•
•
Procedures — Patients at Risk
Lead Screening
Tuberculin Test
✦
✦
✦
✦
✦
✦
✦
Cholesterol Screening
✦
✦
✦
✦
✦
✦
✦
✦
STD Screening
✦
✦
Pelvic Exam
✦
✦
✦
✦
✦
✦
✦
✦
✦
✦
✦
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Anticipatory Guidance
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Injury Prevention
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Violence Prevention
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Sleep Positioning Counseling
Nutrition Counseling
Dental Referral
KEY:
• to be performed
✦ to be performed for patients at risk
s subjective, by history
o objective, by a standard testing method
the range during which a service may be provided,
with the dot indicating the preferred age.
Please note: There is no copayment for pediatric immunizations or preventive care visits. If additional services are received during those visits, a copayment may apply.
LIVING WELL
Take a hike!
Fall is a great time to take a hike. Better still,
it’s a great time to adopt a new walking routine.
Walking is a nearly perfect low-impact exercise: it puts
Look for opportunities to incorporate walking into other
relatively little stress on knees and hips while giving
parts of your life, too. If possible, walk to work or get off
legs, arms and back muscles a vigorous workout. Walk
the bus a few stops short of your destination. Park your
for exercise 30 minutes every day and within a few
car at the far side of the mall and walk to the shops. Or
weeks you’ll probably see results — a drop in blood
take a stroll at lunch. If you have young children, set a
pressure, cholesterol levels, and you’ll strengthen the
good example and take a daily walk together.
efficiency and energy of your heart, lungs and circulatory
system. And don’t be surprised if you find that walking
lifts your mood as well; there are proven psychological
benefits to feeling fit and trim.
Get in stride
For most of us, exercise walking is easy and
inexpensive. The only required equipment is wellsupported, comfortable shoes. However, there is a
Keeping score
Keep a walking diary with daily times and distances
to motivate you. Many serious walkers use a pedometer,
a small, inexpensive instrument worn on your belt. Or
do the arithmetic yourself. The rule of thumb is 100
calories per mile for a 150-pound person. (For additional
calculations see the chart below.)
Overall health, rather than burning calories should
right way to walk to get the maximum benefit. Walk
be your primary goal. To lose a pound of fat strictly
tall with shoulders and hips relaxed, arms bent and
through walking requires that you walk about 35 miles,
swinging front to back, your hands loosely cupped.
which spread over a seven-day week, is five miles a day.
Your heel should contact the ground first; then roll
That’s a lot, especially for beginners. Instead, think of
your weight forward until you push off on your toes.
walking as a practical, inexpensive way to add exercise
Start with a pace that feels comfortable and, as your
energy and endurance grow, increase your daily time,
speed and distance by stages. If you’re motivated by
companionship, find a friend who will commit to
the same program.
to your day.
O
O
OX F O R D I N F O
Through Oxford’s Healthy Bonus® program, Members can purchase
a talking pedometer for a 15 percent discount off the regular price
of $25. To take advantage of these savings, call Brookstone® at
1-800-343-9855 and introduce yourself as an Oxford Member.*
Walking it off
The following chart indicates the number of calories burned
per mile walked based on your weight and walking speed.
Weight in pounds 100 120 140 160 180 200 220
Speed
Calories Burned Per Mile
2.0 mph
65
80
93
105
120
133
145
2.5 mph
62
74
88
100
112
124
138
3.0 mph
60
72
83
95
108
120
132
3.5 mph
59
71
83
93
107
118
130
4.0 mph
59
70
81
94
105
118
129
4.5 mph
69
82
97
110
122
138
151
* For more information on Healthy Bonus offers see page 12.
23
O
O X F ORD C O N TA C T I N F O
important
information
inside
Check out the latest news
about your Oxford coverage
CUSTOMER SERVICE 1-800-444-6222 (8 AM - 6 PM, Monday through Friday)
To reach a Service Associate, please call the toll-free Customer Service number on your Oxford ID card,
or call 1-800-444-6222. If you are hearing impaired and require assistance, you may call Oxford’s TTY/TDD
line at 1-800-201-4875. Please call 1-800-303-6719 for assistance in Chinese, 1-888-201-4746 for
assistance in Korean, 1-800-449-4390 para ayuda en español, or the number on your Oxford ID card
for assistance in other languages.
OXFORD ON-CALL® 1-800-201-4911 (24 hours a day, seven days a week)
Registered nurses offer you healthcare guidance, around the clock.
OXFORD EXPRESS ® 1-800-444-6222
(24 hours a day, seven days a week)
Touch-tone phone options let you confirm eligibility, check the status of a claim, request a new
Oxford ID card or physician roster, and more.
in the Benefits Update section
of this issue and start
making the most of
your health plan.
OXFORD’S FRAUD HOTLINE 1-800-915-1909 (24 hours a day, seven days a week)
If you suspect healthcare fraud on the part of Members, employers or providers, please call our
confidential fraud hotline.
DISEASE MANAGEMENT PROGRAM LINE 1-800-665-4686 (8 AM - 4:30 PM,
Monday through Friday) Oxford offers educational materials to help Members with diabetes, asthma
and depression understand their condition and become active participants in its management.
BEHAVIORAL HEALTH LINE 1-800-201-6991 (8 AM - 6 PM, Monday through Friday)
Behavioral Health Coordinators provide information such as referrals to behavioral health providers
or precertification for mental health or substance abuse services.
RESOURCES ON THE INTERNET AT www.oxfordhealth.com
• Log in with your user name and password to access your policy and benefit information, and perform
transactions such as checking claims’ status, selecting a primary care physician and ordering materials
and Member ID cards.
•
Learn more about Oxford’s various wellness resources, such as our Healthy Bonus® program and
Self-Help Library by logging in to our Member web site.
SM
*Except Thanksgiving and Christmas.
PRESORTED STANDARD
U.S. POSTAGE
PAID
P.O. Box 7081, Bridgeport, CT 06601
ONWARD PUBLISHING INC.
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