Concierge - Winter 2014

L I F E , H E A LT H & W E L L N E S S A P U B L I C A T I O N O F

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Network Health Medicare member, Gary Janssen

LIFENeed to Talk to a Nurse?

HEALTHManaging Multiple Medications

WELLNESSStart the New Year off Right

inside

If you don’t

have a positive outlook, you have

nothing.

EDITORIAL STAFF President Sheila JenkinsChiefAdministrativeOfficer Penny Ransom PublicationsCoordinator Cassie Ashman GraphicDesigner Debra Sutton

EDITORIAL BOARD Marcia Broeren, Joan Merwin, Angie Keenan, Jeanne Skinner, Melanie Draheim, Dawn Rady, Colleen Davison, Renee Corral, Barb Gore, Chuck Rynearson, Teri Kopeke, Sarah Dencker, Natalie Knaack, Barbara Ott

Concierge is published quarterly by Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals.

© 2014 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation. Network Health Medicare Advantage Plans are MSA and PPO plans with a Medicare contract. NetworkCares is a Coordinated Care Plan with a Medicare contract and a contract with the Forward Health Wisconsin Medicaid Program. Enrollment in Network Health Medicare Advantage plans depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change January 1 of each year.* The products and services described include value-added discounts that are only available to Network Health Medicare Advantage plan members. These discounts are value-added and not part of our Medicare contract or your plan coverage.

NetworkHealthMedicare.com2 | ConCierge

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C O N T E N T S

11 Understand Your Risk for High Blood Pressure

12 Feeling Down?How to know when it’s more than just the blues

13 Start the New Year off Right

14 Empower Your Health with Emmi®

15 Provider Directory Changes

19 Help with Advance Care Planning New Dental Plans and

Hearing Aid Offer

BACK COVERMeet Kacey Werner and Your Member Advocate Team

life3 Need to Talk to a Nurse?

3 Member Appreciation Thank You

4 10 Ways to Avoid Slips and Falls This Winter

5 Good Questions for Your Good Health

5 Network Health Medicare Rates High on Quality

6 Help Managing Multiple MedicationsFEATURE8 Better Health Starts With Better Support

wellness

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Y0108_157_120914 Accepted 12152014

Exclusive Reduced Rate for Network Health Medicare Advantage Members

Danú 20th Anniversary TourThursday, March 12 at 7:30 p.m. Tickets $17.

Log on to www.foxcitiespac.com/onlineoffers before January 18, click on the Network Health logo, select Find Tickets and type MEDICARE in the promo code field. Then purchase your tickets by

following the simple instructions that follow.

This offer is only valid for Network Health Medicare members and their families. Not valid on previously purchased tickets. Valid while supplies last.

Gary Janssen controls his health with the help of health professionals, friends and family

life

NetworkHealthMedicare.com ConCierge | 3

S tarting January 1, 2015, all Network Health Medicare Advantage members will have free access to a new nurse line available 24

hours a day, seven days a week through Health Dialog.

1-888-879-8960 TTY 1-888-833-4271This new nurse advice line is available to you at no cost. Health Dialog has been providing services to members for over 19 years, and the nurses you’ll speak with can help answer medical care questions specific to you.

Here are some examples of when to call. • When you have a symptom like a sore throat, muscle pain or a fever • When you have questions about your medicines or are prescribed a new medicine and want to know more about it • When you want more information on a health issue • When you need help determining where to go for care and it’s not an emergency

Every October, we hold our Network Health Medicare Member Appreciation Events. We love

getting the chance to meet our members from all over northeastern Wisconsin. This year, over 10,000 of you attended to learn more about your benefits and get your flu shot. You asked great questions, and we appreciated that many of you brought a guest so they could learn about Network Health. We hope you also stuck around to see a movie and eat some popcorn. Thanks again to all those who attended. See you again next year.

Medicare Customer Service Manager

Need to Talk to a Nurse?Call Network Health’s New Nurse Line

Thank You

10life


Plan ahead. Ask yourself, “What would I do if I fell?”

Take your time. Walk slower and with a wider stance to increase your stability. Don’t be afraid to ask for assistance or a steady arm to hold on to.

Wear proper footwear. Shoes and boots should have tread, rubber soles and little or no heels. Traction devices like Yaktrax® are especially good at preventing slipping.

Get a grip. If you use a cane or walker, consider purchasing ice-gripping cane tips.

Keep your hands free. Avoid using your cell phone and limit carrying packages when you’re walking so your hands are free and you’re not distracted.

Pay attention to your eyesight. If you wear glasses, make sure the lenses are clean. Allow time for your eyes to adjust from dimness indoors to brightness outside. Don’t proceed if your glasses are fogged.

Keep walkways clear. Clean up puddles from melted snow and ice immediately to avoid slipping later.

Protect your bone health. Make sure to get the proper amount of vitamin D. This isn’t always easy since we don’t get enough from the sun in winter, so you may need to use supplements.

Exercise to maintain strength and balance. Many of us are less active in the winter. But, we needtostaystrong,steadyandflexibletoavoid sudden falls and the resulting injuries. Simple exercises can strengthen your upper and lower leg muscles to prevent falls, and help you get up if you do fall.

Avoid alcohol. Drinking two or more alcoholic drinks per day can interfere with your body’s ability to absorb calcium. It can also affect your balance, causing you to be unsteady.

Top Ways to Avoid Slips and Falls This WinterThe falling snow and seasonal decorations make winter a

beautiful time of year. Unfortunately, Wisconsin winters also mean icy sidewalks and slippery streets. By taking these precautions, you can avoid slips, falls and injuries.

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Want to learn more about falls prevention? Consider attending a local Stepping On workshop. Visit wihealthyaging.org/workshops or call us at 920-720-1655 to find a workshop near you.

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Good Questions for Your Good HealthDid you know studies show that people who understand health instructions

make fewer mistakes when they take their medicine or prepare for a medical procedure? It’s true. Informed patients can even manage a chronic health

condition more effectively.

Communication with your doctor is key. And, many health care professionals recommend Ask Me 3™, a patient education program designed to promote communication and improve health outcomes. The program encourages patients to understand the answers to three simple questions.

1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

Ask questions when— You see a doctor, nurse or pharmacist. You prepare for a medical test or procedure. You get your medicine.Make sure to ask these three questions next time you discuss your care with your doctor. It can help you be better informed and understand what you need to do to take care of your health.

Network Health Medicare Rates High on QualityNetwork Health evaluates the quality of care and services provided to members using two nationally recognized tools, the Healthcare Effectiveness and Data Information Set (HEDIS®) and the Consumer Assesment of Healthcare Providers and Systems (CAHPS®). Each tool scores our service in a different way. To view Network Health Medicare Advantage’s results visit NetworkHealthMedicare.com and search for HEDIS® and CHAPS® results. Click the first link that appears in the search results. If you have any questions, or for more information about Network Health’s Quality Improvement Program and national rankings, call 920-720-1229, or toll-free at 800-826-0940, ext. 01229.

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Help Managing Multiple MedicationsF or Network Health Medicare Advantage members who have several health conditions and take many

medications, there’s an increased risk for problems or harmful drug interactions. That’s why we offer a special program to help, called medication therapy management.

WHAT IS MEDICATION THERAPY MANAGEMENT?This program supports you and your doctor to make sure your medicines are working to improve your health. It’s designed to help you manage several medications and do the following. l Improve your medication use. l Reduce the risk of dangerous drug reactions. l Make sure you’re taking medications correctly and as prescribed. l Ensure you are on the most appropriate and cost effective medications.

WHO IS ELIGIBLE?To be eligible for the program, you must meet the following three criteria.

You must have at least three long-term (also called chronic) medical conditions. These may include: l Asthma l Chronic heart failure l Chronic obstructive pulmonary disease l Depression l Diabetes l End stage renal disease l High blood fat levels l High blood pressure l Osteoporosis

For long-term medical conditions, you must take seven or more daily medicines that are covered by Medicare Part D.

Your Part D covered medication must cost more thantheCMSspecifiedannualcostthreshold. For 2015, that amount is $3,138.

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LEARN MOREFor more information about the program, or to

find out if you qualify, call your health care concierge or 800-378-5234, Monday – Friday, 8 a.m. – 8 p.m. (TTY 800-947-3529).


JOINING THE PROGRAMIf you meet the eligibility requirements on the previous page, you’re automatically enrolled in medication therapy management and will receive the following at no cost. l An introductory letter that tells you how to get started. l An offer to participate in a comprehensive medication review each year. lThe chance to review your medications with a pharmacist or other health care professional, including over-the-counter drugs and herbal products. This review will help you get the best results from your medicines. lA letter that outlines this review and suggests next steps. lA targeted medicine review (at least quarterly). lThiswillprovideyouand/oryourdoctorspecific information about making changes to your medication therapy.

KEY THINGS TO KNOW l This program is available at no cost. l Members may participate every year that they meet the eligibility requirements. l Participation in the program is voluntary. l Although members will be automatically enrolled, they may choose not to participate. l Thisisnotabenefitofourplan,butratheravoluntaryprogram.

KEEPING A PERSONAL MEDICATION LISTHaving a list of all your medicines will help doctors, pharmacists and hospitals best take care of you.

It can also prevent potential errors or problems. Share your list with family, and if you go to the hospital or emergency room, take your list with you.

KEEP THIS LIST UP-TO-DATE WITH w Prescription medications w Over-the-counter drugs w Herbals w Vitamins w Minerals

Use the below as a guide to start your own list. Record this information for each drug you take.

For a complete and easy-to-print medication guide, visit NetworkHealthMedicare.com/PersonalMedicationList

Medication and strength I take

How I use it

Why I use it

Date I started using it Date I stopped using it

Why I stopped using it

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COVER STORY

The other day I talked to Crissy for over an hour.

When she calls, I get a different outlook on life.

Do you have COPD? Network Health offers a special program called Breathe at Ease. It’s uniquely designed to help our members with COPD improve or better manage lung conditions. This program gives members access to a registered respiratory therapist and is available at no additional cost. If you are interested in learning more about Breathe at Ease and how it works, call Robyn West, RRT at 920-831-1498 or 920-738-2558.

It’s easy to take breathing for granted—it’s just not something most of us have to think about. Unfortunately, that isn’t the case for people with

chronic obstructive pulmonary disease (COPD). COPD is a complex condition that can make something as natural as taking a breath, become a struggle. When a person is diagnosed with COPD, they know their way of life will have to change. It is a progressive disease and there is no cure. But, COPD can be managed. And, how a person reacts to his or her diagnosis will play a vital role in overall quality of life. Gary Janssen was diagnosed with COPD at age 55 and he admits it was a hard adjustment. Gary was working for the City of Kaukauna and even after 36 years, he still felt too young to retire. But, after being put on oxygen, Gary understood he would need to make some changes.Thankfully, Gary’s boss was very supportive and he

helpedGaryfindawaytoretireearlyandkeephishealthinsurance coverage. As a City of Kaukauna employee, Gary was covered under a commercial Network Health plan which gave him access to the doctors and specialists he wanted to see. At age 62, Gary switched over to a Network Health Medicare Advantage plan. Gary explains, “When I met with the agent, I said show me what you got for Network. I knew I wasn’t going anywhere but with another Network Health plan.” After talking with his agent, Gary decided to enroll in Network Health’s PlatinumPremier plan. Because the plan is a Preferred Provider Organization (PPO) plan, Gary knew he could continue to see the doctors he had come to know and trust. Gary’s relationship with his pulmonologist, Dr. Avery, was especially important to him. And making


By Cassie Ashman Photography by Beth DesJardin, Trove Photography

It takes a village–how Network Health member, Gary Janssen, controls his health with the help of health professionals, friends and family.

BETTER SUPPORT

BETTER HEALTHSTARTS WITH

10 | ConCierge NetworkHealthMedicare.com

sure he would have access to doctors that knew him well and understood his condition was an important factor in choosing a Network Health Medicare Advantage plan. “It’s a good peace of mind knowing that you’re covered,” Gary explains. Another advantage to choosing Network Health, was access to Gary’s own personal nurse care manager. This service is available to all members who qualify for no additional cost. Nurse care managers spend every day helping members coordinate care, giving advice on how to manage conditions and giving tips on how to avoid health problems or complications. When speaking about his nurse care manager, Crissy McNaughton, Gary says, “She’s on my speed dial. When I’ve got questions about my medicines or care, I know she’ll get the answer for me.” Gary appreciates the time Crissy takes to help him with his care. “The other day I talked to Crissy for over an hour. When she calls, I get a different outlook on life.” Because dealing with a condition like COPD is a struggle, you need to have a strong team of people around you to offer support. Of course quality nurses and doctors are a big part of that, but so are family and friends. Gary is fortunate to come from a big family and he

is close with his siblings. In fact, his brother is his best friend. And, Gary also has close relationships with many of his friends and neighbors which keep him going when faced with health challenges. He explains that spending time with people is important to keeping his spirits high. It would be easy for Gary to focus on the negative—not only has COPD made itdifficultforGarytobreathe,buthewasalsodiagnosedwith diabetes. Both diabetes and COPD are considered chronic conditions, meaning they’re life long and need to be actively managed. His conditions have affected his lifestyle. He says “In winter, I’m not as mobile as I’d like to be, but I work around it.” Gary makes it a priority to spend time with family and friends, and every Sunday a server from his church brings him communion. “If you’re living alone, you have to make sure you have local people to talk to. It will change your whole day.” Gary’s optimistic attitude has not only helped him effectively manage his condition, but it’s also given him a better quality of life. His good-natured personality and sense of humor through challenging times have helped him create a strong support system of health care professionals, family members, neighbors and friends.

COVER STORY

Gary with his nurse care manager, Crissy McNaughton


wellnessUnderstand Your Risk for High Blood PressureH igh blood pressure is common among Americans—

nearly one in three U.S. adults has high blood pressure according to the American Heart Association. Unfortunately, this leads to an increased risk for developing serious health conditions, like heart disease and stroke.

Knowing the basics and being informed can help you manage your risk factors and bring blood pressure under control.

What is high blood pressure?As your heart pumps blood to different parts of your body, blood pushes against the walls of your blood vessels and arteries. The force it exerts is what doctors call blood pressure.

High blood pressure usually has no warning signs or symptoms, so many people don’t realize they have it. The only way to know if you have high blood pressure is to have a doctor or other health professional measure it. Measuring your blood pressure is quick and painless.

What causes it?High blood pressure often has no direct cause, however, certain risk factors may increase your risk of developing it. Age, gender, race and family history are a few factors that cannot be controlled. Fortunately, you can help control many of the others.

What should I do if I have high blood pressure?It’s important not to ignore it. If left untreated, it can lead to stroke, dementia, heart and kidney problems and impotence. Discuss your target blood pressure with your doctor. Together, you can decide what steps you need to take to achieve what’s healthy for you.

• Lose weight. If you’re overweight, losing even fivepoundscanhelploweryourbloodpressure. • Get active. Regular physical activity can help lower your blood pressure and keep your weight under control. • Don’t use tobacco and limit alcohol. Smoking or chewing tobacco can raise blood pressure. If you smoke, quit. And, only consume alcohol in moderation. Too much alcohol is also a contributing factor of high blood pressure. • Eat a healthy diet. A diet rich in whole grains, fruits, vegetables, low-fat dairy and low in sodium has been shown to help lower blood pressure. • Reduce stress. Stress can raise blood pressure temporarily and may lead to overeating and tobacco or alcohol use. If you often feel overwhelmed or stressed, it’s important to take steps to change that.

How to Control Your Risk Factors


wellness

The short, dark days can make many of us feel like we’ve caught a case of the winter blues. While slight mood changes can be normal, it’s important to know when it might be something more serious.

Understand What Depression IsDepression can be caused by a combination of genetic, biological, environmental and psychological factors. According to genetic research, depression can result from genes acting together with environmental factors. Seasonal depression, often called seasonal affective disorder (SAD), is a type of depression that occurs each year at the same time.

Some types of depression run in families, but it can occur in people without family histories. In other cases, trauma can cause depression. Loss of a loved one, career or any other stress can trigger depression. However, some episodes of depression can occur without any obvious triggers, too.

You shouldn’t feel ashamed or embarrassed if you think you’re experiencing depression. Instead, take steps to understand it and know when you should talk to your doctor.

Recognize Symptoms w Persistent sad, anxious or empty feelings w Feelings of hopelessness or pessimism w Feelings of guilt, worthlessness or helplessness w Irritability or restlessness w Loss of interest in activities or hobbies you used to enjoy w Fatigue and decreased energy wDifficultyconcentrating,rememberingdetailsand making decisions w Insomnia or excessive sleeping w Overeating or appetite loss w Thoughts of suicide or suicide attempts w Aches or pains, headaches, cramps or digestive problems that do not get better even with treatment

Know If You’re At RiskAccording to the National Institutes of Mental Health, each year about 6.7 percent of U.S adults experience major depression. Women are 70 percent more likely than men to experience depression during their lifetime.

Fortunately, even in severe cases depression can be effectively treated. And, the earlier treatment begins, the more effectiveitis.Thefirststeptogettingappropriatetreatmentistovisitadoctorormentalhealthspecialist.

Feeling Down? How to Know When It’s More Than Just the Blues

Call your health care concierge or 800-378-5234, Monday - Friday, 8 a.m. - 8 p.m. (TTY 800-947-3529)?

our mental state can greatly affect your physical health. It’s not easy to change habits, but by putting the below tips into practice, you’ll notice an improved mood in 2015.

Accept there are things you can’t control. It’s easy to romanticize the past and wish you could just go back to “the good old days.” But don’t allow yourself to get wrapped up in something that’s out of your power. Instead of comparing the present to the past, try to enjoy the moment and don’t worry about how things used to be.

Keep a positive attitude. Easiersaidthandone,right?Itmightbeastruggleatfirst,butitis important to your health. A Boston University study revealed seniors with a positive attitude recover better from surgeries than those with a negative outlook. Being an optimist will make it easier to overcome life’s challenges.

Get and stay socially connected. Remember, your mental and emotional health are just as important as your physical health. Most people understand they need to take time to exercise and eat right to stay healthy. It’s also important to stay connected socially. Try volunteering or doing something nice for others. Helping out can create a sense of purpose and lead to greater happiness.

Start the New Year off RightY


The more knowledgeable you are and the more you’re involved in your health care, the more empowered you’ll be to manage your health successfully. That’s why Network

Health offers online learning programs that members can take advantage of at no cost.

The new online lessons are available through Emmi, an interactive solution that’s easy to use and helps you actively manage your health. You can view it on your computer, tablet or smartphone. Members who use an Emmi program say it answers many of their questions and helps them feel more comfortable taking care of their health.

Emmi offers tutorials on many different health topics and conditions, and each takes about 30 minutes to complete. See an example below. You can watch the modules at your convenience and as many times as you want.


Empower Your Health with Emmi®

New Online Programs Teach Members about Health Conditions

wellness

To get access to an Emmi program, or to

learn more about how an Emmi program can

help you, call 920-720-1695, Monday

through Friday, 8 a.m. – 4:30 p.m.

Do you know how health plans make their decisions?Visit NetworkHealthMedicare.com and click Member’s Corner. Next, look for the Resources heading and click How Health Plans Make Their Decisions. You’ll learn important information about service and appropriateness of care. Or, call 920-720-1602 (TTY 800-947-3529), Monday - Friday, 8 a.m. to 5 p.m. for a hard copy of this information. Bilingual language assistance or translation services are also available.

© 2014 Emmi Solutions, LLC Chronic Low Back Pain program

PROVIDER DIRECTORY CHANGESThis insert lists changes to our Provider Directory for our Medicare plans. Provider additions and deletions are listed. Please pay close attention to the deletions—these providers are no longer in our network. The changes listed are changes since July 31, 2014. If you would like to request a complete directory, call your health care concierge or 800-378-5234, Monday through Friday, 8 a.m. to 8 p.m. (TTY 800-947-3529). For current provider information, please visit our website at NetworkHealthMedicare.com, call your health care concierge or the number listed above. Please note these are changes to the specific providers in bold, not entire facilities.

uPROVIDER ALSO ACCEPTS MEDICAIDWPROVIDER CANNOT BE SELECTED AS A PCP

Network Health recognizes the following specialties as Primary Care Providers: Family Practice, General Practice and Internal Medicine.

ADDITIONS

ADDICTION PSYCHIATRYSHEBOYGANPrevea Sheboygan Behavioral CareBaxter, Carolyn J MD uALLERGY AND IMMUNOLOGY

BROWNPrevea ClinicLocke, Bradley DO u

BEHAVIORAL HEALTHDODGEDodge County Human ServicesKaspar, Judith R LCSW uONEIDASt Marys HospitalPflugardt, Shawn A PsyDuOUTAGAMIEAppleton Medical CenterBehavioral HealthNormington, Katie L LCSWuAppleton Psychiatric andCounseling CenterForslund, Mary S APNP uSHEBOYGANPrevea Sheboygan Behavioral CareHughes, Kathy J LCSW uLintereur, Mamie E LCSW u

CARDIAC ELECTROPHYSIOLOGY MILWAUKEECSMPC Cardiac Rhythm SpecialistsKhazi Syed, Rashad MD uOUTAGAMIECSMPC Cardiac Rhythm SpecialistsKhazi Syed, Rashad MD uOZAUKEECSMPC Cardiac Rhythm SpecialistsKhazi Syed, Rashad MD uSHEBOYGANCSMPC Cardiac Rhythm SpecialistsKhazi Syed, Rashad MD uWINNEBAGO

CSMPC Cardiac Rhythm SpecialistsKhazi Syed, Rashad MD u

CARDIOLOGY/CARDIOVASCULAR DISEASE

OUTAGAMIEAppleton Cardiology ThedacareSidhu, Jasdeep S MD uVarghese, Cherian J MD u SHAWANOAppleton Cardiology ThedacareVarghese, Cherian J MD uWAUPACAAppleton Cardiology ThedacareVarghese, Cherian J MD uWINNEBAGOAppleton Cardiology ThedacareVarghese, Cherian J MD u

CARDIOTHORACIC/THORACIC SURGERY

BROWNPrevea ClinicShen, Paul M MD uDANE UW Health SurgeryMorgan, Angela B PAC u UW Health UW Hospital andClinics SurgeryMorgan, Angela B PAC u OUTAGAMIEAppleton Cardiology ThedacareAugelli, Nicholas V MD u

CHIROPRACTIC

DODGEChiropractic USAEspenscheid, Jenifer DC uWINNEBAGOWinneconne Chiropractic andSports Rehab LLCKellogg, Alexandra DC u

EAR NOSE AND THROAT/OTOLARYNGOLOGY

DANEUW Health UW Hospital andClinics AudiologyRottinghaus, Hannah PAC u

ENDOCRINOLOGY/DIABETESAND METABOLISM

DANEUW Health West Clinic DiabetesFlynn, Maxfield P MD PHD uUW Health West ClinicEndocrinologyFlynn, Maxfield P MD PHD u

FAMILY PRACTICEBROWNBellin Health Family Medical CenterSpott, Sarah R APNP uBellin Memorial HospitalSpott, Sarah R APNP uPrevea ClinicHayward, Pamela M APNP uBellin Health Family MedicalCenter AshwaubenonQuella, Stacy L MD uBellin Health Family MedicalCenter HowardKasper, Alyssa A MD u Prevea ClinicSeverance, Katrina DO uWood, Georgine APNP uCALUMETThedacare Physicians DarboySharma, Deepti MD uThedacare Physicians HilbertSharma, Deepti MD uUW Health Regional SpecialtyServices Portage ClinicRegala, Mitzi M MD uWangerin, Joseph J PAC u

DANEUW Health East TowneUrgent CareAftab, Zahra MD uWUW Health Northeast FamilyMedical CenterVonk, Jantina R MD uWUW Health West TowneClinic Urgent CareAftab, Zahra MD uWUW Health YaharaSwedlund, Matthew P MD uUW Health Verona ClinicWray, Jason R PAC uW

DOORNorth Shore Medical ClinicKnipfer, Ellen L APNP uFOND DU LACAgnesian Work and WellnessWiersma, Teresa J APNP uCHN Medical CenterQuade, Sandralee APNP uGREEN LAKECHN Medical CenterQuade, Sandralee APNP uKEWAUNEEBellin Health Family Medical Center AlgomaTorzewski, Ellen A APNP uOUTAGAMIEAffinity Medical GroupGorenc, Jessica E APNP uThedacare Physicians NorthTurnmeyer, Denise L APNPuVanlannen, Jessica L APNPuAffinity Medical GroupChiu, Albert H DO uAffinity Medical GroupHancock, Jessica L MD uSHEBOYGANPrevea Sheboygan Family



PracticeArmendariz, Jose A MD u Olaso, Sarah M MD uWAUPACARiverside Medical CenterOwnby, Kim H PAC uWINNEBAGOThedacare PhysiciansMenashaSharma, Deepti MD uAffinity Medical GroupLuangla, Mysee APNP uWThedacare Physicians Neenah WestPotokar, Tina L PAC uAffinity Medical GroupBeeson, Matthew F MD uAffinity Medical GroupPrucha, Katie L APNP u

FOOT SURGERYCALUMETCalumet Medical CenterDevries, Jason G DPM u

GASTROENTEROLOGYBROWNPrevea ClinicGorospe, Emmanuel C MD uDANEUW Health Digestive Health CenterZablotney, Monica M APNP uSHEBOYGANColumbia St MarysSheboygan Outpatient CenterKhiani, Vijay S MD u Prevea SheboyganGastroenterologyWolfert, Marla Z MD u

GERIATRIC MEDICINEDANEUW Health University StationClinic Internal MedicineEastman, Alexis M MD u

GERIATRIC PSYCHIATRYSAUKUW Health Specialty ClinicSauk PrairieFischer, Barbara L PsyD uSHEBOYGANPrevea Sheboygan Behavioral CareBaxter, Carolyn J MD u

GYNECOLOGIC ONCOLOGYDANE

UW Health Carbone Cancer CenterOdonnell, Kelin B PAC uRobillard, Janet A PAC u

GYNECOLOGYDANEUW Health UW Hospital andClinics GynecologyKing, Cara R DO u

HEMATOLOGYOUTAGAMIEThedacare Medical OncologyChaudhary, Vijay MD uWeiss, Matthias MD uWAUPACAThedacare Medical OncologyWeiss, Matthias MD u

INFECTIOUS DISEASEDANEUW Health UW Hospital andClinics Infectious DiseaseKayon, Brian C PAC u

INTERNAL MEDICINEBROWNPrevea ClinicShittu, Maryam MD uDANEUW Health East TowneInternal MedicineJelenc, Briana L MD uOUTAGAMIEEast Wind Healthcare SCWeiner, H Richard MD uThedacare PhysiciansInternal Medicine ECHKagen, Michael A MD uSchoenborn, Jami M APNP u

NEONATAL-PERINATALMEDICINE

DANEUW Health UW MeriterHospital Neonatal CenterWraight, Catherine L MD uUW Health American FamilyChildren’s Hospital Neonatal IntenWraight, Catherine L MD u

NEONATOLOGYDANEUW Health UW MeriterHospital Neonatal CenterBush, Kelly A MD uMagnuson, Katherine M MD uMcBride, Elizabeth B MD u

UW Health American FamilyChildren’s Hospital Neonatal IntenBush, Kelly A MD uMagnuson, Katherine M MD uMcBride, Elizabeth B MD u

NEPHROLOGYDANEUW Health Kidney ClinicWaheed, Sana MD uWisconsin Dialysis Fitchburg ClinicWaheed, Sana MD uWisconsin Dialysis East ClinicWaheed, Sana MD u

NEUROLOGYDANEUW Health UW Hospital andClinics NeurologyBazalakova, Mihaela H MD uUW Health UW Hospital andClinics Pediatric NeurologyElkay, Muruvet MD uPORTAGEMinistry Medical Group Rice ClinicSpitzer, Alexander R MD uOBSTETRICS AND GYNECOLOGY

BROWNPrevea ClinicMilosavljevic, Jennifer MD u

ONCOLOGYCOLUMBIAUW Health Regional SpecialtyServices Divine SaviKyriakopoulos, Christos MD uDANEUW Health Carbone Cancer CenterKyriakopoulos, Christos MD uOUTAGAMIEThedacare Medical OncologyChaudhary, Vijay MD uMarohn, Sally A APNP uWeiss, Matthias MD uWAUPACAThedacare Medical OncologyWeiss, Matthias MD u

OPTOMETRYBROWNShopko Eyecare CenterKizewski, Erin R OD u Prevea ClinicIsenhart, Jessica OD u

CALUMETValley Eye AssociatesAbata, Katie OD uDANEUW Health Deming Way Eye ClinicSteinhauer, Andrew T OD uMANITOWOCShopko Eyecare CenterKizewski, Erin R OD uMARINETTEShopko Eyecare CenterKizewski, Erin R OD uOCONTOShopko Eyecare CenterKizewski, Erin R OD uOUTAGAMIEValley Eye AssociatesAbata, Katie OD uJorgensen Schulz andAssociates The Eye CareCenterRosiek, Tracy L OD uShopko Eyecare CenterKizewski, Erin R OD u SHEBOYGANWisconsin Vision IncWilson, Joseph OD uWINNEBAGOShopko Eyecare CenterKizewski, Erin R OD uValley Eye AssociatesAbata, Katie OD u

ORAL AND MAXILLOFACIALSURGERY

OUTAGAMIETMJ Treatment Centers LMG IncTache, Daniel E DMD u

ORTHOPAEDIC SPINESURGERY

BROWNPrevea ClinicTeddy, Shelia PAC uDANEUW Health Research ParkSpine MedicinePoliak Tunis, Michelle A MD u

ORTHOPAEDIC SURGERYBROWNPrevea ClinicMc Dougall Schick, Patricia A MD uSeverance, Daniel L DO uDANEUW Health UW Hospital andClinics Orthopedic SurgeryJulka, Abhishek MD u

DELETIONS


DODGE Fond du Lac Regional ClinicZweiger, Cassandra J PAC uFOND DU LACSt Agnes HospitalZweiger, Cassandra J PAC uRipon Medical CenterPrimary Care Services ClinicMeincke Reza, Jeffrey W MD uZweiger, Cassandra J PAC uMANITOWOCLakeshore OrthopaedicsGoddeyne, Eric PAC uSylvester, Thomas J MD uPORTAGE Ministry Medical Group Rice ClinicPhelan, Benjamin J PAC uSHEBOYGANPrevea SheboyganOrthopaedicsBrazzale, Kristen A APNP uSt Nicholas HospitalMc Dougall Schick, Patricia A MD u

PAIN MANAGEMENTDANEMadison Surgery CenterAbd Elsayed, Alaa A MD uUW Health East Clinic Pain ClinicAbd Elsayed, Alaa A MD uPoliak Tunis, Michelle A MD uUW Health UW Hospital andClinics AnesthesiologyAbd Elsayed, Alaa A MD uMILWAUKEEAdvanced Pain ManagementGozner, Gerald PAC uTravnicek, Katherine D MD uSAUKAdvanced Pain ManagementTravnicek, Katherine D MD u

PHYSICAL MEDICINE AND REHABILITATION

DANEUW Health East Clinic Pain ClinicPoliak Tunis, Michelle A MD u

PLASTIC SURGERYBROWNPrevea ClinicSauerhammer, Tina M MD u

PODIATRYCALUMETCalumet Medical CenterDevries, Jason G DPM u

MANITOWOCLakeshore OrthopaedicsSnellgrove, Jonathan A DPM u

PSYCHIATRY-GENERALDANEUW Health Behavorial Healthand Recovery ClinicGannage, Melissa A MD uOUTAGAMIEAppleton Psychiatric andCounseling CenterForslund, Mary S APNP uAffinity Behavioral HealthBentham, Wayne D MD uSHEBOYGANPrevea Sheboygan Behavioral CareBaxter, Carolyn J MD uOlsen, John L MD u

PSYCHOLOGY-GENERALONEIDASt Marys HospitalPflugardt, Shawn A PsyD uSHEBOYGANPrevea Sheboygan Behavioral CareLukach, Brian M PhD u

RECONSTRUCTIVE REARFOOT ANKLE SURGERY

CALUMETCalumet Medical CenterDevries, Jason G DPM u

RHEUMATOLOGYDANEUW Health RheumatologyDondlinger, Susan M APNP uUW Health West ClinicRheumatologyDondlinger, Susan M APNP u

SLEEP MEDICINEDANEWisconsin Sleep LabBazalakova, Mihaela H MD u

SURGERYBROWNSt Vincent HospitalShiley, Janet L MD uDANEUW Health Digestive Health CenterCarchman, Evie H MD uUW Health SurgerySteiman, Jennifer G MD uUW Health West Clinic

Vascular SurgeryWepfer, Victoria A APNP uUW Health UW Hospital andClinics Breast CenterSteiman, Jennifer G MD uUW Health UW Hospital andClinics SurgeryHauser, Michelle R PAC uNelson, Sarah M APNP uYeager, Jennifer D APNP uAffinity Medical GroupLady, Ping D MD u

SURGERY-HANDDANEUW Health UW Hospital andClinics Orthopedic SurgeryJulka, Abhishek MD u

SURGICAL ONCOLOGYDANEUW Health Digestive HealthCenterCarchman, Evie H MD uClinics Orthopedic SurgeryJulka, Abhishek MD u

UROLOGYDANEUW Health UrologyGralnek, Dan R MD uUW Health UW Hospital and ClinicsDoerfer, Kristin L APNP uGralnek, Dan R MD uRichards, Kyle A MD u

VASCULAR SURGERYDANEUW Health West ClinicVascular SurgeryPhillips, Cynthia J APNP uDURABLE MEDICAL EQUIPMENT

BROWNBellin Health Home CareEquipmentHAMILTONRoche Health Solutions Inc

PHYSICAL THERAPYBROWNOconto Physical Therapy LLCDODGEAdvance Physical Therapyand Sports Rehab LLCOUTAGAMIEThe Bridges of Appleton

BEHAVIORAL HEALTHPORTAGEOswald Counseling Associates IncPflugardt, Shawn A PsyDCARDIOLOGY-INTERVENTIONAL

OUTAGAMIE Appleton Cardiology ThedacareAlaswad, Khaldoon MDSHAWANOAppleton Cardiology ThedacareAlaswad, Khaldoon MDDWINNEBAGOAppleton Cardiology ThedacareAlaswad, Khaldoon MD

CARDIOLOGY/CARDIOVASCULAR DISEASE

DANEUW Health Cardiovascular MedicineSidhu, Jasdeep S MDUW Health East ClinicCardiovascular MedicineOUTAGAMIEAppleton Cardiology ThedacareAlaswad, Khaldoon MSHAWANOAppleton Cardiology ThedacareAlaswad, Khaldoon MWINNEBAGOAppleton CardiologyThedacareAlaswad, Khaldoon M

CHIROPRACTICPORTAGELysne Chiropractic CareLysne, Marshall T DC

ENDOCRINOLOGY/DIABETESAND METABOLISM

DANEUW Health West Clinic DiabetesFrese, Abby C APNPUW Health West ClinicEndocrinologyFrese, Abby C APNPJaume, Juan C MDOUTAGAMIEFox Valley NephrologyPartners SCRadich, Roxanne D APNPCNS CDESHAWANOFox Valley NephrologyPartners SC


Radich, Roxanne D APNPCNS CDEWINNEBAGOAffinity Medical GroupCardenas, Maria O MDFox Valley NephrologyPartners SCRadich, Roxanne D APNPCNS CDE

FAMILY PRACTICE

UW Health Belleville FamilyMedical ClinicMassaro, Lana A MDAffinity Medical GroupAshta, Raman MDDANEUW Health Northeast FamilyMedical CenterMassaro, Lana A MDUW Health ArboretumFamily Medicine ClinicSharp, Samantha N MDUW Health Odana Atrium ClinicSharp, Samantha N MDUW Health Verona ClinicMassaro, Lana A MDEAU CLAIREUW Health Eau Claire Family MedicineGalewyrick, Kenneth L MDOCONTONorthern Health Centers IncDailey, Janet M APNPCMH Oconto Falls Primary Care ClinicPerez, Iris Tc MDOUTAGAMIEFox Valley NephrologyPartners SCRadich, Roxanne D APNPCNS CDEAffinity Medical GroupMittelstadt, Kim A APNPSHAWANO Fox Valley NephrologyPartners SCRadich, Roxanne D APNPCNS CDEThedacare PhysiciansShawanoCloutier, Vickie M MDWINNEBAGO Affinity Medical GroupAshta, Raman MDFox Valley Nephrology

Partners SCRadich, Roxanne D APNPCNS CDEAffinity Medical GroupDias, Jose C MDSports Medicine Center SCLundgren, Laura M PAC

GASTROENTEROLOGYBROWNGastroenterology AssociatesAmarnani, Narayan H MDPrevea ClinicDzwonkowski, Peter MD

HEMATOLOGY

GREEN LAKECHN Hematology Oncology ClinicGeller, Robert B MD

INTERNAL MEDICINE

BROWNPrevea ClinicLim, Luigi Martin C MDDANEUW Health West ClinicInternal MedicineDachel, Theresa A APNPUW Health West ClinicInternal Medicine at Women’s HealthStumm, Eleanore K APNPMANITOWOCHoly Family MemorialInternal Medicine andGastroenterologyStephens, Joanna MDONEIDAMinistry Medical GroupRhinelanderStephens, Joanna MD

NEPHROLOGYDANEUW Health Kidney ClinicAlfonso Jaume, Maria A MD

NEUROLOGYDANEUW Health NeurologyTunnell, Evelyn C MDUW Health UW Hospital andClinics Epilepsy Clinic ATunnell, Evelyn C MDUW Health UW Hospital and Clinics Multiple Sclerosis ClinicFleming, John O MDJEFFERSON

UW Health Regional SpecialtyServices Fort MemoriTunnell, Evelyn C MDMANITOWOCHFM Manitowoc Health andRehab ClinicErlemeier, Steven A MDHoly Family Memorial Family MedicineErlemeier, Steven A MDHoly Family MemorialNeuroscienceErlemeier, Steven A MDHoly Family Memorial ShadyLane ClinicErlemeier, Steven A MD

NEUROSURGERY/NEUROLOGICAL SURGERY

BROWNNeuroscience GroupBrazzale, Kristen A APNPSHAWANONeuroscience GroupBrazzale, Kristen A APNPWINNEBAGONeuroscience GroupBrazzale, Kristen A APNP

OBSTETRICS AND GYNECOLOGY

DANEUW Health Carbone Cancer CenterWirkus, Jessica L APNPONEIDAMinistry Medical GroupRhinelanderFrimpong, James N MDVILASMinistry Medical GroupEagle RiverFrimpong, James N MD

ONCOLOGYGREEN LAKECHN Hematology Oncology ClinicGeller, Robert B MD

OPHTHALMOLOGYDANEUW Health University StationEye Clinic OphthalmologyGirgis, Dalia O MDUW Health East Eye ClinicOphthalmologyGirgis, Dalia O MDUW Health Deming Way Eye ClinicGirgis, Dalia O MD

ORTHOPAEDIC SURGERYBROWNNeuroscience GroupBrazzale, Kristen A APNPDODGEDean Clinic Beaver DamFamily and SportsOrthopaedic CenterDamon, Rachel R APNPGREEN LAKECHN General SurgeryMeincke Reza, Jeffrey W MDCommunity Medical Center ofGreen LakeMeincke Reza, Jeffrey W MDSHAWANONeuroscience GroupBrazzale, Kristen A APNPWINNEBAGONeuroscience GroupBrazzale, Kristen A APNPSports Medicine Center SCLundgren, Laura M PAC

PAIN MANAGEMENT

MANITOWOCAdvanced Pain ManagementMoore, Wendy L APNPMILWAUKEEAdvanced Pain ManagementMoore, Wendy L APNPSHEBOYGANAdvanced Pain ManagementMoore, Wendy L APNPWASHINGTONAdvanced Pain ManagementMoore, Wendy L APNP

PHYSICAL MEDICINE ANDREHABILITATION

FORESTMinistry Medical Group CrandonTan, Hongjing MDLINCOLNMinistry Medical Group TomahawkTan, Hongjing MDONEIDAMinistry Medical Group RiversideTan, Hongjing MD

PLASTIC SURGERYOUTAGAMIEFox Valley Plastic Surgery SCSerret, Marc A MDWINNEBAGOFox Valley Plastic Surgery SC


Serret, Marc A MD

PSYCHIATRY-GENERALBROWNPrevea ClinicSta Romana, Josefina M MDMARATHONMinistry Medical Group WestonHangiandreou, Gabriella A MDONEIDASt. Marys HospitalHangiandreou, Gabriella A MD

PSYCHOLOGY-GENERAL

PORTAGEOswald Counseling Associates IncPflugardt, Shawn A PsyDSHEBOYGANBridgepoint Health LLCWoythal, Constance L PsyD

PULMONARY MEDICINE

OUTAGAMIEFox Valley PulmonaryMedicine LLCDellamater, Eric T APNPWINNEBAGOFox Valley PulmonaryMedicine LLCDellamater, Eric T APNP

RHEUMATOLOGYBROWNPrevea ClinicMufti, Kashif A MD

SPORTS MEDICINEWINNEBAGOSports Medicine Center SCLundgren, Laura M PAC

SURGERYGREEN LAKECHN General SurgeryMeincke Reza, Jeffrey W MDCommunity Medical Center ofGreen LakeMeincke Reza, Jeffrey W MDKEWAUNEEHoly Family MemorialLakeshore Medical SpecialistsSbar, Alan D MDMANITOWOCManitowoc Surgical AssociatesSbar, Alan D MD

UROLOGYGREEN LAKEUW Health UW Hospital and ClinicsGery, Daniella APNP

VASCULAR SURGERYCOLUMBIAUW Health Regional SpecialtyServices Portage ClinicEngelbert, Travis L MDDANEUW Health West ClinicVascular SurgeryEngelbert, Travis L MDRICHLANDUW Health Regional SpecialtyServices Richland Med CtrEngelbert, Travis L MD

MAGNETIC RESONANCEIMAGING

Excel OrthopedicsPHYSICAL THERAPY

Current Physical TherapyCommunity Health Network Rehab

Apria Healthcare No Longer In-Network Effective January 1, 2015, Apria Healthcare will no longer be a participating provider with Network Health’s Medicare Advantage (PPO) plans. You may continue to work with Apria for durable medical equipment (DME) needs, however you’ll pay the out-of-network amount, which is 50 percent of the cost. If youneedhelpfindingaDMEproviderthat’sin-network,toavoid out-of-network costs, call your health care concierge or our customer service department at 800-378-5234, Monday - Friday, 8 a.m. to 8 p.m. (TTY 800-947-3529).

Need Help with Advance Care Planning?Network Health has created a practical guide available to all members to assist with advance care planning. Advance care documents ensure your wishes are honored when you’re receiving care. To access this guide, visit NetworkHealthMedicare.com and click on Member’s Corner. Scroll down until you see the heading Forms. Click on Advance Care Planning/Power of Attorney for Health Care Form. Make sure to print, complete and then share the form with your provider. If you don’t have a computer, call us for a hard copy.

New Dental Plans and Hearing Aid Offer Good news—in 2015, Network Health Medicare Advantage members will have more choices for dental coverage and an exclusive discount on high-quality hearing aids.* To learn more about the new dental plans and hearing aid offer, visit NetworkHealthMedicare.com/members/platinum-perks.php(Please note that these dental plans do not apply to NetworkCares (SNP) members. NetworkCares members will continue to have comprehensive dental coverage through IHC Dental.)

PLATINUMPERKS

NETWORK HEALTH MEDICARE

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800-378-5234TTY 800-947-3529NetworkHealthMedicare.comMonday - Friday, 8 a.m. to 8 p.m.

Enjoy discounts at local businesses and organizations throughout northeast Wisconsin just by showing your Network Health Medicare Advantage (PPO) ID card.Y0108_348_091814 NHIC 09/2014

1570 Midway Pl. Menasha, WI 54952

Health or Wellness or Prevention Information

Q: What is the first thing a member should do if they want to make an appeal?A: “The first thing a member should do is call customer service. The health care concierge can help them make a verbal appeal. Or, if a member prefers, they can also send in a letter. And, a doctor or provider can always make an appeal at the member’s request.”

Q: What is the next step in the process?A: “The member advocate team gets the request right away. Soon, the member will receive an acknowledgement letter which provides more information and the status of the appeal.

Q: What does Kacey wish members knew about the member advocate team?A: “We understand how frustrating it can be when something is denied. We truly empathize with the member. As member advocates, we want to make sure members are getting the best and appropriate care.”

Q: What does Kacey enjoy most about her role as member advocate supervisor?A: “I’m very happy in my current role—it’s nice to work for a company like Network Health. The dedication to our Medicare members and the length associates will go to help our members is pretty unique. What I enjoy most would have to be knowing I had a hand in helping a member get a service they needed. Any time we can get a necessary service approved, we’re happy about it.”

Q: What are some of the challenges related to her position? A: “Network Health closely follows Medicare guidelines. Itcanbedifficultforamemberwhodoesn’treceiveapproval for a treatment their doctor has suggested, but we want the member to understand all of Network Health’s approval decisions are based on medical data and appropriate care best practices.”

Did you know that Network Health has a team of dedicated professionals who work together on your behalf? Our member advocates do just that to make sure you have access to the right care.

When a request for a medical service is denied, and a member or doctor challenges the decision (commonly called an appeal), our member advocate team goes to work.

Member Advocate Supervisor, Kacey Werner, explains “It’s our job to help support the member or doctor’s request.” To learn more about how the process works, read our interview with Kacey below.

Meet Kacey Wernerand Your Member Advocate Team

Top row, left to right – Dawn Mason, Kacey Werner, Kari Kamuda. Bottom row, left to right - Jeanne Skinner and Joi Ahrens

Health Care Concierge Your personal Network Health customer service representative. You can always call this person directly.WHAT’S THAT?

Concierge - Winter 2014

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Transcript of Concierge - Winter 2014