Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ ✦ Anticipatory Guidance • • • • • • • • • • • • • • • Injury Prevention • • • • • • • • • • • • • • • Violence Prevention • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 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. HMHBFA/8340