• A m e r i g r o u p C o m m u n i t y C A r e •

MakeHealthQuarter 4, 2012

Protect Yourself from the Flu

Member Services

tennCare1-800-600-4441

CHOICES1-866-840-4991

ttY 1-800-855-2880

ttY Español1-800-855-2884

Amerigroup On Call1-866-864-2544

1-866-864-2545 (español)

HappenInside this issue: Signs of

Sleep Disorders in Children

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Another flu season is here. Are you planning to get a yearly flu vaccine to help protect you from the flu? If not, consider these common myths:

“I am healthy, so I don’t need a flu vaccine.”Even if you are healthy, you need a flu vaccine to help prevent the flu. That’s why the Centers for Disease Control and Prevention (CDC) recommends the vaccine for everyone 6 months of age or older. For people with certain health conditions, the flu can lead to serious illness or even death. The flu vaccine will not give you the flu. To learn more, go online to www.cdc.gov/flu.

“I am pregnant, so I shouldn’t get a flu vaccine.”Actually, being pregnant is a major reason to get vaccinated. Pregnant women who get vaccinated pass the immunity on to their babies.

“I don’t like shots.”If you or a child is needle-shy, ask if the nasal spray flu vaccine is an option.

“I don’t know where to go for a flu vaccine.”Getting the flu vaccine is easy for Amerigroup members. You can get a flu shot from your Primary Care Provider (PCP) or your local health department.

Talk to your PCP about any questions or concerns you may have about the flu vaccine, especially if you have an egg allergy. He or she knows your health history. If you are age 65 or older, talk to your PCP about the pneumonia vaccine, too. this vaccine may also be needed for those under age 65 with certain health conditions.

zz zzzzzzz

n Self-care such as bathing or dressing?

n Getting around the home?

n Preparing meals?

n Doing household chores?

If so, you may benefit from TennCare CHOICES in Long-Term Care, or CHOICES for short. CHOICES is TennCare’s program for long-term care services. Long-term care services include care in a nursing home. Long-term care also includes care in your own home or in the community. These are called Home- and Community-Based Services, or HCBS. this type of care may keep you from having to go to a nursing home for as long as possible.

Do you or does someone you care for need help with things like:

You’ve Got CHOICES in Long-Term Care!

If you think you need long-term care services, you can call Amerigroup at 1-866-840-4991. To qualify for CHOICES, you must need the level of care provided in a nursing home and qualify for Medicaid long-term care.

At Amerigroup, we strive to make sure you receive quality health care. Are you getting proper information, care and services based on your health needs?

Our focus is to keep our members and providers informed. We provide education around wellness care, disease management and other important health-related topics. We want your health care providers to use the most current data about prevention, diagnosis, treatment and cost-effectiveness of your care.

For example, the American Cancer Society has guidelines about when you should have screenings for breast cancer, colorectal cancer and polyps and cervical cancer. It is your provider’s job to discuss these screenings with you and help you set up appointments for them. Your part is to make sure you keep the appointments with your provider for the checkups and screenings.

Every year at Amerigroup, we collect data through a tool called Healthcare Effectiveness Data Information Set, or HEDIS. We look at your provider’s records to make sure he or she is requesting that you get your screenings.

Here are some of our recent rates compared to the prior year:

the last column in this chart lets Amerigroup know that the scores in 2011 were lower then the scores in 2010. We want to reach our 2012 goals. This will mean more members are going for needed preventive care to help live healthier lives. A true win-win!

Screening Measure 2010* 2011* 2012 Goal

Breast Cancer 42.71 40.22 57.37

Cervical Cancer 70.66 67.12 74.24

*2010 HEDIS Rates collected in 2011; 2011 HEDIS Rates collected in 2012

Quality Care is a Partnership

Member Services n 24-hour Nurse HelpLine1-800-600-4441 (TTY 1-800-855-2880)

Reaching a Healthy WeightSticking with it!

www.myamerigroup.com

Real

Solutions

My asthma action plan

TN-AAP-0111

HP-C-0624-12 03.12

Green means go Yellow means caution Red means danger

Use the colors of a traffic light to help you control your asthma.

NAME:

DATE:

GO Use these daily medicines to help prevent asthma attacks.

How you feel: MEDICINE AMOUNT WHEN

n Can breathe easy

n Do not cough or wheeze

n Sleep through the night

ACTION: You can work and play.

CAUTION Take your daily medicines and add these rescue medicines.

How you feel: MEDICINE AMOUNT WHEN

n Chest is tightn Coughing or wheezing

n May have the start of a cold

ACTION: Call your doctor.

DANGER Use these emergency medicines. Call your doctor NOW.

How you feel: MEDICINE AMOUNT WHEN

n Hard to breathen Hard to talkn Medicine not helping

ACTION: Call your doctor.

Your doctor will want to see you right away. If you cannot contact your doctor, go to the emergency room.

Call 911 if needed.

Doctor: Pharmacy:

Daytime Phone: Phone:

After Hours:

You can talk to a nurse anytime day or night. Just call our 24-hour Nurse HelpLine at 1-800-600-4441.

ARE YOU LIVING WITH HIGH BLOOD PRESSURE? LEARN WHAT YOU CAN DO TO KEEP IT UNDER CONTROL.

Blood pressure is the amount of force it takes for your heart to push blood through your body. When your blood pressure is high, your heart works harder than it should. High blood pressure is also called hypertension. “But I’m such a calm person!” Hypertension has nothing to do with being tense or nervous. Even a very relaxed person can have it.

A lot of people have high blood pressure and don’t even know it. Often there are no symptoms. Having your blood pressure checked is the only way to know if yours is too high. Everybody should have their blood pressure checked.

How High Is Too High? Normal blood pressure = lower than 120/80 Higher than normal = between 120/80 and 139/89 High blood pressure = 140/90 or higher

How to read the numbers: n The top number is the pressure as your heart beats. It’s called the systolic pressure. n The bottom number is the pressure in between heartbeats. It’s called the diastolic pressure.n When you say it out loud, say “over” where the slash is. So 120/80 would be “120 over 80.”

Keep Your Blood Pressure in CheckPut check marks by the steps that you will try first:__ I will see my family doctor and get my blood pressure checked at least once a year.__ I will find ways to be more active.__ I will make healthier food choices by: p Eating less salt p Eating more fruits, vegetables, chicken and fish p Eating less red meat, cheese and butter __ I will smoke fewer cigarettes per day with a goal to stop.__ I will look for ways to relieve stress.__ If I drink alcohol, I will only do so in moderation.__ I will lose weight slowly (if overweight) at a rate of around 1 to 2 pounds per week.

What If You Have High Blood Pressure?Knowing you have blood pressure that is above normal is the first step. Now you can work with your doctor to control it. The steps above will help, but you may also need medication. If you do, be sure to take your medication, even if you feel well. To learn more about high blood pressure, you can visit the American Heart Association website at www.americanheart.org or call 1-800-AHA-USA1 (1-800-242-8721).

HIGH BLOOD PRESSURE (HYPERTENSION)

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www.myamerigroup.com/TN

Time for a checkup!www.myamerigroup.com/tn

P.O. Box 62509Virginia Beach, VA 23466-2509

Flu vaccines: the sooner, the better Who should not get vaccinated?n Children 6 months of age or youngern Patients who are severely allergic to chicken eggsn Patients with history of allergic reaction to flu vaccine or development of Guillain-Barre syndrome within six weeks of receiving vaccinen Patients who are currently running a fever due to moderate or severe illness should wait until symptoms subside

Have questions about caring for high-risk members? Give Amerigroup* Provider Services a call. *In New Mexico, Amerigroup Community Care of New Mexico, Inc.

Who should get vaccinated?Everyone over 6 months of age, but especially those at high risk for contracting the virus, including:n Children 6 months to 5 years oldn Pregnant women (injection only – not nasal vaccine)n Adults 65 years and oldern Chronically ill patients, including those with controlled/mild asthma, neurological diseases and heart diseasen Alaska Natives and American Indiansn Caretakers of high-risk patientsFind the latest flu season info on the CDC website at www.cdc.gov/flu.

Amerigroup m usepad messenger

Your Explanation of Benefits (EOB) gives you important information about your claims processed by Amerigroup. It is not a bill. You will receive an EOB when Amerigroup has processed a claim for a service that you have received. the provider who gave you this service will get a notice.

Review Your EOB Carefully n Check for errors.n Make sure you received the service

that is being billed.

Here is a sample of an EOB:

What is an Explanation of Benefits?Patient Name

Patient #

Provider’s Name

Claim number

Dates of Service

Member Co-Pay

Paid to Provider

Procedure Description

Explanation Code Description

F

E

G

H

000000000Jane DoeDr. Smith

AF

D E

BC

GH

I

ID

C

B

A

If you see services listed that you did not receive, please let us know right away. this could be fraud. Report all suspected fraud and abuse to 1-800-600-4441 (TTY 1-800-855-2880).

Amerigroup Tennessee, Inc.Member Explanation of Benefits

Signs of Sleep Disorders in ChildrenIs your child sleepy during the day? Does he or she have trouble going to sleep or staying asleep? If so, it could be the sign of a sleep disorder.

A lack of good sleep can lead to accidents and injuries, behavior and learning problems. Talk to your pediatrician if your child shows any of the following signs:n Snoring n Breathing pauses during sleep n Restless sleep or unusual events during sleep

such as nightmaresn trouble staying awake during the day n Daytime tiredness, mood swings or

attention problems

Help Your Child Sleep Bettern Set a time for bed and a time to wake up each

morning.n Make a bedtime routine, such as giving

your child a warm bath or reading a story together.

n Avoid caffeine and large meals before bedtime.

n Make sure your child’s bedroom is cool, dark, quiet and comfortable.

n try not to let your child fall asleep watching tV or listening to music.

Member Co-Pay

Paid to Provider

Procedure Description

Explanation Code Description

More About AmerigroupAmerigroup Community Care has a Quality Management/Quality Improvement (QM/QI) program that guides our processes, including how we look at patient safety. We listen to your comments and look at claims data to help us know where we need to do better. If you would like information about our performance, our efforts to improve patient safety or any other information about our QM program, please write us at:Amerigroup Community Care22 Century Blvd, Suite 310, nashville, tn 37214You have a right to file a complaint about Amerigroup or your care. If your complaint is about either physical health care and/or behavioral health care, you can call Amerigroup at 1-800-600-4441 (TennCare) or 1-866-840-4991 (CHOICES). Or write to us at:Amerigroup Community Care22 Century Blvd., Suite 310, nashville, tn 37214

To report fraud or abuse to the Office of Inspector General (OIG), you can call toll free 1-800-433-3982. Or go online to www.state.tn.us/tenncare and click on “Report Fraud.” To report provider fraud or patient abuse to the Tennessee Bureau of Investigation’s Medicaid Fraud Control Unit, call toll free 1-800-433-5454.We do not allow unfair treatment in tennCare. no one is treated in a different way because of race, color, birthplace, religion, language, sex, age or disability. Do you think you’ve been treated unfairly? Do you have more questions or need more help? If you think you’ve been treated unfairly, call the Family Assistance Service Center for free at 1-866-311-4287. In Nashville, call 743-2000.Amerigroup is a culturally diverse company. We welcome all eligible individuals into our health care programs, regardless of health status. If you have questions or concerns, please call 1-800-600-4441 (TennCare) or 1-866-840-4991 (CHOICES) (TTY 1-800-855-2880) and ask for extension 34925. Or visit www.myamerigroup.com.

When you have asthma, using the right medication the right way can make all the difference. Asthma is a disease that keeps you from getting air in your lungs. Your airways swell up, making it hard to breathe. Medications can help you breathe easier. There are two types of medications used to treat asthma.

1. Long-Term Control Medications Most people with asthma need one or more medications every day to help them breathe easy. These medications help people manage or control their asthma and are known as controller medications. They:

n Help reduce the swelling inside the airways or help relax airway muscles

n May reduce the number of flare-ups and help you control your symptoms

n Are taken each day, as directed by your doctor, even when you feel fine

2. Quick-Relief Medication Everyone with asthma needs a quick-acting inhaler for times when it is hard to breathe. A quick-acting medication: n Works fast to make it easier for you to breathen Helps to open your airwaysn Should be used as directed by your doctor

Tips:n talk to your doctor if you do not have a

controller medication or inhaler.n Keep your quick-relief inhaler with you at

all times.n Develop an Asthma Action Plan with your

doctor at your next visit. It will:• tell you when and how to take each medicine • Explain when to seek help or call your doctor• Help you manage your asthma from day to day

Amerigroup has a program to help you manage your asthma called the Asthma Care Management program. to speak with one of our nurse care managers about this program, please call 1-888-830-4300.

Medication to Manage Asthma

Do you need help with this information? Is it because you have a health, mental health or learning problem, or a disability? Or do you need help in another language? If so, you have a right to get help; and we can help you. Call Amerigroup Community Care at 1-800-600-4441 (TennCare) or 1-866-840-4991 (CHOICES) for more information.

Do you have a mental illness and need help with this information? the tennCare Advocacy Line can help you. Call them for free at 1-800-758-1638 (TTY 1-877-779-3103).

If you have a hearing or speech problem, you can call us on a ttY/tDD machine. Our ttY/tDD number is 1-800-855-2880.

¿Habla español y necesita ayuda con esta carta? Llámenos gratis al 1-800-600-4441 (TennCare) o 1-866-840-4991 (CHOICES).

Need help in another language? You can call Amerigroup Community Care for language assistance at 1-800-600-4441 (TennCare), 1-866-840-4991 (CHOICES) or the numbers in the next column. Interpretation and translation services are free to TennCare members.

Foreign Language LinesCall if you need help and need to speak with someone in one of these languages:

(Arabic) 1-800-758-1638(Bosnian) 1-800-758-1638(Kurdish-Badinani) 1-800-758-1638(Kurdish-Sorani) 1-800-758-1638

(Somali) 1-800-758-1638 (Spanish) 1-800-758-1638

(Vietnamese) 1-800-758-1638

If you don’t have a way to get to your health care visits, you may be able to get a ride.You can get help with a ride:• Only for your TennCare services and• Only if you don’t have any other way to get there

If you are a child under the age of 21, you can have someone ride with you. If you need help with a ride, you can call 1-866-680-0633.

If you want to know more about a doctor or hospital, such as professional qualifications, please call Amerigroup Member Services at 1-800-600-4441 (TennCare) or 1-866-840-4991 (CHOICES) (TTY 1-800-855-2880).

It’s easy for your child to get a wellness checkup. Just call your child’s doctor and schedule a visit today.

If you need help with a ride, you can call 1-866-680-0633.

TENNderCARE at a glanceTENNderCARE is a program that provides free checkups for eligible children younger than 21 years of age. Every child and teen needs regular health checkups, even if they seem healthy. TENNderCARE also pays for all medically necessary care to treat problems found at the checkup.

What happens at a wellness checkup?n Health historyn Physical examn Lab tests (as needed)n Immunizationsn Vision/hearing screening

n Developmental/behavioral screening (as needed)

n Advice on how to help keep your child healthy

Medication to Manage Asthma

P.O. Box 62509Virginia Beach, VA 23466-2509www.myamerigroup.com/tn

www.myamerigroup.com/tn

Make Health Happen is published by Amerigroup to give information. It is not a way to give personal medical advice. Get medical advice directly from your physician. ©2012. All rights reserved. Printed in the USA.

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Could you benefit from substance use treatment? Take this quiz to find out:1. Have you ever felt that you should cut down

on drinking or drug use?2. Have you ever felt guilty about the way you use alcohol

or drugs?3. Have you ever found you cannot remember periods of

time following drinking or drug use?4. Have you ever used alcohol or drugs to start your day?5. Have you ever needed medical attention because of

alcohol or drug use?6. Has alcohol or drug use ever caused you not to

meet important responsibilities (job, school, family, financial)?

7. Have you ever been in trouble because of alcohol or drug use?

8. Have you ever thought about talking to someone about the way you use alcohol or drugs?

If you answered yes to two or more questions, talk to your doctor about substance use treatment. He or she can help you find support or a treatment program in your area.

Amerigroup is ready to help you. Our Disease Management Centralized Care Unit can provide education, support and resources related to substance use treatment. Care managers work with you one-on-one to help create personalized care plans to help you set and achieve your goals.

For more information, call 1-888-830-4300. You can also contact the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Locator by calling 1-800-662-HELP (4357) or going online to www.findtreatment.samhsa.gov