Celebrating Years of Great Care with Great Ease November

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Celebrating Years of Great Care with Great Ease November Powered By Docstoc
					                                                                                             November, 2001
Celebrating
20 Years of
Great Care    Chiropractic Network Expands
 with Great   Effective January 1, 2002, Valley Health Plan members will have more
 Ease!        chiropractic providers to choose from throughout VHP’s 15 county
              service area.
              It is expected that 35 clinic locations will be     January 1, 2002 or contact VHP’s Customer
              added to the VHP chiropractic network. This         Relations Department at (715) 836-1254 or
              expansion in provider sites is the result of        1-800-472-5411 to verify that they are
              VHP’s ongoing effort to enhance its commit-         remaining under VHP’s new network, Health
              ment to outstanding service to our members.         Services Management, Inc. (HSM).
              It is expected that all of the current chiroprac-   The chiropractic benefit provides coverage
              tic providers in the Valley Health Plan             according to your plan for services that are
              network will continue to participate. You may       clinically appropriate and provided by a
              want to check with your chiropractor prior to                             Continued on inside panel


              VHP Quality Improvement Program
              The VHP Quality Improvement Program was developed to address the
              quality and safety of clinical care and the quality of service
              provided to the Plan’s members.
              The written program description defines our         completed in a matter of months, others are
              quality improvement program structure,              ongoing and will be followed by VHP
              objectives, processes, and resources used to        throughout the year.
              identify, review, measure, monitor, and             The VHP Quality Management Committee
              evaluate the activities implemented by VHP          meets on a weekly basis to review and
              to meet the goals of the program.                   monitor the progress of the activities listed
              VHP has also developed a Quality                    in the Work Plan. Participation by individual
              Improvement Work Plan. This is the compre-          VHP network providers is also essential
              hensive listing of activities implemented to        to the functioning of our Quality
              meet our program goals. Projects focusing on        Improvement Program.
              patient safety, behavioral health issues,           If you would like any information regarding
              utilization of services, member and provider        the VHP Quality Improvement Program
              communications, confidentiality, disease            Description or Work Plan, please contact
              management, prevention, and continuity of           Michelle Larson, VHP Quality Project
              care for members have been implemented.             Coordinator at 715-836-1294. VHP will
              The timeframe for completion of each project        provide this information on request. ❖
              is very different. One may be very simple and
“Women’s Health & Cancer
Rights Act of 1998”
One of Valley Health Plan’s goals is keeping you healthy. This
includes providing coverage for routine care.
Breast cancer screenings are one of the most     N Prostheses and treatment of physical
important aspects of women’s health care.           complications at all stages of the
Women should discuss breast cancer preven-          mastectomy, including lymphedemas.
tion with their healthcare provider and devel-   For more information on Women’s Health
op a prevention plan that’s right for them.      and Cancer Rights, your specific plan
The “Women’s Health and Cancer Rights            benefits, or to request a copy of VHP’s
Act of 1998” extended coverage for all Plans     preventive health care brochure, please call
offering mastectomy coverage to include:         the VHP Customer Relations Department at
                                                 (715) 836-1254 or 1-800-472-5411. ❖
N Breast reconstruction on which a
   mastectomy was performed.
N Surgery and reconstruction of the
  non-affected breast to produce a
  symmetrical appearance.


Chiropractic Network
Continued from cover

participating chiropractor. Please remember                             Best Chiropractic Clinic. . . . . . . . . . . . . . . . . . Hudson
that maintenance care is not a covered ser-                             Frank Chiropractic. . . . . . . . . . . . . . . . . . . . . . Hudson
vice. Maintenance care is ongoing treatment                             Harel Chiropractic . . . . . . . . . . . . . . . . . . . . . . Hudson
after an acute condition has passed or recov-                           Lauritsen Chiropractic Clinic. . . . . . . . . . . . . . Hudson
ery from the condition plateaus. Chiropractic                           Miller Chiropractic, Inc . . . . . . . . . . . . . . . . . . Hudson
care that is not directly related to a specific                         Wallace Chiropractic . . . . . . . . . . . . . . . . . . . . Hudson
condition is not a covered service.                                     Allied Health-Ladysmith. . . . . . . . . . . . . . . Ladysmith
                                                                        Weidner Chiropractic . . . . . . . . . . . . . . . . Menomonie
The following list indicates the present                                Schmittfranz Chiropractic . . . . . . . . . . . . . . . Mondovi
HSM site name and location:                                             Allied Health-Buffalo County Chiropractic . . Mondovi
Black River Chiropractic Center . . . . Black River Falls               Black River Chiropractic Center . . . . . . . . . Neillsville
Allied Health-Advanced                                                  Vrieze Chiropractic . . . . . . . . . . . . . . . New Richmond
Chiropractic . . . . . . . . . . . . . . . . . . . Black River Falls    Olson Chiropractic . . . . . . . . . . . . . . . . . . . . . Osceola
Black River Chiropractic Clinic . . . . . . . . . . . . . . Blair       Markgren Chiropractic . . . . . . . . . . . . . . . . . . . . Osseo
Allied Health-Chetek . . . . . . . . . . . . . . . . . . . . Chetek     Williamson Chiropractic . . . . . . . . . . . . . . . . . Prescott
Adams Chiropractic Center . . . . . . . . . Chippewa Falls              Allied Health-Rice Lake . . . . . . . . . . . . . . . Rice Lake
Allied Health-Chippewa Falls . . . . . . . Chippewa Falls               Rice Lake Chiropractic Clinic . . . . . . . . . . . Rice Lake
Chippewa Falls Chiropractic . . . . . . . . Chippewa Falls              Murphy Chiropractic Clinic . . . . . . . . . . . . . Rice Lake
William Stockman, DC . . . . . . . . . . . . Chippewa Falls             Cleveland Family Chiropractic Center . . . . River Falls
Paulson Chiropractic. . . . . . . . . . . . . . . . . . Clear Lake      Iehl Chiropractic . . . . . . . . . . . . . . . . . . . . . River Falls
Klug Chiropractic . . . . . . . . . . . . . . . . . . . . Eau Claire    River Falls Chiropractic Health Center . . . . River Falls
Tenold Chiropractic. . . . . . . . . . . . . . . . . . . Eau Claire     Somerset Chiropractic . . . . . . . . . . . . . . . . . . Somerset
Wolter Chiropractic . . . . . . . . . . . . . . . . . . . Eau Claire    Lauritsen Chiropractic Clinic . . . . . . . . . . . . . Spooner
Nissen Chiropractic . . . . . . . . . . . . . . . . . . . Ellsworth     Bont Chiropractic Clinic . . . . . . . . . . . . St. Croix Falls
Marek Chiropractic . . . . . . . . . . . . . . . . . . . . . Frederic   Harris Family Chiropractic. . . . . . . . . . . . . . . . Stanley
Galesville Area Chiropractic Clinic . . . . . . . Galesville            Trempealeau Family Chiropractic . . . . . . Trempealeau
Coping With “The Flu Bug”
Aches. Chills. Fever. Headache. Fatigue. Weakness. It returns every
winter. THE FLU BUG! A major illness with potential life
threatening complications like bronchitis and pneumonia,
influenza is highly contagious.
Dr. Dale Reid, Family Practice Physician at        compli-
Midelfort Clinic and Assistant Medical             cations can
Director of VHP says having the flu is never       set in during a
any fun! Dr. Reid gives some recommenda-           bout with the flu, it is important for patients to
tions to patients suffering from the “bug.” “If    be on the lookout for problems. Patients
your body is sending you the indication that       shouldn’t hesitate to contact their physician if
you are fatigued and you just don’t feel well,     something seems wrong. An exam, x-rays and
listen to it! If you come down with the flu        blood tests can aid a doctor in helping to deter-
virus, you should eat small amounts of food        mine if anything really serious is taking place.
and drink frequently, rather than trying to eat
regular meals.” Dr. Reid emphasizes rest is        Prevention
very important. “Rather than saying, I must
                                                   Vaccination is a safe and effective way to
get this or that done, I must push ahead, take
                                                   protect yourself from the flu and is highly
some time to rest. I don’t think anyone has
                                                   recommended. “If you are 65 or over or fall
ever shown that you get over the flu more
                                                   into an ‘at risk’ group, I would certainly
quickly by resting, but you may be able to get
                                                   recommend a vaccination,” says Dr. Reid.
back to being more productive, more quickly.
                                                   Factors that would put a person in this high-
Even people who consider themselves
                                                   risk group include anyone who has a chronic
extremely healthy, who are otherwise fit, eat
                                                   heart, lung, kidney or blood disease, or has
all the right things, etc., may not be able to
                                                   diabetes. “In addition, if you live or work
avoid the more severe effects of flu.”
                                                   with these high risk patients in any capacity, I
Dr. Reid further recommends that patients do       would also advise you to receive the vaccine,”
not exercise when they have the flu. “Far too      says Dr. Reid.
often you see patients trying to push them-
                                                   If you have the flu, cover your mouth and
selves by trying to continue their running,
                                                   nose when you cough or sneeze and avoid
walking or swimming. There have been cases
                                                   contact with others as much as possible. To
of mild carditis (inflammation of the heart)
                                                   further reduce the chance of spreading germs,
resulting from this type of activity, so I would
                                                   individuals should wash their hands frequent-
again recommend to take it easy. If you feel
                                                   ly particularly while preparing food.
like taking a little walk, that’s fine, but you
should avoid exposure to the elements. If you      Last year’s delivery of flu vaccine shipments
are running a fever, you should definitely stay    were considerably delayed due to problems
inside and take it easy. Again listen to what                                Continued on next page
your body is telling you. If you feel fatigued,
rest at that time.”

When To Seek Physician’s Advice                      Season’s Greetings
It is not unusual for many patients suffering              May the Spirit of the Holidays
from the flu to have severe symptoms for a                   remind you of the strength
day or so. However, if something seems out of              and perseverance of our nation
the ordinary and the condition is persistent, a                    and its people.
physician should be consulted. Because other
Coping With “The Flu Bug”
Continued from previous page

that arose during the growing and purifying        vaccine this year, but with deliveries running
phase of production. Shipments have been           late, healthy people are being urged to
running late again this year due to overall        postpone their shots so the elderly and people
distribution delays, but ample supplies should     at high risk can be vaccinated first.
arrive in plenty of time for adequate              Yes, the flu season is once again upon us!
protection. Valley Health Plan wants to make       Hopefully you won’t be bitten by the “BUG”!
it clear it is still very important to get a flu   Just remember, knowledge and prevention
shot no matter what time the vaccine arrives.      can be your best weapons against this
The good news is there will be enough flu          formidable foe. ❖



  Provider Update
  Please call VHP’s Member Service Dept.           Forming and maintaining provider
  before making appointments to verify that        relationships is an ongoing process at
  services from a particular provider are          Valley Health Plan. The following are
  covered benefits under your policy. To           additions and removals to our provider
  request an updated provider listing, please      network:
  call 836-1254 or 1-800-472-5411.
  ADDITIONS                                        Kirk Lane, MD - Family Practice
  Thomas Anderson, MD - Family Practice              Krohn Clinic
    Osceola Medical Ctr.                           Michael Melby, MD - Family Practice
  Alex Beuning, MD - Family Practice                 New Richmond Clinic
    Midelfort Clinic - Bloomer                     James Peters, MD - Family Practice
  Etson Cameron, MD - Family Practice                Marshfield Clinic-Indianhead
    Krohn Clinic                                   Srinivasan Purighalla, MD - Neurosurgery
  Eric Carlsen, MD - Rehab Medicine                  Luther Midelfort - Eau Claire
    Marshfield Clinic-Indianhead                   Delbert Rogers, MD - Family Practice
  Srinivas Chetty, MD - Internal Medicine            Krohn Clinic
    Marshfield Clinic - Indianhead                 Rita Schumann, MD - Family Practice
  Pamela Doorenbos, MD - Family Practice             River Falls Medical Clinic
    St. Croix Regional Medical Ctr.                Robert Solberg, Jr., MD - Family Practice
  Jeffrey Hall, MD - Family Practice                 Marshfield Clinic-Indianhead
    St. Croix Regional Medical Ctr.                Michael Tacheny, MD - Family Practice
  Melissa Hall, MD - Family Practice                 St. Croix Regional Medical Ctr.
    St. Croix Regional Medical Ctr.                Robert Taylor, MD - Family Practice
  Robert Hoch, MD - Pulmonary                        Wabasha Clinic
    Luther Midelfort - Eau Claire                  Mark Wikenheiser, MD - Orthopedics
  Deborah Hower, MD - Internal Medicine              St. Croix Regional Medical Ctr.
    Luther Midelfort - Eau Claire                  Gregory Young, MD - Family Practice
  Chris Hower, MD - General Surgery                  Hudson Physicians, Inc.
    Luther Midelfort - Eau Claire                  REMOVALS
  Vicki Kubesh, MD - Family Practice               Jensen Plaza Pharmacy, Eau Claire - Closed
    St. Croix Regional Medical Ctr.                Lakeland Pharmacy, Rice Lake - Closed
      November is National
      Diabetes Awareness Month
      Diabetes is a serious and common, yet controllable disease
      affecting more than 330,000 people in Wisconsin.

      People with Diabetes are at increased risk       Some common signs of diabetes include:
      for many complications, including blindness,     N Frequent urination
      kidney disease, foot and leg amputations,
      heart disease, stroke, and infections. Many of   N Increased thirst
      these problems can be prevented by use of        N Extreme tiredness
      an aggressive program of more preventive
                                                       N Weight loss
      care, prompt identification of problems, and
      earlier intervention and treatment.              N Blurred vision
      Some common risk factors for diabetes            VHP encourages preventive care and early
      include the following:                           detection of diseases. If you have diabetes or
                                                       any questions or concerns please talk to your
      N Family history of diabetes
                                                       physician. A VHP Customer Relations
      N Being overweight and inactive                  Representative can also assist you in setting
      N Being over the age of 45                       up an appointment with a VHP provider. ❖
      N Being of African, Hispanic, or Native
        American heritage



Federal Employment Laws

      Health Coverage for Subscribers
      Called Up to Active Duty in the
      U.S. Military
      Since the events of 9/11/01, President Bush has called up
      approximately 50,000 military reservists.

      It is quite possible a number of Valley Health   In short, this law requires all employers,
      Plan members have been or will be directly       including small group employers, to offer
      affected by this action.                         these employees 18 months of continuation
                                                       coverage. COBRA coverage may run
      The Veteran’s Reemployment Rights Act, as        concurrently with this coverage. When the
      amended, governs the employment relation-        employee returns to their employment, pro-
      ship between employers and their employees       vided he/she does so within a certain amount
      who enlist or are called up for active-duty in   of time, Valley Health Plan will not impose
      the military. Section 4317 of this law           any waiting period or special exclusions
      specifically governs how health insurance        relating to this military service (other than
      benefits will be affected by an employee’s       certain service-related injury exclusions) on
      active duty military service.                    the individual or his/her dependents. ❖
We Want You To Know...
N Valley Health Plan maintains a drug             N A student status mailing is sent in
formulary, which is a list of medications         December to update information for 2002.
intended for use by our plan physicians and       Student status inquiries should be returned
pharmacists. The formulary helps the physi-       promptly to ensure continuous coverage. A
cians to assess effectiveness of the drug and     copy of the student’s class schedule will be
maintain cost for the plan and the members.       required. If VHP receives the class schedule
N Non-formulary prescription medications          prior to December 10th, you will not be
may be covered if requested by your physi-        receiving an inquiry in the mail.
cian, but your prescription co-pay may be         N Services are paid for by VHP only in
higher. For prescription benefits, please check   accordance with each member’s policy.
your handbook for specifics and exclusions.       Member’s should read their policy and know
If you have additional questions about our        which services are covered and which are
procedures or need a copy of the drug             not. Providers coordinate the member’s care
formulary, please call the VHP Customer           and are not responsible for knowing or
Relations Department.                             quoting coverage
                                                  issues.                   Letting You Know is a
N To obtain behavioral health services,                                      publication of Valley Health
hospital services or specialty care, you can      N HMO policies             Plan, Inc., a joint venture
                                                                             with Midelfort Clinic -
either talk to your physician, check your         require members to         Mayo Health System and
                                                                             Cobalt Corp. Its purpose is
provider directory or call Customer Relations     use VHP providers.         to inform and communicate
for assistance at (715) 836-1254 or               Coverage for out-of-       with Health Plan members.
                                                                             This information is not
1-800-472-5411.                                   area non-urgent care       intended to replace
N There are new treatment plans, procedures,      is not included. This      professional health care. See
                                                                             your healthcare professional
service items, drugs, etc., being developed       does not apply to          for information relevant to
each year. New technology requests are            Point-of-Service           your medical history.

researched by the VHP Medical Director and        policies.                  Please submit suggestions or
                                                                             ideas to:
reviewed by the Medical Management                                           Newsletter Editor
                                                                             Valley Health Plan, Inc.
Committee prior to approval. Questions                                       P.O. Box 3128,
regarding new technology should be directed                                  Eau Claire, WI
                                                                             54702-3128
to the Customer Relations Department.




2270 EastRidge Center                                                                  PRSRT STD
P.O. Box 3128                                                                         U.S. POSTAGE

Eau Claire, WI 54702-3128                                                                 PAID
                                                                                     PERMIT NO. 1360
                                                                                     EAU CLAIRE, WI