live healthier today with arise health plan • winter 2016€¦ · healthy fats, protein, and...

Furry Friends and Your Health

Your Health Plan Member Rights and Responsibilities

Up Next: The Hazards of Binge-Watching

Inside Features:

arise shineand™

Live Healthier Today with Arise Health Plan • Winter 2016

Wintertime

Wellness

4 Where to Turn for Mental Health

6 Superfoods or Supergimmicks? (How to Tell the Difference)

8 Up Next: The Hazards of Binge-Watching

10 Want to Avoid Back Surgery? Try Physical Therapy

11 External Review Process in Wisconsin

In Every Issue

Healthy RecipeSee page 7 for our Beefy Vegetable Soup recipe!

4 6

8

10

Inside This Issue winter 2016

™

A combined 79 million U.S. households have either a cat or a dog. Call them pets—or extensions of the family—these furry friends are reliable sidekicks and fun play partners. If you’re thinking about adding a pet to your family, be sure to consider the potential effects on your health.

THE PERKSHealtHier Heart Owning a pet—especially a dog—may lower your risk of heart disease.

Fitness Buddy Dog owners are more likely to get the recommended 2½ hours of physical activity each week.

Creature ComFort When loving animals are around, kids with autism aren’t as anxious, and people with Alzheimer’s disease may be less agitated.

less stress Pet ownership often comes with lower blood pressure. And studies show the presence of pets may help people recover better from stressful situations.

THE RISKSallergy attaCk No dog or cat is 100% allergy-free. That’s because a certain protein in pet skin is the problem, not the hair. Think you might be allergic? Ask your doctor about testing to confirm—and treatment to help.

astHma alert For people with asthma, pet aller-gies can cause wheezing and chest tightness. Make sure bedrooms and furniture are off-limits for pets if you have asthma.

litter Box toxins Outdoor cats may carry a para-site in their feces, leading to an infection in humans called toxoplasmosis. It can be passed to a baby during pregnancy. Moms-to-be, it’s OK to keep your cat: Just leave litterbox duty to someone else.

Critter Carriers In the spring and summer, dogs and cats are more likely to bring home unwelcome visitors: fleas and ticks. Ask your vet about tick-control products. Vacuum often to ward off fleas.

Furry Friends

AND youR HEAlTH

WeCareForWisconsin.com 3

Your Rights and Responsibilities as a Health Plan Member

Utilization management decision-making at Arise Health Plan is based only on appropriateness of care and exis-tence of coverage. Arise Health Plan does not specifically

reward practitioners or other individuals for issuing deni-als of coverage or service. No financial incentive is given to encourage decisions that result in underutilization.

Arise Health Plan is committed to maintaining a mutually respectful relationship with you that promotes high-quality, cost-effective health care.

AffIRmATIvE STATEmENT REgARDINg INcENTIvES

The member rights and responsibilities listed below set the framework for cooperation among you, practitioners, and us.

Your Rights as a Health Plan Member

• You have the right to receive information about us, our services, our practitioners and providers, and your member rights and responsibilities.

• You have the right to be treated with respect and recognition of your dignity and your right to privacy.

• You have the right to participate with practitioners in making decisions about your health care.

• You have the right to a candid discussion of appro-priate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.

• You have the right to voice complaints or appeals about us or the care we provide.

• You have the right to make recommendations regard-ing our member rights and responsibilities policies.

Your Responsibilities as a Health Plan Member

• You have the responsibility to supply information (to the extent possible) that Arise Health Plan and our practitioners and providers need in order to provide care.

• You have the responsibility to follow plans and instructions for care that you have agreed to with your practitioners.

• You have the responsibility to understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.

Have questions about your health plan? Visit www.WecareforWisconsin.com or call toll-free at 888-711-1444. Member Services is available 8 a.m. to 4:30 p.m., Monday through Friday, Central Standard Time.

4 Live Healthier Today with Arise Health Plan

turn

for

unableWhere to

HealthMentalto cope

medication

suicide

abusing drugs

support groups

overwhelm

edtreatable

get professional help

anxious

stressed

feeling of sadness

habitssleeping

mood swings

counseling

anger

abusing alcohol

emotions

self-help group

suicide

crisis centers

health center

get help

It’s normal to feel stressed or anxious now and then. But it’s time to call for help if emotional issues persist for a significant period of time and interfere with your life, your job, or your personal relationships.

With all the mental health resources and effective treatments available these days, you don’t need to suffer and wonder what’s wrong. Education and awareness have done much to erase the stigma once attached to mental illness. Still, many people don’t seek help for mental health needs.

Mental conditions are real, and can be life-threatening, but they’re also common and very treatable. How do you know you need help? As with many physical conditions, change is the key. If you have a marked and persistent change in personality, mood, or eating or sleeping habits, that’s a sign something may be going on.

Symptoms to KnowThese are other warning signs:

• Feeling unable to cope with your day-to-day problems, work assignments, or usual household activities

• Being overwhelmed by a deep sense of sadness, hopeless-ness, or helplessness

• Having extreme mood swings, from high or hyper to down in the dumps

• Abusing alcohol or drugs

• Getting very angry or acting violently

• Having thoughts about suicide or hurting someone else

• Having a plan of how you would commit suicideIf you experience any of these symptoms, it’s better to get

treatment sooner than later. These are warning signs that you definitely need help.

Make the CallGet help right away any time you believe you might hurt yourself or someone else. Call 800-SUICIDE (800-784-2433)

or your local crisis center. Or, look in the government pages of your local phone book for the numbers of emergency mental health treatment facilities near you. Finally, if you are in an immediate state of crisis, it is best to go to a hospital emer-gency room for temporary help. The emergency department doctors will also be able to tell you where and how to receive additional assistance.

Other resources:

• Your health care provider. Your health care provider knows you and probably will notice any changes in your mood or personality. Your health care provider can also rule out possible physical reasons for your symptoms.

• Employee assistance programs (EAP). If your company has an EAP, ask for a referral to an appropriate provider or treatment program in your community.

• Community mental health centers. These organizations provide counseling and other services on a sliding-fee scale, based on your income.

• Crisis centers. On-site mental health professionals provide immediate evaluation and treatment.

• Support and self-help groups. Alcoholics Anonymous and the National Alliance on Mental Illness are examples of peer and family support groups that meet both online and in person.

• Word-of-mouth referrals. These can come from friends or family.

• Psychiatrist or medical doctor. These professionals can provide counseling and prescribe medication.

• Psychologists. These professionals have doctorate degrees and specialize in psychotherapy and human behavior.


THREE WAyS To ADD Joy To lIfEThe secret to happiness, like the secret to success, has long been studied and debated. What makes one person happy could well stress out someone else (take skydiving, for example). Still, psychologists and other researchers have found that some activities and mind-sets appear more than likely to increase joy and contentment. Here are three to try:

Help other people. Doing things for others obviously helps them, but research shows it can increase your happiness, too. Big

projects that involve a lot of time or money are great. Yet small gestures, done with sincerity, can also help. Call a friend or family member you haven’t spoken with in a while, smile at a stranger, or even hold the eleva-tor or subway door.

take time to play. Playfulness helps anyone of any age be more resilient, happy, flexible, and creative. It teaches us to manage

and transform stress and negative emotions, too. It’s easy to be playful with pets and children. But look-ing for ways to play with grown-ups at work and home is a great way to increase the strength and health of your relationships.

do something you enjoy. It doesn’t matter if it’s a hobby you’ve been doing for years or something you’ve never tried

but have always wanted to. Carve out some time from the hours you spend watching TV or surfing the Web, and do it.

1 2 3

Call them superfoods, functional foods, or nutritional powerhouses. No matter what term you use, adding them to a healthy diet can offer additional protection against heart disease, cancer, and other chronic diseases and their complications.

Of course, food marketers have jumped onto the superfood bandwagon. These days, you’ll find packages labeled all-natural, cholesterol-lowering, and heart-healthy. While some assertions they make hold up to researchers’ scrutiny, others seem designed to lead you astray. Here’s your guide to what’s real—and what doesn’t live up to the hype.

Foods That Deserve a Health HaloScience suggests these foods can lay legitimate claim to pre-venting or treating common ailments.

• Nuts. Healthy fats, protein, and fiber in nuts fill you up, helping control your weight and your blood glucose. Magnesium-rich cashews and almonds can lower blood pressure. Research shows that walnuts, pecans, and almonds reduce cholesterol. Serve nuts instead of chips as a snack—try pistachios, which have shells that slow you

down and keep your portions in check. Or use them in place of bread to coat meat or fish.

• Fish. Fatty fish like tuna, salmon, and sardines are so good for your cardiovascular system that the American Heart Association recommends at least two servings per week. And their reputation as brain food is well-earned: One recent study showed women who eat more fish are less likely to develop depression. Bake or grill, rather than fry, seafood dishes to avoid excess fat and calories.

• Tea. Compounds in tea called flavonoids lower LDL, or “bad,” cholesterol, widen blood vessels, and prevent dan-gerous clots from forming. Some evidence even links tea to a lower risk for cancer. Brew a cup of green or black—both have health benefits.

• Cruciferous vegetables. Kale, cauliflower, broccoli, and their cousins contain special chemicals called glucosinolates. Your body breaks them down into potentially cancer-fighting sub-stances. Scientists have found them promising against prostate, colon, lung, and breast cancer. Cook kale into omelets or stews, snack on raw cauliflower, or top your pizza with broccoli.


Some food products claim to have magical traits, but don’t be fooled: The science isn’t there. But increasingly, scientists are recognizing that some foods have real health-promoting powers.

Superfoods or Supergimmicks?(How to Tell the Difference)

Looking to Eat Healthy?Visit our Healthwise Library online at www.WecareforWisconsin.com/members/healthwise and type “nutrition” in the search box.


BEEfy vEgETABlE SouP1 teaspoon vegetable oil1 pound beef, cut into half-inch cubes1 28-ounce can crushed tomatoes28 ounces of water (fill empty tomato can)2 large carrots, diced (about a cup)2 stalks celery, diced (about a cup)1 onion, chopped (about a cup)2 cloves garlic, minced3 small red potatoes, diced (about

a half-pound)2 tablespoons dried parsley1 cup frozen peas

• Flaxseed. Rich in fiber and omega-3 fatty acids, these small seeds pack a big punch. In one recent study, overweight people with prediabetes added flaxseed to their daily diets. After 12 weeks, they reduced their blood sugar and improved their body’s ability to use insulin. Stir ground flaxseed into breakfast cereal, yogurt, breads, or muffins.

• Cranberries. Components in these tart fruits may prevent bacteria from clinging to the urinary tract, warding off infections. Some evidence suggests they can help prevent stomach ulcers. And laboratory studies show anti-oxidants from cranberries can fight plaque on your teeth, reducing your risk for gum disease. Drink a glass of cranberry juice to quench your thirst and take advantage of these perks.

• Ginger. Modern science now sup-ports ancient Asian beliefs about this tropical plant. Thanks to compounds such as 6-gingerol, ginger relieves nausea during pregnancy, after sur-gery, and due to motion sickness, as well as easing symptoms of vertigo. Use fresh or powdered ginger to add spice to sweet or savory dishes.

• Garlic. Pungent and flavorful, this edible bulb can boost heart health. Phytochemicals inside keep arteries clear, lower cholesterol and blood pressure, and may even ward off some cancers. Eat garlic raw or cooked in salads, sauces, stews, and stir-fries.

Health Claims with Sketchy ConnectionsWith all those evidence-backed edibles, who needs food fakes? Beware these broken food promises:

• Gluten-free foods, for most people. For the 3 million Americans with celiac disease, avoiding gluten—a protein in wheat, barley, and rye—is essential for good health. Many others have gluten intolerance and experience digestive distress when exposed to these grains. However, avoiding gluten has no known health benefits for people without these conditions.

• Acai. Juices, powders, tablets, and capsules from this fruit are said to halt aging and speed weight loss. Trouble is, no research supports these declarations. Like other berries, acai may have anti-inflammatory and anti-oxidant properties, but not enough to serve as any miracle cure.

• Coconut oil. There’s no reason you can’t use this oil for cooking on occasion, provided you choose vir-gin coconut oil and skip products labeled “partially hydrogenated” (that means it’s full of harmful trans fats). But don’t expect it to result in weight loss or prevent Alzheimer’s disease; there’s no evidence to back these claims.

• Coconut water. Contrary to popu-lar belief, this light beverage isn’t a good stand-in for sports drinks.

It doesn’t have enough sugar or electrolytes to replenish you after a truly hard workout, and for short or light workouts, water works just as well. What’s more, any antiaging assurances are pure bunk.

The Best Medicine? A Healthy DietEven research-tested, doctor-approved superfoods don’t work in isolation. For best results, combine them all into a healthy, nutrient-rich diet. Load your plate with foods from these groups, and you’ll stand the best chance at a long, healthy life:

• Vegetables—the more colors and types, the better

• Brightly colored fruits and 100 percent fruit juice

• Whole grains

• Low-fat and fat-free dairy foods, including milk, cheese, and yogurt

• Lean meats, poultry, fish, eggs, and legumes

• Nuts and seedsAlways talk with your doctor or a

dietitian if you have specific concerns about food and your health.

Heat oil to hot in large pot and put beef in one layer to brown quickly. Add all other ingredients except peas. Bring to boil and reduce heat to medium low. Cook for about 90 minutes to two hours on stovetop. Add peas and serve.Makes eight 1½-cup servings.

PER SERVING: 147 calories, 15 g protein, 3 g fat, 33 mg cholesterol, 18 g carbohydrate, 4 g fiber, and 422 mg sodium. (For less salt, use low-salt tomatoes.)

UP NexT:The Hazards of Binge-Watching

In this new era of web series and streaming services, binge-watching has turned into a household term. But can keeping your eyes glued to the screen for hours hurt your body or mind? Research hasn’t quite caught up to our new viewing habits—but early findings raise concerns.

Streaming threat: Mental distress. People who report spending more time sedentary—in other words, with their rear parked on a couch or chair—have more psychological distress, one recent study found.

BUffeR IT By: PacINg yoURself. Cutting back on TV time by just 30 minutes per day was tied to fewer feel-ings of depression and anxiety, the same study showed. So did getting 10 minutes more of physical activity per day. Hit pause and do a few body weight exercises, such as push-ups, or go for a walk.

Streaming threat: Poor sleep. Blue light from glowing screens, especially late at night, stimulates nerve pathways in your brain. Scrambled signals alter hormones, body temperature, and other cues

related to your biological clock. This leaves you bright-eyed when you should feel drowsy.

BUffeR IT By: sHUTTINg DoWN eaRly. Glasses that block blue light could counteract these effects. Better yet, sleep experts say: Power down.

Take screens out of your bedroom and use the hour before sleep to do something relaxing, like taking a hot bath, instead of squeezing in one more episode.

Streaming threat: Weight gain. TV and poor diet choices often go hand in hand. A recent study in the journal Eating Behaviors showed the more viewing time adults logged, the greater their risk for binge-eating. Plus, working the remote burns far fewer calories than other activities you might do instead, such as walking or doing chores.

BUffeR IT By: ReDUcINg TeMPTaTIoN. Remove unhealthy snacks such as chips and cookies from your home. Eat meals at the table rather than in front of the TV, so you can focus on the food. Then go for a walk instead of immediately pressing play.

Streaming threat: Kids turning violent. The danger grows if binge-watching occurs in early years. Children exposed to dark, disturbing programs may come to think of aggression as a solution to their problems. The more media violence they watch, the higher risk to imitate these behaviors.

BUffeR IT By: seTTINg RUles. Limit daily screen time and monitor what your child sees. If a violent scene occurs when you’re watching together, take time to let your child know that you disapprove. Discuss better ways to handle challenges.

A new season of your favorite comedy or drama comes online. You can’t help but zip through the episodes in a week—or a single night. At this point, you know the characters as well as your real-life friends and family.

higher risk for

heart disease

greater chance of dying

(from any cause)

increased risk for type 2 diabetes

hours of TV per day is linked to:


We Want to Hear from You!We value your feedback and suggestions. How can we improve Arise Health Plan’s services, the Arise & Shine newsletter, or our website? If you have questions, comments, or suggestions, please e-mail [email protected].


For information about our Quality Improvement Program and performance results, visit us at WeCareForWisconsin.com/quality.

We are proud of our progress and continuous improvement.


Want to Avoid Back Surgery? Try Physical Therapy

No magic pill can make back pain instantly disappear. In fact, the best and most cost-effective remedy might not involve medicine at all. Instead consider a prompt prescription to physical therapy.

That’s according to a new study of more than 750,000 patients with a new bout of low back pain. About 17,000 of them received early physical therapy—within two weeks of their first doctor’s visit. Their sessions focused on active treat-ments.

Two years later, those patients were less likely to have undergone advanced imaging, had surgery, or received spinal injections. Plus their care cost 60 percent less. That’s compared to others who went to physical therapy later or not at all.

The Healing Power of PTHeading straight to the physical therapy clinic might have several important benefits, the study authors note. In gen-eral, doctors recommend stretching and resuming normal activities as soon as possible after short-term back pain devel-ops. This increases flexibility and speeds healing compared with resting in bed.

Physical therapy might help you comply with this direction. What’s more, it may provide a psychological boost. Physical therapists offer practi-cal tools and techniques to stay active without worsening pain. In the process, they instill hope and self-confidence. Meanwhile, imaging tests often provoke fear and worry—even if they don’t reveal a serious problem.

uPDATE To PAIN mANAgEmENT BENEfITSArise Health Plan is dedicated to ensuring quality care in the most cost-effective and appropriate manner for our Members. Our medical director and nurse case specialists periodically review care that our Member’s receive. Effective January 1, 2016, many Member certificates will reflect updated guidelines that limit amounts per calendar year for a few select pain management procedures and injections. Some pain management services may be considered experimental/investigational/unproven and might not be covered. It is always a good idea to refer to your certificate or contact Customer Service at 1-888-711-1444 to verify your specific coverage for pain management injections.

fouR SmART BAcK-SAvERS

In addition to physical therapy, healthy lifestyle choices can also prevent back pain and ease it after it occurs. To stabilize your spine:

exercise. Beyond strength-ening and stretching moves, aerobic workouts keep your weight in check. This

reduces the pressure on your back. If you’ve coped with back pain before, ask your doctor or physical therapist about the best routine for you.

eat a healthy diet. Watching portion sizes also prevents back-straining weight gain. Also, eat foods containing

calcium and vitamin D to pro-mote strong vertebrae and other bones. Good choices include green, leafy veggies and fortified orange juice.

maintain good posture. Don’t slouch when stand-ing or sitting. Reducing the curve in your spine helps

your lower back better support your weight.

lift safely. If you must hoist a heavy load, keep your back straight. Rather than bending over the item, lift

by putting stress on your legs and hips.

1

2

3

4


external Review Process in Wisconsin

If members are not satisfied with the outcome of their griev-ance, a Wisconsin law provides the opportunity for all persons covered by health benefit plans an additional way to resolve disputes involving medical decisions.

Members may request an external review if coverage was denied because:

• Services were deemed not medically necessary;

• Services were considered experimental or investigational;

• Services were rendered by an out-of-network practitioner whose clinical expertise was felt to be medically necessary and the expertise is not available from an in-network practitioner;

• Services were for a pre-existing condition exclusion; or

• The policy or certificate was rescinded.The external review process provides members with an

opportunity to have medical professionals who have no connection to their health plan review their dispute. The decision of the Independent Review Organization (IRO) is binding on the health plan and the member.

When a coverage request is initially denied, information on how to request a review is provided with the denial. External review is available only after the grievance procedure has been completed. Members may be entitled to an expedited external review when certain situations apply.

A request for an external review must be made within four months of the date of the adverse determination or experimen-tal treatment determination, or from the date of receipt of notice of the grievance panel decision, whichever is later.

As with any product or service, members may have questions or complaints about their health insurance plan. Members should first attempt to resolve a com-plaint by contacting the health plan’s Members Services department locally at 920-490-6900 or 888-711-1444 toll-free. Members may also file a grievance with the insurer. All insurance compa-nies offering health benefit plans in Wisconsin are required to have an internal grievance process to resolve complaints from the member or the member’s authorized representative.

Do You Have Any Questions?If you have any questions or need additional informa-tion, please contact Arise Health Plan locally at 920-490-6900 or 888-711-1444 toll-free, the Wisconsin Office of the Commissioner of Insurance (OCI) at 800-236-8517, or visit OCI’s website at www.oci.wi.gov.

PRovIDER DIREcToRy AvAIlABlE oNlINEFor the most up-to-date provider information, please visit our website, www.WeCareForWisconsin.com. Click on “Find a Doctor” then enter your “Group Number” from your Arise Health Plan ID Card. You can also get cur-rent provider information or request a printed directory by calling Member Services at 920-490-6900 (local) or 888-711-1444 (toll-free).

PRSRT STD

U.S. Postage

PaidArise Health Plan

arise HealtH Plan421 Lawrence Drive, Suite 100 De Pere, WI 54115

Phil colmenares MD, MPH, editor in chief DeDe Darrow, Managing editor Arise & Shine is published by Arise Health Plan. The information contained in this publication is intended to educate about subjects pertinent to health, not to substitute for consultation with a personal physician. © 2016 Printed in U.S.A.26480-085-1601

Arise Health Plan offers a full line of insurance products. Not all the information contained in this publication pertains to all lines of business. Fully insured business is underwritten by WPS Health Plan Inc. ASO business is ad-ministered at the request of the employer. The information contained in this newsletter does not guarantee benefits. Please see your certificate of insurance or summary plan description for your specific benefit language.

Printed on Recyclable Paper 318M

arise shineand

Have you heard of the American Heart Association’s Go Red for Women campaign? Each February, women around the country put on red dresses to promote heart disease awareness. But there’s no reason to stop with your wardrobe. Dress up your plate with some red-hued foods every day. Here are some ideas.

Strawberries These berries pack more than 150 percent of your required immune-boosting vitamin C for the 50 calories per eight medium berries, they serve as a guilt-free dessert.go ReD By: Blending frozen strawberries (make sure there’s no added sugar) into smoothies; serving them on sandwiches with peanut butter; topping a salad with a touch of their sweetness

TomatoesA natural pigment called lycopene lends

tomatoes their rosy hue. Lycopene gives you potential protection against cancer and

heart disease. Don’t think you only need to eat them fresh off the vine: Your body actually more easily absorbs lycopene from processed tomato products, such as paste and sauce.go ReD By: Chopping tomatoes into salsa; stuffing them into omelets; or making your own sauce with low-sodium canned tomatoes, tomato paste, onions, garlic, and spices

Cranberries Compounds called proanthocyanidins in these tiny, tart fruit remove bacteria from your bladder. Research shows this process may reduce your risk for urinary tract infections. Cranberries also boast another compound, resveratrol, which has been found to reduce blood pressure.go ReD By: Tossing dried cranberries in your salad; spread-ing cranberry sauce on sandwiches; drinking 100-percent cranberry juice

Cherries All cherries contain compounds called antioxidants that zap stress-inducing free radicals. But tart cherries deliver even more than their sweet counterparts. The result? Some people who eat them feel less pain from arthritis, gout, and after exercising. go ReD By: Drinking tart cherry juice; baking dried tart cherries into cookies and muffins; stirring frozen cherries into oatmeal as it cooks

Red bell peppersA single bright pepper contains your entire daily

dose of vitamins A and C, nutrients that strength-en your immune system. This means better protec-

tion from infection and faster wound healing. go ReD By: Slicing raw peppers and serving in

a pita with hummus; roasting and adding to sandwiches; or sautéing them into a stir-fry

The Nutritious, Delicious Way to Go

SEE PAgE 6 foR moRE NuTRITIoN TIPS!

edR

live healthier today with arise health plan • winter 2016€¦ · healthy fats, protein, and...

Documents