1. health and fitness

ivingwell
WWW. SOU T HER NHEAL TH.CO M
KELSEY GRAMMER’S SECOND CHANCE
r
page 6
FALL/WINTER 2010
A SOUTHERN HEALTH MAGAZINE
/64,
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Five ways to
skip getting sick
this season
PAGE
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*65;963
How to help prevent
heart disease
PAGE
2
SIMPLE TIPS FOR HEALTH
Stop. Breathe deeply. Repeat as needed.
Share a fruit snack with a friend.
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HE ALTH SPARKS
W
a
40%
6-(+<3;:
report having insomnia
symptoms in a given
year. Flip to page 4
for sound slumber
advice.
Southern Health
OFFERS
case management
to help our members
effectively manage
their health problems
and live a better quality
of life. If you have any
questions about our
health management
programs, please
contact the Case
Management Division
at 800-424-0077.
Welcome to Living Well
WHAT A RELIEF
TO HAVE BEATEN
THE SUMMER
HEAT. When the
outdoor thermometer
was pressing triple
digits this past July,
I think we were all
pleading for a cool
day to arrive. Well,
it’s here and thank
goodness. Welcome friends, to the fall/
winter issue of Living Well.
Doctors may be trained professionals with years of schooling under their
belt, but one thing they cannot do is read
minds. To best evaluate your health,
your doctor needs to hear from you, the
patient. Be upfront. If you notice a change
in how you feel, even if you think it’s only
minor, tell your doctor. What’s more,
don’t be afraid to ask questions. There is
no such thing as a “silly” or “stupid” question. Help your doctor help you. Read
“Beyond the Surface” on page 5.
Recent studies by the National Sleep
Foundation and the journal Archives of
Internal Medicine show that not getting
adequate rest can increase your risk of
diabetes, heart disease, weight gain and
depression. Recharge your batteries—
and your health—by getting plenty of
shut-eye. Helpful tips to increase those
ZZZs can be found in “Sleep Matters” on
page 4.
On television, he played a stressed out,
sometimes grumpy, uptight radio psychiatrist, Dr. Frasier Crane. In real life, stress
almost got the best of Kelsey Grammer in
the form of a near-fatal heart attack. “They
had to blast me twice,” said the 53-yearold actor whose heart had quit beating.
Though his comedic personality is one
in a million, Grammer’s brush with death
is one of a million—new cases of heart
attacks reported each year in the U.S.,
that is. Thankfully, the Hollywood funnyman is getting a “Second Chance” on
page 6, and he wants you to understand
the controllable risk factors he didn’t learn
until it was almost too late.
As always, I thank you for your membership. We hope you enjoy the articles
in this issue of Living Well. We truly appreciate each and every one of you and look
forward to continuing our commitment
to you and your family’s health care
needs. Should you ever have any questions, please don’t hesitate to call us at
800-627-4872.
Drew A. Joyce
CEO
livingwell
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Coventry’s health plans and insurance companies operate under the names: Altius Health Plans, Coventry Health Care, Coventry Health and Life Insurance Company, Carelink Health
Plans, First Health, FirstHealth Services, Group Health Plan, HealthAmerica, HealthAssurance, HealthCare USA, OmniCare, PersonalCare, Southern Health, Coventry Health Care of
Florida and WellPath. LivingWell is published by McMurry. ©2010. 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 makes no endorsements or warranties regarding any of the products and
services included in this publication or its articles. ©2010 WALTER MCBRIDE/RETNA LTD./CORBIS (PAGE 6)
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to
in
se
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ho
to
h
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livingwell
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LIFEST YLE
Sleep Matters
Good rest is good for you. Don’t deprive yourself.
GOOD
to know
Are you tempted
to take sleep
aids? Speak
with a doctor
first. They may
do more harm
than good.
D
o you pride yourself on being able to
include insomnia, sleep apnea—a condition in
“get by” on just a few hours of sleep a
which you stop breathing for several seconds—
night? In fact, it’s nothing to crow
or restless leg syndrome, which causes unusual
about. Lack of sleep can lead to health issues
feelings or jerking movements in your legs.
both large and small.
According to the National Sleep Foundation
HOW TO GET MORE ZZZS
(NSF), sleeping too little can cause you to put
For most people, simple changes can help a lot.
on weight because sleep deprivation increases
If you try the tips listed below and still can’t sleep
appetite. It can also raise your risk for diabetes,
well, you may want to talk to your doctor.
heart problems and depression. Not getting
enough rest can impair your attention and reten-
For better sleep:
tion skills, too, and lead to an increased chance
1. Don’t consume caffeine or alcohol in the late
of car accidents.
Adults who sleep less than seven hours a
night even have greater odds of getting a cold
compared to people who sleep eight hours
or more a night, says a study published in the
afternoon and evening, and don’t smoke.
2. Get regular exercise, but call it quits at least
three hours before bedtime.
3. Don’t nap during the day if you have trouble
sleeping at night.
journal Archives of Internal Medicine.
4. Create a pleasant, comfortable, dark and
WHAT’S ENOUGH?
5. Develop a bedtime routine that lets you relax,
quiet sleeping environment.
The NSF says healthy adults should get between
sending a signal to your brain that it’s sleep
seven and nine hours of sleep a night. Plus,
time. Try listening to soothing music or taking
quality is just as important as quantity. Waking
a hot bath before bed.
up frequently and having a hard time getting
back to sleep, may cause a “sleep debt” that
can be harmful over time.
Also, don’t discount the tried-and-true
counting sheep method. Counting, or focusing
If you do shift work or travel across time
on any repetitive notion, may quiet your mind
zones a lot, it’s also likely you’re not getting
and distract you from any worries, letting you
the quality of sleep your body needs. Other
ease into your ZZZs. =
conditions that aggravate sound slumber
4
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TAKE NOTE
beyond the
surface
There’s more to regular checkups than
blood tests and weigh-ins. Sure, your
vital stats are important, but don’t
gloss over the things your doctor
can’t see or measure.
It’s important to establish comfortable communications with your doctor.
Don’t be shy about sharing, even if
it feels embarrassing. Your doctor
needs to know about changes in your
lifestyle or your body to make the best
assessment of your health.
Be sure to mention any unusual
pain, emotional changes or symptoms
you never had before. And don’t be
afraid to ask questions about anything
that’s been on your mind or comes up
during your visit.
The better you communicate, the
better care your doctor can provide.
Chocolate:
The Reason
Or the Cure?
An article recently published
in the Archives of Internal
Medicine verified a link
However, researchers admit
between mood and choco-
that further study is needed to
late. Research showed that
determine the reason for this
depressed people ate the most
association. It’s possible that
chocolate per month, com-
depression could stimulate
pared to people who were less
chocolate cravings as “self-
depressed. Those who did not
treatment” if chocolate has
exhibit signs of depression ate
mood benefits, as suggested
the least chocolate.
in some previous studies. On
The study confirmed the
the other hand, it could be that
belief that people eat chocolate
chocolate actually contributes
when they’re feeling down.
to a depressed mood.
The Savings ARE CLEAR
As a Southern Health member, you now have access to savings
on the nation’s most popular and successful elective procedure:
LASIK eye surgery.
Coventry Health Care has partnered with QualSight LASIK to bring
members savings of 40 to 50 percent off the national average
price for Traditional LASIK. QualSight’s network of the nation’s
most experienced LASIK surgeons has collectively performed
over 2.5 million procedures. Choose from more than
800 locations nationwide for your free LASIK consultation to find out if you are a candidate for this
life-changing procedure. To locate a provider
near you, call 877-213-3937 or visit
www.QualSight.com/-Coventry for
more information.
livingwell
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SPOTLIGHT
Second
CHANCE
Kelsey Grammer is back in business after
a major heart attack. Here’s how to reduce your
odds of having one at all!
DR. FRASIER CRANE, the character Kelsey
focus on his health, which includes paying
als
Grammer is best known for playing on the
more attention to his diet.
co
TV shows Cheers and Frasier, could easily be
or
Grammer never spoke of any heart
described as “uptight.” And while Grammer
disease risk factors he had, other than stress.
may not share this trait, the actor has stated
According to the American Heart Association
fac
that stress may have contributed to his near-
(AHA), however, men are more likely to develop
to
fatal heart attack in 2008.
heart disease, and the risk for heart disease
“I had no blocked arteries. I had no
B
co
increases with age.
cholesterol buildup,” he told the media. “I had
an event they think was stress-related.”
C
AH
Get in Control
aro
There are risk factors no one can control,
dis
chest pains and was taken to a hospital,
including a family history of heart disease.
mu
where his heart stopped. “They had to blast
There are also plenty of steps you can take to
Be
me twice and get me started all over again,”
reduce your odds of developing heart troubles.
blo
Without a doubt, stress is an issue. It’s not
dia
considered one of the major risk factors, but
dis
Grammer was 53 when he experienced
Grammer said.
After the heart attack, he eased back into
physical activity. Grammer soon returned
researchers have recognized a connection
to the limelight and since said he has a new
between stress and heart disease. Stress may
H
ca
or
be
men are more likely to develop heart disease,
and the risk for heart disease increases with age.
6
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Ba
Fo
did
an
CES
r
s.
op
also lead to unhealthy behaviors that can
contribute to heart disease, such as smoking
or drinking too much alcohol.
Cigarette smoking is considered a major risk
factor for heart disease, so quitting is one way
to do your heart a lot of good.
Being overweight or obese is another major
contributor to heart disease. According to the
AHA, people with excess body fat, especially
around the waist, are at greater risk for heart
disease and stroke, because carrying too
much weight makes your heart work harder.
o
Being overweight typically raises cholesterol,
es.
blood pressure and the risk of developing
ot
diabetes—all conditions that can lead to heart
Heartfelt Emotions
Dr. Frasier Crane, the fictional psychiatrist portrayed by Kelsey
Grammer, experienced the blues from time to time.
That was TV, but depression is a very real condition—and
as many as one in three people says he’s felt depressed
following a heart attack, according to the American Academy
of Family Physicians.
After a heart attack, it’s important to watch for symptoms
of depression, particularly sadness or loss of interest in daily
activities that persist for two weeks or more. A doctor can
treat depression with counseling, medication or both.
t
disease, too.
ay
can have high blood pressure, high cholesterol
Broadway musical debut in La Cage Aux Folles,
or diabetes. These are health issues that need to
a performance for which he received a Tony
be managed to reduce your heart-disease risk.
Award nomination.
Back on Track
and active lives after a heart attack. But why go
Fortunately for Kelsey Grammer, his heart attack
through the stress? Reduce your controllable
didn’t take his life. He’s since starred in TV shows
risk factors and you can help avoid having
and movies—and earlier this year he made his
one altogether. =
However, even if you’re not overweight, you
Plenty of people like Grammer return to full
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TIMELINE
Tracking for Health
Successful diabetes care takes a custom plan and a proactive approach.
D
iet, exercise, medication, glucose testing and
MOST DAYS
doctor’s appointments … oh my! If you have
Get at least 30 minutes of physical activity. Ride a
diabetes, all these things may feel like a lot
bike, take a dance class or do yard work. For most
to keep track of. But staying on top of your health
people, a brisk walk is an easy, safe way to exercise.
doesn’t have to be a chore. Work with your doctor to
Do some stretching and strength-training, too.
*
come up with a game plan, and create a schedule so
you know exactly what you need to do and when.
Use the tips below as a guideline, and customize it
EVERY 3–6 MONTHS
If you take insulin, or your blood glucose levels aren’t
to the regimen you and your doctor develop just for
in good control, the American Diabetes Association
you. Write it out or put reminders on your computer or
recommends seeing your doctor four times a year.
phone to keep you on track.
Even if your diabetes is well-managed or you take
oral medication, your doctor will want to see you at
EVERY DAY
Watch what you eat, following the meal plan that best
least twice a year, if not more.
At most visits, your doctor will perform the
works for your condition. Eat your fruits, veggies and
following screenings:
whole grains, stick to lean protein and dairy products,
- A1C test, to measure your level of blood
and limit fats and sugar.
If you test your blood glucose, do so as directed by
your doctor. Keep notes of your readings to take to
your next appointment.
± Take time to unwind, using the
O
Th
glucose control over the last three months
- Blood pressure
- Weight and/or body mass index (BMI)
- Foot exam
Bring your home blood glucose testing record to
by
healthy method that works best for you. Try
discuss with your doctor. This information and your
meditation, deep breathing exercises, playing
other test results will help your doctor make any
GE
needed adjustments to your care regimen.
Be
with your pet or reading a good book.
yo
co
EVERY 12 MONTHS
Usually once a year, but sometimes more often, your
visit to the doctor will include the following screenings:
af
- Cholesterol test
- Blood and/or urine test to check kidney function
na
or
or
Also, get your eyes checked at least once a year.
str
A comprehensive dilated eye exam is essential
for people with diabetes, who are at increased
EA
risk for glaucoma, cataracts and retinopathy, a
Lik
nerve disorder.
yo
An annual eye exam can diagnose eye problems
early, when they can be effectively treated, and is a
covered benefit for people with diabetes. =
+
h
lik
8
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PRENATAL POINTERS
*
*
FINANCIAL
FACTS OF
(NEW) LIFE
e.
’t
o
*
gs:
r.
have a baby, finances
are also a major consideration. Make a
budget that accounts
Oh, Baby!
for another mouth
to feed (and clothe,
entertain and educate),
Thinking about getting pregnant? First, get ready.
I
and start saving as
early as you can.
If you and your part-
t’s true: You can never fully prepare for
foods including whole grains, fruits, vegetables,
parenthood. What you can do, though,
low-fat dairy products and protein. Also, the
ner are both employed,
is give your baby the best possible start
March of Dimes recommends taking a daily multi-
try living off one income
vitamin with 400 micrograms of folic acid before
for a while, especially
and during early pregnancy. Folic acid can help
if you plan on a long
reduce the risk of certain birth defects.
maternity leave. And
by preparing your body.
r
ur
When planning to
GET FIT
Before becoming pregnant, strive for and maintain
while it’s tempting to
your ideal weight. This will reduce your risk of
LIVE WELL
buy the latest genera-
complications during pregnancy.
Limit your caffeine intake and give up alcohol
tion of baby gadgets
and cigarette smoking. Also, do everything you
and those oh-so-
a few days a week, start before you get preg-
can to reduce stress. See your doctor for a pre-
nant. A brisk walk or a spin on a bike—indoors
pregnancy checkup, too.
adorable outfits, don’t
If you don’t already engage in physical activity
or out—are two easy options. Also consider yoga
Talk to your partner about the emotional
or Pilates, which deliver the combined benefits of
aspects of becoming parents. Chat with friends
stretching and strength training.
who have children or—better still—offer to
babysit. Having a baby is life-changing, so do
EAT RIGHT
your part to prepare as much as possible for
Like exercise, a good diet can help you maintain
everything the future holds. =
your best weight. Choose a variety of nutritious
go overboard. Take
advantage of local
secondhand stores
and hand-me-downs
from friends.
And, besides, that’s
what baby showers
are for!
+ According to the March of Dimes, research shows that the
healthier a woman is before pregnancy, the more
likely she is to have a healthy baby.
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A DOSE OF
PREVENTION
Did you get your
flu shot yet? Just
about everyone
should, says
the Centers for
Disease Control
and Prevention.
It’s the best
defense against
the flu.
An annual flu
shot is especially
important for
young children,
pregnant women,
people over age
65 and people
with chronic health
conditions like
asthma, diabetes
or heart disease.
Also, talk to
your doctor about
a pneumonia
vaccine if you’re
over 65, or if
you’re younger
and smoke or
have asthma.
10
HOME
Security System
No, not burglars—germs!
WE’RE TALKING ABOUT PROTECTING YOUR FAMILY from the
inevitable bout of viruses that plague daycares, schools and offices.
Create a safe haven within your home by practicing these tips.
1|
AVOID CARRYING GERMS INTO
YOUR HOUSE. The moment you
get home, wash your hands thoroughly. Using
warm water and soap, rub your hands together
vigorously and scrub all surfaces for 15 to
20 seconds, says the Centers for Disease
Control and Prevention (CDC).
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PRE VENTION
2|
STAY GERM-FREE WHEN YOU’RE OUT AND ABOUT.
Frequent hand-washing is key, wherever you are throughout
the day. Also, carry mini-bottles of alcohol-based hand sanitizer for
times when soap and water aren’t available. Use hand sanitizer, and
encourage your kids to use it, after contact with others, money, shared
school supplies or other objects that can carry germs. At work, wipe
down your phone, keyboard and workstation with disinfectant cloths.
Maintain a safe distance from people who are sick. And encourage
your co-workers to stay home if they’re ill.
3|
KEEP YOUR
HOME SANITARY.
Use disinfectant to clean
surfaces thoroughly,
especially in the kitchen
and bathroom. Avoid
using and re-using
sponges and rags
because germs love to
live in them. If you do
use sponges, change
them once a week,
throw them in the
dishwasher or soak
them in bleach
for 15 minutes to
kill germs.
4|
COVER YOUR MOUTH
WHEN YOU COUGH OR
SNEEZE. Don’t use your hands,
though. Direct your mouth into your
elbow or a tissue. Toss the tissue and
wash up after. Also, remind your family
to avoid touching their eyes, mouth
and nose throughout the day.
5|
IF YOU OR A FAMILY MEMBER IS SICK, THERE’S NO
PLACE LIKE HOME. Sure, you’ve taken all these precautions to keep your home germ-free, but if someone is ill he or she
has no business going out and spreading germs. Wash your hands
after caring for a sick person. After the bug has left the building,
disinfect sick rooms, garbage cans, door handles and anything sick
people may have come in contact with. Once everyone’s feeling better, you can join forces to clean the house from top to bottom. =
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RE ALIT Y CHECK
your :
health
s,
i
h
t
o
d
at
not th
Are You
Behaving Badly?
Five habits you should give up for good.
I
f you’re like most people, you have at least one unhealthy habit you
could stand to kick—and doing so might add years to your life, based
on a recent study published in the Archives of Internal Medicine. The
four bad behaviors were smoking, drinking too much, inactivity and poor diet.
We’ve added one more to round out the top
five unhealthy habits you can—and should—do without.
1
smoking cigarettes.
Lung disease, heart disease,
eating too much
4 fast food. That’s one
stroke and cancer—throughout the
definition of a “poor diet.” Most fast
body, not just in the lungs—are four of
food is high in fat and calories and
the many serious health issues smok-
can contribute to obesity and the
ing can cause.
development of type 2 diabetes.
2
drinking to excess.
Overindulging can lead to heart
disease, liver disease and cancer,
among other health problems. Limit
yourself to one drink per day for
Opt instead for fresh fruits and vegetables, whole grains, lean protein
and healthy fats like olive oil.
carrying extra
5 pounds. Being
women and two per day for men.
overweight can lead to diabetes,
That’s 12 ounces of beer, 5 ounces
heart disease and even some forms
of wine or 1.5 ounces of 80-proof
of cancer, among other health
distilled spirits.
problems. The good news is that
3
being sedentary.
changing bad habits 2, 3 and 4 can
help you drop this one.
Just 30 minutes of
moderate activity most days can
Don’t get overwhelmed by lifestyle
help reduce your risk of type 2
changes or set yourself up for failure
diabetes, high blood pressure, high
by setting unrealistic goals. Instead,
cholesterol, heart disease, osteoporo-
make small changes every day, and
sis and some kinds of cancer.
ask friends and family for support. =
BE KIND TO YOUR BODY As you seek better health, get a
handle on stress, too. If you’re often under pressure and anxious, you’re hurting your body. Improve your overall well-being by taking time to relax without
resorting to the bad habits above.
12
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PARENT POINTERS
DO GOOD,
feel
good
A variety of studies
have demonstrated
the health benefits
of volunteering. In
one study of older
adults who pitched
in at local schools,
researchers found
A GIFT TO LAST
A LIFETIME
Teach your kids the joy of charity and goodwill.
that physical,
cognitive and social
activity increased
in volunteers.
Other studies
have shown that
volunteering can
strengthen the
T
he holidays are a season of giving,
allowance and let them personally donate it to
immune system,
but many children can focus on
a local charity. Or take them with you to volun-
lower rates of
the spirit of getting. In some ways,
teer at a community outreach activity. Suggest
depression and
who can blame them? Television and other
that they donate their old toys before they begin
reduce the intensity
media outlets herald all the cool toys and
asking for new ones.
of chronic pain.
Ask children and teens what causes are
games kids should want.
Some researchers
important to them. Kids today are more socially
believe that help-
children special gifts during the holiday
aware. Are yours concerned about the envi-
ing others releases
season, but it’s also a great opportunity
ronment or feeding the hungry? Identify what
endorphins—the
to teach them about giving.
matters most to them and then help them
“feel-good” hor-
decide how to give, whether through donations
mone—which can
or volunteering.
reduce stress and
There’s nothing wrong with giving your
No matter what your faith or personal beliefs,
being charitable is a trait to cherish. And every
child can grasp the meaning of helping others.
Help kids understand giving by making it
tangible. Have them set aside a portion of their
pass it on ...
Children will recognize how good it feels to
promote feelings of
help, and you’ll be teaching them that it really
well-being, both of
is better to give than to receive. =
which have been
Check www.goodwill.org for
details on how to donate gently used toys and books. Contact
a local church, children’s hospital, family shelter or social service agency for even more options.
shown to have a
positive impact on
your overall health.
So reach out to
others, and you may
just be doing yourself a favor, too.
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PL AN NOTES
Here to
HELP
We welcome your
feedback. Please
How We Measured Up
Based on an annual review, here are some areas to address.
Y
our health plan participates in an
annual Medical Record Review
project as part of the health plan
1]
CONTROLLING HIGH BLOOD
PRESSURE (BP): This measure
focuses on the percentage of members who
continue your efforts
accreditation process. Rate performance is
had a diagnosis of hypertension and whose BP
to improve your and
calculated into the health plan’s NCQA
was adequately controlled (<140/90) during
your child’s compli-
(National Committee on Quality Assurance)
the measurement year. We found the diag-
ance in receiving
accreditation scores. Over 20,000 medical
nosis was present, and blood pressures were
the recommended
records were reviewed in spring 2010. Nearly
being monitored, but a concerning number
preventive health
80 quality measures helped us to assess the
were not in control.
assessments and
health status of our members, the effective-
health maintenance.
ness of care, access to care and use of the
Speak with your
health care delivery system. These measures
health care provider
are referred to as HEDIS® (Healthcare Effective-
centage of members with heart disease and
if you have any
ness Data and Information Set).
diabetes who have an annual screening for an
2]
LDL-C LEVELS (CHOLESTEROL):
This measure focuses on the per-
LDL-C level. The LDL-C level considered
questions relating
We have identified several noncompliant
to this information.
areas regarding members’ health conditions.
compliant is <100. LDLs are being done but
You may also call
As participants in your treatment planning,
an increasing number were not in control.
Customer Service at
we want to share these areas of concern in
the number on your
an effort to support improved compliance.
member ID card for
assistance.
The following highlight some areas of
concern:
3]
RETINOPATHY SCREENING:
Diabetic members should be receiv-
ing annual dilated eye exams for retinopathy
screening. Records from PCPs showed referrals for an eye exam, but there were no results
found in the record to show the member
actually went for the eye exam or the eye
exam performed was only for vision (glasses/
contacts). A specific diabetic eye exam is
considered a medical exam and is covered
whether or not you have a vision benefit.
4]
IMMUNIZATIONS: Childhood immunizations are based on the American
Academy of Pediatrics’ recommendations. In
order to be compliant, children are expected
to have all of their required immunizations by
the date of their second birthday. Our findings
revealed some children were receiving their
immunizations after their second birthday,
while some received all required immunizations
by age 2 with the exception of the MMR (with
no documentation to support a reason for
its omission). 14
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PROPER CARE
What You Need
To Know
Learn about our UM program.
U
tilization management (UM) is a
system for reviewing eligibility for
benefits for the care that has
been or will be provided to patients.
The UM department is composed of:
Preauthorization
Concurrent review
Case management
Notification is sent to the member, provider and facility within three working days
after receiving all necessary information
to make the medical necessity determina-
Medical necessity is based upon clinical
tion. This notification includes the criteria
standards and guidelines as well as clinical
used and the clinical reason for the adverse
judgment. All clinical standards and guidelines
decision. It includes instructions for recon-
used in the UM program have been reviewed
sideration and a contact person’s name,
and approved by practicing, participating
address and telephone number. The facility,
physicians in our network. Providers can
attending physician or the member may
receive a copy of our clinical standards and
request an appeal.
guidelines by calling their Network Manage-
The policy on payment for services ensures
UM STAFF
are available
Monday through Friday,
8 a.m. to 5 p.m., for
questions regarding
UM decisions. They can
receive fax communication
after hours. Phone and fax
ment/Provider Relations Representative. All
that the UM decision-making process is
numbers are listed on our
members receive notification of any preautho-
based on consistent application of appropri-
website under Plan Mem-
rization decisions.
ate criteria and policies rather than financial
bers > Member Contact
incentives.
Information. You may also
UM decision making is based only on
call the Customer Service
DOCTORS MAKE THE DECISIONS
The medical director makes all final decisions
appropriateness of care and service and
number on the back of the
regarding the denial of coverage for services
the existence of coverage.
member ID card.
when the services are reviewed via our
We do not reward practitioners, providers
UM program. The provider is advised that
or other individuals conducting utilization
the decision is a payment decision and
review for issuing denials of coverage or
not a denial of care. The responsibility
for treatment remains with the attending
service care.
The compensation that we pay to prac-
physician. The medical director is
titioners, providers and staff assisting
available to discuss denials with attending
in utilization-related decisions does not
physicians and other providers during the
encourage decisions that result in under-
decision process.
utilization or barriers to care or service. livingwell
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PRESORTED
STANDARD
U.S. POSTAGE
PAID
DANBURY, CT
PERMIT NO. 48
Southern Health Services, Inc.
9881 Mayland Dr.
Richmond, VA 23233
Southern Health Customer Service
(800) 627-4872
www.southernhealth.com
SH
Re
cycl
e This
M
Always verify with Customer Service that services we mention in Living Well are covered under your benefit plan.
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Pa
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E AT SMART
Healthy Holidays
Keep your eating merry and light.
T
here’s no shortage of opportuni-
BE PICKY: Choose your indulgences
ties to pack on a few extra
wisely. Scan the party’s offerings to
pounds in the fall and winter,
decide what you really want. Load up on
from cold-weather comfort food to
veggies, salad and healthy options like
Thanksgiving dinner and holiday parties.
shrimp cocktail (without the sauce!) first.
How about enjoying the season’s bounty
Then add a few treats.
without overdoing it? Here are a few
savvy strategies.
PLAN AHEAD: If you know you’re
SAVOR EVERYTHING: Eat slowly
to enjoy every bite, and wait at least
10 minutes before going back for more. You
going to a gathering, eat light the rest
might decide you’re full. Spend more time
of the day, but don’t skip meals. Have
mingling than eating—and stand some-
a small healthy snack before going to
where other than next to the food table.
a party to avoid overdoing it at the
buffet table.
BRING SOMETHING: Don’t come to
a party empty-handed. Whip up a healthy
dish, like the unique and tasty recipe
Cheddar & Parmesan PEAR DIP
5 fresh pears
orange juice to cover pears
¼ c. cheddar and parmesan
shown below. CUT pears in half and remove core. Cut each half into four slices.
PLACE sliced pears in a bowl and cover with orange juice. Let sit for
5 minutes then REMOVE pears from juice. This will help to keep the
pears from turning brown. COMBINE remaining ingredients and mix well.
salad dressing
¼ c. fat-free sour cream
2 Tbsp. sweet pickle relish
½ tsp. ground tarragon
TRANSFER dip into a small serving bowl. Put serving bowl in the center
of a large plate and surround with pear slices. Serves 5.
NUTRITION INFORMATION PER SERVING: 174 calories, 6.4 g fat, 32 g
carbohydrates, 1.1 g saturated fat, 5 g fiber, 157 mg sodium, 2 g protein.
Source: www.fruitsandveggiesmatter.gov
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