How to control pollens and molds—and manage your

Spring |
S u m m e r 2 0 13
The We llne s s M agazine by Independent H ealth
How to control
pollens and
manage your
Easy ways to
remember to take
your medications
Helping to create a
culture of health one
initiative at a time
Page 2
Health Reform
New way to get
health insurance
Page 4
25 years of family,
fitness and fun
Page 14
Prenatal Care
Assess your health
before pregnancy
He alth c are reform
$0 copay preventive
services reminder
Many top-risk factors leading to illness
and premature death are preventable.
That’s why preventive care is the most
important step you can take to
manage your health.
Preventive services can find health
problems early, when treatment works
best, and can reduce your risk for
getting certain diseases.
As an Independent Health member,
you may currently be eligible to
receive more than 60 preventive care
services and screenings at no cost to
you when performed by an in-network
health care provider.* These services
include mammograms, cholesterol
screenings, colonoscopies, annual
physicals, women and children well
visits, immunizations and more.
Please note that if you visit your
doctor for a preventive service, any
non-preventive service rendered as
part of your visit is subject to the
applicable member liability as outlined
in your General Health Contract. For
example, if your physician determines
that an electrocardiogram is required
during your routine physical, you
would be responsible for the
applicable copayment, coinsurance or
deductible based on your plan option
for that test.
Well visits that turn into sick visits
are also subject to member liability.
For example, during a routine physical,
you mention to your doctor that
you’ve been experiencing some
discomfort in your ear and, upon
examination, you’re diagnosed with an
ear infection. This would be
considered a sick visit.
What the Health Benefits
Exchange will mean to you
If you ever wished you could comparison
shop for health insurance and buy your
coverage with the click of a mouse, the
Affordable Care Act (ACA) is about to
make it a reality. A new Web-based health
insurance marketplace is opening on
October 1, 2013; it allows individuals and
small employer groups to choose their
coverage (which begins January 1, 2014).
This marketplace, called the Health
Benefits Exchange, will be a one-stop
shopping experience similar to Travelocity®
or Esurance®, where shoppers can go online
to look at plan options, including prices and
benefits. A toll-free telephone line will also
be available for consumers. New York State
will operate the marketplace based on
federal specifications.
A majority of people are used to
receiving health care coverage on the job,
and for many that will not change.
For those who do not have access to
coverage currently or for those who lose
coverage, this new marketplace will let
you shop for plans, enroll in a plan and
pay premiums online. Every plan sold
in the Health Benefits Exchange will
cover services that include preventive
screenings (offered with no copayment
or deductible), prescription drugs,
hospitalization, maternity care and
chronic disease management. Individuals
are guaranteed coverage regardless of
pre-existing conditions.
Organizations known as Navigators
will be available to help shoppers find the
coverage that meets their needs.
Individuals who meet income guidelines
will receive federal assistance to pay a
portion of premium costs or even some
out-of-pocket expenses, such as
copayments or deductibles. The
streamlined one-page application will
also determine if individuals are eligible
for Medicaid coverage and assist with
enrollment in that program.
Independent Health’s Member Services
is available to answer your questions about this new marketplace, or you can visit
New York State’s website at:
We encourage you to take advantage
of $0 preventive care services. To
learn more about these services,
please visit the Member section
at or Also, talk with
your doctor to make sure you are
up-to-date on your preventive care.
*Benefits vary by plan.
HealthStyles | Spring/Summer 2013
commun it y i n itiative s
Helping to create a culture of health
one initiative at a time
Independent Health has partnered with
several local organizations to offer
initiatives that help Western New Yorkers
take charge of their health.
• The Independent Health Family
Branch YMCA is YMCA Buffalo
Niagara’s newest and largest branch.
Located at 150 Tech Drive in Amherst,
this state-of-the-art 94,000-square-foot
facility houses an Independent Health
Member Information Center,
rehabilitation offices run by Buffalo
Rehab Group and a demonstration
kitchen sponsored by Wegmans. Other
features include two 7,700-square-foot
gymnasiums, an indoor running/
jogging track, fitness center/weight
room, two swimming pools, aerobic
studios and an Alaskan Adventure
Room for children sponsored by First
Niagara Foundation. Independent Health
also provides health and wellness
programs and resources. Visit to view our
calendar of activities.
• In conjunction with YMCA Buffalo
Niagara, Independent Health introduced
Fitness in the Parks during the summer
of 2012. Open to the entire community,
this free weekly exercise program was
developed to encourage individuals to
stay on track with their fitness goals by
attending fitness classes at participating
parks throughout the region. Under the
direction of a YMCA certified instructor,
individuals had the opportunity to take
part in Pilates, Zumba® and yoga classes.
We look forward to working with
YMCA Buffalo Niagara to offer this
program again this summer.
• In an effort to promote healthier
lifestyles in our community,
Independent Health has joined forces
with Snyder Corporation and Fitness
Ridge Worldwide to bring the Biggest
Loser Resort Niagara to Western New
York at the Beaver Hollow Conference
Center in Wyoming County. Inspired
by NBC’s hit weight-loss series, The
Biggest Loser, the resort focuses on
exercise, healthy nutrition and
education. The rigorous program gives
participants the tools they need to
adopt lifestyle changes to stay healthy
and reduce their risk for chronic
disease, like diabetes and heart disease.
Independent Health will continue to
collaborate with community partners as
we establish a culture of health and
wellness here in Western New York. In
doing so, we will further improve the
health and vitality of the community,
while lowering rates of preventable illness
and overall medical costs.
The Buffalo Museum of Science presents BODY WORLDS Vital
BODY WORLDS Vital—sponsored by Independent Health—is the
latest chapter in the series of BODY WORLDS Human Saga
exhibitions. Opening May 31 for a limited engagement, Vital
presents a special collection of specimens designed to show visitors
the essentials for human health and wellness. The exhibition
includes whole-body plastinates, a large arrangement of individual
organs, organ and arterial configurations, and translucent slices that
give a complete picture of how the human body works.
Vital tells the fascinating story of how to best fight, manage and
prevent life-threatening diseases—such as cancer, diabetes and
heart ailments—through healthy choices and lifestyle changes. The
BODY WORLDS display by Gunther von Hagens, M.D., features
authentic human bodies, willed by donors and preserved through
plastination. The series is designed to educate the public about the
human body and increase health awareness. Learn more at Show your Independent Health member ID
card at the Buffalo Museum of Science box office to receive a $2
discount on the regular exhibit admission.
After visiting Vital, be sure to check out all the new experiences
the museum has to offer, including its interactive health sciences
studio, Explore YOU, presented by Independent Health. Explore
YOU offers visitors a hands-on experience to explore all there is to
know about the human body, ways to stay healthy and advances
in life-changing medical technology.
fitness focus
Three healthy
habits to teach
your children
Want to leave a lasting legacy that
will benefit your children for their
entire lives? Teach them healthy
habits. Better yet, show them how
to practice healthy living through
your example.
Set a good example for your kids
by following these three simple
Habit 1: Eat slowly
In today’s busy families, too often
kids rush through meals before
running off to activities. Show your
children how to slow down and
enjoy their food, by chewing
thoroughly and taking breaks
between bites.
The benefit: Food digests better,
you can savor a meal’s flavors and
you are less apt to overeat.
Habit 2: Quench thirst wisely
Don’t buy and serve sugary drinks
or foods just to please your children.
When they’re thirsty, serve water.
With meals, offer a glass of 100%
fruit juice or calcium-rich milk.
The benefit: You avoid drinks that
offer “empty” calories, which can
lead to weight problems.
Habit 3: Buckle up for safety
Car accidents are a leading cause of
death among American children.
Sadly, many of these deaths could
be prevented if youngsters were
properly restrained with seat belts
or child safety seats. Refuse to start
your car until all passengers—
yourself included—are buckled in.
The benefit: Greater safety for
everyone and better peace of mind
for you.
Remember, what you do may have
far more influence than what you
say. Practicing these habits just may
boost your own health and wellbeing, too.
Kids Run celebrating 25 years
of family, fitness and fun
If you’re looking for a fun and healthy
way to spend time with your family, we
invite you to take part in the 25th annual
Independent Health Foundation’s Kids
Run, which is scheduled for 9 a.m.,
Saturday, June 1, at the Zoofari
Courtyard at Delaware Park.
This free event includes a mini dash
for kids ages 2 to 5 and a 1.8-mile run/
walk for all ages. Trophies are awarded to
the winning boys and girls, and each
participant receives a medal (while
supplies last) at the finish line. All ages
are welcome—strollers, too. After the
race, make a day of it at the Buffalo Zoo
with discounted admission for all
participants. Kids Run is made possible
by Wegmans.
Soccer for Success
Youngsters from the Soccer for Success
program will also be on hand at the Kids
Run to display their soccer skills. Soccer
for Success is a free after-school, sportsbased youth development program that
uses soccer as a tool to combat childhood
obesity and provides nutrition education
and mentorship to children in
underresourced communities.
More than 700 children have
participated in the program since
it was launched last fall by the
Independent Health Foundation.
Participants have had an overall increase
in physical endurance, while lowering
their overall body mass indexes.
Soccer for Success is made possible by
a grant from the U.S. Soccer Foundation
and is run in collaboration with the
Buffalo Soccer Club and the United Way
of Buffalo and Erie County.
Register for the Kids Run
To learn how you, your family or your
organization can participate in the Kids
Run, visit
foundation or call the Foundation at
(716) 635-4959. We also encourage you
to Like the Independent Health
Foundation on Facebook.
HealthEdge, Delta Dental and
Personal Computers, are proud sponsors
of the Independent Health Foundation’s
HealthStyles | Spring/Summer 2013
e ati ng well
Offering healthy options at the Taste of Buffalo
The Independent Health Foundation’s
Healthy Options program is once again
partnering with the Taste of Buffalo to
require that all participating restaurants
serve a healthy food item at this year’s
event, which is scheduled for July 13
and 14.
The Healthy Options program was
integrated into the Taste of Buffalo in
2007, making it the only food festival in
the United States to require that all
participating restaurants offer a healthy
option item. Last year, more than 50
restaurants offered a variety of healthy
options, from garlic grilled shrimp
skewers to veggie bliss sandwiches.
The 2012 Healthy Options Contest
winners were:
• First place—Kabab & Curry’s Malai
Tikka (grilled chicken skewer with sour
cream and yogurt marinade)
• Second place—Orazio’s Faye Salad
(mixed greens topped with candied
walnuts, craisins, mandarin oranges,
red onions, Kalamata olives and
Gorgonzola cheese, served with a fatfree raspberry vinaigrette)
• Third place—Applebee’s Grilled
Jalapeno Lime Shrimp (marinated
chipotle lime shrimp paired with a
black bean corn salsa on grilled
zucchini, tomatoes, onions and red
Established in 2004, the Healthy Options
program is designed to help our
community make more informed
decisions when dining out and help
address the high rates of stroke and heart
disease prevalent in Western New York.
Through this program, the Foundation
works with area restaurants to offer
heart-healthy food options, which are
considered lower in fat, saturated fat,
cholesterol and sodium.
“We want to make sure your diningout experiences are just as healthy as the
ones in your own kitchen,” said Carrie
Meyer, executive director,
Independent Health Foundation. “By
working with area chefs, we can help you
make better decisions about the meals
you order when eating out. And the best
part is, you don’t have to compromise on
taste. You can be sure that along with
being healthy, meals also taste great.”
Looking for a great place to eat?
For a list of participating
restaurants, please visit The Healthy Options program is
made possible by Roche Diagnostics.
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for your benefit
You’re invited to
learn more about
your coverage
At Independent Health, we want to
make sure we address any questions
our members may have about their
health plan. One way we help our
members understand their coverage is
by holding informational orientation
sessions on a quarterly basis.
Upcoming member orientations
are scheduled for the following
• Wednesday, June 12
• Wednesday, September 18
• Wednesday, December 11
By attending one of these sessions,
you will have the opportunity to ask
specific questions about the health
plan you are enrolled in. These
sessions are held at our Customer
Service Center, located at 250 Essjay
Drive in Williamsville, and begin
promptly at 6 p.m.
Reservations are strongly
encouraged. To register for one of
these orientation sessions, please
call our Member Services
Department at (716) 631-8701 or
1 (800) 501-3439, Monday
through Friday, from 8 a.m. to
8 p.m., or email us at
[email protected]
Get the
you need,
quickly and
At Independent Health, we understand
that it’s important that our members be
able to safely access their health
insurance information whenever and
wherever they need it. That’s why we
were pleased to be the first health plan in
Western New York to offer a mobile app
to its members, when we introduced
MyIH in May 2012.
Available as a free download for
Android and iPhone, the MyIH app
provides our members (depending on their
plan) with the information they are looking
for whether they are at home, at work or
on the go. The virtual ID card is especially
convenient for members who are out of
town on business or vacation and college
students who are away from home.
Key features and member benefits of
the MyIH app include:
• Find a Doctor or Facility—members
can search Independent Health’s
entire local network of participating
doctors, hospitals, pharmacies and
other providers, such as urgent care
centers, and use GPS technology to
find directions and maps to their
addresses. This feature also allows
users to call the physician or provider
directly from the search result.
• My ID Card—allows members the
ability to see and show their health
insurance ID cards, and email and fax
their cards to any health care provider
or facility, so users’ ID cards will never
be forgotten for a visit to the doctor’s
office or unavailable for an unexpected
trip to the emergency room.
• My Benefits—provides members of
our fully insured plans with easy access
to benefit summary information,
including copayments and coinsurance,
benefit limits and coverage.
Online account
You can also keep your membership
information up-to-date and have instant
access to the information you want and
need, 24 hours a day, seven days a week,
at the Independent Health website.
By registering your online account, you
will be able to:
• Update your address and
telephone number
• Verify your plan details and
• Check the status of a claim
• Change or add a primary care
• Order new ID cards
To enroll for your own secure account,
simply visit and
click on the “Register” link in the “Secure
Log In” box, which is located in the upper
right-hand corner of our website.
HealthStyles | Spring/Summer 2013
plan i nformation
Understanding how your deductible works
As a way to provide individuals greater
flexibility and control over their health
care decisions, Independent Health offers
several high-deductible health plans,
including iDirect, Empower and Evolve.
Members of these plans pay out of
pocket for covered health care services
until their annual deductibles are met, at
which time copayments or coinsurance
may apply.
To help make it easier for our members
to use their high-deductible health plans,
here are the answers to several common
questions about deductibles:
Q: Do all my medical services go
toward my deductible?
No. Select in-network preventive care,
vision and dental services do not apply
toward the deductible. Please refer to
your Benefit Summary for the listing of
in-network preventive services.
Q: If I needed surgery, would that be
subject to my deductible?
Yes, only in-network preventive care
services can be waived from the
deductible on a qualified high-deductible
health plan. Vision and dental services are
also not subject to the deductible.
Q: How is the deductible calculated?
Independent Health determines the
deductible as of the date the claim is
processed, not the date services were
rendered. Because providers have up to
120 days to file claims, it could possibly
take up to three months after the original
date of service for a claim to be received
and processed by Independent Health.
Q: What is the difference between my
deductible and the out-of-pocket
expense limit?
A deductible is the initial out-of-pocket
amount that you must reach before you
are eligible to pay copayments or
coinsurance. The out-of-pocket maximum
is the dollar limit for deductibles,
copayments and coinsurance amounts that
you are responsible for in a given time
period. Once you reach your out-of-pocket
maximum, all services are covered in full
for the remainder of your contract year.
As always, if you have any questions
about your coverage, please call our
Member Services Department at
(716) 631-8701 or 1 (800) 501-3439,
Monday through Friday, from 8 a.m.
to 8 p.m.
Q: How do I know whether I’ve met
the deductible?
Independent Health now provides you
with a monthly deductible balance
statement that summarizes the amount
you have paid toward your iDirect plan
deductible the previous month and your
remaining plan year deductible balance.
The statement also includes an overview
of your out-of-pocket expense limit
(if applicable).
In addition, you can track your claims
and/or get your deductible balance by:
• Referring to your Explanation of
Benefits (EOB)
• Logging on to your online account at
Reminder for FlexFit and FlexFit Select members
Independent Health’s FlexFit® and FlexFit Select® are lifestyle
plans that make it easier for individuals to build a healthier
life. One of the unique benefits of being enrolled in these
plans is that they offer two options: Active or Family. As a
result, you can choose the plan option that fits you, or your
family, best.
Members of both the Active and Family options receive
debit cards for as much as $250, which can be used for
participating fitness center memberships. In addition,
members with the Active option can use their debit cards
toward yoga and tai chi classes, vitamins, diet consultations,
acupuncture and massage. Members with the Family option
can use their debit cards for swimming lessons, youth soccer
leagues, gymnastics classes and after-school programs.
As an added convenience to our FlexFit debit card holders,
we now provide monthly balance statements. In addition, our
members can now create a Personal Identification Number
(PIN) for their FlexFit debit card by contacting the Card
Activation Center at 1 (866) 898-9795. This PIN option is also
available to members who have a personalBest! debit card.
To search the health and wellness locations where FlexFit cash
is accepted, please visit the “FlexFit and FlexFit Select” page in
the “Health Plans” section at
your he alth c are
Don’t wait—
Complete a health
care proxy today!
Research shows nearly a quarter of
older adults may require someone
else to make end-of-life decisions
for them. Do your loved ones know
what your wishes are should you
become incapacitated? It’s not easy
to talk about these types of issues,
but avoiding them may make it
harder on your loved ones in a time
of crisis.
Independent Health encourages
you, if you haven’t done so, to have
the conversation about your wishes
and complete a health care proxy.
Plan ahead with four easy steps:
1. Think about what is important
to you and how you want to
receive care.
2. Select a person (health care
agent) to speak for you if you are
unable to speak for yourself.
Choose someone you trust and
who is agreeable to the role. You
may choose an alternate agent
to speak for you if your primary
agent is not available. Also, make
sure family members know the
choices you’ve made and who
your agent is.
3. Talk about your health care wishes.
4. Put your health care choices in
writing using the New York State
Health Care Proxy Form.
Health care proxy forms are
available from your doctor and at
hospitals. In addition, you can
download a form by visiting the
“Frequently Used Forms” section at Once
your form is signed, keep the
original and give copies to your
doctors and your health care agent.
Revitalizing primary care by
empowering physicians
Using Patient-Centered Medical Home
(PCMH) principles as the foundation,
a group of community physicians and
Independent Health launched The
Primary Connection, a unique, innovative
approach to health care delivery that
connects a strong, collaborative group
of primary care physician practices with
specialists and other health care
This physician-led initiative is designed
to focus on improving patients’
experience of care, enable closer
coordination with specialists and other
providers, and achieve better outcomes,
which will lead to lower health care costs.
While the PCMH program focused on
each individual physician’s practice,
The Primary Connection model will
focus on increased coordination and
collaboration between primary care
physicians and specialists.
Primary care physician Fuad Sheriff,
M.D., FACP, of Amherst Medical
Associates, participates in The Primary
Connection because he believes primary
care in the U.S. must improve.
“When there is inability of patients
to access care, the quality of care goes
down, and this drives up the cost,” said
Dr. Sheriff.
According to Independent Health
Executive Vice President and Chief
Medical Officer Thomas Foels, M.D., the
collaborative program improves efficiency
and access through enhanced
coordination between all areas of care.
“The Primary Connection allows the
primary care physician to be a vital part
of improving our health care system,”
said Dr. Foels. “We are empowering
primary care physicians to expand their
influence and provide more patientcentered care. The successes we have
experienced in our PCMH program have
well-positioned us for continued success
as we begin to implement The Primary
Connection program.”
This progressive approach initially
involves 28 practices and their 168 adult
and pediatric primary care physicians.
Practices are undergoing transformation
to improve care coordination, access and
availability. Plus, physicians are engaging
their employees and transforming their
relationships with specialists, focusing on
advance communication.
“We are talking to specialists, doing
what is known as a preconsult,” said
Dr. Sheriff. “Even before the patient ends
up in their office, we call them up by
phone or send an electronic message
telling them about the visit, the history of
the patient and why we want the patient
to have a consult in the first place.”
Dr. Sheriff and his team are building
upon the valuable skills and resources
obtained through the physician
collaborative sessions Independent Health
offers. Applying these cutting-edge
concepts at Amherst Medical Associates
has resulted in noticeable benefits for
“Years ago, just getting blood work
results took weeks,” added Dr. Sheriff.
“Now with our patient portal system,
we have results the next day. It’s a
considerable improvement.”
HealthStyles | Spring/Summer 2013
your he alth c are
HEALTHeLINK: Improving care quality through
clinical information exchange
As an emergency room physician at Erie
County Medical Center (ECMC), David
Ellis, M.D., FACEP, (pictured right) must
make timely decisions regarding patient
care—often without knowing the patient’s
medical history.
Fortunately, with HEALTHeLINK,
Western New York’s clinical information
exchange, linking local hospitals,
physicians and health plans to patients’
up-to-date clinical information, Dr. Ellis
can quickly review a patient’s history and
determine the best course of action in
emergency situations.
“In the Emergency Department, every
patient is a new patient,” he said. “We
have to very quickly find out what is
going on with the person, what is
happening with them and where this
episode they’re presenting fits into their
overall course of care.”
Nearly 500,000 Western New Yorkers
have authorized treating physicians to
access their electronic medical records
through HEALTHeLINK. The elimination
of redundant, costly and potentially
harmful diagnostic testing has been the
biggest benefit of HEALTHeLINK,
Dr. Ellis said.
He pointed to an example of a young
woman who arrived at ECMC with a
condition normally requiring a diagnostic
test, such as a computed tomography
(CT) scan.
“Exposing young women to radiation
is something that we’re very careful
about, and we want to try to avoid it at
all costs,” Ellis said. “Just as we were at
the point of thinking, ‘We’re going to
have to order this test,’ we were able to
find out the information we needed on
HEALTHeLINK and avoid that whole
Independent Health was one of the
various health care stakeholders that
helped establish HEALTHeLINK in 2006,
with Michael W. Cropp, M.D., president
and CEO, as the inaugural chairman of
the board.
As Ellis said, “One of the beauties of the
system here in Buffalo is the involvement of
all the major components of our health care
system, and one of the biggest components
is Independent Health.”
If you would like providers to have access to your electronic medical records through
HEALTHeLINK, you must first sign a consent form. At your next doctor’s
appointment, ask for a HEALTHeLINK consent form or download one at
We want to make sure you’re receiving quality care
Independent Health’s Quality Management approach is guided
by the knowledge of and commitment to our principles, which
incorporate a “continual improvement” methodology. Quality is
a way of thinking, a way of acting and a way of understanding
the data generated by our processes. It’s more than graphs and
numbers. It’s our ability to understand the messages contained
in our data.
If you would like to receive a complete paper copy of
Independent Health’s Quality Management Program, which
includes our Patient Safety Program, please call our Servicing
Department at (716) 631-8701 or 1 (800) 501-3439. TDD
users: (716) 631-3108. You also may view it online at
medic ations
Easy ways to remember when it’s time
to take your medications
A significant number of the 3.9 billion
prescriptions filled each year aren’t taken
correctly. As a result, many Americans are
putting their health and lives at risk.
Taking medication as prescribed is
important to properly manage your
health; an extra, missed or wrong dosage
can be dangerous. But there are things
you can do to personalize your pill-taking
routine so that taking the right
medication at the right time becomes
Have a system
If you have more than two medications to
manage, consider getting a pill
organizer—a special container marked
with the days of the week. Besides
housing multiple medications, a
compartmentalized organizer can be
useful for keeping track of the
medications you’ve taken.
Many people can’t remember if they
took their pill or if they simply thought
about taking it, so they skip dosages or
take too many pills. But by using an
organizer, you can simply check to see if
the pill is missing from that day’s bin. Still,
if you use an organizer, be sure to label
each bin with the name of the medication
and other relevant information so that you
consistently load the organizer correctly.
Take your cues
If you have trouble remembering to take
your medications, you’ll need to develop
cues that remind you, perhaps in addition
to using an organizer. For example,
consider programming your cellphone
alarm or investing in a triathlon
wristwatch, which can be set to sound
reminder alarms. Also, you can purchase
pill caps that beep or sound an alarm
when you need to take the medications.
After you replace the pill cap, the timer is
automatically reset for the next time.
If your problem is remembering to
take your medications in the morning or
at night, train yourself to remember to do
it by placing them in strategic locations. If
you have orange juice every morning, for
example, put your medications on the
breakfast table and consciously try to
take your pills every morning when you
drink your juice.
A surprisingly effective, low-tech
option is to make a checklist of all your
medications and the time and day you
need to take them, then put it on your
refrigerator or another prominent place.
You simply make a checkmark every time
you take your medication.
Make sure you’re charged correctly by
showing your member ID card
Many pharmacies offer low-cost generic drugs, oftentimes at a price lower
than a member’s copayment. Since Independent Health requires pharmacies to
accept the lower of a member’s copayment or the Usual and Customary Retail
(UCR) price, members will automatically pay the lower costs that the
pharmacies are charging.
For example, a member with a $7 tier 1 copayment would pay $7 for all
tier 1 drugs that have a retail price of $7 or higher. However, if the price
has dropped to $4 for the same generic drug, the member would only be
charged $4. Likewise, if a pharmacy is offering a drug at a cost of $0 for a
tier 1 drug, this drug would be covered in full at no cost to the member
(in accordance with the member’s prescription drug formulary).
Therefore, it’s important that you always present your pharmacist with
your current Independent Health member ID card so that all your
prescription claims are billed correctly. Not only will this ensure you receive
the proper pricing, it will allow us to have a complete health record for you,
which will enable us to provide appropriate care oversight, such as drug
interaction screening.
HealthStyles | Spring/Summer 2013
g o o d t o kn o w
Several resources
available for those
who have HIV
What you can do to help
prevent health care fraud
Health care fraud is a serious crime that
affects everyone. It’s committed when a
dishonest provider or consumer
intentionally submits, or causes someone
else to submit, false or misleading
information in order to obtain benefits
they may not be entitled to.
Some examples of health care fraud
• Filing claims for services or medications
not received
• Forging or altering bills or receipts
• Using someone else’s coverage or
insurance card
• Leaving other dependents on your
health insurance contract when they
are no longer eligible
• Faking workers’ compensation injury to
receive disability payments
The National Health Care Anti-Fraud
Association estimates that the financial
losses due to health care fraud are in the
tens of billions of dollars each year. Here
are some simple ways you can avoid health
care fraud and keep health care costs
down for everyone:
• Protect your health insurance ID card
like you would a credit card. In the
wrong hands, a health insurance card is
a license to steal. Don’t give out policy
numbers to door-to-door salespeople,
to telephone solicitors or over the
Internet. Be careful about disclosing
your insurance information, and if you
lose your insurance ID card, report it to
your insurance company immediately.
• Be informed about the health care
services you receive, keep good records
of your medical care and closely review
all medical bills you receive.
• Read your policy and benefits
statements. Read your policy,
Explanation of Benefits (EOB)
statements and any paperwork you
receive from your insurance company.
Make sure you actually received the
treatments for which your insurance
was charged, and question suspicious
expenses. Are the dates of service
documented on the forms correct?
Were the services identified and billed
for actually performed?
• Beware of offers for free health care
services, tests or treatments. These
offers are usually too good to be true
and are often fraud schemes designed
to bill you and your insurance company
illegally for thousands of dollars of
treatments you never received.
Human immunodeficiency virus,
commonly known as HIV, is a virus
that attacks the body’s immune
system. Over time, most people
infected with HIV become less
able to fight off life-threatening
infections and cancers. AIDS
(acquired immune deficiency
syndrome) is the last stage of
HIV disease.
HIV knows no boundaries.
A person of any age, sex, race,
ethnic group, religion, economic
background or sexual orientation
can become infected with this virus
if he or she participates in
unprotected sex or needle-sharing
activities with someone who is
already infected. Women with HIV
can pass the virus to their babies
during pregnancy, delivery or
It’s very important to seek
medical guidance if you feel you
have been exposed to HIV.
The New York State Department
of Health has the following
resources for people exposed to
the HIV virus:
• 1 (800) 541-2437
(AIDS General Information)
• 1 (800) 872-2777
(HIV Counseling)
• 1 (800) 542-2437
(AIDS Drug Assistance Program)
• 1 (800) 233-7432 Español
(Spanish AIDS Hotline)
Independent Health’s Case
Management Department is
available for members with HIV or
AIDS and can help you receive
proper treatment. If you would like
more information, please call
1 (800) 501-3439 and ask to speak
with a member of our case
management team. All calls are
kept confidential.
In addition, if you suspect possible fraud or abuse, call our confidential Fraud Hotline
at 1 (800) 665-1182. Callers have the option of remaining anonymous.
preventive care
Manage your asthma by controlling pollens
and molds
When you have asthma, your airways
may be sensitive to tiny particles in the
air, such as pollens and molds. In fact,
these allergy and asthma triggers can
leave you struggling to catch your breath.
Not all asthma is aggravated by pollens
and molds; other allergies, such as allergies
to dust mites, cockroaches and pets, can
trigger asthma. In addition, respiratory
infections (such as the common cold),
change of weather and irritants like
cigarette smoke exposure and air pollution
can bring on asthma symptoms.
However, in many cases, pollen and
mold are major contributors; therefore,
the following information should be of
help in understanding asthma.
What are pollens and molds?
The wind carries pollen from weeds,
grasses and trees. Plants can release pollen
from early spring to late fall—and yearround in warm climates. Like pollen, mold
spores are in the air during the growing
season and year-round in warm climates.
But mold can also grow indoors in damp,
moist areas of your home anytime.
People who are allergic to pollen or
molds can have many symptoms, such as
sneezing, stuffy or runny nose, watery
eyes, and itchy eyes, nose and throat.
What can you do
to control your allergies?
The best way to prevent an asthma attack
is to stay away from triggers such as pollen
and mold. Here are some helpful tips:
• Check your daily weather reports to
find out local pollen and mold counts.
When counts are high, stay indoors or
reduce your outdoor activity. Pollen
counts are usually highest on warm, dry,
windy days. Mold counts can be high
during both dry and humid weather,
depending on the type of mold.
• Try gardening in the early morning or
evening, when the pollen count is at its
lowest. If possible, avoid raking wet leaves,
mowing the grass or handling gardening
material, like compost and mulch.
• When you come in from outside, wash
your skin and hair, if possible.
• If you have them, turn on the air
conditioners at home and in your car;
and close windows and doors when
pollen and mold counts are high.
• Keep your home dry by removing
carpet from damp rooms and cleaning
moist areas and surfaces in your
kitchen and bathroom. Use a
dehumidifier to keep indoor humidity
at less than 50%.
• Use safer cleaning products. Look for
the Environmental Protection Agency
(EPA) Design for the Environment
(DFe) logo on the label.
• Clean or replace the filters on air
conditioners and other ventilation
systems. Air filters can reduce a variety
of airborne substances that may
worsen your asthma.
• Be sure to use your controller
medication as prescribed, even if you
are feeling well. Always have your
quick-relief medicine—such as
albuterol—at hand.
If steps to reduce your exposure to pollens
and molds do not keep your asthma under
control, your doctor may prescribe allergy
medications or allergy shots. With your
doctor’s help, you can also create an
asthma action plan.
Need help managing your asthma and allergies?
Work with your doctor to create an asthma action plan. Your doctor may also
prescribe allergy medications or allergy shots. In addition, a Health Coach from
Independent Health can give you the support and knowledge you need to make
lasting changes to achieve better health and well-being. Call us at 1 (800) 501-3439,
Monday through Friday, from 8 a.m. to 5 p.m., and ask to speak with a Health Coach.
HealthStyles | Spring/Summer 2013
preventive care
How to live well with COPD
Chronic obstructive pulmonary disease
(COPD), including emphysema and chronic
bronchitis, is a chronic lung disease that
makes it hard to breathe. About 12 million
Americans have COPD. In a given year, the
condition will cause 126,000 deaths.
Cigarette smoking is the leading cause
of COPD. Cigar and secondhand smoke,
air pollution and workplace exposure to
dust, fumes, smoke, gases and vapors
also increase the risk for the condition.
COPD tends to develop slowly over
time, affecting middle-aged and older
adults more than younger people. It’s not
contagious. Although COPD has no cure,
medical treatment and self-care can
improve the symptoms and slow the
condition’s progress.
Symptoms and treatments
People with COPD may find they cough
or wheeze a lot, are short of breath and
have increased sputum or mucus. Also,
physical activity may be a struggle for
them. In addition, tests may show their
blood is low in oxygen and high in carbon
dioxide. The most important test to
determine whether a person has COPD is
a simple breathing test called spirometry.
COPD treatments may include:
• Bronchodilators, inhaled steroids,
antibiotics or all three
• Supplemental oxygen
• Pulmonary rehabilitation (a program
of breathing help that can include
exercise or nutrition training)
• Flu and pneumonia vaccines
Making the following lifestyle changes
can also help you manage the symptoms
of COPD:
• Don’t smoke. Talk with your doctor
if you have trouble quitting.
• Avoid secondhand smoke, air pollution
and other lung irritants.
• Take all medications as prescribed.
• Adjust your physical activities to
accommodate your energy level.
Avoid climbing stairs, for instance.
Asking for support from friends and
relatives can help make living with COPD
easier and less stressful. In addition, if
you have any concerns, talk with your
doctor or call Independent Health at
1 (800) 501-3439, Monday through
Friday, from 8 a.m. to 5 p.m., and ask to
speak to one of our Health Coaches.
Should aspirin be
part of your daily
Cardiovascular disease results in one
of every three deaths in the United
States. There are many effective
ways to take control of your heart
health, such as understanding your
risk for heart disease, increasing
regular physical activity, and eating
fresh fruits, vegetables and foods
low in sodium, saturated fats, trans
fat and cholesterol.
Treating heart disease also means
following your doctor’s advice
for medicines and taking aspirin,
if advised by your doctor. Research
now shows that aspirin reduces
the risk for another heart attack
or stroke.
How can aspirin help?
Aspirin is part of a group of
medicines called salicylates.
When you take it, your body stops
producing substances that cause
blood clots, swelling, pain and
fevers. By preventing blood clots
from forming in blood vessels,
low-dose aspirin may reduce your
risk for heart attack and some
types of stroke.
Talk with your doctor about
taking a recommended dosage
daily if you:
• Are a man between ages 45 and
79 or a woman ages 55 to 79
• Have heart disease in your family
• Have high blood pressure, high
cholesterol or diabetes
• Smoke
• Have had a heart attack or stroke
Talk with your doctor
People who should avoid taking
aspirin include those with bleeding
disorders or an aspirin allergy. For
many others, the benefits of daily
aspirin outweigh the risks.
Therefore, you should never start—
or stop—taking regular aspirin unless
you’ve discussed it with your doctor.
prenatal c arE
Is labor induction right for you?
When you’re pregnant, it can feel like a long
wait to have your baby. And if your labor is
slow or late to start, you may begin to feel
impatient. In some cases, no earlier than 39
weeks into your pregnancy, your doctor
may offer you a medication or other
methods to start your labor. This is called
inducing labor.
Health risks
Inducing labor has become a fairly common
practice. It helps new mothers and doctors
plan for birth. But studies show that it may
cause health risks for mothers and their
babies. Some of these risks include:
• More cesarean section (C-section)
deliveries. One study showed that
one-third of women who were
induced had a C-section. Only onefifth of those who were not induced
had a C-section. Having a C-section
can cause the baby to have breathing
problems and a reaction to the
medication used to induce labor. It can
also cause more bleeding, a risk for
infection and a longer recovery time
for the mother.
• Preterm birth. It’s hard to know
exactly when a baby is conceived. If
you are induced, your baby might not
yet be full term. Babies born just a few
weeks early can have more problems
with feeding, breathing, temperature
control and jaundice.
• Problems with the umbilical cord, such
as a compressed cord. This can limit
the baby’s oxygen supply and cause
serious problems.
• Lowering of the baby’s heart rate. The
drug given to induce labor can lower
the baby’s heart rate during birth.
When induction is necessary
Sometimes labor is induced for medical
reasons. This might happen when the
mother has a medical problem, such as
diabetes or an infection. In these cases,
the benefits of inducing labor may
outweigh the risks. If your doctor
suggests inducing labor, be sure to ask
about the risks and benefits for you.
It’s important to assess your health before pregnancy
If there’s a chance that you could start a family soon, take time
to take stock of your health. The Centers for Disease Control
and Prevention provides guidelines that advise women to focus
on their health before they become pregnant—for the first time
or the next time.
It’s best to check in with your doctor before conception,
if possible. During your doctor’s visit, you can review your
health history, as well as your family’s. In addition, your doctor
may advise you to take these steps:
• Get 400 micrograms of folate daily. Folate can be found in
asparagus, broccoli, romaine lettuce, spinach and orange
juice. You can get folic acid by eating fortified breakfast
cereal and enriched breads and pastas, or by taking a folic
acid supplement, doctor-recommended prenatal vitamins
and some multivitamins. Folate can reduce the risk for
birth defects.
• Make sure you’ve had all the vaccinations and preventive
health screenings you need.
• Tell your doctor about any prescription and over-the-counter
medicines you take.
• Stop smoking if you smoke. Women who smoke risk
premature birth or birth defects.
• Avoid alcohol because you may become pregnant and not
know for several weeks or more.
• Lose weight if you are overweight. This can reduce the risks
for complications during pregnancy, including type 2
diabetes and heart disease.
• Manage any medical conditions you have, such as asthma
or diabetes.
Another way to protect your baby is to steer clear of certain
harmful substances. For example, avoid chemicals such as
fertilizers and pesticides. The same goes for secondhand smoke.
HealthStyles | Spring/Summer 2013
prenatal c are gu i deli ne s
counseling and Education
Services/Screening Tests
This chart outlines the services that are generally provided at each visit during
the course of a woman’s pregnancy. If you’re planning to become pregnant, we
recommend that you speak with your doctor first. It’s important to talk about your
health and lifestyle to make sure that your pregnancy is as healthy as it can be.
Visit 1
6 to 8 Weeks
Visit 2
12 Weeks
Visit 3
16 to 18 Weeks
Visit 4
22 Weeks
Visits 5 and 6
28 and 30 Weeks
(Every 2 Weeks)
Visits 7 and 8
32 Weeks
(Every 2 Weeks)
Visits 9 and 10
36 Weeks
(Every 2 Weeks)
Visits 11 to 13,
38 to 41 Weeks
Risk profiles
Height and
OB history and
CBC (complete
blood count)
Rubella (German
Rh factor
Urine culture
Hepatitis C/HIV
Domestic abuse
Sickle cell
Pap test
Thyroid screening
Blood pressure
Fetal heart tones
Blood pressure
Fetal heart tones
Screening for
possible birth
Uterus height
Blood pressure
Fetal heart tones
Uterus height
Assess infectious
disease risk
Preterm labor
Blood pressure
Fetal heart tones
Uterus height
Diabetes with
Domestic abuse
Rh antibody
CBC and platelets
Blood pressure
Fetal heart tones
Uterus height
Blood pressure
Fetal heart tones
Uterus height
Confirm fetal
Culture for Group
B strep
Screen for
Blood pressure
Fetal heart tones
Uterus height
Vaginal exam
Warning signs
Course of care
Body changes
Testing for risks
in pregnancy
Alcohol and drug
Fetal growth
Review lab results
Body mechanics
Baby movement
Body changes
Preterm labor
Prenatal classes
Family issues
Length of stay
Diabetes with
Work activity
Physiology of
Fetal growth
Awareness of
fetal movement
Preterm labor
Repeat cesarean
section vs. vaginal birth after
and benefits
Pediatric care
Labor and
delivery issues
Warning signs/
Postpartum care
Management of
late pregnancy
When to call
Infant CPR
Labor and
delivery update
TD (tetanus/
(if needed)
Hepatitis B
(if needed)
These guidelines are an overview of what
pregnant women should expect at each
prenatal visit. They are a framework for the
evaluation, care, and medical treatment
of expectant mothers. They should not be
considered a replacement for the judgment of
a doctor or other health care professional.
Postpartum Visit
4 to 6 Weeks
After Delivery
Interval history
Blood pressure
Pelvic examination
Uterine height
Emotional status
Depression screening
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Material published in HealthStyles® is not
intended to provide personal medical advice.
Consult your physician before making
changes in your health care regimen.
Benefits discussed in HealthStyles® may vary
by plan. © 2013
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Are you part of the hypertension epidemic?
The silent killer lurks in the bodies of about
68 million Americans. It often causes no
warning signs. And as it spreads, it’s
striking at younger ages.
It’s not a vicious bug in a horror movie—
it’s high blood pressure, and it contributes
to about 1,000 U.S. deaths each day. High
blood pressure is a major risk factor for
heart disease, stroke, kidney disease and
other life-threatening illnesses. Fortunately,
treatment and lifestyle changes can help
keep this problem in check.
Younger generations at risk
Blood pressure tends to rise with age.
People ages 55 and older are still at highest
risk for hypertension. However, the
childhood obesity epidemic has increased
the number of young patients. According
to a new study in the journal Hypertension,
the number of children hospitalized with
high blood pressure nearly doubled over a
10-year period.
Other risk factors include:
• Family history
• Smoking
• Lack of exercise
• Poor diets with too much salt and
unhealthy fats
High blood pressure typically has no
symptoms. But inside your body, your
blood is pushing harder against your blood
vessels. Over time, this pressure can
weaken vessel walls; damage organs, such as
your kidneys and eyes; and cause blood
clots that lead to heart attack and stroke.
Turning the numbers around
No matter your age, a healthy lifestyle can
reverse high blood pressure or prevent it
from developing. Start by:
• Changing your diet. Add fruits, vegetables
and whole grains. Decrease saturated and
trans fat, cholesterol and salt.
• Maintaining a healthy weight.
• Coping with stress through exercise,
music or other relaxation techniques.
Time for a change?
• Getting at least 30 minutes of physical
activity most days of the week.
This may be especially important for
people with a family history of high
blood pressure, according to a
recent study.
Have your blood pressure checked
regularly. The top number should be
lower than 120 mm Hg, and the bottom
number lower than 90 mm Hg. Your
health care team, including your doctor
and pharmacist, may recommend
medications to bring high numbers down.
Our Health Coaches can help you make lasting
lifestyle changes to achieve better health. To learn more, call 1 (800) 501-3439,
Monday through Friday, from 8 a.m. to 5 p.m., and ask to speak with a Health Coach.