1. health and fitness

In this issue:
Ask the Doc | pg. 2
What To Do With Your Doctor’s Bill | pg. 4
Brand-name or Generic Drugs | pg. 5
Learn About Your Coverage | pg. 7
Spring 2010
How To Be a Good Patient
Have you ever missed your doctor’s appointment? It may not
seem like a big deal, but you could be putting your health
at risk. It could take time to get another appointment. Call
your doctor’s office and let the staff know if you can not
make your appointment. It is the right thing to do.
How long it can take to get an appointment depends on why
you need to see your doctor. California sets the standard for
waiting times. To help you understand waiting times, see
the table below.
Type of Visit
Waiting Time
Reason for Visit
Emergency
None. Available 24
hours, 7 days a week.
Go to the nearest
emergency room.
Symptoms you feel may
be life threatening
(ex., chest pain,
shortness of breath)
Urgent
Less than 48 hours
You are sick or injured
but don’t have lifethreatening symptoms
Routine exam or
checkup
with your doctor
Less than 30
calendar days
No symptoms (annual
exam, preventive
checkup)
Now that you know why you should not miss your
appointment, be ready. Have you ever left your doctor’s
office with more questions than answers? You can get the
most out of your appointment by doing the following:
• Be sure the time and date works for you. Ask for different
times and dates if needed.
• Arrive 10 to 15 minutes early.
• Bring your L.A. Care ID cards.
• Bring your medications with you (including vitamins
and herbal drugs).
• Write down questions or concerns you have and bring
them with you.
• If your doctor does not speak your language, request an
interpreter by calling L.A. Care at 1-888-839-9909 or
TTY 1-866-522-2731.
• Be patient. Office waiting room time can be up to
45 minutes.
• Go over your list of questions with your doctor.
• Take notes.
• Tell your doctor if you are being treated by other doctors.
Remember, you and your doctor are a team. Working
closely with your doctor—getting to your appointments,
asking questions, listening to and following his or her
advice—is good for your health.
Elaine Batchlor, MD
Ask the Doc:
What Can I Do if My Child
Has Type 2 Diabetes?
What is Type 2 diabetes?
Diabetes is a life-long disease where there is too much blood sugar (glucose) in the body. There is no cure for it,
but it can be controlled. If it is not controlled, diabetes can damage the heart, eyes, kidneys and nerves. Blood
sugar comes from the foods we eat. It is also stored in our liver.
Why are children getting Type 2 diabetes?
Support your child.
In the past, diabetes was mostly seen in older adults. Over
the past 10 years, it has become more common in overweight
and obese kids. More children are getting diabetes because
they eat unhealthy foods and don’t get enough exercise.
• Help your child understand what diabetes is and how
important it is to control it.
• Let your child talk about his feelings about diabetes.
What are the risk factors?
• As a family, drink water at meal times. Limit sugary
drinks such as soda, juice, and sport drinks.
• Eat smaller portions.
• Teach your child how to make healthy snacks and
meals using fruits, vegetables, whole grains, and lowfat foods.
• Remind your child to eat at the same time each day
and to eat healthy snacks.
The risk factors for Type 2 diabetes are:
• Poor diet
• Lack of exercise
• Being overweight
• Having a family member with diabetes.
Help your child control his diabetes!
Take the following steps to keep your child’s blood sugar as
close to normal as possible:
Education is the key!
• Learn all you can about diabetes. Talk to your
child’s doctor.
• Go to a class on diabetes.
• Call L.A. Care Member Services for health education
materials at 1-888-839-9909.
Ask your doctor or call
1-888-839-9909 for a
free copy of this booklet.
2 | Member News SPring 2010
Help your child stay at a healthy weight by being a good influence.
Be active!
• Limit TV and computer time to less than two hours
a day.
• Walk as a family, play at the park, and have your child
play sports.
Take your child to regular health checkups.
• Talk to your child’s doctor.
• Ask questions.
• Make sure your child takes his medicine and checks
his blood sugar.
Diabetes and Your Eyes
If you have diabetes, keep an eye on your sight. Diabetic eye disease can cause blindness! Diabetes damages
tiny blood vessels in your eye. This is called diabetic retinopathy.
What are the warning signs?
You may have changes in your sight like blurred side vision OR blurred central vision.
But often you may have no symptoms.
What can I do?
Get an eye exam at least once a year. It’s PAINLESS and it’s FREE.
MAY is Healthy Vision Month. Call your doctor and get your eye exam if you have not done so in the past year.
Blurred SIDE vision
Blurred CENTRAL vision
What To Do if Your
Doctor’s Office is Closed
1. Call your doctor’s office. Ask for your doctor or the doctor on
call to call you back.
2. Call your health plan’s 24-hour Nurse Advice Line. The number
is on the back of your member ID card.
3. Call 911 or go to the nearest emergency room if you think you
have a life-threatening condition.
You can reach your doctor 24 hours a day, 7 days a week. When you
are not sure what you should do, CALL YOUR DOCTOR. Your
primary care doctor knows you better than the ER doctor. You may
not have to wait in the emergency room.
Your doctor can give you this brochure with more information.
|3 |3
Spring
20102010
Member
NewsNews
Spring
Member
Important
Phone Numbers
What To Do With
Your Doctor’s Bill
Do you have questions about your
health plan or your benefits? Call
your health plan directly or call
L.A. Care Health Plan.
Did you know your health plan pays the doctor for all covered health care
services that you receive? Many of the payment amounts are set by the state.
However, if your doctor does not agree with the payment received from the
health plan, he or she may send you a bill for the difference. This is known as
balance billing, and it is against the law.
Medi-Cal Members
Anthem Blue Cross
1-888-285-7801
What you should do if you get a bill from your doctor:
Care1st Health Plan
1-800-605-2556
1. Call right away. Let L.A. Care know about the bill immediately by calling
1-888-839-9909. Have the bill in front of you so you can answer
any questions.
Community Health Plan
1-800-475-5550
2. Don’t pay. The health plan will call the doctor about the bill and let you
know what to do next.
Kaiser Permanente
1-800-464-4000
3. File a complaint. If you’ve called L.A. Care and keep getting bills from
your doctor for covered services or for services you did not receive, file a
complaint. You can complain to:
L.A. Care Health Plan
1-888-839-9909
L.A. Care Health Plan Medicare
Advantage HMO,
Healthy Families Program,
and Healthy Kids Members
L.A. Care Health Plan
1-888-839-9909
L.A. Care Fraud and Abuse Hotline
1-800-400-4889
L.A. Care Family Resource Centers
Inglewood
1-888-213-9374
Lynwood
1-888-525-9693
Visit us online
• Find a doctor, hospital or pharmacy
• Find out about your benefits
• Learn about health topics
• Register for L.A. Care events
These are just some of the things you
can find on our Web site. Take a minute
to visit www.lacare.org today!
4 | Member
5 | Member
NewsNews
SPringSPRING
2010 2009
Your Health Coverage
Medi-Cal
Healthy
Families
Healthy
Kids
California Department of Managed Health Care
(DMHC)
1-888-466-2219
X
X
X
Department of Health Care Services
(DHCS)
1-916-445-4171
X
Who to Call
Centers for Medicare and Medicaid Services (CMS)
1-800-633-4227
Managed Risk Medical Insurance Board (MRMIB)
1-916-324-4695
Medicare
X
X
Please remember that you must still pay your co-pay (if you have one) and for
health care services you receive that are not covered by your health plan.
Come to L.A. Care’s
New Family Resource
Center in Inglewood!
Brand-name or Generic Drugs:
Which are Better?
Is a brand-name drug better than a generic drug? No. According to the Food
and Drug Administration (FDA), a generic drug must have the same chemical
makeup, the same prescribed amount, and be in the same form (such as a pill or
liquid) as the brand-name drug. This means a generic drug is just as good as a
brand-name drug.
Today, about 50% of all prescriptions are for generic drugs. If you are not sure
whether the generic drug is right for you, talk to your doctor.
You should ask your doctor or pharmacist the following questions about any medicine:
•
•
•
•
•
•
•
•
What is the name of this drug?
What does this drug do?
What does it look like (color, pill or liquid, etc.)?
How and when do I take this drug?
How long do I need to take it?
Does it have side effects?
What should I do if I have side effects?
Will it affect any other medicines I take?
For an updated list of drugs covered by your health plan, visit L.A. Care’s Web site.
If you are an L.A. Care Medi-Cal member with one of our Plan Partners, visit your
health plan’s Web site.
What is Fraud, Waste and Abuse?
L.A. Care celebrated the opening of
its Inglewood Family Resource Center
(FRC) in July 2009. The FRC offers free
classes on health education, exercise,
good eating habits, and parenting to
L.A. Care members and the community.
Most classes are taught in English and
Spanish. Children are welcome. Member
services are available by appointment to
help visitors with questions about their
coverage or choosing a doctor.
Many people visit the Inglewood FRC.
The Pilates class, offered on Monday
and Thursday evenings, is very popular.
“It’s part of my life now,” said Krissy
Huff, who has gone to the class since
the FRC opened. She also said she
has “much more energy than before.”
Huff tells friends and family about the
FRC. She is glad the FRC is there for
the community.
There is also a FRC in the City of
Lynwood. Stop by today!
Family Resource Center
3111 W. Century Blvd., Suite 100
Inglewood, CA 90303
1-888-213-9374
Family Resource Center
3180 E. Imperial Highway
Lynwood, CA 90262
1-888-525-9693
To see a calendar of events at the FRC,
visit www.lacare.org.
All L.A. Care members should report fraud, waste and abuse if they suspect it.
Here are a few examples:
Fraud: Using another person’s member ID card to receive free services.
Waste: Visiting many doctors for the same condition. This leads to more costs.
Abuse: Getting medications or services you don’t need.
If you think any of the above has taken place, please call the L.A. Care Fraud
and Abuse Hotline at 1-800-400-4889 or contact L.A. Care’s Compliance
Officer at 213-694-1250 ext. 4292.
|5 |5
FALLSpring
2009 2010
Member
Member
NewsNews
Special Services
You Can Get
Outside of Your
Health Plan!
You can get most of your health care
through L.A. Care Health Plan. But if
you have special health care needs, you
can get these services through other
agencies. These special services are extra
Medi-Cal benefits provided by other
agencies. These services include:
Alcohol and drug treatment
California Children’s Services (CCS)
In-home nursing services
In-home support for HIV/AIDS
Mental health visits
Regional Centers for people with
disabilities
• Rehabilitation
•
•
•
•
•
•
Below are some frequently asked
questions (FAQs) about these services.
Question:
Breastfeeding—It’s Good
for Moms and Babies
For babies, breastfeeding:
• Provides all the nutrients they need for the first six
months of life
• Helps them stay healthy and prevents colds and
ear infections
For moms, breastfeeding:
• Burns calories to help lose weight faster
• May lower the risk of breast cancer
If you can’t breastfeed all the time, you may be able to get a breast pump. Talk
to your doctor about any concerns you have or call WIC (Women, Infants and
Children) at 1-888-942-9675. WIC now gives breastfeeding women more
healthy food choices like fruits and vegetables, canned fish, whole grains, and
soy products.
New Breast Cancer Screening Guidelines
Women age 40 and older may no longer need a mammogram every year. A
mammogram is an X-ray of the breast that helps detect cancer. If you are between
the ages of 40 and 50, talk to your doctor about whether you need a mammogram. Women age 50 and older should get a mammogram every two years. A mammogram
ordered by your doctor will be covered by your health plan.
How do I get special services?
Answer:
For most of the programs or services,
like CCS or Regional Centers, you
need to have a special health condition.
Question:
Do I need a referral from my doctor?
Answer:
Tips to Control Asthma at Home
Wash sheets and
blankets in hot
water at least
once a week.
Wipe off dust
in your home
with a damp
cloth regularly.
For CCS, you will need a referral.
But you can call directly for most of
the programs.
Each agency has its own phone number.
The best way to learn more is by calling
L.A. Care Member Services at 1-888839-9909 or visiting our Web site at
www.lacare.org.
6 | Member News SPring 2010
Never allow
anyone to
smoke in your
home or car!
Talk to your
PCP doctor
for more tips.
Learn About Your Coverage
When you first join L.A. Care, and then every year after, you will get a package of
important information about your health care coverage. Please read it and call us if
you have any questions. You can visit our improved Web site at www.lacare.org for
the information listed below and more:
Basic Information
Special Programs
• What benefits and services are covered
• What benefits and services are not covered
• How your health plan makes decisions about
new treatments
• What care you can and can not get when you are
out of Los Angeles County
• How to access care when you are out of Los Angeles
County
• How to change or get care from your primary care
physician (PCP)
• How to get information about doctors
• How to get a referral
• What to do when you need care right away or when the
office is closed
• What to do if you have an emergency
• How to get prescriptions filled and other pharmacy
information
• Co-payments and other charges
• What to do if you get a bill
• How L.A. Care makes sure you get good health care
• Programs for people with disease, like diabetes or asthma
How decisions are made about your care
• How our doctors and staff make decisions about your care
• How to reach us if you want to know more about how
decisions are made about your care
• How to appeal a decision about your care
Member Issues
•
•
•
•
If you would like paper copies, please call us at 1-888-839-9909.
Not sure which health plan
you are in? Not sure which
program you belong to?
Check your ID card!
Or call L.A. Care at 1-888-839-9909 and
we’ll tell you.
No matter which program or
health plan you belong to, you
are still part of the L.A. Care family!
You can always call us for help.
Your rights and responsibilities as a health plan member
How to complain when you are unhappy
What to do if you are disenrolled from your plan
How L.A. Care protects and uses your personal health
information
L.A. Care Health Plan
Medi-Cal with
Anthem Blue Cross
L.A. Care Health Plan
Medicare Advantage HMO
Medi-Cal with
Care1st
Health Plan
Members
Medi-Cal with
Community
Health Plan
Medi-Cal with
Kaiser
Permanente
Medi-Cal with
L.A. Care
Health Plan
Healthy Families
with L.A. Care
Health Plan
Healthy Kids
with L.A. Care
Health Plan
Members
Members
|7 |7
Spring
20102010
Member
NewsNews
Spring
Member
Անվճար թարգմանչական ծառայություններ խնդրելու կամ այլ
լեզվով, խոշոր գրվածքով, ձայնագրությամբ կամ Բրայլի տպագրով
տեղեկություն ստանալու համար, զանգահարեք L.A. Care ՝1-888-839-9909
կամ TTY 1-866-522-2731 հեռախոսահամարներով:
(Armenian)
如果您需要免費口譯服務，或需要其他語言版本、大型字體、
音訊或盲文版本的資訊 請致電 L.A. Care的電話1-888-839-9909或
TTY 專用電話1-866-522-2731。
(Chinese)
To request free interpreting services or for information in another language,
large print, audio or Braille, call L.A. Care at 1-888-839-9909 or TTY 1-866-522-2731.
(English)
(Farsi)
edImºIes~IsuMesvabkE¨bPasaeday²tKit«fÂ É sMrab’BtámanCaPasamYyep§geTot
Gk§reVHBumõx~atFM sMeLg É Gk§rsMrab’mnus§xÃak’ sUmTUrs&Bæmk L.A Care elx
1-888-839-9909 É TTY 1-866-522-2731 .
무료 통역 또는 다른 언어나 큰 글씨, 음성녹음, 혹은 브라유 점자로 된
자료가 필요하신 분은 L.A. Care, 1-888-839-9909 혹은 TTY 1-866-522-2731로
전화 주십시오.
(Korean)
Чтобы запросить о предоставлении бесплатных услуг переводчика или о
получении информации на другом языке, напечатанной крупным шрифтом,
записанной в аудио формате или шрифтом Брайля, звоните в L.A. Care по
телефону 1-888-839-9909 или по телетайпу TTY 1-866-522-2731.
Para solicitar servicios de interpretación o pedir información en otro idioma,
letra grande, audio o Braille, llame a L.A. Care al 1-888-839-9909 o
TTY 1-866-522-2731.
LA0485 4/10
Upang humiling ng libreng serbisyo ng pagsasalin o para sa impormasyon sa
ibang wika, malalaking titik, audio o Braille, tumawag sa L.A. Care sa
1-888-839-9909 o TTY 1-866-522-2731.
Để yêu cầu dịch vụ thông dịch hoặc nhận tin tức bằng ngôn ngữ khác, bản
in khổ lớn, băng âm thanh hoặc chữ nổi Braille, xin gọi L.A. Care tại số
1-888-839-9909 hoặc TTY 1-866-522-2731.
(Khmer)
Member News is a publication for
members of L.A. Care Health Plan.
Published two times a year by L.A. Care,
Member News goes to members
in Medi-Cal, L.A. Care Health Plan
Medicare Advantage HMO, Healthy
Kids and Healthy Families Programs.
If you want the information contained
in this newsletter in another language
or in large print, Braille, or audio
(cassette or CD) call L.A. Care at 1-888839-9909 or TTY 1-866-LA-CARE1
(1-866-522-2731).
(Russian)
(Spanish)
www.lacare.org
(Tagalog)
(Vietnamese)
©2010 L.A. Care Health Plan. All rights reserved.
Health or wellness or prevention information
PRSRT STD
U.S. POSTAGE
PAID
ORANGE, CA
PERMIT NO. 646
Ask the Doc | pg. 2
What to Do With Your Doctor’s Bill | pg. 4
Brand-name or Generic Drugs | pg. 5
Learn About Your Coverage | pg. 7
In this issue:
SPRING 2010