Top Allergens Need Help? - Aetna€¦ · Top. Allergens. Here’s a list of common . allergens and how to avoid them this season. Indoors: 2. Cat dander. You can try bathing your

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Top AllergensHere’s a list of common allergens and how to avoid them this season.Indoors: 2 Cat dander. You can try

bathing your cat once a week or using pet wipes. Vacuum your home often.

2 Insect or mice droppings. Keep food sealed and seal wall cracks. Keep your home clean and uncluttered. Call a pest control expert if necessary.

2 Dust mites. If you can, replace carpets with hard flooring. Use sheet and pillow case protectors to prevent dust mites. Wash and dry bedding on hot.

Outdoors:2 Pollen. Check the news

for pollen counts and stay inside when it’s high. Keep windows closed at home and in the car. Shower before going to bed at night to wash off pollen.

2 Mold. Also check the news for mold counts—stay indoors when it’s high.

A Coventry Health Care Newsletter

SPRING 2014

Turn to www.coventrycareswv.com. From the Member home page, click Understand Your Rights to learn about:2 Submitting a claim for covered

services2 Benefits included and excluded

from your coverage2 Finding network providers and

information about them2 Benefit limits and getting care

outside the system or service area2 Charges you may be

responsible for2 Getting care after office hours2 Getting emergency care and

knowing when to call 9112 Getting primary care, including

points of access and pharmacy procedures

2 The prescription drug formulary2 Filing a complaint or an appeal

2 Disease case management programs

2 Member rights and responsibilities2 Our privacy practices2 What utilization management

is, how we make decisions, and how to contact our UM Department

2 Standards for our providers 2 Our quality and compliance efforts,

including our quality newsletter2 Evaluation of new medical

technology2 Getting specialty or hospital care2 Getting patient safety information 2 Language assistance including

interpreter services

Need Help?

No Internet Access? Call Customer Service at 1-888-348-2922 and ask for a paper copy of any information on our website.

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3 Ways to Avoid Back PainIf you’ve ever injured your back, you know it’s not easy to fix. You can prevent back pain though. Here are some tips.

Lift properly. Remember to squat, don’t bend. Tighten your stomach muscles to protect your

back. Don’t try to lift things that are too heavy for you; ask for help.

Exercise. You’re more likely to hurt your back if you are out of shape. A strong core can help you avoid back injuries. Many exercises can help you improve

core strength—pushups, squats, lunges and others.

Lose weight. Being overweight can put extra strain on your back. Just losing 10 percent of your body weight can make injuring your back less likely.

Watching Your Weight? Check out www.myfitnesspal.com. This free website will help you estimate how much to eat. That way you can lose pounds or maintain a healthy weight.

Quality MattersIt is important to us that you receive quality health care and member services.

Have a problem? Our goal is to correct any prob-lems our members may have. If you have a problem, call Member Services at 888-348-2922.

What is a complaint? A complaint is when you are not happy with a service you received. An example may be a long wait time at your doctor’s office. Another example may be your overall satisfaction with the health care services you received.

Who can file a complaint? Members or someone for a member (a friend, family member or doctor).

When and how can I file a complaint? You can file a complaint by call-ing or writing Customer Service. A complaint may be filed any time you are unhappy with your health care services.

What if I’m not happy after Customer Service has tried to help me? If you are not happy with the out-

come of your complaint, you may file a formal grievance under the Appeals and Griev-ances Program. Read the Appeals and Grievances section of your Member Handbook or call Member Services to learn more.

If your Formal Grievance is be-cause we have denied any part of your request for a health care service, it is called an “Appeal.” If your Formal Grievance is because of any other reason that you are unhappy with CoventryCares Health Plans, your coverage or your provider, it is called a “Complaint.”

If you need help to file a formal grievance (Appeal or a Complaint) you can call us at 1-888-348-2922. If you have hearing or speech problems you can call the 711 Relay Service or the TTY/TDD line at 1-800-207-1262.

You can also go on the Web to www.coventrycareswv.com.and on the Member homepage, pick Frequently Asked Questions and look at how to file an Appeal or Complaint.

When filing an appeal, you’ll need to send us a letter that has: 2 Your name

2 Your pro-vider’s name

2 The date of service2 Your mailing address2 The reason why we should

change our decision2 A copy of any information

that you think supports your Appeal, such as additional documents, records or information related to your Appeal

When filing a Complaint you’ll need to send us a letter that has:2 Your name2 Your mailing address2 The reason why you are filing

the complaint and what you want CoventryCares to do

The address where to send your Appeal or Complaint letter is:CoventryCares of West Virginia3721 TecPort DriveP.O. Box 67103Harrisburg, PA 17106-7103Attn: Appeals

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Diabetes and Foot CareDo you have diabetes? Then you’re at risk for foot prob-lems. Diabetes damages the blood vessels and nerves in your legs and feet. That can lead to calluses, fungal infec-tions, ingrown toenails, ulcers and even gangrene.

Here are some tips for proper foot care:

Inspect your feet. Look for injuries, ingrown nails and changes in color, shape or sensation. Call your doctor is you notice problems. Your doctor should check your feet at least once a year.

Take care of your feet. Wash and dry your feet well and then apply lotion on the tops and bottoms (but not between your toes) every day. Trim your nails regularly.

Protect your feet. Always wear shoes and socks to protect your feet from injury, heat and cold.

Move your feet. Put your feet up when sitting and don’t cross your legs. Wiggle your toes and move your ankles for five minutes three times a day. Exercise to improve circulation.

Matters of the HeartWe all want to avoid heart disease. There’s no one answer. But start by keeping your blood pressure and cholesterol in a healthy range. How do you know if your numbers are OK? Your doctor can run tests to find out. Here’s more about those two important heart health tests:

BLOOD PRESSURE SCREENING—every 1 to 2 years. You’ve probably had this simple test before. A doctor or nurse will wrap a cuff around your upper arm. The cuff will inflate and tighten for a few

seconds then quickly loosen. This one-minute test measures how much pressure is being put on your arteries. A healthy blood pressure is 120/80 mm/Hg or less. You should have this test at every doctor’s visit.

CHOLESTEROL BLOOD TEST—every 5 years, starting at age 20. This is a fasting blood test. So you’ll be asked not to eat the night before your test. A nurse or doctor will draw your blood and test it to find out your total cholesterol, LDL (bad) cho-lesterol, HDL (good) cholesterol and triglycerides.

Benefits of BreastfeedingDo you have a baby on the way? Experts agree that breastfeeding is best. It can help bond you and your baby. There are many health benefits, too. Doing it for at least six months can: 2 Prevent illness. Babies who

are breastfed are sick less often

and with less intensity. 2 Prevent asthma. Infections

that start in the lungs trigger asthma. Babies who are breastfed are less likely to get infections.

2 Prevent obesity. Babies who are breastfed are less likely to

become obese or have high blood pressure later on.

2 Prevent infections. Babies who are breastfed are less likely to have ear, respiratory and diarrheal infections. Visit www.cdc.gov/

breastfeeding to learn more.

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Hiding Places For GermsGerms are everywhere, and they can make you sick. Here are some of the germiest places and how to protect yourself.

RESTAURANTS—menus, lemon wedges and table condiments.

What you can do: Use hand sanitizer after ordering and using condiments. Skip the lemon, and keep silverware and menus apart.

GROCERY STORES—grocery carts and credit card pin-pads.

What you can do: Use the store-provided sanitizing wipes on your hands and cart when you enter and leave the store.

PUBLIC RESTROOMS— restroom door handles and soap dispensers.

What you can do: Wash with soap and hot water for 20 seconds. Then use the hand towel you dry with to open the door when you leave.

Quality Matters Did you know you can file a complaint or appeal a decision about your health care? See page 2 to learn more.

BCL

500 Virginia St. East Suite 400 Charleston, WV 25301

www.coventrycareswv.com

PRESORTEDSTANDARD

U.S. POSTAGEPAID

FLORENCE KYPERMIT NO. 313

Are you having problems reading or understanding this or any other information? The information in this notice is available in other languages and formats by calling 1-888-348-2922. If you are hearing or speech impaired, call TTY/TDD: 711 or 1-800-877-8973.

Published by McMurry/TMG, LLC ©2014. All rights reserved. No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not take the place of—the recommendations of your health care provider. Consult your physician before making major changes in your lifestyle or health care regimen. McMurry/TMG makes no endorsements or warranties regarding any of the products and services included in this publication or its articles.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS)® is a survey that measures how satisfied members are with their health plan. It also rates the quality of the care they received through the year. CoventryCares staff learns about areas where we are doing well and areas where we need to improve.

Areas where we improved were:2 Getting needed care 2 Doctors’ communication 2 Customer service

Areas where we think we can improve:2 Understanding benefits2 Not enough doctors

in network2 Getting to doctors/labs2 Reducing language and

cultural barriers to care2 Increased use of member

website

How we plan to improve:2 Customer Service will help

members with appoint-ments, benefit questions and use of website.

2 The Special Needs Unit will help members with their needs.

2 CoventryCares will help members communicate better with their providers.

2 We will explain to members how to file an appeal.

2 We will give members tips on what to expect during an exam.

2 CoventryCares will assess member satisfaction after calls to Customer Service.

2 We will identify areas where there is a need for more providers.

CoventryCares wants to ensure our members are satisfied with their plan and the quality of care they receive.

Member Satisfaction