Blue & You - Summer 2010
HEALTH INSURANCE REFORM ANSWERS; Good news for graduates! Arkansas Blue Cross extends health insurance coverage; Need more information before visiting a specialist? We can help!; Redesigned PHS wins top scores in national review
HEALTH INSURANCE REFORM ANSWERS;
Good news for graduates! Arkansas Blue Cross extends health insurance coverage;
Need more information before visiting a specialist? We can help!;
Redesigned PHS wins top scores in national review
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<strong>Summer</strong> 10<br />
A publication for the policyholders of the<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield<br />
family of companies<br />
HEALTH<br />
INSURANCE<br />
REFORM<br />
ANSWERS
6 Good news for graduates!<br />
12 Need more information before visiting<br />
a specialist? We can help!<br />
19 Redesigned PHS wins top scores<br />
in national review<br />
Cal Kellogg, Ph.D., explains<br />
what you need to know about<br />
health insurance reform.<br />
on Page 8<br />
INSIDE<br />
3 Out of the <strong>Blue</strong><br />
4 Health Insurance Reform & <strong>You</strong><br />
6 Good news for graduates! Arkansas <strong>Blue</strong> Cross<br />
extends health insurance coverage<br />
8 <strong>You</strong>r health insurance, your health care, your future<br />
12 Need more information before visiting a<br />
specialist? We can help!<br />
Lose weight The Healthy Weigh!<br />
13 Chronic job stress and your waistline<br />
How much exercise do women really need?<br />
16 Lifelong Health with Dr. David<br />
18 Warning issued for “baby slings”<br />
Can breastfeeding save lives?<br />
19 Redesigned PHS wins top scores in national review<br />
Food for thought: certain foods may keep<br />
aging brains healthy<br />
20 From the Pharmacist — What’s in a drug name and<br />
why did mine change?<br />
21 The Doctor’s Corner<br />
22 Financial Information Privacy Notice<br />
23 Good for your community<br />
Customer Service telephone numbers<br />
24 Good for you<br />
<strong>Summer</strong> 10<br />
is published four times a year by<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield for<br />
the company’s members, health care<br />
professionals and other persons<br />
interested in health care and wellness.<br />
Editor: Kelly Whitehorn — BN<strong>You</strong>-Ed@arkbluecross.com<br />
Assistant Editor: Jennifer Gordon<br />
Designer: Gio Bruno Photographer: Chip Bayer<br />
Contributors: Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming,<br />
Trey Hankins, Heather Iacobacci-Miller, Ryan Kravitz, Kathy Luzietti and Mark<br />
Morehead<br />
Vice President, Communications and Product Development: Karen Raley
Out of the<br />
<strong>Blue</strong><br />
A message from our<br />
CEO and President,<br />
Mark White<br />
The enactment of new health insurance reform legislation<br />
has left many of our valued customers confused<br />
and unsure of how the new law will affect them. We<br />
are hearing questions concerning the changes that can<br />
be expected as various provisions of the new law take<br />
effect from employers, individuals and families, as well<br />
as agents who market our products. And the confusion<br />
is certainly understandable as the law is far-reaching<br />
and complex. At Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield,<br />
we are working every day to provide accurate answers<br />
to the questions you pose. We also are working with<br />
various government agencies to clearly understand and<br />
effectively implement the regulations that will result<br />
from the reform legislation passed by Congress.<br />
One of the most frequent questions we answer for<br />
our members relates to cost. Our members are concerned<br />
that, as a result of new regulations, their premium<br />
costs will rise. And that is a valid concern. There are<br />
many provisions in the law that will increase the cost<br />
of health insurance premiums for many people. After<br />
all, health insurance premiums are a reflection of health<br />
care costs. Unfortunately, the new law does little to address<br />
the rising cost of medical services but adds new<br />
rules that will increase administrative requirements and<br />
new fees that will have to be funded.<br />
As we move into the implementation phase of the<br />
new health insurance reform bill, we will be focused on<br />
making coverage affordable for consumers. Arkansas<br />
<strong>Blue</strong> Cross remains committed to working with employers,<br />
providers of care (such as doctors and hospitals)<br />
and state and federal government agencies to reduce<br />
the cost and wasteful use of medical services, which<br />
leads to higher medical premium costs. We will continue<br />
to participate in initiatives that keep people healthy<br />
and help them manage chronic disease. And, we will<br />
work to develop new payment models so that health<br />
care providers are rewarded for providing effective,<br />
high-quality care rather than more care. Also, we will<br />
take a fresh look at how we operate and seek greater<br />
administrative efficiency.<br />
In a period of rapid and radical change in health care,<br />
one thing remains constant. Arkansas <strong>Blue</strong> Cross is<br />
committed to providing our members with peace of<br />
mind, as we have done for more than 60 years. That<br />
commitment is even more important in today’s uncertain<br />
health care environment. So if you have questions<br />
about how health insurance reform will affect your<br />
health care, we hope you will check our Web sites for<br />
our analysis. Or call us. We’re happy to hear from you.<br />
In this rapidly changing health care environment, we<br />
haven’t forgotten who we work for every day. <strong>You</strong>.<br />
3<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
4<br />
T<br />
(PPACA), which was signed into law on March 23,<br />
<strong>2010</strong>, ultimately will touch almost every American. The<br />
provisions of the law will be phased in throughout the<br />
next 10 years, with the most significant changes taking<br />
place in 2014. At this early stage, it is very difficult to<br />
predict what changes are in store for each of us. That is<br />
because there are numerous federal and state entities<br />
that must issue regulations, which will explain to insurance<br />
companies and others involved how the law will<br />
be implemented.<br />
The PPACA will make dramatic changes in the insurance<br />
marketplace. The new law will require all health<br />
insurance policies to contain new benefits. It will require<br />
that health insurers rate health plans in new ways.<br />
Many health industry suppliers will be called upon to<br />
pay new taxes to cover the uninsured, thereby increasing<br />
their costs. The new reform legislation did not<br />
contain substantial provisions to control medical costs,<br />
which are the primary drivers of premium costs. These<br />
facts taken together mean that for most Americans, the<br />
cost of health insurance will rise. By 2014, many Americans<br />
will be eligible for government subsidies, which<br />
will help offset those increases. In the meantime, those<br />
with private insurance should expect there to be some<br />
increase in cost as reform provisions are implemented.<br />
That being said, Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield<br />
and its family of companies are committed<br />
to doing all we can to hold costs down and<br />
help our customers understand how they<br />
will be affected. With the understanding<br />
that the final rules are not in place, described<br />
in this article are the changes we<br />
believe will be required by the new law<br />
during the next 18 months, based on<br />
the kind of policy you have and when<br />
Health Insurance<br />
he Patient Protection and Affordable Care Act you enrolled in it. Until we better understand the requirements,<br />
which will come with the issuance of regulations,<br />
we are not able to accurately price the changes.<br />
If you have health insurance through<br />
your employer and were enrolled before<br />
March 23, <strong>2010</strong> (at least one enrolled person):<br />
Insurance policies that were in place on the day<br />
the law was passed are considered “grandfathered”<br />
plans. The new requirements for these plans are more<br />
limited than for those sold after the law was enacted.<br />
Changes that members enrolled in grandfathered employer<br />
group plans can expect during the next six to 18<br />
months may include:<br />
• New rules around pre-existing<br />
health conditions<br />
for children, which may<br />
mean that children<br />
who are<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Reform & <strong>You</strong><br />
insured under their parent’s health plan do not have<br />
to meet any pre-existing condition waiting periods<br />
even if the parents are required to do so as a result<br />
of some condition of their enrollment (late enrollment,<br />
no prior creditable coverage, etc.).<br />
• Dependents can continue coverage under a parent’s<br />
plan until their 26 th birthday. Dependents are eligible<br />
regardless of student or marital status. Dependents<br />
also are eligible regardless of whether they are<br />
claimed as a dependent on their parent’s tax return.<br />
Policies in place before March 23, <strong>2010</strong>, are allowed<br />
to exclude coverage to dependents if they have access<br />
to their own coverage from<br />
another employer-sponsored<br />
health plan. This exception<br />
expires on Jan. 1, 2014.<br />
(More information on dependent coverage is in the<br />
article on Page 6.)<br />
• Lifetime dollar limits will be removed on “essential<br />
benefits.” The rules and guidelines outlining what<br />
benefits are considered essential have not been<br />
defined by the government as of this printing.<br />
• On most Arkansas <strong>Blue</strong> Cross plans, the lifetime<br />
maximum benefit is currently $5,000,000. This lifetime<br />
benefit would become unlimited.<br />
• The dollar limits for some benefits in place today<br />
may be adjusted by the law. The benefits to which<br />
this regulation applies have not been determined.<br />
If you had an individual or family medical<br />
policy in place March 23, <strong>2010</strong> (in which you<br />
were enrolled):<br />
Insurance policies that were in place on the day the<br />
law was passed are considered “grandfathered” plans.<br />
The new requirements for these plans are more limited<br />
than for those sold after the law was enacted. Changes<br />
that members enrolled in grandfathered plans can expect<br />
during the next six to 18 months<br />
may include:<br />
• Dependents can continue coverage under a parent’s<br />
plan until their 26 th birthday. Dependents are eligible<br />
regardless of student or marital status. Dependents<br />
also are eligible regardless of whether they are<br />
claimed as a dependent on their parent’s tax<br />
return. (More information on dependent coverage<br />
is in the article on Page 6.)<br />
• Lifetime dollar limits will be removed on<br />
“essential benefits.” The rules and guidelines<br />
outlining what benefits are considered<br />
essential have not been defined<br />
by the government as of this printing.<br />
• On most Arkansas <strong>Blue</strong> Cross<br />
Reform, continued on Page 14<br />
5<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Good news for graduates!<br />
Arkansas <strong>Blue</strong> Cross extends health insurance coverage<br />
Health and Human Services to pre-<br />
• Standard pre-existing condition<br />
vent a disruption of services to our<br />
waiting periods will apply.<br />
members.<br />
The following is information on<br />
how this affects you and your adult<br />
child depending on your health<br />
insurance plan:<br />
If you have a fully insured<br />
health care plan through an<br />
employer (small business or<br />
large corporation)<br />
• Dependents who currently are<br />
If you have an individual or<br />
enrolled on their parent’s cover-<br />
family medical insurance<br />
age (regardless of insurance<br />
policy<br />
carrier) as of May <strong>2010</strong>, will be<br />
• Dependents who currently are<br />
allowed to remain on that cover-<br />
enrolled on their parent’s cov-<br />
age as long as they are under<br />
erage as of May <strong>2010</strong>, will be<br />
age 26. These dependents are<br />
6<br />
To help our members who<br />
have dependents who are graduating<br />
from high school or college this<br />
spring or may be “aging off” their<br />
parent’s medical policy, Arkansas<br />
<strong>Blue</strong> Cross and <strong>Blue</strong> Shield has<br />
extended health insurance coverage<br />
for most young adults up to age 26<br />
who currently are covered by their<br />
parent’s individual or fully insured<br />
group plan.<br />
Although this provision of the<br />
health insurance reform law (the<br />
Patient Protection and Affordable<br />
Care Act) becomes effective on the<br />
renewal date of a member’s policy<br />
beginning Sept. 23, <strong>2010</strong>, or after,<br />
Arkansas <strong>Blue</strong> Cross, along with 38<br />
other independent <strong>Blue</strong> Plans, has<br />
extended dependent care coverage<br />
early (it began June 1) at the<br />
request of the U.S. Secretary of<br />
allowed to remain on that coverage<br />
as long as they are under<br />
age 26. Dependents are eligible<br />
regardless of student or marital<br />
status. Dependents also are<br />
eligible regardless of whether or<br />
not they are claimed as a dependent<br />
on their parent’s tax return.<br />
• There will be no rate impact on<br />
this change until renewal on<br />
plans already in place as of<br />
May 15 or before. However, a<br />
premium must be paid to cover<br />
the cost of the dependent.<br />
• Those dependents who are<br />
under age 26, and who lost<br />
eligibility for dependent coverage<br />
earlier, can apply to be added<br />
back to the plan at the effective<br />
date of the regulation, which is<br />
Oct. 1, <strong>2010</strong>.<br />
• These dependents will be subject<br />
to medical underwriting.<br />
eligible regardless of student<br />
or marital status. Dependents<br />
also are eligible regardless of<br />
whether or not they are claimed<br />
as a dependent on their parent’s<br />
tax return.<br />
• Dependents who are under the<br />
age of 26, who were not covered<br />
under their parent’s plan as of<br />
May <strong>2010</strong>, and who lost eligibility<br />
for dependent coverage earlier,<br />
can be added back to the group<br />
plan at the effective date of the<br />
regulation, which is the first<br />
renewal date beginning Oct. 1,<br />
<strong>2010</strong>, or after.<br />
• A special 30-day open enrollment<br />
period for dependents who had<br />
previously aged off their coverage<br />
will be held for each group<br />
health plan beginning on their<br />
renewal date. <strong>You</strong> will receive<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
notification before the open<br />
enrollment period. Dependents<br />
on COBRA due to “aging off”<br />
their parents’ coverage, who are<br />
still younger than 26, also will be<br />
allowed to rejoin the group during<br />
open enrollment. They would<br />
again be eligible for COBRA<br />
when they reach the age of 26.<br />
• Policies in place before March<br />
23, <strong>2010</strong>, are allowed to exclude<br />
coverage to dependents if they<br />
have access to their own coverage<br />
from another employer-sponsored<br />
health plan. This exception<br />
expires on Jan. 1, 2014.<br />
• There is no premium rate impact<br />
until the group’s renewal. However,<br />
a family premium (employee/child)<br />
will continue to be<br />
charged.<br />
• If the current plan covers dependents<br />
to age 27, the change<br />
does not impact their plan (fully<br />
insured large group plans only).<br />
• Although this change will be<br />
made automatically, employer<br />
groups may choose to “opt out.”<br />
If you are an employee of a<br />
self-insured group<br />
• <strong>You</strong>r employer will make the<br />
decision. Employers are being<br />
notified of this industry trend<br />
toward early implementation.<br />
• Without early implementation,<br />
the increase in dependent to<br />
age 26 coverage will take effect<br />
at renewal.<br />
• A special 30-day open enrollment<br />
period for dependents who had<br />
previously aged off their coverage<br />
will be held for each group<br />
health plan beginning on their<br />
renewal date. <strong>You</strong> will receive notification<br />
before the open enrollment<br />
period.<br />
If you have an Arkansas<br />
<strong>Blue</strong> Cross dental plan<br />
through your employer<br />
• Dependent rules are the same<br />
as for the fully insured group<br />
health plans.<br />
• There is no premium rate impact<br />
until the group’s renewal. However,<br />
a family premium (employee/child)<br />
will be charged.<br />
• Although this change will be<br />
made automatically, employer<br />
groups may choose to “opt out.”<br />
Dental plans for<br />
individuals and families<br />
(if you purchased your own<br />
dental plan)<br />
• Dependents who are age 19 and<br />
aging off their parent’s plan can<br />
apply for an individual dental<br />
policy.<br />
If you are a state or public<br />
school employee in Arkansas<br />
• The change to cover dependents<br />
up to age 26 was implemented<br />
on April 1, <strong>2010</strong>, and a 90-day<br />
open enrollment period was given<br />
to employees to add previously<br />
dropped dependents.<br />
• The provisions for adding dependents<br />
prior to plan renewal are<br />
as follows:<br />
° Child must be unmarried.<br />
° Parent’s home is the<br />
primary residence of the<br />
dependent.<br />
° Parent provides bulk of the<br />
financial support.<br />
• After plan renewal, all dependents<br />
up to age 26 can be added<br />
regardless of their residence or<br />
marital status.<br />
If you are a federal<br />
employee (FEP)<br />
• This change does not impact FEP<br />
members until Jan. 1, 2011.<br />
7<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
<strong>You</strong>r health insurance, your health<br />
8<br />
Cal Kellogg, Ph.D., senior vice president and chief strategy<br />
officer for Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield,<br />
closely followed health insurance reform as the debate<br />
was waged in Congress and has become an expert on<br />
the resulting Patient Protection and Affordable Care Act<br />
(PPACA). <strong>Blue</strong> & <strong>You</strong> recently sat down with Dr. Kellogg<br />
to discuss the overall effect the new law will have, not<br />
only on the lives of our members, but also on the lives<br />
of all Americans.<br />
What were the goals of health care reform?<br />
Looking back, the initial goal of “health care” reform<br />
legislation was to solve three problems, according<br />
to Dr. Kellogg.<br />
1. Get as many people as possible covered by<br />
health insurance.<br />
2. Address the overall cost of care.<br />
3. Make sure Americans receive high-quality health<br />
care services.<br />
Kellogg said the new law addresses goal No. 1. However,<br />
“that means we have to work on the other two<br />
issues,” he said. “That can be done legislatively, or we<br />
will have to do that as an industry.”<br />
What do our members need to know about<br />
health insurance reform?<br />
According to Kellogg, members need to keep three<br />
important points in mind:<br />
1. Personal Responsibility<br />
As a consumer of health care services, it is important<br />
to take personal responsibility for your own health.<br />
This will benefit you and your family both financially and<br />
personally. “The current reform package doesn’t address<br />
the underlying causes of the increases in medical<br />
costs,” Kellogg said. “People can manage their own<br />
health to prevent illnesses by doing simple things like<br />
eating healthy, exercising and reducing stress — we<br />
just need to be proactive. Rather than saying, ‘let it<br />
happen and then we’ll fix it,’ we should say, ‘let’s do<br />
what we can to prevent illness,’ because the prevented<br />
illness is the one that is the least expensive.”<br />
2. Changes to <strong>You</strong>r Coverage<br />
There will be changes related to your health insurance<br />
coverage because of PPACA. We will keep you<br />
informed through <strong>Blue</strong> & <strong>You</strong> and our Web sites. “While<br />
reform will ensure that more Americans have health<br />
insurance,” Kellogg said, “the coverage will cost more,<br />
simply because of how the changes in the marketplace<br />
are structured by the new law.” He explained that under<br />
reform, individual and family insurance plans will have<br />
rules similar to the current small group insurance plans.<br />
“If you look at the current marketplace, premiums<br />
for small employer groups are about three times higher<br />
Cal Kellogg, Ph.D.<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
care, your future<br />
What you need to know about<br />
health insurance reform<br />
“While reform will<br />
ensure that more<br />
Americans have<br />
health insurance,”<br />
Kellogg said, “the<br />
coverage will cost<br />
more, simply because<br />
of how the changes<br />
in the marketplace<br />
are structured by the<br />
new law.”<br />
than for individual health insurance policies written for<br />
individuals and their families without an employer sponsor,”<br />
Kellogg explained. “This is because small group<br />
health insurance plans are “guaranteed issue,” which<br />
means that employees and their dependents can have<br />
coverage regardless of any health conditions they may<br />
have. In addition, premiums are based in part on the<br />
health conditions of all the employees on the group<br />
plan. So if there are a number of very sick people within<br />
a group, the group premiums will be higher.”<br />
Kellogg said the rates in Arkansas’ current individual<br />
marketplace are some of the lowest in the United<br />
States because of the manner in which the laws in<br />
Arkansas allow health plans to calculate premiums.<br />
Currently, each state has its own set of laws and regulations<br />
that take into<br />
account the unique<br />
circumstances that<br />
may exist in its marketplace.<br />
“If you are<br />
relatively healthy, you<br />
get a much lower<br />
rate,” he said. “If you<br />
are unhealthy, you<br />
may have to pay a<br />
surcharge, or you may<br />
not be offered individual<br />
coverage in the<br />
private marketplace.<br />
<strong>You</strong> would still have access to the high-risk pool, where<br />
the premium rates are closer to the premium rates for<br />
small employer groups.” But beginning in 2014, individual<br />
insurance policies in Arkansas will be required<br />
to be “guaranteed issue” as well. For that reason, the<br />
rates are expected to be closer to what we see in small<br />
employer group health plans today.<br />
In addition, PPACA changes the process and the<br />
factors that insurance companies currently use to set<br />
premium rates. Currently, older individuals generally pay<br />
higher premiums than younger people because they<br />
are likely to need more medical services. But in 2014,<br />
insurance companies will be limited in the difference<br />
in premium charged between an older person and a<br />
younger person. This works out well for you if you are<br />
older and not so well if you are younger.<br />
Also, in 2014, PPACA requires that each state establish<br />
health insurance exchanges or marketplaces where<br />
citizens can go to shop for insurance. At that time, Kellogg<br />
said, a person who buys individual insurance and<br />
whose household income is under 400 percent of the<br />
federal poverty level will receive government subsidies<br />
to help pay for their insurance coverage. Subsidies will<br />
be available to people from 133 percent of the federal<br />
9<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
poverty level up to 400 percent of<br />
to $250, but an older person<br />
the federal poverty level on a sliding<br />
paying $750 might move<br />
scale. People who earn more than<br />
down to $650 a month,” Kel-<br />
400 percent of the poverty level will<br />
logg said. “The impact is go-<br />
not receive a subsidy. “If you are on<br />
ing to vary a lot for people in<br />
the lower end of the scale, you may<br />
the individual policy market.”<br />
not end up paying very much more<br />
Kellogg said the new law<br />
for your policy,” he said, “but if you<br />
doesn’t have as much of<br />
are on the higher end of the scale,<br />
a direct impact on people<br />
you may pay a significant amount.”<br />
ages 65 and older. He noted<br />
10<br />
It is difficult to explain how the<br />
new health insurance reform law<br />
will affect people financially, Kellogg<br />
said, because it depends on their<br />
situation. “Say I’m a 55-year-old<br />
with diabetes. In the current environment,<br />
if I get individual coverage<br />
it may be very expensive because<br />
of my health condition, or I might<br />
not be offered coverage at all in<br />
the private marketplace. But under<br />
the new law, I will be able to get<br />
coverage regardless of my health<br />
condition and it might be a little<br />
less expensive than it would otherwise<br />
have been. This is because<br />
of the new limits in the difference<br />
in premiums that the insurance<br />
company will be able to charge<br />
between an older, unhealthy person<br />
and a younger, healthy individual.<br />
Now, if I’m a single 22-year-old man,<br />
I might see my rates double or triple<br />
because of those same limits, plus<br />
the law’s inclusion of maternity and<br />
other medical services as essential<br />
benefits.<br />
“A young person’s membership<br />
premium might move from $90 up<br />
that they did receive some<br />
immediate relief for prescription<br />
drug coverage and that the<br />
“donut hole” in prescription drug<br />
coverage would close by 2020.<br />
3. The Cost Issue<br />
Health insurance reform does not<br />
fix all the problems in the health<br />
care system. There are still many<br />
important issues to be addressed.<br />
While the new health insurance<br />
reform law deals with access to<br />
insurance, Kellogg said it doesn’t<br />
address the problem of increasing<br />
medical costs. And there is still a<br />
question of whether our medical<br />
system will have the capacity to<br />
serve everyone.<br />
“We are estimating that 500,000<br />
previously uninsured Arkansans will<br />
be able to get coverage,” he said.<br />
“There may be problems with being<br />
able to see doctors as quickly, or<br />
scheduling appointments as easily.<br />
In rural areas, it may be even more<br />
of an issue, because there are fewer<br />
physicians. It also may be a little<br />
bit tighter with the addition of new<br />
Medicaid patients who have not had<br />
insurance and have not been seeing<br />
primary care physicians as frequently<br />
as they should.” There will<br />
be a rise in premiums for young and<br />
healthy people who already have<br />
insurance. Because of this, some<br />
of these individuals may choose not<br />
to pay the higher premiums and go<br />
without coverage.<br />
Some proponents of the new law<br />
have said there will be a windfall<br />
for the insurance companies with<br />
all the new people in the system,<br />
but Kellogg said it doesn’t necessarily<br />
work out that way. “Yes, there<br />
will be new people in the system,<br />
but they may not be as healthy,<br />
and that is going to drive costs,” he<br />
explained. “Our experience is that<br />
folks who have not had insurance,<br />
and then get coverage, tend to use<br />
their coverage quite a bit, which<br />
creates higher volume. <strong>You</strong> take all<br />
those things together and we could<br />
run into some supply problems.”<br />
Advice to Members<br />
Kellogg suggested members not<br />
make any significant changes in their<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Making the Most of It<br />
will take to comply, including the im-<br />
Going forward, Kellogg<br />
plications for them and positives and<br />
said, Arkansas <strong>Blue</strong> Cross<br />
negatives for some of the choices<br />
will focus on ways to effec-<br />
they may make,” he said. “So, hope-<br />
tively pay for benefits and to<br />
fully, that will help our members<br />
provide information to help<br />
if they have employer coverage.<br />
customers find the most<br />
Employers are going to be struggling<br />
effective treatments and the<br />
to understand this; this isn’t their<br />
places with the best out-<br />
business, this is our business, so<br />
comes. “And we want to pay<br />
we’d better be the experts on it and<br />
coverage until there is more information<br />
about the regulations. “The law<br />
has been passed, but the regulations<br />
that define the law really don’t<br />
exist yet. And, until they exist, we<br />
don’t really know exactly how things<br />
will work.”<br />
For example, Kellogg said, the law<br />
discusses “essential benefits,” which<br />
are medical services that every<br />
health insurance plan in the country<br />
will be required to cover, but the regulations<br />
don’t exist to explain which<br />
benefits are considered “essential.”<br />
We have to understand the details<br />
in the regulations before you start<br />
making changes.<br />
Kellogg said that for the<br />
next six to 18 months the law is in<br />
the implementation stage, which<br />
will include some minor changes<br />
and explanation of the law through<br />
regulations. “<strong>You</strong> are not going to<br />
see major changes until 2014,<br />
when these significant structural<br />
changes will happen to the<br />
insurance market.”<br />
providers — not for the number<br />
of services they provide<br />
— but for the outcomes that they<br />
generate for their patients,” he said.<br />
“We can help people identify where<br />
there is waste in the system and<br />
get rid of it. And, if we do all these<br />
things in a relatively short time, then<br />
we can lessen the cost impact that<br />
reform will otherwise have on our<br />
members.”<br />
Implementation<br />
Kellogg said that Arkansas <strong>Blue</strong><br />
Cross is working to understand the<br />
regulations as quickly as they are<br />
announced and will implement them<br />
in a timely, organized fashion with<br />
minimal disruption. “Hopefully, for<br />
our members, transitions will be as<br />
painless as possible and they hardly<br />
will notice that they’ve happened,”<br />
he said, “unless it’s a situation<br />
where they have the opportunity<br />
to extend coverage for their child<br />
or whatever the situation might be<br />
and then we will have a process for<br />
doing that.”<br />
“We also are going to try to keep<br />
help them.”<br />
What is the Silver Lining?<br />
Kellogg said that under reform<br />
many previously uninsured people<br />
will now have access to coverage.<br />
“And, beginning in 2014, if you have<br />
a lower income, there will be significant<br />
government subsidies and<br />
it won’t cost you as much for insurance.<br />
For those groups it is positive.”<br />
But that silver lining isn’t for<br />
everyone. “For the rest of the folks,<br />
the subsidies have to come from<br />
taxes, so the increased tax burden<br />
will be out there,” Kellogg said. “And<br />
for people who are at or above 400<br />
percent of the federal poverty level,<br />
they won’t get any subsidy and<br />
there will be added costs.”<br />
But Kellogg said the efforts to<br />
change health care have only just<br />
begun. “The other positive is now<br />
that the issue of access has been<br />
addressed, we can focus on other<br />
major issues, like cost and quality,”<br />
he said. “I guess that is the biggest<br />
positive.”<br />
11<br />
employer groups informed of what it<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
12<br />
Need more information<br />
before visiting a specialist?<br />
We can help!<br />
If you are planning a visit to the doctor and need a little more information<br />
on what medical care may be appropriate for you, Physician<br />
Connection can help. Physician Connection allows you (as a member)<br />
to find quality information for a specific health condition or physician<br />
specialty.<br />
Quality information is available Physician Connection is available<br />
exclusively for members to<br />
for health conditions such as pregnancy,<br />
diabetes, heart, eye and help you make informed health<br />
respiratory conditions. The quality decisions. It’s available in the<br />
information also is available for secure My <strong>Blue</strong>print sections of<br />
the following specialties: allergy/ our Web sites — arkansasbluecross.com,<br />
healthadvantage-<br />
immunology, cardiology, endocrinology,<br />
family practice, internal hmo.com and blueadvantagearkansas.com.<br />
Visit the home<br />
medicine, neurology, obstetrics/<br />
gynecology, ophthalmology, otolaryngology,<br />
pediatric medicine,<br />
page to register or log in.<br />
pulmonary diseases and urology.<br />
What is quality information?<br />
Medical experts have established guidelines that most informed<br />
practitioners believe physicians should follow in many — but not all —<br />
situations. Quality measures show how often physicians in our network<br />
(as a group) provide frequently recommended treatments to their<br />
patients.<br />
Within Physician Connection on our Web sites, under the section<br />
called “Quality measures for my physician’s specialty,” you can select a<br />
physician specialty, read the recommended treatment options (quality<br />
measure) for specific conditions, and review a graph that shows how<br />
often physicians in that specialty followed the recommended treatment<br />
(quality measure) for their patients.<br />
In a similar section on our Web sites called “Quality measures for my<br />
health condition,” you can select a health condition (such as diabetes)<br />
and review the graph that shows (by specialty) how often physicians<br />
who treat diabetes followed the recommended treatment (quality measure)<br />
for their patients.<br />
Lose<br />
weight<br />
The Healthy<br />
Weigh!<br />
The Healthy Weigh! Education<br />
Program is free for members of<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield,<br />
Health Advantage (except state and<br />
public school employees*), <strong>Blue</strong> Cross<br />
and <strong>Blue</strong> Shield Service Benefit Plan<br />
(Federal Employee Program), Medi-Pak<br />
Advantage (PFFS) and eligible members<br />
of <strong>Blue</strong>Advantage Administrators<br />
of Arkansas.<br />
To enroll, complete the attached<br />
enrollment form and return it in the<br />
self-addressed, postage-paid envelope<br />
included in this magazine. The program<br />
starts when you enroll.<br />
After enrollment, you will begin to<br />
receive information through the mail,<br />
which you can read in the privacy of<br />
your own home and at your own pace.<br />
The program is completely voluntary,<br />
and you may leave the program at any<br />
time. If you have further questions<br />
about the program, call the Health<br />
Education Program’s toll-free number<br />
at 1-800-686-2609.<br />
* Our state and public school members can<br />
access the “Nourish” program through<br />
Life Synch.<br />
Simply complete, sign and return the<br />
attached enrollment form in the selfaddressed,<br />
postage-paid envelope.<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Chronic job stress and your waistline<br />
Are you stressed out at work? Worried about job<br />
security? Feeling like you have little control? Chronic<br />
stress may be adding to employees’ waistlines, according<br />
to a recent study conducted by the University of<br />
Rochester Medical Center.<br />
Researchers found that workers who suffered from<br />
chronic job stress had a higher Body Mass Index (BMI)<br />
than less stressed workers. According to the study,<br />
workers dealing with chronic stress tended to look “forward<br />
to going home and ‘vegging out’ in front of the<br />
TV.” And, when layoffs were occurring, the unhealthiest<br />
snacks were the first to go from vending machines. Employees<br />
noted that they did not take time to exercise or<br />
eat better in order to remain at their desks.<br />
One conclusion that the study made is that employers<br />
should “focus on strengthening wellness programs<br />
to provide good nutrition, ways to deal with job demands<br />
and more opportunities for physical activities<br />
that are built into the regular workday without penalty.”<br />
Sources: University of Rochester Medical Center,<br />
msnbc.com<br />
13<br />
How much exercise do<br />
women really need?<br />
We’ve all heard the standard 30 minutes a day, most<br />
days of the week recommendation. But recent research<br />
shows that may not be enough for women as they age.<br />
According to a study in the Journal of the American<br />
Medical Association, middle-aged women may actually<br />
need closer to 60 minutes a day of moderate-intensity<br />
exercise. Don’t be discouraged so quickly. The study<br />
uses Metabolic Equivalent (MET) hours. To put it into<br />
perspective, 1 MET would be equivalent to lying in bed<br />
for an hour while running at 6 mph would equal approximately<br />
10 METs.<br />
So, in order to meet the 60-minute recommendation<br />
to prevent weight gain,<br />
middle-aged women would<br />
need to aim for a minimum of<br />
21 METs per week. To hit those<br />
MET requirements in less time,<br />
up the intensity of your workouts,<br />
which will allow you to<br />
meet the MET requirements<br />
in less than an hour a day.<br />
Source: Health.com<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Reform, continued from Page 5<br />
14<br />
plans, the lifetime maximum benefit is currently<br />
$5,000,000. This lifetime benefit would become<br />
unlimited.<br />
If you were enrolled in a health plan<br />
through your employer effective April 1,<br />
<strong>2010</strong>, or after:<br />
For more recently effective health plans, a number of<br />
changes apply during the next six to 18 months. These<br />
changes may include:<br />
• New rules around pre-existing health conditions for<br />
children, which may mean that children who are insured<br />
under their parent’s health plan do not have to<br />
meet any pre-existing condition waiting periods even<br />
if the parents are required to do so as a result of<br />
some condition of their enrollment (late enrollment,<br />
no prior creditable coverage, etc.).<br />
• Dependents can continue coverage under a parent’s<br />
plan until their 26 th birthday. Dependents are eligible<br />
regardless of student or marital status. Dependents<br />
also are eligible regardless of whether they are<br />
claimed as a dependent on their parent’s tax return.<br />
(More information on dependent coverage is in the<br />
article on Page 6.)<br />
• Lifetime dollar limits will be removed on “essential<br />
benefits.” The rules and guidelines outlining what<br />
benefits are considered essential have not been<br />
defined by the government as of this printing.<br />
• On most Arkansas <strong>Blue</strong> Cross plans, the lifetime<br />
maximum benefit is currently $5,000,000. This lifetime<br />
benefit would become unlimited.<br />
• The dollar limits for some benefits in place today<br />
may be adjusted by law. The benefits to which this<br />
regulation applies have not been determined.<br />
• Emergency services must be covered at the innetwork<br />
coinsurance or copayment level even if you<br />
receive the services at an out-of-network facility.<br />
(This benefit is already offered by Arkansas <strong>Blue</strong><br />
Cross and Health Advantage.)<br />
• Access to any in-network primary care physician or<br />
pediatrician who is accepting new patients. (Already<br />
available.)<br />
• Direct access for women to obstetricians/gynecologists<br />
without a referral.<br />
• Preventive services identified by the U.S. Preventive<br />
Services Task Force will be covered with no member<br />
cost-sharing (copayments, deductibles or coinsurance.)<br />
The specific services that will be covered have<br />
not yet been identified.<br />
If you were enrolled in a family or<br />
individual medical policy on April 1, <strong>2010</strong>,<br />
or after:<br />
For more recently effective health plans, a number<br />
of changes apply over the next six to 18 months. These<br />
changes may include:<br />
• New rules around pre-existing health conditions for<br />
children which may mean that children who are in-<br />
For more information on health insurance reform,<br />
go to our Web sites or call Customer Service<br />
(telephone numbers found on Page 23).<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
sured under their parent’s health plan do not have to<br />
meet any pre-existing condition waiting periods even<br />
if the parents are required to do so.<br />
• Dependents can continue coverage under a parent’s<br />
plan until their 26 th birthday. Dependents are eligible<br />
regardless of student or marital status. Dependents<br />
also are eligible regardless of whether they are<br />
claimed as a dependent on their parent’s tax return.<br />
(More information on dependent coverage is in the<br />
article on Page 6.)<br />
• Lifetime dollar limits will be removed on “essential<br />
benefits.” The rules and guidelines outlining what<br />
benefits are considered essential have not been<br />
defined by the government as of this printing.<br />
• On most Arkansas <strong>Blue</strong> Cross plans, the lifetime<br />
maximum benefit is currently $5,000,000. This lifetime<br />
benefit would become unlimited.<br />
• The dollar limits for some benefits in place today<br />
may be adjusted by law. The benefits to which this<br />
regulation applies have not been determined.<br />
• Emergency services must be covered at the innetwork<br />
coinsurance or copayment level even if you<br />
receive the<br />
services at<br />
an out-ofnetwork<br />
facility. (Arkansas <strong>Blue</strong> Cross already offers<br />
this benefit.)<br />
• Access to any in-network primary care physician or<br />
pediatrician who is accepting new patients. (Already<br />
available.)<br />
• Preventive services identified by the U.S. Preventive<br />
Services Task Force will be covered with no member<br />
cost-sharing (copayments, deductibles or coinsurance).<br />
The specific services that will be covered have<br />
not yet been identified.<br />
• Direct access for women to obstetricians/gynecologists<br />
without a referral will be included in all policies.<br />
In addition to the new requirements described above,<br />
PPACA includes additional regulations that may impact<br />
members. These provisions include:<br />
• New appeals processes will be established.<br />
• The federal Department of Health and Human Services<br />
will create a Web site to facilitate consumer<br />
and small group health plan shopping.<br />
• State ombudsman programs will be established.<br />
• Over-the-counter drugs not prescribed by a physician<br />
can no longer be reimbursed from a flexible spending<br />
account or HRA.<br />
These are the changes you can expect in the next<br />
six to 18 months. As regulations are clarified, Arkansas<br />
<strong>Blue</strong> Cross will notify you of those provisions that<br />
impact your policy. Most importantly, we will keep you<br />
informed of the impact these changes may have on<br />
your rates.<br />
The most substantial changes will be implemented<br />
in 2014. Those provisions will change where and how<br />
you buy insurance, how it is priced and how you pay for<br />
it. As regulations are issued, Arkansas <strong>Blue</strong> Cross will<br />
provide you with as much information as possible to<br />
help explain health insurance reform and its impact on<br />
the health care industry. Please visit our Web sites or<br />
contact us with any questions you may have.<br />
15<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Lifelong Health<br />
with Dr. David<br />
16<br />
David A. Lipschitz, M.D., Ph.D.<br />
For women, heart attack<br />
prevention and education<br />
are key<br />
In recent years, American women have become increasingly<br />
aware that heart disease is not just a “man’s<br />
issue.” Before menopause, a woman’s risk of heart<br />
attacks is lower than a man’s. But post-menopause, the<br />
risk slowly increases, and within a decade both sexes<br />
have similar statistics. We now know that in the last<br />
two decades of life, a woman’s risk of heart attack and<br />
death from heart disease is significantly greater than<br />
a man’s.<br />
In many women, coronary artery disease is different<br />
from that found in men. Women tend to deposit<br />
cholesterol and fats uniformly throughout their arteries,<br />
whereas men tend to have more localized disease. This<br />
may make women less prone to a massive heart attack,<br />
but more likely to have different symptoms, including<br />
potentially fatal abnormal heart rhythms. Prior to menopause,<br />
estrogens protect the heart from the ravages<br />
of a sedentary and stressful lifestyle, unhealthy diets,<br />
elevated cholesterol levels and smoking. However, after<br />
menopause, the protection disappears and hormone replacement<br />
therapy seems to make the problem worse<br />
rather than better.<br />
As women grow older, heart attacks become more<br />
common, but the symptoms are quite different from<br />
our stereotypic expectations. Most Americans imagine<br />
a heart attack to be preceded by a sudden crushing,<br />
centralized chest pain that feels as if the chest is in a<br />
vice. This is rarely the case. For many women, chest<br />
pain is not the initial symptom. Instead, symptoms<br />
can be extremely varied, including a sudden shortness<br />
of breath, palpitations,<br />
nausea and vomiting,<br />
or feeling<br />
clammy and<br />
ill. If chest<br />
pain does<br />
occur, it<br />
frequently<br />
is atypical,<br />
meaning it<br />
For many women,<br />
chest pain is not the initial<br />
symptom. Instead, symptoms<br />
can be extremely varied,<br />
including a sudden shortness<br />
of breath, palpitations, nausea<br />
and vomiting, or feeling<br />
clammy and ill.<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Editor’s Note: David A. Lipschitz, M.D., Ph.D., is nationally<br />
recognized as a leader in the field of geriatrics.<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield is honored to have<br />
him as a contributor to <strong>Blue</strong> & <strong>You</strong> magazine.<br />
doesn’t fit the classic description of pain associated<br />
with a heart attack. It may be in the back or abdomen<br />
and is often attributed to a muscle strain or indigestion.<br />
Frequently there is no pain at all or merely a feeling of<br />
pressure or tightness across the chest or throat.<br />
Heart attacks with atypical symptoms or no chest<br />
pain are frequently misdiagnosed, or diagnosed after it<br />
is too late. A recent report published in a major medical<br />
journal showed that pain-free heart attacks, particularly<br />
common in older women, are three times more likely to<br />
be fatal than those with typical symptoms.<br />
There are some very important lessons to be learned<br />
from this information. Women must remember that<br />
they are not immune to heart disease. From a young<br />
age, all women must pay attention to a heart-healthy<br />
lifestyle of diet, exercise and stress management. If<br />
medical concerns are present, such as high blood pressure<br />
and elevated cholesterol, they should be treated<br />
and managed.<br />
In addition to prevention, women need to be more<br />
informed and aware of the initial symptoms of heart<br />
attacks. Do not ignore a sudden shortness of breath,<br />
sweating, nausea, vomiting or unexplained palpitations.<br />
Never ignore an unusual pain such as a heaviness or<br />
tightness in the chest, pain in the back, arm or abdomen,<br />
particularly if you have never had anything like this<br />
before. The sudden onset of any of these symptoms<br />
is best handled by taking an aspirin and calling 911; it<br />
could save your life. When it comes to issues of the<br />
heart, it is far better to be safe than sorry!<br />
17<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Warning issued for “baby slings”<br />
18<br />
The U.S. Consumer Product Safety<br />
Commission (CPSC) has issued a<br />
warning concerning the use of infant<br />
carriers known as “baby slings.”<br />
A baby sling is a soft fabric carrier<br />
with a padded shoulder strap connecting<br />
to a hammock-style cradle<br />
that is worn by an adult. The warning<br />
was issued after three infants suffocated<br />
in baby slings in 2009.<br />
Babies younger than four months<br />
old have very weak neck muscles<br />
and can’t control their heads. An<br />
infant can suffocate in as little as two<br />
minutes if the strap from a baby sling<br />
covers his/her nose and mouth.<br />
Also, baby slings can force an<br />
infant’s chin downward to his or her<br />
chest, making breathing difficult and<br />
possibly causing a slower suffocation.<br />
Children with breathing problems<br />
and a low birth weight are at a<br />
higher risk.<br />
The CPSC has not issued a recall<br />
on baby slings, but advises parents<br />
to take special care when using the<br />
device. Specifically, parents should:<br />
• Place the child’s chin up<br />
with his/her face clearly<br />
visible.<br />
• Check on the child<br />
often.<br />
• Do not allow the sling to cover<br />
the child’s face.<br />
• Do not carry the child too low in<br />
the sling.<br />
• Do not carry the child hunched,<br />
with his/her chin touching<br />
the chest.<br />
• Do not carry the child with his/her<br />
face pressed tightly against the<br />
wearer of the sling.<br />
Can<br />
breastfeeding<br />
save lives?<br />
Nearly 900 babies could be saved<br />
each year, along with billions of dollars,<br />
if 90 percent of U.S. women<br />
fed their babies only breast milk<br />
for the first six months of life, according<br />
to a cost analysis published<br />
in the April issue of the journal<br />
Pediatrics.<br />
The analysis studied the prevalence<br />
of 10 common childhood<br />
illnesses, costs of treatment, including<br />
hospitalization, and the level of<br />
disease protection other studies<br />
have linked with breastfeeding.<br />
Breastfeeding is thought to protect<br />
against stomach viruses, ear infections,<br />
asthma, juvenile diabetes,<br />
sudden infant death syndrome and<br />
even childhood leukemia.<br />
The $13 billion in estimated<br />
losses includes an economist’s calculation<br />
partly based on lost potential<br />
lifetime wages — $10.56 million<br />
per death.<br />
The methods were similar to<br />
a widely cited 2001 government<br />
report that said $3.6 billion could<br />
be saved each year if 50 percent of<br />
mothers breastfed their babies for<br />
six months. Medical costs have<br />
climbed since then, and breastfeeding<br />
rates have increased only<br />
slightly.<br />
About 43 percent of U.S. mothers<br />
do at least some breastfeeding for<br />
six months, but only 12 percent follow<br />
government guidelines recommending<br />
that babies receive only<br />
breast milk for six months.<br />
Source: Pediatrics, Associated Press<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Redesigned PHS wins top scores<br />
in national review<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />
Shield’s new Personal Health Statement<br />
— a redesign of the traditional<br />
Explanation of Benefits (EOBs) —<br />
earned a first-place finish, as well as<br />
a designation of “Excellent,” during a<br />
recent national review of insurance<br />
companies’ EOBs.<br />
The EOB, which is generated each<br />
time a member’s doctor or hospital<br />
files a claim, is the primary way<br />
Arkansas <strong>Blue</strong> Cross communicates<br />
with its members. The goal was to<br />
simplify and personalize the benefit<br />
statement so members will understand<br />
exactly what is happening with<br />
their claims and their benefits.<br />
The new Personal Health Statement<br />
is designed to help members<br />
understand a complex industry in<br />
everyday language.<br />
It helps members:<br />
• Understand claims and how they<br />
were handled.<br />
• Monitor out-of-pocket costs<br />
(deductibles, copayments,<br />
coinsurance)<br />
• See benefits and how they work.<br />
• Have a better understanding of<br />
discounts on services.<br />
• Know how to contact their health<br />
insurance plan.<br />
• Have a quick understanding of<br />
how much they owe and<br />
to whom.<br />
DALBAR, a leading third-party<br />
evaluator in the financial services<br />
industry, conducted this first-ever<br />
national evaluation of the EOB. The<br />
evaluation gave 68 percent of EOBs<br />
failing grades. Arkansas <strong>Blue</strong> Cross,<br />
however, was deemed innovative<br />
for recognizing the importance<br />
of this member communication<br />
and transforming its EOBs into<br />
Personal Health Statements that<br />
are understandable and useful<br />
consumer tools.<br />
The DALBAR report evaluates<br />
EOBs according to clarity, content<br />
and design. Three DALBAR designations<br />
are used: Excellent: 80-100<br />
points, Very Good: 70-79 points and<br />
Good: 60-69 points.<br />
19<br />
Food for thought:<br />
Certain foods may keep aging brains healthy<br />
Eating a Mediterranean diet may<br />
help keep your brain healthy as<br />
you age, findings from an ongoing<br />
study show.<br />
A “Mediterranean diet” encourages<br />
the following:<br />
• Vegetables<br />
• Fruits<br />
• More fish, less meat<br />
• Olive oil<br />
• Moderate wine<br />
• Whole grains<br />
• Nuts and seeds<br />
The study included 4,000 adults<br />
aged 65 and older who were given<br />
series of tests to examine their<br />
mental abilities every three years<br />
during a 15-year period. Those who<br />
scored highest in following a Mediterranean<br />
diet were least likely to<br />
suffer cognitive decline, the study<br />
authors found.<br />
Source: National Institutes of Health<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
What’s in a drug name<br />
and why did mine change?<br />
20<br />
Every drug usually has three stems include suffixes like -mab for<br />
names: the chemical name, the monoclonal antibodies, such as infliximab.<br />
Names that include stems,<br />
generic name and the brand name.<br />
Each name is subject to different chemistry roots or other coded<br />
rules and regulations.<br />
information are easier to remember<br />
The chemical name specifies the and give clues to the drug’s use.<br />
chemical structure of the drug. It These names, however, may sound<br />
does not have to be preapproved by or look alike and can contribute to<br />
any organization. Chemical names medication errors.<br />
are primarily used by researchers The brand name is created as<br />
but not in medical practice.<br />
soon as a generic name has been<br />
The generic name usually is created<br />
when a new drug is ready for between drug names that look or<br />
established. To minimize confusion<br />
marketing. It is selected by the U.S. sound alike, the FDA rejects about<br />
Adopted Names (USAN) Council, one-third of an average of 400 possible<br />
brand names submitted based on<br />
whose expertise is recognized by<br />
the U.S. Food and Drug Administration<br />
(FDA), according to principles Still, confusion from similar-<br />
similarities with other drug names.<br />
developed to ensure safety, consistency<br />
and logic. These names To monitor the situation, the FDA<br />
sounding drug names does occur.<br />
typically are used by health care has a medication errors committee<br />
professionals.<br />
that occasionally recommends a<br />
Generic names are made using name change.<br />
an established stem, or group of The most recent name change<br />
letters, that represents a specific happened this year. Kapidex ®<br />
drug class. For example, the USAN (dexlansoprazole), a proton pump<br />
From the<br />
inhibitor that hit the market in February<br />
2009, became confused with<br />
the similar-sounding drug name<br />
Casodex ® . The FDA committee<br />
recommended a name change for<br />
Kapidex ® and effective April <strong>2010</strong>, it<br />
became Dexilant ® .<br />
The last time the FDA changed<br />
a drug name after it was approved<br />
was in 2005, when the Alzheimer’s<br />
medication Reminyl ® was confused<br />
with the diabetes drug Amaryl ® and<br />
one person died. The Alzheimer’s<br />
medicine now is called Razadyne.<br />
The need to change a drug’s<br />
name does not happen often and<br />
usually occurs within the first year<br />
a drug is marketed. The complex<br />
procedure of giving each drug a<br />
chemical, generic and brand name<br />
does not always eliminate confusion.<br />
However, the pharmaceutical<br />
companies, the USAN Council and<br />
the FDA all share one basic goal —<br />
to create a name for each drug that<br />
easily distinguishes it from other<br />
drug names, ensuring patient safety.<br />
Pharmacist<br />
Source: fda.gov<br />
by Trey Gardner, Pharm D.,<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
The<br />
Doctor’s<br />
Corner<br />
No smoking!<br />
Two new studies have determined<br />
that smoking bans in public<br />
by Ray Bredfeldt, M.D.,<br />
Regional Medical Director<br />
Northwest Region, Fayetteville<br />
Drugs used to treat high<br />
blood pressure also may<br />
keep dementia away<br />
ACE-inhibitors are commonly<br />
used to treat high blood pressure,<br />
but evidence now indicates that<br />
these same medications also may<br />
prevent the worsening of dementia.<br />
Researchers recently discovered<br />
that people who take “centrally active”<br />
ACE-inhibitors (examples are<br />
captopril and lisinopril) had memory<br />
function that declined 65 percent<br />
less when compared to those not<br />
taking these same medications. Of<br />
course, more research needs to be<br />
completed, but for someone with<br />
dementia who already is taking high<br />
blood pressure medications, switching<br />
to one of these medications<br />
might be something to consider.<br />
places significantly reduces the rate<br />
of heart attacks. The studies found<br />
that the overall rate of heart attacks<br />
in cities that have banned smoking<br />
in public places has decreased by as<br />
much as 36 percent during a threeyear<br />
study. Exposure to smoke (or<br />
smoking) can cause blood vessels<br />
of the heart to constrict, which can<br />
cause a heart attack. One of the<br />
studies, published recently in the<br />
Journal of the American College of<br />
Cardiology, estimated that a nationwide<br />
smoking ban in public places<br />
could prevent more than 150,000<br />
heart attacks each year.<br />
No link between cell phones<br />
and brain cancer<br />
Someone may have sent you an<br />
e-mail or some sort of “document”<br />
that suggests that radio waves from<br />
cell phones cause an increase in<br />
brain cancer. Scientists have found<br />
no evidence that radio waves can<br />
damage a cell’s DNA, which would<br />
be necessary for cancer to occur<br />
from cell phones. Now, a new<br />
study gives further assurances of<br />
the apparent safety of cell phones<br />
related to radio waves and brain<br />
cancer. Researchers have found no<br />
increase in the rate of brain cancer<br />
in four different countries during the<br />
10 years after a significant increase<br />
in cell phone use occurred in those<br />
countries.<br />
Take folic acid prior to<br />
pregnancy<br />
For many years, doctors have recommended<br />
that women take folic<br />
acid (vitamin B9) during pregnancy<br />
to help prevent birth defects. Now,<br />
evidence suggests that taking folic<br />
acid prior to getting pregnant has<br />
definite advantages. Women thinking<br />
about getting pregnant should<br />
probably start taking folic acid up to<br />
one year prior to becoming pregnant.<br />
A recent study discovered that<br />
women who take folic acid before<br />
getting pregnant reduce their risk of<br />
having a premature baby by 50 to<br />
70 percent. The recommended preconception<br />
dose of folic acid is 400<br />
micrograms per day.<br />
21<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield<br />
Financial Information Privacy Notice<br />
At Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />
Shield and its affiliates (including<br />
HMO Partners, Inc. d/b/a Health<br />
Advantage), we understand how<br />
important it is to keep your private<br />
purchase and use of our<br />
products.<br />
• Information related to the fact<br />
that you have been or currently<br />
are a member.<br />
information. Improper access and<br />
use of confidential information by an<br />
employee can result in disciplinary<br />
action up to and including termination<br />
of employment.<br />
22<br />
information just that — private.<br />
Because of the nature of our<br />
business, we must collect some<br />
personal information from our<br />
members, but we also are committed<br />
to maintaining, securing and<br />
protecting that information.<br />
Customer Information<br />
Arkansas <strong>Blue</strong> Cross and its<br />
Sharing of Information<br />
Arkansas <strong>Blue</strong> Cross and its<br />
affiliates do not disclose, and do not<br />
wish to reserve the right to disclose,<br />
non-public personal information about<br />
you to one another or to other parties<br />
except as permitted or required by<br />
law. Examples of instances in which<br />
Arkansas <strong>Blue</strong> Cross and its affiliates<br />
Disclosure of Privacy Notice<br />
Arkansas <strong>Blue</strong> Cross and its<br />
affiliates recognize and respect the<br />
privacy concerns of potential, current<br />
and former customers. Arkansas <strong>Blue</strong><br />
Cross and its affiliates are committed<br />
to safeguarding this information. As<br />
required by state regulation, we must<br />
notify our members about how we<br />
affiliates only compile information<br />
will provide information to one<br />
handle non-public financial information<br />
necessary for us to provide the<br />
another or other third parties are:<br />
of our members. If you would like<br />
services that you, our member,<br />
request from us and to administer<br />
your business. We collect non-public<br />
personal financial information (defined<br />
as any information that can be tied<br />
back to a specific person and is<br />
gathered by any source that is<br />
not publicly available) about our<br />
members from:<br />
• Applications for insurance coverage.<br />
The application includes<br />
information such as name, address,<br />
personal identifiers such<br />
as Social Security number, and<br />
medical information that you<br />
authorize us to collect.<br />
• Payment history and related<br />
financial transactions from the<br />
• To service or process products<br />
that you have requested.<br />
• To provide information as permitted<br />
and required by law to<br />
accrediting agencies.<br />
• To provide information to comply<br />
with federal, state or local<br />
laws in an administrative or<br />
judicial process.<br />
How We Protect <strong>You</strong>r<br />
Information<br />
Arkansas <strong>Blue</strong> Cross and its<br />
affiliates use various security<br />
mechanisms to protect your personal<br />
data including electronic and physical<br />
measures as well as company<br />
policies that limit employee access<br />
to non-public personal financial<br />
to review the Financial Information<br />
Privacy Notices for all Arkansas <strong>Blue</strong><br />
Cross members, you can visit our Web<br />
site at arkansasbluecross.com or call<br />
the appropriate Arkansas <strong>Blue</strong> Cross<br />
affiliate company to receive the Privacy<br />
Notice. Our customer service areas<br />
are open from 8 a.m. to 4:30 p.m.,<br />
Central time, Monday through Friday.<br />
To receive a copy of the Privacy<br />
Notice, members should call:<br />
Arkansas <strong>Blue</strong> Cross —<br />
1-800-238-8379.<br />
Health Advantage — 1-800-843-1329.<br />
Self-funded group members should<br />
call Customer Service using the tollfree<br />
telephone number on their<br />
ID card.<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
Heart-healthy walking<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield employees<br />
raised more than $8,000 for the American Heart Association<br />
<strong>2010</strong> Central Arkansas Heart Walk, which was held<br />
April 17 at the North Shore River Walk in downtown<br />
North Little Rock. Mike Brown, executive vice president<br />
and chief operating officer, served as the overall Central<br />
Arkansas Heart Walk chairman and launched thousands<br />
of participants for the 5K, including more than 300<br />
Arkansas <strong>Blue</strong> Cross employees.<br />
<strong>Blue</strong>Ann leads Anti-Drug<br />
Walk in Arkadelphia<br />
For the 12th year, <strong>Blue</strong>Ann Ewe helped lead the annual<br />
“Just Say No” drug prevention walk hosted by Perritt<br />
Primary School in Arkadelphia. On April 9, <strong>Blue</strong>Ann<br />
helped lead the fight against drugs with hundreds of<br />
elementary students, high school and college mentors,<br />
parents, teachers and administration staff, and community<br />
supporters during the 23rd year of the event. Community<br />
and state leaders greeted the walkers, pledging<br />
their support in the fight against drugs. Clark County<br />
Sheriff’s Office<br />
staff, Arkadelphia<br />
Police<br />
Department<br />
officers and<br />
members<br />
of the Arkadelphia<br />
Fire<br />
Department<br />
Rescue Unit<br />
participated<br />
as well.<br />
We love to hear from you!<br />
May we help? For customer service, please call:<br />
Little Rock<br />
Number (501)<br />
Toll-free<br />
Number<br />
Medi-Pak members 378-3062 1-800-338-2312<br />
Medi-Pak Advantage members 1-877-233-7022<br />
Medi-Pak Rx members 1-866-390-3369<br />
Arkansas <strong>Blue</strong> Cross members 378-<strong>2010</strong> 1-800-238-8379<br />
Pharmacy questions 1-800-863-5561<br />
Specialty Rx Pharmacy questions 1-866-295-2779<br />
Health Advantage members 378-2363 1-800-843-1329<br />
Pharmacy questions 1-800-863-5567<br />
<strong>Blue</strong>Advantage members 378-3600 1-888-872-2531<br />
Pharmacy questions 1-888-293-3748<br />
State and Public School members 378-2364 1-800-482-8416<br />
Federal Employee members 378-2531 1-800-482-6655<br />
Looking for health or dental insurance? We can help!<br />
For individuals, families<br />
and those age 65 or older 378-2937 1-800-392-2583<br />
For employer groups 378-3070 1-800-421-1112<br />
(Arkansas <strong>Blue</strong> Cross Group Services, which includes<br />
Health Advantage and <strong>Blue</strong>Advantage Administrators<br />
of Arkansas)<br />
Prefer to speak with someone close to home? Call or visit one<br />
of our regional offices:<br />
Pine Bluff/Southeast Region 1-800-236-0369<br />
1800 West 73rd St.<br />
Jonesboro/Northeast Region 1-800-299-4124<br />
707 East Matthews Ave.<br />
Hot Springs/South Central Region 1-800-588-5733<br />
100 Greenwood Ave., Suite C<br />
Texarkana/Southwest Region 1-800-470-9621<br />
1710 Arkansas Boulevard<br />
Fayetteville/Northwest Region 1-800-817-7726<br />
516 East Milsap Rd., Suite 103<br />
Fort Smith/West Central Region 1-866-254-9117<br />
3501 Old Greenwood Rd., Suite 5<br />
Little Rock/Central Region 1-800-421-1112<br />
320 West Capitol Ave., Suite 900<br />
<strong>You</strong> can contact customer service through our Web sites:<br />
arkansasbluecross.com<br />
healthadvantage-hmo.com<br />
blueadvantagearkansas.com<br />
Related Web sites:<br />
blueandyoufoundationarkansas.org<br />
blueannewe-ark.com<br />
23<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>
24<br />
At Arkansas <strong>Blue</strong> Cross<br />
and <strong>Blue</strong> Shield, we are<br />
always looking for new<br />
ways to be "Good for <strong>You</strong>."<br />
Here are some of our<br />
latest accomplishments.<br />
Know <strong>You</strong>r Exposure<br />
To protect our members from overexposure to ionizing<br />
radiation used in medical imaging, Arkansas <strong>Blue</strong><br />
Cross and <strong>Blue</strong> Shield and its family of companies<br />
are including a calculation of a member’s equivalent<br />
dose of radiation from medical procedures in the<br />
new Personal Health Statements. The information,<br />
supplied by National Imaging Associates (NIA), is<br />
based on claims data from health care providers.*<br />
It is important to talk with your doctor about your<br />
medical imaging choices. This additional information<br />
can help you make informed health care decisions.<br />
<strong>You</strong>r doctor can explain the need for a medical imaging<br />
procedure based on the benefits and potential<br />
risks involved.<br />
* Claims data is provided to NIA from Arkansas <strong>Blue</strong> Cross and<br />
<strong>Blue</strong> Shield, Health Advantage and <strong>Blue</strong>Advantage Administrators<br />
of Arkansas at regular intervals. If a claim has not been<br />
filed or was not paid, if the patient has had a lapse in coverage<br />
or if the employer group has opted not to participate, there<br />
may be information on exposure to ionized radiation that is not<br />
factored into this calculation.<br />
New Tools for Small Groups<br />
Effective June 1, Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />
Shield and Health Advantage will introduce two new<br />
services for small group (2-50) customers.<br />
eBill Manager is an electronic billing service that<br />
can replace the traditional paper invoice. Only employer<br />
groups that have signed up for <strong>Blue</strong>print for<br />
Employers will be able to access this new service.<br />
eBill Manager will be available to all new groups<br />
sold on or after June 1, and to all renewal groups<br />
on their anniversary date beginning June 1. Electronic<br />
applications for new employees (e-apps) will<br />
be available for all small groups who are registered<br />
for <strong>Blue</strong>print for Employers effective June 1, <strong>2010</strong>,<br />
regardless of their anniversary date.<br />
NIA provides prior authorization services for outpatient diagnostic<br />
imaging services for Arkansas <strong>Blue</strong> Cross, Health Advantage<br />
and <strong>Blue</strong>Advantage. NIA is an independent company that<br />
operates separately from these companies.<br />
<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>