Member CULTURAL COMPETENCY. Flu Shots Reminder FOCUS ON FITNESS. to Help Prevent or Control Type 2 Diabetes Page 10 MEMBER PORTAL. Page 5.

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1 Member FALL 2019 CONNECT HMO Medicare Member Newsletter CULTURAL COMPETENCY Page 5 Flu Shots Reminder Page 7 WITH OUR DO MORE ONLINE MEMBER PORTAL See page 3 for details FOCUS ON FITNESS to Help Prevent or Control Type 2 Diabetes Page 10 H8170_2019Q3MbrNwsltr_C

2 FALL 2019 ALL IN THIS ISSUE 2 Always Available to Our Members 3-4 Register & Do More Online with our Member Portal! 5 Cultural Competency 6 See your Doctor (soon) after Discharge from the Hospital 6 ATTENTION DIABETICS: Call the Health Plan for Diabetic Resources! 7 Carenet Health Answers to your healthcare questions are just a call away! 7 Flu Shots Reminder 8 When Life Gets You Down 8 Stay Healthy with Regular Check-Ups and Annual Wellness Visits 9 Communication is Key! 9 Preventive Health Benefit: Mammography 10 Focus on Fitness to Help Prevent or Control Type 2 Diabetes 11 Lose Weight, Gain Health and Wellness 12 Eye Exam - How Often Should I get One? 12 Prescription Drugs and the Donut Hole 13 Fraud Waste & Abuse 13 Lab Services 13 Hurricane Season is Here! 13 How to Receive Regular and Behavioral Health Services 14 Member Rights & Responsibilities 15 Non-Discrimination Notice & Multi-language Interpreter Services Always Available to Our Members The Plan offers a lot of information for our members on our website. This includes resources and programs available to our members. Please visit our website at: Click on links below for more information on the following topics: Advance Directives: Quick Links g Quality & UM g Advance Directives Clinical Health Guidelines: Providers g Clinical Healthcare Resources Fraud, Waste & Abuse: Quick Links g Fraud, Waste & Abuse Grievances & Appeals: Quick Links g Appeals & Grievances Member Rights & Responsibilities: Members g Your Rights and Responsibilities Newsletters: Members g Member Newsletters Patient Safety Programs: Quick Links g Quality & UM g Patient Safety Preventive Health Information: Quick Links g Quality & UM g Preventive Health Information Privacy: Quick Links g Privacy Practices Quality Management Programs: Quick Links g Quality & UM Quality Management Performance: Quick Links g Quality & UM g Monitoring Quality 16 Finding Participating Providers 16 Advance Directives: Donate Life 2 America s 1st Choice of South Carolina - Member Newsletter FALL 2019

3 Register & Do More Online with our Member Portal! Here are some of the benefits you will receive: Place & track orders for your over-the-counter medication and diabetic supplies. Find a Plan Doctor, Pharmacy, Hospital and covered drug. Print and order your ID CARD, provider directory, formulary and other Plan materials. Gain access to health & wellness information including electronic prescription refill reminders. View your claims activity and benefit information. Track your out-of-pocket expenses. (MOOP) Try our Personal Health Tracker and other member Self Management Tools. Access important Plan forms and documents from a central location. Complete your Health Assessment Form; enroll in one of our Disease Management Programs. Log onto See next page on how to sign up now for the Member Portal. click on Member Portal and Register Today! America s 1st Choice of South Carolina, Inc. is an HMO with a Medicare contract. Enrollment in America s 1st Choice of South Carolina, Inc. depends on contract renewal. This information is not a complete description of benefits. Call (TTY: 711) for more information. From October 1 to March 31, we are open 7 days a week from 8 a.m. to 8 p.m. EST. From April 1 to September 30, we are open Monday through Friday, 8 a.m. to 8 p.m. EST. America s 1st Choice of South Carolina, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. America s 1st Choice of South Carolina, Inc. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. America s 1st Choice of South Carolina, Inc. 遵守適用的聯邦民權法律規定, 不因種族 膚色 民族血統 年齡 殘障或性別而歧視任何人. Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). 繁體中文 (Chinese): 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (TTY:711) TTY:

4 Please check front side for Member Portal Registration benefits. If it s your first time accessing the Member Portal, click on the New User Sign UP Now button to create a user name and password to log in with. The New Member Registration page will be displayed. Begin by entering in the required information. 4 America s 1st Choice of South Carolina - Member Newsletter FALL 2019

5 Do you speak a language other than English? Do you speak a different language than your doctor? Do you have vision or hearing difficulties? We are committed to being able to interact with people of different backgrounds. This could be cultural beliefs. It could be ethnic backgrounds. We want to do this well. We are always looking for ways to be better at serving you. We strive to be sensitive to diverse beliefs. We promote differences in our members. We are also sensitive to our providers. We also think about the needs of our employees. This means we are culturally competent. It is important to think about our members needs. If not, members will be at risk for poor health care. What if you don t speak the same language as your doctor? You may not be able to talk to the doctor about your needs. You may not understand the doctor s instructions for you. This can reduce the effectiveness of the healthcare process. What if you called the health plan and didn t understand the person who answered the phone? You may not be able to get the information you need. What if you were given written information in a language you didn t understand? We work hard to make sure this doesn t happen to you. Let us know if you have any problems when talking to your doctor. Let us know if you need help or if you can t understand our employees when you call. We can arrange interpreter services. We can also help if you have vision and hearing difficulties. You can contact us for information on our TTY: 711 services. These services are no cost to you! 5

6 See your Doctor (soon) after Discharge from the Hospital Chances are if you were in the hospital recently, you received a call from Case Management staff when you got home. Calls after discharge are important for us to make sure that you have the needed services in place. In order to follow your discharge orders, you have to be ready to do so. You also need to understand what to expect and what you need to do. One of the questions that is always asked by Case Management is whether or not you have an appointment to see your PCP or Specialist after discharge. The staff offers to assist you in scheduling the follow-up appointment. The Plan recommends that you see your doctor within 7 days of discharge or sooner. Why is this important? A lot of things can change while you are in the hospital. Your regular doctor knows you and your health. Don t assume that he or she has all the latest information from the hospital. If there is a problem with managing the discharge instructions or medications, they can get fixed quickly if you see your doctor. Your doctor can determine how you are doing after being home and if the discharge instructions are working. If not, they can be changed. It doesn t make sense to wait until you feel really bad or realize that what was planned isn t working for you at home. Leaving the hospital and going home is stressful enough. When there are problems, the stress gets worse. Here are some good reasons to plan to see your doctor quickly. To: Review discharge instructions (It s a good idea to bring them to the visit) Get your questions answered (Write them down as they come up so you won t forget them) Let the doctor know how you are feeling since you left the hospital Know what to watch for such as warning signs and when you should report them to the doctor Review your current medication list (Let the doctor know if there are problems with obtaining them or taking them) Know what to do if you don t feel better and when you should followup with the doctor again Making the Appointment When you call your doctor s office for a follow-up appointment after a hospitalization, make sure to tell them the following: 1. WHY you were in the hospital 2. WHAT hospital you were in 3. HOW LONG you were in the hospital 4. That you need to see the doctor to follow-up after your discharge. It s important that the doctor s office doesn t think this is a routine visit. Make sure that you get an appointment within 7 days of discharge as recommended. The Case Management staff can assist you if you are having problems getting the appointment scheduled. It s important not to wait until your next routine visit. Too many things can change with your health before then. By getting to your doctor early, you are helping yourself in the recovery process. ATTENTION DIABETICS: Call the Health Plan for Diabetic Resources! If you have diabetes, you should be utilizing the benefits and resources that are included with your Medicare Advantage Health Plan. Health Plan representatives such as Nurses, Social Workers, and Member Services professionals are available to direct you to valuable benefits. This includes assistance with Over the Counter (OTC) items like blood glucose test strips and glucose monitors. You can speak to a Health Plan nurse about: Information related to a disease process. Diabetic dietary needs. Meal preparation tips. Identifying support groups with the help of our Social Services team. And much more. As a reminder, people with diabetes should get their HbA1c tested at least two times a year. If you are not meeting your goals, you may need to have this test more often. This test is an important tool for checking your blood sugar over time. It is not a replacement for your daily selfchecks. The Health Plan nurses can help in arranging an appointment with your provider to have this test completed. 6 America s 1st Choice of South Carolina - Member Newsletter FALL 2019

7 CARENET Health Answers to your healthcare questions are just a call away! We are happy to offer you access to a nurse advice line through Carenet Health. Carenet Health is staffed with experienced nurses that are available to you 24 hours a day and 7 days a week. It s simple to use and free. WHY USE THE NURSE ADVICE LINE? If you experience a new or worsening symptom after business hours, you can have peace of mind knowing you have a nurse available to speak with by simply calling the free nurse advice line. You might even be able to avoid an unnecessary emergency department visit. HOW DOES THE NURSE ADVICE LINE WORK? All you have to do is dial and let the representative know you are an America s 1st Choice member calling to speak with a nurse. The nurse line is staffed with highly skilled, registered nurses, available 24-7 to assist with your health concerns whether it s a twisted ankle, high fever, drug reaction or other urgent and non-urgent medical concerns. WILL I GET BILLED? No, the nurse advice line is completely free to you and available to you at all times. HOW OFTEN MAY I CALL? You can call as often as you need. It s always best to get health guidance from your doctor because s/he knows more about your medical condition(s). Just remember, the nurse advice line is an additional option available to you for medical advice. If you are experiencing a life threatening emergency, please dial 911, or seek immediate medical attention at the closest hospital emergency room. Reminder FLU SHOTS Don t forget to get your flu shot, there is no cost to Medicare members. The flu, also known as influenza, can cause significant illness or even death in young adults, older adults and people with chronic illnesses. Protection against the viruses begins after two weeks and will last through the flu season. It is best to get your flu shot as early as it is available for the best protection when flu activity is highest. CVS, Walgreens, Publix and many of our other participating pharmacies offer the flu vaccine. Please call the pharmacy in advance to ensure that they have a supply of the vaccine on hand. There is no co-payment for flu shots. Please bring your plan identification card with you when you go. Other pharmacies in the Health Plan network also provide flu shots at no cost to Medicare members. For a listing of other participating pharmacies, please contact our customer service department at: America s 1st Choice Member Services: TTY: 711 or access our online provider directory: Additionally, many primary care providers also offer the flu vaccine. Please check with your doctor to see if they are providing the shots. You may also be able to get a flu shot at your local health department. For more information, talk with your primary care doctor or visit the Center for Disease Control website at 7

8 when life gets you DOWN Depression can be a difficult topic to discuss. The fact is that many people deal with these feelings. For some, depression is long-lasting and debilitating. For others, depression may occur as the result of a major life event or stressful situation such as the loss of a loved one or serious illness. This is often referred to as situational depression. The most common symptoms of situational depression are feelings of sadness or hopelessness, missing work or social activities, and changes in sleeping or eating habits. Unlike major depression which is ongoing, situational depression usually goes away once you have adapted to your new situation. Most people feel that they can handle situational depression on their own. However, there are benefits to exploring behavioral health services during this time: Treatment can help you cope with your stress and get back to normal. Behavioral health providers are able to offer individual therapy or counseling specific to your situation. They can also connect you with situation-specific support groups. The provider can evaluate you to determine if medication to help control anxiety or for trouble sleeping could help. For many people, the coping skills they learn in treatment can become valuable tools to help them face future life events. If you believe that you are depressed, the Health Plan has Social Workers available to help. They can provide resources to help and assist you in finding and scheduling appointments with a behavioral health provider. To speak with a Social Worker, call the Case and Disease Management department at or TTY/TDD 711. Regular business hours are Monday through Friday 8 a.m. to 4:30 p.m. EST. You can also call the Plan s behavioral health vendor Beacon Health Options at A referral from your doctor is not needed to access these services. Stay Healthy with Regular Check- Ups and Annual Wellness Visits Regular checkups can help maintain good health. Taking care of your health now may help prevent future problems. If you do have a health problem, it is better to find out early so your doctor can start treatment, if necessary. The type of exams and tests you need will depend on your gender, age, health history, family history, and lifestyle choices. Your health plan recommends that you have a complete check-up every year or more frequently if your doctor advises. During your check up, your doctor may: Check your blood pressure Weigh you to measure your body mass index Ask questions about your health history, including what medicines you take Perform a complete physical examination Order lab tests, like cholesterol or blood glucose Let you know what other tests you may need Adults should have their weight, body mass index, blood pressure and cholesterol levels monitored regularly. After age 50, women should have mammograms to screen for breast cancer, and both women and men should be tested for colorectal cancer. These are age appropriate routine tests. Your doctor will also make sure you have all the shots you need, like flu and pneumonia. Every year, you should also get your annual wellness visit. During this visit, your PCP will do a basic health exam. You will also be asked to fill out a questionnaire to determine your current health and risk factors. Then your PCP will develop a personalized plan to help you stay healthy. Call your PCP and schedule your annual wellness visit today. MAKE YOUR HEALTH CHECK-UP OR WELLNESS VISIT APPOINTMENT NOW. CATCH ANY HEALTH ISSUES EARLY. DON T WAIT UNTIL IT S TOO LATE. 8 America s 1st Choice of South Carolina - Member Newsletter FALL 2019

9 Communication is KEY! It is important for you to take an active role in your health care. The more involved and informed you are the greater your chances for success. You and your doctor can work together to achieve your best possible health results. This relationship depends on good communication. Don t be afraid to discuss things with your doctor; (s) he is there to help you. Here are some examples of questions you can ask your doctor to prompt discussion. Feel free to take notes on the doctor s responses: How often should I have a complete health exam? What tests should I have done annually? Are there any tests that I should have done more often? What are the results of the last lab work or tests that I received? What do these results mean? Are there any trends I should be aware of? What does my diagnosis mean? What are my treatment options? Should I be monitoring my blood pressure or blood glucose at home? If yes, how do I go about doing this? What does my blood pressure reading mean? Do you recommend screenings for cancer or heart disease? Can you tell me my body mass index (BMI)? What do these numbers mean? I have these new symptoms what do you suggest? Be sure to share your health risk factors with your doctor: Do you exercise? How often? What kind of exercise? Do you smoke? How often? Do you have any previous medical concerns or family history of medical conditions that your doctor should be aware of? Understanding your doctor s responses is essential to your quality of health care. Make sure you ask enough questions until you clearly understand your doctor s responses. To help you remember your conversation, take notes or get a friend or family member to take notes for you. You could also ask your doctor to write down his or her instructions to you, or provide you with printed material about your diagnosis or treatment plan. If you still want more information, your doctor or the office staff should be able to direct you where to go for more information or helpful resources. PREVENTIVE HEALTH BENEFIT Mammography Your health plan provides many preventive benefits that can help you stay healthy. These benefits may help to identify and treat problems early, before they become serious. One such benefit is mammography. A mammogram is a test that uses x-rays to detect breast cancer at an early stage. A mammogram can identify lumps that are too small to be detected in other ways. It can also identify early breast changes in women who have no other signs or symptoms of breast cancer. We want to make sure all of our female members have this important test. It is recommended that women between the ages of years get a mammogram every 2 years. Talk to your doctor about when you should get a mammogram. Many women have fears or concerns about mammograms. If you have questions about getting a mammogram, talk with your doctor. Facilities that do this test have experienced female staff members who will make it as comfortable and easy as possible. To schedule a mammogram, see your doctor to get a referral. To find a facility in the health plan s network that performs mammograms, ask your doctor. Or call Customer Service at the number listed on your ID card. They will direct you to a convenient place to get the test. They can also help you arrange an appointment. There is no cost to you for the test. Take care of your health now to enjoy life for years to come TTY:

10 FOCUS ON FITNESS Approximately 12 million Americans over age 65 1 have type 2 diabetes. If you don t have it, you probably have a friend or family member who does. Having type 2 diabetes means your blood sugar levels are above normal. If you have diabetes you may also have other health problems, such as heart disease, stroke, high blood pressure, kidney disease and problems with the nervous system. What can you do to help prevent type 2 diabetes? How can you better manage type 2 diabetes if you already have it? You can start today by eating a healthy diet and getting enough exercise. DIET PLAYS A BIG PART IN PREVENTING OR MANAGING DIABETES. Stick to healthy foods that are low in fat and calories, such as fruits, vegetables and whole grains. Eating smaller amounts can also help keep your blood sugar at a healthy level. But no single diet is perfect for everyone. You and your doctor can decide which foods are best for you. Always talk with your doctor before starting an exercise program. DOING AT LEAST 30 MINUTES OF AEROBIC EXERCISE EACH DAY CAN HELP PREVENT OR MANAGE DIABETES. Regular exercise can help lower your blood sugar through weight loss, and it can help move sugar to the cells where it is turned into energy. Exercise also helps your body need less insulin to get the sugar to the cells. Check with your doctor about the right type and amount of exercise for you, then get moving. USE YOUR FREE SILVERSNEAKERS BENEFIT TO GET ACTIVE AND REDUCE YOUR RISK. SilverSneakers is the nation s leading fitness program for seniors, and it s your benefit at no additional cost as an America s 1st Choice member. SilverSneakers is a convenient and fun way to get active and reduce your risk for diabetes and many other chronic health conditions. TO HELP PREVENT OR CONTROL TYPE 2 DIABETES SilverSneakers members have access to: Classes 2 for all fitness levels Instructors who specialize in senior fitness Use of amenities at thousands of locations 3 nationwide Group fitness classes 2 outside traditional gyms SilverSneakers On-Demand TM videos, SilverSneakers GO TM mobile app, health and nutrition tips Take control of your health. Help prevent or control type 2 diabetes with a healthy diet and exercise. Get your ID number or find locations at SilverSneakers.com or call (TTY: 711) Monday - Friday, 8 am - 8 pm ET Membership includes SilverSneakers instructor-led group fitness classes. Some locations offer members additional classes. Classes vary by location. 3. Participating locations ( PL ) are not owned or operated by Tivity Health, Inc. or its affiliates. Use of PL facilities and amenities is limited to terms and conditions of PL basic membership. Facilities and amenities vary by PL. SilverSneakers is a registered trademark of Tivity Health, Inc. SilverSneakers GO and SilverSneakers On-Demand are trademarks of Tivity Health, Inc Tivity Health, Inc. All rights reserved Tivity Health, Inc. All rights reserved. FH5222_ America s 1st Choice of South Carolina - Member Newsletter FALL 2019

11 Lose Weight, Gain Health and Wellness It is important to maintain a healthy weight. Being overweight can lead to many health conditions, such as diabetes, high blood pressure, high cholesterol, and heart disease. Losing weight improves your mobility, which especially helps if you have lung disease such as COPD. Losing even a little bit of weight can help reduce the risk of serious health problems. It may also give you more energy and make you feel better all around. Steps to WEIGHT LOSS 1. The first step is simply making a commitment to weight loss. 2. Once you make the commitment to a healthier lifestyle, you can assess where you are in your weight loss journey and set realistic goals. Everyone has a different goal for a healthy weight. A good measure of healthy weight is Body Mass Index (BMI). Ask your doctor to calculate your BMI, which is determined from a person s weight and height. Knowing your BMI can help you understand your weight category and if you are at risk for health problems. 3. The final step is to make lifestyle changes. Losing weight needs to be thought of as a lifestyle change instead of a short-term diet or program. It is essential when trying to lose weight that you do it in a healthy way and follow your doctor s instructions. The key to losing weight includes healthy eating and portion control in conjunction with exercise. You want to lose weight slowly (1 to 2 pounds a week) and focus on keeping the weight off. EATING RIGHT FOR WEIGHT LOSS Healthy eating is all about making smart food choices and controlling your portion sizes. Smaller portions equal fewer calories. Eating healthy requires planning ahead, especially when you grocery shop. Try to eat many different types of colorful fruits and vegetables, which give your body a wide range of useful nutrients. Make sure at least half of your grains are from whole grains that contain fiber, which will keep you full longer. Avoid eating too many foods that are heavily processed, contain solid fats, or have a lot of added sugars. Eat lean cuts of meat and poultry. Choose foods that are baked, broiled, grilled, steamed, sautéed or boiled, instead of fried. Season foods with condiments such as lemon juice, herbs, and spices, rather than butter and salt. Your doctor may want you to follow a certain diet depending on your health conditions. Ask your doctor if you have any dietary restrictions, such as low sodium and/ or a lower sugar or sugar-free diet. EXERCISING FOR WEIGHT LOSS The other part of achieving and maintaining a healthy weight is physical activity. Exercise gives you great health benefits. Remember to always check with your doctor before starting any new exercise program. Your doctor will know which activities are best for you, and will warn you about anything you should know before you start your program. In any exercise program, you should start slow and build up the length and the amount of times per week that you exercise. A general goal is to aim for at least 30 minutes of physical activity every day. Exercise doesn t have to be complicated. You can start by adding some simple changes to your daily routine such as walking and taking the stairs instead of the elevator. In addition to the physical benefits of exercise (losing weight and building stronger muscles), regular physical activity also improves your mood and boosts your energy levels. This helps your overall well-being and can make you feel happier and more relaxed. KEEPING TRACK OF YOUR PROGRESS It is important to continually selfmonitor when trying to lose weight. It is a good idea to weigh yourself regularly (daily, weekly or monthly). Record your weight in a journal to show your progress. You can also use a journal or food diary to record and monitor healthy eating habits. This allows you to keep track of your meals and snacks. Jot down what you ate each day as well as times when you felt hungry. To monitor your physical activity, you can keep a calendar to mark the days that you exercise. At the end of the month, you can see how many days you exercised. These tools can motivate you to keep up your lifestyle changes. As an incentive, use these tools to treat yourself with non-food items at certain milestones (10 pounds, 20 pounds, or 5 days in a row of exercise). All of these tips will help you achieve and maintain your weight loss goals. Remember, becoming and staying healthy is a long-term lifestyle change! TTY:

12 EYE EXAM - How Often Should I Get One? During a dilated eye exam, an eye care specialist looks at the inside of the eye by using eye drops that widen the pupil. Your eye doctor may not always dilate your eyes during a routine eye exam for a new pair of eyeglasses or contact lenses. Be sure to ask your eye doctor for a dilated eye exam. People with special risks, such as diabetes, previous eye injury or a family history of glaucoma may need a dilated eye exam more frequently. People having trouble with their eyes should see an eye doctor immediately. Are You Taking Care of Your Eyes? 1 3 EASY STEPS FOR TAKING CARE OF YOUR EYES Call our Member Services Department at to get a list of Argus eye doctors in your area. The Health Plan provides eye care benefits to our members by Argus. Argus is an eye care company that works with a network of eye doctors. The experts at Argus recommend that everyone receive a routine, complete eye exam including pupil dilation. In order to get the most from your benefits, call our Member Services Department at to get a list of Argus eye doctors in your area. REMINDER: Be sure to tell your eye doctor that you are using the Argus network. This will ensure they file your eye exam visit to Argus to make the most of your benefit. 2 3 Call an Argus eye doctor and schedule a comprehensive eye exam with dilation. When checking out after your exam, remind your eye doctor to send the claim to Argus. Prescription Drugs and the Donut Hole You may not know that under Medicare Part D you may enter a prescription drug coverage gap, often referred to or known as the donut hole. This means that after you and your Medicare drug plan have spent a certain amount of money on prescription drugs; you are then responsible for paying a percentage of the cost of each of your medications up to a certain amount. These amounts are set by Medicare and can change from year to year. For most people with Medicare, the donut hole can present serious financial challenges. It might be difficult to avoid the donut hole completely, but planning ahead can help make it easier to get through. Potential options to help in easing the donut hole may be to: - Set aside money each month to help cover the cost of your medicine once you hit the donut hole. - Pay attention to the Explanation of Benefits (EOB) the Plan sends you each month. This will tell you how much more money you have to spend before you hit the donut hole. Once you are in the donut hole, it will tell you how much money you have left to spend before you get out of it. - Take steps to lower your medicine costs. Use generic drugs whenever possible. - You might also get a better price if you order through a preferred mail order pharmacy. Consider ordering 3-month supplies of your eligible prescriptions if your plan offers a discount. - Talk to your doctor about each of your medications and ask if there are cheaper alternatives that can provide the same benefit? Do they have any samples they can offer you? - Use My Advocate to help you find and apply for programs that could assist you in paying for your medications. To get started you can take a simple online questionnaire at or call If you have already hit or are close to hitting the donut hole and don t know how you will afford your medications, don t just stop taking them. Talk to your doctor about it. You can also contact a Social Worker at the Health Plan. Social Workers are available Monday through Friday from 8 a.m. to 4:30 p.m. They can be reached by calling or TDD/TTY America s 1st Choice of South Carolina - Member Newsletter FALL 2019

13 FRAUD WASTE & ABUSE Did You Know? Identity theft is a serious crime. Identity theft happens when someone uses your personal information without your consent to commit fraud or other crimes. Personal information includes things like your name and your Social Security, Medicare, or credit card numbers. Guard against identity theft by keeping your personal information safe. Fraud schemes to be on the lookout for include: People using your Medicare or health plan member number for reimbursements of services you never received. People calling you to ask for your Medicare or health plan numbers or banking information. The health plan will never ask you for banking information. Guard against identity theft by keeping your personal information safe. Look at your Health Plan Explanation of Benefits (EOB) carefully to make sure that the plan has been billed for medical services or goods that you really received. Check to see that the date of services is correct. DO NOT let anyone borrow your Health Plan ID card. Treat your card the way you treat your credit card. Make sure you are dialing the telephone you are trying to reach. If someone comes on the line stating you have won a gift card and they ask you for the debit or credit card number, it is a SCAM. Please hang up immediately. To report suspected Medicare fraud contact America s 1st Choice at LAB SERVICES Your Health Plan contracts with the following lab vendors. Make sure your doctor forwards your labs to one of these in network vendors. Laboratory Services of America (LabCorp) Quest Laboratory Hurricane Season is HERE! Have you completed your Hurricane preparations? It is better to be prepared than to wait for the storm to be on the way. We can help you review what you need to do to get ready. Visit our website and click Quick Links then Newsletters to view our Disaster Preparation Guide for This Guide is full of valuable information. This Guide will assist you and your family if an emergency is declared. Source: NOAA How to Receive Regular and Behavioral Health Services Your PCP (Primary Care Physician) will arrange your health needs. You will need to have your PCP send in any requests for referrals or authorizations to the Plan. If you have any questions please contact Member Services. This number is located on the back of your ID card. The Plan uses Beacon Health Options for your mental health benefits TTY:

14 & Member Rights Responsibilities Member Rights As a member of the Plan, you have the right to: Be treated with courtesy and respect, with appreciation of your dignity, and protection of your need for privacy A prompt and reasonable response to questions and requests Know who is providing medical services and who is responsible for your care Know what patient support services you can get and if an interpreter is available if you do not speak English Know what rules and laws apply to the conduct of the staff of the Plan and contracted providers Be provided information about diagnosis, planned course of treatment, alternatives, risks, and prognosis by the Plan s providers Refuse any treatment, except as provided by law If eligible for Medicare, know upon request and in advance of treatment, if the health care provider or health care facility accepts the Medicare assignment rate Receive, before treatment, a reasonable estimate of charges for medical care Receive a copy of a reasonable, clear, and understandable detailed bill and, upon request, to have the charges explained Access to medical treatment or accommodations, regardless of race, national origin, religion, physical handicap, or source of payment Treatment for any emergency medical condition that will get worse from failure to provide treatment Know if medical treatment is for experimental research and to grant consent or refusal to take part in such experimental research Private handling of medical records and, except when required by law, be given the chance to approve or refuse their release Voice complaints or appeals about the organization or the care it provides Express grievances about any violation of your rights through the Plan s grievance and appeals system, and to appeal to a state grievance and appeal oversight entity, or for Medicare members, through the CMS established appeal process You have certain rights while you are getting medical care. You also have certain responsibilities as a patient. The following is a summary of your rights and responsibilities. Participate with practitioners in making decisions about your health care, and provide input into your proposed treatment plan Receive information about the Plan, its services, practitioners and providers, and members rights and responsibilities Participate with practitioners in making decisions about your health care Have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage Make recommendations regarding the Plan s member rights and responsibilities policies Member Responsibilities As a member of the Plan, your provider expects you to: Provide your health care provider, to the best of your knowledge, correct and complete information about present complaints, past illnesses, hospital stays, medicines and other health matters Report unexpected changes in your condition to your health care provider Understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible Discuss with your health care provider if you do not comprehend a course of treatment or what is expected of you Follow the treatment plan suggested by your health care provider and agreed upon by you Keep appointments, and when you are unable to do so for any reason, notify your health care provider or health care facility Answer for your actions if you refuse treatment or do not follow the health care provider s instructions Assure that the financial obligations of your health care are fulfilled as promptly as possible Follow health care facility rules and laws that affect patient care and conduct 14 America s 1st Choice of South Carolina - Member Newsletter FALL 2019

15 Discrimination Is Against the Law NON-DISCRIMINATION NOTICE Notice Informing Individuals about Nondiscrimination and Accessibility Requirements. America s 1st Choice of South Carolina, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. America s 1st Choice of South Carolina, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. America s 1st Choice of South Carolina, Inc.: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) MULTI-LANGUAGE INTERPRETER SERVICES English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (TTY: 711). Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). 繁體中文 (Chinese): 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (TTY: 711) Tiếng Viết (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (TTY: 711). 한국어 (Korean): 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: 711) 번으로전화해주십시오. Français (French): ATTENTION: Si vous parlez français, des services d aide linguistique vous sont proposés Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact the America s 1st Choice of South Carolina Civil Rights Coordinator. If you believe that America s 1st Choice of South Carolina, Inc. has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: America s 1st Choice of South Carolina Civil Rights Coordinator P.O. Box Columbia, SC Phone: , TTY: 711 Fax: gratuitement. Appelez le (ATS: 711). Tagalog (Tagalog Filipino): PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (TTY: 711). Русский (Russian): ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: 711). Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (TTY: 711). જર ત (Gujarati): ચન : જ તમ જર ત બ લત હ, ત ન: લ ભ ષ સહ ય સ વ ઓ તમ ર મ ટ ઉપલબ છ. ફ ન ર (TTY: 711). مقرب لصتا.ناجملاب كل رفاوتت.(711 :مكبلاو مصلا فتاه مقر) ثدحتت تنك اذإ :ةظوحلم (Arabic): ةيبرعلا ةيوغللا ةدعاسملا تامدخ نإف ةغللا ركذا You can file a grievance by mail, fax, or phone. If you need help filing a grievance, the America s 1st Choice of South Carolina Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C , (TDD) Complaint forms are available at Português (Portuguese): ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para (TTY: 711). 日本語 (Japanese):) 注意事項 : 日本語を話される場合 無料の言語支援をご利用いただけます (TTY: 711). まで お電話にてご連絡ください Українська (Ukrainian): УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером (телетайп: 711). ह द (Hindi): ध य न द : यद आप ह द ब लत ह त आपक ल ए म फ त म भ ष सह यत स व ए उपलब ध ह (TTY: 711) पर क ल कर ខ ម រ (Cambodian): ប រយ ត ន ប ស នជ អ នកន យ យ ភ ស ខ ម រ, ស វ ជ ន យផ ន កភ ស ដ យម នគ តឈ ន ល គ អ ចម នស រ ប ប រ អ នក ច រ ទ រស ព ទ (TTY: 711) 15

16 Member FALL 2019 HMO Medicare Member Newsletter 250 Berryhill Road, Suite 311, Columbia, SC CONNECT Finding Participating Providers The health plan uses the Patient Centered Medical Home Model. The Primary Care Provider (PCP) coordinates all of your care including referrals and authorizations. The designated PCP is considered your medical home. Except for in emergency or urgent care situations, or for out-of-area renal dialysis or other related services, you should receive all routine care from the network of plan providers. Discuss your health needs with your PCP and allow them to assist you in finding an appropriate network provider. To find a network provider near you, log on to the plan website at You can also call member services at (TTY: 711). Sometimes people become unable to make health care decisions for themselves. This could be due to accidents or serious illness. You should prepare for these situations in advance by letting your wishes be known in writing. You can express your wishes in a legal document called an advance directive. One common type of advance directive is Anatomical Donation. This can be an organ and tissue donation to persons in need. It can also be a donation of your body for education and research. You can become an organ donor in a couple of different ways: You can designate it on your driver s license or state identification card You can fill out a uniform donor form or express your wish in a living will ADVANCE DIRECTIVES Donate Life You can register on the Donate Life website. This organization provides a registry of all of the organ donors in each state. Visit your state s website to register as an organ donor, update your registry, or view other resources about organ and tissue donation. - South Carolina: For more information on Organ and Tissue Donation, visit the Department of Health & Human Services Division of Transplantation website at: Remember, it is your choice whether or not to file an advance directive. Your health plan does not discriminate against you based on whether or not you have signed an advance directive.