Health Journal: The Priority Health Magazine for Healthy Living

Spring 2015
GET OUR APP FOR YOUR
BENEFITS ON THE GO
page 2
START SAVING ON YOUR
HEALTH CARE WITH OUR NEW
COST ESTIMATOR TOOL
page 3
EARN CASH BACK THROUGH
PRIORITY HEALTH MEMBER PERKS
page 4
Member spotlight:
Shelley Irwin, host of The
WGVU Morning Show, Team
Priority Health Champion,
triathlete, marathoner
page 5
CONTACT US
We’re here for you when you need us.
Send a secure email anytime by visiting
priorityhealth.com and clicking on “Contact us.”
Call the phone number on the back of your
Priority Health membership card. We’re open
Monday – Thursday, 7:30 a.m. to 7 p.m.; Friday,
9 a.m. to 5 p.m.; and Saturday, 8:30 a.m. to noon.
¿No hable inglés? Comunicarse a el 888.389.6645
y pedir un traductor.
Download our
app for benefits
information on
the go!
The Priority Health app offers
convenient ways to access your
benefits anytime, anywhere online
through your smartphone or tablet.
It’s easy to view your mobile membership card, personal
plan and benefit information, and tools like Cost Estimator
and Healthcare Bluebook to help you be a more informed
consumer. Plus, you can schedule a virtual doctor visit, check
claim summaries, renew prescriptions and much more.
To access: Register your account and download the app.
2 • Health Journal Spring 2015
We want to
hear from you
Not only do we care about you, but we care
about your world, too. That’s why we’re
committed to printing less paper. Soon, we’ll
be emailing you a brief online survey on your
interest in reading the Health Journal in a
digital format. Your responses are confidential
and will help us gather feedback. Make sure to
register your account on priorityhealth.com so
we have your current email address on file.
Register your online account
1. Visit priorityhealth.com and click Register
2. Select I’m a member
3. Enter your contract number found on the
front of your Priority Health membership card
(each family member has a different contract
number), plus your birth date and the last 4
digits of your Social Security number
4. Choose a username, password and
security question
5. Enter your email address
Download the Priority Health app
to your smartphone or tablet
1. Download the Priority Health app for Android
or iPhone
2. Log in by entering the username and
password you use for your online account
GET ACTIVE
WITH US!
start
saving on
your
We love to support events
where our community can get
health care
out and be active. We believe
in improving the health and
Estimate your out-of-pocket
lives of our members and all
costs with our new
Michiganders. Join us at the
Cost Estimator
next local race as a participant
or a volunteer. Meet us at the
Priority Health tent for a chance
to grab fitness gear giveaways
at these upcoming events:
You wouldn’t book a
vacation or purchase a
flat screen TV without
first knowing the cost—
shouldn’t the same apply
to your health care?
The Cost Estimator even recommends
lower-cost doctor/facility options to
help ensure you get the highest-quality
care at the best price. It could save you
thousands of dollars.
Priority Health thinks so. That’s why
we partnered with Healthcare Bluebook
in 2013 to give our members access
to the cost and quality of the most
common health care services before they
receive care.
Don’t just take it from us. Recent media
coverage from Becker’s Hospital Review,
MLive, WXMI TV 17 and WZZM TV 13
has confirmed our role in leading Michigan
in the reduction of health care costs by
helping members make more informed
decisions through increased engagement
and transparency with the Cost Estimator.
And now, we are furthering this mission
with our new Cost Estimator that
shows Priority Health members how
much they pay for a service, based
on their health plan, for hundreds of
common health care procedures like
X-rays, MRIs, lab tests and surgeries.
From your phone, computer or
tablet, log into your member account
at priorityhealth.com and click
Cost Estimator to check out how
you can start saving.
Get your FREE preventive care
Priority Health has covered preventive care like routine physicals,
blood pressure screenings, body mass index (BMI) and depression
screenings for nearly 30 years. Schedule your FREE yearly physical and see a full list
of covered preventive health care services today at priorityhealth.com and search:
preventive health care guidelines.
April
19 Gazelle Girl Half
Marathon Grand Rapids
May
3
Priority Health 5K Walk
(Borgess Run), Kalamazoo
9
Fifth Third River Bank
Run Grand Rapids
June
14 Grand Rapids Triathlon
Grand Rapids
27 Gran Fondo
Grand Rapids
July
11 Meijer Festival of
Races (Cherry Festival)
Traverse City
September
5
Priority Health Arts in
Motion 5K/10K, Royal Oak
Health Journal Spring 2015 • 3
Earn cash back to support your
healthy lifestyle with our new
Member Perks program
Traveling this spring?
You’re covered for
emergencies—
anywhere, anytime
Headed for the sunshine? Or
perhaps planning a staycation
just outside of town this spring?
Wherever you go, you’re covered
for urgent care (in an urgent care
center) and emergency care—
anywhere, anytime. While we
hope you stay well, here are some
helpful tips if you or your family
should need care while on your
next vacation:
Spring is finally here. So if you’re
gearing up for your next outdoor run
or treating yourself to some “you”
time, then we have a great way to
save you some green while you
stay fit. Our partnership with Benefit
Mobile, Inc. allows our members
to download the Benefit app for
Android or iPhone and every dollar
spent within the app results in money
that he picked up on the way home
from soccer practice, putting him back
in the driver’s seat of his busy life.
Choose a virtual visit when you or a
family member has a:
If you have an emergency, call
911 or go to the emergency
room or an urgent care center.
And if you become ill or
injured while traveling more
than 100 miles from home—
around the country or
worldwide—the Assist America
coverage included with your
Priority Health plan can help
get you medical care, provide
medical referrals, monitor
evacuations, coordinate
prescriptions and lost luggage
assistance, a compassionate
visit, care of minor children and
even arrange your travel back
home safely.
Log into your account at
priorityhealth.com and search
travel to download a reference
card to carry when you travel.
4 • Health Journal Spring 2015
you can use to support a healthy
lifestyle. Purchase running shoes,
exercise equipment, athletic gear, spa
treatments and more to help you be
your healthiest. Receive up to 10%
cash back when you purchase digital
gift cards from dozens of national
retailers, from Amazon to Zappos.
Visit priorityhealth.com and search
perks to access.
SEEING THE DOCTOR DOESN’T
ALWAYS MEAN LEAVING HOME
Ryan, a 38-year-old Priority Health
member, knows a busy schedule all too
well. He’s in back-to-back meetings
during the day and busy driving his
school-aged children to soccer practice
at night. Fitting in a trip to the doctor
for a severe case of poison ivy wasn’t
in the cards. He called his primary
care provider, but they didn’t have
any same-day appointments. He was
already scheduled to be out of town for
the next available appointment. Since it
wasn’t life-threatening he knew he didn’t
need to pay the extra cost for an ER or
urgent care visit. The solution: an online
or over the phone doctor visit with
Priority Health. The physician emailed a
prescription to Ryan’s local pharmacy
Cold or flu
Sinus infection
Fever
Sore throat
Respiratory
infection
Other nonemergencies
Register today to access the
service before you need it
Create your account now so you can
quickly get the care you need the next
time you need it. Registration takes just
minutes. Visit priorityhealth.com/virtualdoc
or call 888.632.2738 to get started.
How virtual visits work:
Members can be treated by a boardcertified doctor through an online video chat
or over the phone anytime, anywhere—
including nights, weekends, holidays and
while traveling. Remember, if you have an
emergency, call 911 or go to the emergency
room, but if you’re sick and thinking about
urgent care, consider getting care from
the comfort of your home.
MEMBER SPOTLIGHT
Shelley Irwin is an
award-winning radio
host/producer of
The WGVU Morning Show,
the local NPR radio affiliate
in Grand Rapids.
Shelley wears many hats: board
member for numerous community
organizations, dog owner, triathlete,
marathoner and Priority Health
member. For the past three years,
Shelley has represented Team Priority
Health as a Champion in runs,
triathlons and bike races. She lives to
inspire others in the community to be
healthy and she is about to set one
of her greatest examples yet – she
will compete for Team USA in the
International Triathlon Union’s (ITU)
World Championships this summer in
Motala, Sweden. Here is her story.
Journey to Sweden:
How to qualify for Team USA
my fellow Champions, but a triathlon
requires being above average in
the skills of swimming, cycling and
running. So, to begin the process
of “being good” in all three sports,
I began with an indoor triathlon.
Indoor triathlons usually go as such:
15 minute all out swim, five minute
break, 15 minute all out bike, five
minute break, and then a 15 minute
all out run. Once spring hit, I would
take the skills I learned indoors and
continue my outdoor rituals, including
half marathons, 25ks, and yes, the
occasional marathon.
The progression
The Grand Rapids Triathlon debuted
in 2011. That race was my first time
swimming competitively in open
water, cycling with others and running
in a single event. Initially, I was the
swimmer doing the backstroke and
I was the cyclist with the purple road
bike with clip-less pedals and donning
jogging shoes. And a race belt? What
was that?
“Wanted: athletes to qualify
to represent Team USA in the
2015 ITU Long Course* Triathlon
World Championships! To
represent your country, you have
to be the best of the best.”
When I saw that, I somehow knew that
was a goal I could achieve. In order to
qualify I needed to enter a qualifying
race and ironically, the 2014 Qualifying
Race to participate in the ITU World
Championships (Long Course
Triathlon*) in 2015 was in Grand
Rapids, Michigan: my home court.
Starting off
As a Priority Health Champion, I’ve
always been active and motivated by
Since then my progression towards
qualifying for world championships has
continued. In the past four years there
have been countless other triathlons and
five half irons. In all that time, I haven’t
drowned yet! It was the summer of 2014
that offered the opportunity to qualify to
be on a world team. I had reservations,
but ultimately, the Grand Rapids Triathlon
race directors gave me the faith to
pursue the necessary training and to
remind me that I could very well make
this happen.
Race day: June 2014
To qualify for Team USA, an athlete
needed to finish in the top 25 of
their age group at the Grand Rapids
*A long distance triathlon is a half iron (1.2 mi. swim, 56 mi. bike, 3.1 mi. run)
Image courtesy of Ian Anderson
Triathlon long distance. I looked
around at the start line of the 1.2 mile
swim, 56 mile bike ride, and 13.1
mile run ahead and saw rock-hard
women; all experienced. I felt soft and
intimidated, but before I had too much
time to dwell on that, the air-horn blew
and we all dove in.
At the end of the day, I qualified for
Team USA. I wasn’t the first and I
wasn’t the last. On June 27, 2015
in Motala, I will be representing
our country in the World ITU Long
Distance Championships. All it took
was that first step of indoor triathlons,
having people who believed in me, and
some necessary training. I tell my story
to help motivate others. This journey
to Sweden is now in my grasp! At the
start line in Motala, there will again be
experienced, rock-hard women. And
you know what? I plan to be one of
them. Go team USA!
Health Journal Spring 2015 • 5
UNDERSTANDING
your
benefits
DISEASE MANAGEMENT
PROGRAMS
Learn what programs
are available to help you
manage chronic illnesses,
how to use the services
and how to become eligible.
Keyword: programs
PRESCRIPTION DRUG
UPDATES
We regularly review new
drugs to help make sure
you’re receiving safe and
effective care. If you take
prescriptions, please
review our Approved Drug
List occasionally to note
changes or updates. We
also provide information
about our prescription
coverage and pharmacy
management procedures.
Keyword: prescriptions
PRIVACY STATEMENT
Learn how we’re
committed to keeping your
health information private.
Keyword: privacy
6 • Health Journal Spring 2015
We make important information available online and in print
to help you understand how your health plan works. Visit
priorityhealth.com and type the keyword(s) below in the search
box. For print copies, call Customer Service at 800.446.5674.
PLAN BASICS
Review your coverage
documents and member
handbook for information
about benefits, procedures
and much more. You’ll find
the benefits and services
included and excluded from
coverage, copayments and
other charges, restrictions
on services outside the
network, how to submit
claims and how we evaluate
new technology for inclusion
as a covered benefit. You’ll
also find information about
in-network doctors, getting
primary care and specialty
care like behavioral health
and hospital services,
getting care after normal
office hours and receiving
emergency care, including
when you’re out of our
service area. Keywords:
coverage documents,
handbook
QUALITY PERFORMANCE
Review summary
information regarding
our Quality Improvement
Program performance and
quality results. Keyword:
accreditation
RIGHTS AND
RESPONSIBILITIES
Know what you can expect
from us and what we expect
from you. Keywords:
member rights
BENEFIT DECISIONS
Our goal is to cover
care that meets high
medical standards and
is also cost-effective.
This is called utilization
management. If you have
questions regarding our
process or decisions,
contact Customer Service
at 800.446.5674, and
they’ll contact a health
management staff member
to help. Know that all
utilization management
decisions are based on
appropriateness of care
and service and that no
financial incentives exist for
issuing denials. Keyword:
utilization
GRIEVANCE PROCEDURE
Get information about how
our grievance procedure
works. Keyword:
grievance
Reconstructive surgery following breast cancer
If you have surgery for breast cancer,
Priority Health will consult with you to
determine coverage for the
following services:
NOW ACCEPTING BOARD
MEMBER NOMINATIONS
•• Reconstruction of the breast
on which the mastectomy
was performed
•• Surgery and reconstruction of
the other breast to produce a
symmetrical appearance
•• Prostheses and treatment of
physical complications at all
stages of the mastectomy,
including Lymphedemas
This is in compliance with the Women’s
Health and Cancer Rights Act of 1998.
Information about your costs for these
benefits is included in your coverage
documents and any applicable riders
included in your Priority Health plan.
HELP AVOID FRAUD, WASTE AND ABUSE
Our compliance program helps us
detect and prevent fraud, waste and
abuse, which contribute to rising health
care costs. You can help by:
•• Checking your medical bills and
claim activity summaries to make
sure you were only charged for
services you received
•• Never giving your Social Security
number, health plan information
or banking information to
someone you don’t know
•• Knowing that free services do
not require you to give your plan
number to anyone
If you have questions, or if you
suspect fraud or abuse, tell us.
You don’t have to give your name,
address or phone number.
Contact us in the way that’s
most convenient:
•• Call Customer Service at
800.446.5674 Monday – Thursday
7:30 a.m. – 7 p.m.; Friday 9 a.m. –
5 p.m.; or Saturday 8:30 a.m. – noon.
•• Call our Compliance Department
at 800.942.0954 from 8:30 a.m. –
5 p.m.
•• Call the Compliance Helpline at
800.560.7013. This third-party
organization is open 24 hours a
day, and they’ll report your
concern to us.
•• Use the Fraud, Waste and Abuse
Report form on priorityhealth.com.
•• Contact us by mail at Fraud and
Abuse Program, MS 3175, 1231
E. Beltline NE, Grand Rapids, MI
49525 or fax 616.942.7916.
We’re accepting nominations for
our Board of Directors. Nominees
must have Priority Health HMO/POS
coverage. Send résumés and letters
of interest by March 31, 2015, to:
Board Nominations—MS 1345
Priority Health
1231 East Beltline NE
Grand Rapids, MI 49525
Follow Team
Priority Health
and be inspired
Team Priority Health is made up of
people just like you—Champions
of their own fitness and health.
They are real people (see our cover
story!) who want to inspire you
with their stories. Maybe your goal
is to get to the gym three days a
week or to complete your first 5K
run or distance bike race. Or to
be a part of Team Priority Health
and become a Champion! You can
follow the Champions to get free
tips and advice about similar goals.
Read their inspirational stories at
teampriorityhealth.com or follow
them on Facebook on the Team
Priority Health fan page.
Health Journal Spring 2015 • 7
1231 East Beltline Ave. NE
Grand Rapids, MI 49525
Get the latest news, tips and information.
“Like” us on Facebook or follow
@PriorityHealth on Twitter and Pinterest.
Health and wellness or prevention information
Health Journal is presented by Priority Health, 1231 East Beltline NE, Grand Rapids, MI 49525-4501. © 2015. All rights reserved. Health Journal and its
graphic representation are trademarks. Reproduction without permission is strictly prohibited. No material in this issue may be reproduced without written
permission. The publishers do not assume responsibility for unsolicited editorial material. Health Journal is an information newsletter for the customers of
Priority Health. The information provided in this newsletter is intended to be used as a general guideline and should not replace the advice of your physician.
Always consult your physician for individualized care. If you have any questions, please call the number on the back of your membership card. Priority Health
encourages physicians to discuss all treatment options with their patients regardless of benefit level or coverage.
introducing
ThinkHealth
Good health requires quality
information every step of the
way. Which is why Priority Health
has launched ThinkHealth—your
online resource for
HEALTHY
LIVING TIPS
INFORMATION
ON HEALTH
CARE TRENDS
HEALTH
INSURANCE
EDUCATION
You’ll find:
Ideas for improving your fitness and health
Guidance for getting quality care from your doctor
And much more
Visit priorityhealth.com Keyword: thinkhealth
8 • Health Journal Spring 2015
©2015 Priority Health 8579A 03/15