Spring 2002

DigestiveHealth:The InsideStory

DigestiveHealth:The InsideStory

~ “Holding Down health Care Costs” inside ~~ “Holding Down Health Care Costs” inside ~

F.A.Q. F.A.Q.ons frequently asked questions frequently asked questions frequently asked questions

... about USAble Administrators

Q: USAble Administrators is called a third-party administrator or TPA. What does that mean?A: A third-party administrator is a company that provides claim-processing services to employer groups that are self-funded. The employer group designs the benefit package and establishes the guidelines for processing claims. The third-party administrator issues the claim Explanation of Benefits (EOB)/payments in accordance with these guidelines. Theemployer group reimburses the claim payments, as well as a fee for administration of the claims.

Q: How do I file a claim?A: Most providers will file your claim for you. You can file the claim when the provider does not.You may download a claim form from the USAble Administrators Web site at USAbleAdminArkansas.com. If you needhelp completing the form or if you need a form, please call Customer Service at the number on your identification (ID)card or e-mail Customer Service.

Q: If I need to mail in the claim form, where should I mail it?A: Please mail the claim form to:

USAble AdministratorsP.O. Box 1460Little Rock, AR 72203

Q: Will I be notified when you have processed my claim form through USAble Administrators?A: Yes, an EOB form will be mailed to you. The EOB details the amount paid to the service provider, any amount deniedwith the reasons for denial, and the portion you are responsible for paying.

Q: If I have received an EOB explaining payment of a claim, and I have questions about the EOB, whom do I contact?A: Most inquiries concern benefits. Refer to your Summary Plan Description (SPD) provided by your employer. Otheroptions are to retrieve benefit information on the USAble Administrators Web Site, call the Customer Service number onyour ID card or e-mail Customer Service. For more information about reading your EOB, visit the “Understanding YourEOB” section of our Web site at USAbleAdminArkansas.com or call the Customer Service number on your ID card.

Q: If I have questions about claim status or benefits, whom do I contact?A: Refer to your SPD or call Customer Service at the number on your ID card.

Q: If I lose my ID card, how do I replace it?A: Simply call Customer Service at 1-888-USABLE-1 to request a new card.

Q: Why is it important to show my ID card to my provider of service?A: Your ID card contains important information regarding program participation. It lets your provider of service knowwhether you participate in specific physician networks so that you may receive the highest benefit you are allowed. Italso provides the ID number that is reflected in our claim processing system. This number is necessary to match theclaim with the member when the claim is submitted, and it expedites the processing of your claim payment. Also,always have your ID card on-hand if you ever need to call Customer Service.

3

is published four times a year byArkansas Blue Cross and Blue Shieldfor the company’s members, healthcare professionals and otherpersons interested in health careand wellness.

Vice President of Advertising and Communications:Patrick O’Sullivan

Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com

Designer: Gio Bruno

Contributors: Tammi Bradley, Janice Drennan, Damona Fisherand Kathy Luzietti

Customer Service Numbers

Little Rock Toll-freeCategory Number (501) Number

State/Public School Employees 378-2437 1-800-482-8416

e-mail: publicschoolemployees@arkbluecross.com stateemployees@arkbluecross.com

Medi-Pak (Medicare supplement) 378-3062 1-800-338-2312

Medicare (for beneficiaries only): Part A (hospital benefits) 378-3151 1-877-356-2368 Part B (physician benefits) 378-2320 1-800-482-5525

UniqueCare, UniqueCare Blue, Blue Select®, BlueCare PPO & PPO Plus (individual products) 378-2010 1-800-238-8379

Group Services 378-2070 1-800-421-1112

BlueCard® 378-2127 1-800-880-0918

Federal Employee Program (FEP) 378-2531 1-800-482-6655

Health Advantage 221-3733 1-800-843-1329

USAble Administrators 378-3600 1-800-522-9878

For information about obtaining coverage, call:Little Rock Toll-free

Category Number (501) Number

Medi-Pak (Medicare supplement) 378-2937 1-800-392-2583

Blue Select®, BlueCare PPO & PPO Plus (individual products) 378-2937 1-800-392-2583

Regional Office locations:Central Little RockNortheast JonesboroNorthwest FayettevilleSouth Central Hot SpringsSoutheast Pine BluffSouthwest TexarkanaWest Central Fort Smith

Customers who live in these regions may contact the regionaloffices or call the appropriate toll-free telephone numbers above.

Web sites: www.ArkansasBlueCross.com,www.HealthAdvantage-hmo.com, www.BlueAnnEwe-ark.com,www.USAbleAdminArkansas.com

INSIDETHIS ISSUE

~SPRING 2002~

The Inside Tract ........................................... 4Colon cancer screenings for over 50s ......... 6Obesity-related illnesses ............................. 8Extra pounds can lead to extra problems ..... 9Why fiber is important ............................... 10Diverticulosis & diverticulitis .................... 11Constipation is no laughing matter ............ 12Irritable Bowel Syndrome........................... 13Inside indigestion ...................................... 14Facts about food poisoning ....................... 15Digestive disease quiz ............................... 16Focus on digestive health .......................... 17The pharmacist is in; member discounts ......... 18Health Advantage member info .................. 19On-line discounts & you; Don’t Start ............. 20Readership survey; Medi-Pak info .................. 21Member rights and responsibilities ........... 22Maternity & Baby Fair................................ 22Blue & Your Community; Texarkana move ....... 23Blue On-line ............................................... 24

4Below the surface of your epidermis, nestled

beneath the protective cover of your muscles lies a long,winding road of organs that turn food into fuel for yourbody. The digestive system is a series of hollow organsjoined in a long, twisting tube about 30 feet long, fromthe mouth to the anus (see diagram this page). Two soliddigestive organs, the liver and the pancreas, also help thedigestive process, as do nerves and blood.

The digestive system consists of the mouth (32 teethstart the breakdown of food), esophagus,stomach, gallbladder, liver, pancreas,appendix, small intestine (duodenum,jejunum and ileum), large intestine (ascend-ing, transverse, descending and sigmoidcolon), rectum and anus.

Digestion is the process by which foodand drink are broken down into theirsmallest parts so that the body can usethem to build and nourish cells and toprovide energy.

Food must be changed into smallermolecules of nutrients before it can beabsorbed into the blood and carried to cellsthroughout the body. Digestion involves themixing of food, its movement through thedigestive tract, and the chemical breakdownof the large molecules of food into smallermolecules.

Although eating and drinking are voluntary pro-cesses, digestion is an involuntary process controlledby the nerves. Once food is swallowed, the digestionprocess begins.

Mucosa is the substance that lines the mouth,stomach and small intestine. Mucosa contains tinyglands that produce juices to help digest food. Thehollow organs of the digestive system have muscles thatcause their walls to move and contract. Food and drink

are broken down by the digestive juicesand move through the system by

muscles mixing with the contentsof each organ for processing.

“Peristalsis” is the movementof the esophagus, stomach and

intestine. The esophagus connectsthe throat and stomach. Food and

drink are taken in and move like an ocean wave throughthe esophagus, pushing slowly down the organ.

The OrgansFood is pushed down the esophagus toward the

stomach. A valve (esophageal sphincter) closes thepassage between the two organs. However, when foodand drink are being digested, the muscles around thering-like valve relax and allow food to pass into the

stomach. A malfunction of this valve is themost common cause of heartburn.

The stomach then has three tasks toperform in its digestive role. At first, thestomach serves as a storage facility forfood and liquid. The stomach relaxes toallow large volumes of swallowed food toaccumulate. Next, the lower part of thestomach flexes its muscle to mix up thedeposited food with the digestive juices itproduces. Finally, the last task of thestomach is to empty its contents into thesmall intestine, slowly.

The small intestine (about 20 feet inlength) is the next organ on food’s journeyto fuel, processing about two gallons offood, liquid and digestive secretions eachday. As food is digested in the small intes-tine and dissolved into the juices from the

pancreas, liver and intestine, the contents of the intestineare mixed and pushed forward to allow further digestion.

Digested nutrients are absorbed through the intesti-nal walls. The waste products of this process includeundigested parts of the food, known as fiber, and oldercells that have been shed from the mucosa. Thesematerials are propelled into the colon, where theyremain, usually for a day or two, until the feces areexpelled by a bowel movement. There is no nutrientabsorption in the colon — its main job is to reclaim theexcess water from the intestinal waste and recycle it backinto your bloodstream for reuse.

The Glands and “Juices”If you’ve ever wondered why it is so important to

drink water, understanding the digestive process can helpyou see the need to replenish liquid in the body.Throughout the digestive process, there are lots of

THE INSIDE TRACT

Esophagus

Liver

Stomach

Transverse Colon

PancreasGall Bladder

Spleen

Small IntestineDescendingColon

AscendingColon

Cecum

Appendix

Rectum

SigmoidColon

Esophagus

Liver

Stomach

Transverse Colon

PancreasGall Bladder

Spleen

Small IntestineDescendingColon

AscendingColon

Cecum

Appendix

Rectum

SigmoidColon

DuodenumDuodenum

AnusAnus

5“liquids” required.

The salivary glandsproduce the first liquidneeded for digestion.Your body produces upto two quarts of salivadaily. Saliva contains anenzyme that begins todigest the starch from

food into smaller molecules.The stomach lining is the next set of glands used for

digestion. They produce stomach acid and an enzymethat digests protein.

When food passes from the stomach to the smallintestine, enzymes from the wall of the intestinecontinue to break down food. The juices from thepancreas and the liver also kick in to digest food. Thepancreas produces a juice that contains a wide array ofenzymes to break down the carbohydrates, fat andprotein in our food. The liver produces bile — anotherdigestive juice. Bile is stored between meals in thegallbladder. At mealtime, it is squeezed out of thegallbladder into the bile ducts to reach the intestine andmix with the fat in our food. The bile acids dissolve thefat into watery contents of the intestine. Once fat isdissolved, it is digested by enzymes from the pancreasand the intestinal lining.

NutrientsDigested molecules of food, water and minerals

from the diet are absorbed from the cavity of the uppersmall intestine. The absorbed materials cross the mucosainto the blood and are carried off in the bloodstream toother parts of the body for storage or further chemicalchange. Different types of nutrients are absorbed atdifferent rates.• Carbohydrates —␣ Some of the most common foods

contain mostly carbohydrates: bread, potatoes, candy,pastries, pasta such as spaghetti, rice, vegetables andfruit. Many of these foods contain both starch (whichcan be digested) and fiber (which cannot be digested).Starch is digested in two steps: saliva and pancreaticjuice breaks starch into molecules called maltose; thenan enzyme (maltase) splits the maltose into glucosemolecules that can be absorbed into the blood.

Glucose is carried through the bloodstream to the liverwhere it is stored or used to provide energy for thework of the body. Table sugar is converted intoglucose and fructose which are absorbed into theblood. Milk contains lactose, another kind of sugar,which is changed into absorbable molecules by anenzyme called lactase.

• Protein — Meat, eggs and beans consist of giantmolecules of protein that must be digested by enzymesbefore they can be used to build and repair bodytissues. Enzymes in the stomach and small intestinedigest large proteinmolecules into smallmolecules called aminoacids. These small mol-ecules can be absorbedinto the blood and carriedto all parts of the body tobuild walls and otherparts of cells.

• Fats — Fat molecules are a rich source of energy forthe body. The first step in digestion of a fat such asbutter is to dissolve it into the watery content of theintestinal cavity. Bile acids act as natural detergents todissolve fat in water and allow enzymes to break fatdown into fatty acids and cholesterol. Bile acidscombine with fatty acids and cholesterol and helpmove newly formed molecules back into the cells ofthe mucosa. These converted molecules (called

Your Digestive System and How it Works

(Inside Tract, continued on Page 14)

6Colorectal cancer (cancer of

the colon or rectum) will causemore than 56,000 deaths in theUnited States this year. Colorectalcancer is the second leading causeof cancer-related deaths after lungcancer. If everyone aged 50 andolder had the recommendedscreening tests, one third of thedeaths from this type of cancercould be avoided.

RisksBoth men and women are at

risk for colorectal cancer, but 93percent of cases occur in people aged 50 or older. Certainrisk factors increase the chances of getting colorectalcancer. These include:• Diagnosis of inflammatory bowel disease, including

ulcerative colitis or Crohn’s disease; and• Personal or family history of colorectal cancer or

colorectal polyps.Also suspected of contributing to risk are:

• Lack of physical activity;• Low fruit and vegetable intake;• Low-fiber, high-fat diet;• Obesity;• Alcohol consumption; and• Tobacco use.

Early DetectionColorectal cancer almost always develops from

precancerous polyps in the colon or rectum. Symptomsare not always present, especially in the early stages,when the disease is more treatable. That’s why it’simportant for everyone 50 or older to have thescreening tests. A proactive course of action also

should include exercise, a healthydiet, limited alcohol intake and

no tobacco use.The American Cancer

Society, American MedicalAssociation and othermajor medical societies,and the U.S. Centers forDisease Control and Preven-

tion (CDC) agree that

colorectal cancer screeningis necessary to find andremove precancerous polypsand to find and treat early-stage cancers. These institu-tions also agree on therecommended type andfrequency of testing, butstatistics show that testingis far underused. Manypeople fear the tests, whichcan be uncomfortable butare usually not painful.Arkansans fall in the lower

tier in CDC statistics, with less than 39 percent of adultsaged 50 or older having recommended screening tests.

Screening TestsYour doctor will recommend one or a combination

of the screening tests for colorectal cancer. The cur-rently available tests and generally recommendedfrequency are:

• Fecal Occult Blood Test (FOBT) or Stool Test:Annually beginning at age 50

This is a noninvasive test. Your doctor gives youa test kit to take home. Stool samples you returnare checked for blood, which can be a symptom ofcancerous polyps.

• Flexible Sigmoidoscopy (Flex Sig): Every three tofive years beginning at age 50

Your doctor inserts a short, thin, flexible, lightedtube into your rectum. The doctor checks forpolyps,bleeding,inflamma-tion, abnor-mal growthsand ulcersin therectum andlower thirdof thecolon,which iscalled thesigmoidcolon.

Everyone 50 or older should have colon cancer screening

Everyone 50 or older should have colon cancer screening

7

Preparation for the test involves 12 to 24 hours offollowing a liquid diet and sometimes calls forlaxatives and an enema.

Colonoscopy: Every 10 years beginning at age 50 asrecommended by your physician

Your physician may recommend a colonoscopy as afollow-up test if any of the other screening tests areabnormal. This test allows the physician to use a longer,thin, flexible lighted tube to check for polyps, inflamedtissue, abnormal growths, ulcers, bleeding and musclespasms inside the rectum and the entire colon. Prepara-tion for the test takes one to three days to clean out thecolon through diet, laxatives and an enema. When youhave a colonoscopy, you usually are given pain medica-tion or a mild sedative to help you relax during theexam. If the physician finds anything unusual, he or shetakes a small sample to send to a lab for testing.

Double Contrast Barium Enema (DCBE): Every fiveto 10 years beginning at age 50 as recommended byyour physician

In this test, you are given an enema using barium,which makes it easy for the doctor to see the outline ofyour colon in a series of X-rays taken while you are indifferent positions. The doctor examines the X-rays forevidence of polyps or other abnormalities. Preparation

for this test involves a liquid diet for up to two daysbefore the test and sometimes laxatives and an enema.

SymptomsAlthough symptoms are not usually present in the

early stages of colorectal cancer, you should consult yourphysician immediately regardless of your age if you haveany of the following conditions:• Blood in or on your stool;• Unexplained and frequent pain, aches or cramps in

your stomach;• A change in bowel habits, such as having stools that

are narrower than usual; and• Unexplained weight loss.

Innovation in ScreeningResearchers at the Sidney Kimmel Comprehensive

Cancer Center at Johns Hopkins have developed anexperimental noninvasive colorectal cancer screeningtest. The test detects a mutated gene that is a marker ofcolon cancer in stool samples. The New England Journalof Medicine reported results of the first feasibility trials ofthe new test in the Jan. 31, 2002, issue. The trial detectedgene mutations in 61 percent of the early-stage colorectalcancer patients tested and returned no false positives.Innovations such as this test usually reach your doctor’soffice about five years later, after further research andclinical trials.

— Sources:1. U.S. Dept. of Health and Human Services, Centers for

Disease Control and Prevention, National Center forChronic Disease Prevention and Health Promotion,Division of Cancer Prevention and Control

2. National Institutes of Health, National Institute of Diabe-tes and Digestive and Kidney Diseases

3. American Medical Association Quality Care Alert,“Colorectal Cancer: Screening and Surveillance,”Oct. 19, 2001

4. Johns Hopkins Medical InstitutionsOffice of Communications andPublic Affairs, news releaseentitled “Stool Test for ColonCancer Reported byKimmel Cancer Center atJohns Hopkins,”Jan. 30, 2002

8More than 90 percent of U.S. health insurance plans

responding to a recent survey offer a wide variety of programs topromote regular physical activity, an essential component ofreversing some of the nation’s most troubling health trends. Thesurvey results were released recently as part of a study by theBlue Cross and Blue Shield Foundation on Health Care in col-laboration with Partnership for Prevention and the Centers forDisease Control and Prevention.

Responding to concerns addressed by U.S. Surgeon GeneralDavid Satcher, M.D., Ph.D., who named obesity-related illnessesas one of the major causes of death in the United States, thestudy is intended to establish a baseline for health plans’ effortsto promote physical activity among their members and in thecommunity.

“Health plans recognize the advantages of increased physicalactivity, but there has been a limited amount of objective dataavailable to increase the scope of the programs,” said ScottSerota, Blue Cross and Blue Shield Association (BCBSA) presi-dent and chief executive officer. “Blue Cross and Blue ShieldPlans already play an active role in promoting physical fitness byintegrating it into broader preventive and disease managementprograms. This study begins to provide the industry with abaseline to develop new programs.”

“From this study, it appears that health insurance plansrecognize the seriousness of this public health problem,” said Dr.Satcher, who addressed a roundtable meeting of health leadersrecently at the Washington offices of BCBSA, where the studywas released. “The insurance industry must continue to workcreatively and cooperatively with its members, others in thehealth care delivery system, communities, schools, employers,and the media if we are going to have a real impact on this

national public health priority.”Ninety-five percent of the responding health plans routinely provide healthy-lifestyle messages to members and half

of all health plans offer financial incentives for members such as discounted health club memberships and healtheducation classes.

Sixty health plans, or about one-fourth of all health plans in the U.S., responded to the survey,providing information on more than 373 initiatives that incorporate physical activity and exercise

in some way. Eighty-five percent sponsor fitness-oriented community events, such as racesand health fairs, 60 percent have various partnerships with community organizations, and17 percent of health plans provide grant support in the community to encourage fitnessactivities.

Nearly all health plan respondents, 92 percent, said they offer such programs toimprove health and increase member satisfaction. More than half said the reduction oflong-term health care costs was a goal.

SURVEY SHOWS

OBESITY-RELATED ILLNESSES ARE

TARGETS OF HEALTH PLAN PROGRAMS

SURVEY SHOWS

OBESITY-RELATED ILLNESSES ARE

TARGETS OF HEALTH PLAN PROGRAMS

9If you need to lose a few pounds because you would

rather partake of apple pie á la mode than an apple, youare not alone. Approximately 60 percent of Americansaged 20 and older are overweight.

Genetic, environmental, psychological and otherfactors all play a part in keeping Americans from tippingthe scales at their appropriate weight for their height andbody shape. Obesity tends to run in families, suggestinga genetic cause; but families also share lifestyle and diethabits. Americans also tend to eat high-fat foods and puttaste and convenience ahead of nutrition. They also tendto put physical activity on the back burner. Many peoplealso eat in response to negative emotions, such as

boredom, sadness or anger.Obesity is more than a

cosmetic problem; it isdangerous to yourhealth. Seriousillnesses that are

linked to obesityinclude diabe-tes, heartdisease, highblood pressure,

stroke and evencertain types of

cancer. Otherdiseases linked to

obesity include:gallbladder disease and gallstones, liver disease, osteoar-thritis, gout, pulmonary (breathing) problems, andreproductive problems in women. The more obese aperson is, the more likely the person is to develophealth problems.

Extra pounds can lead toextra problems

Get healthy by eating right1. Eat a variety of foods.2. Balance the food you eat with physical activity.3. Choose a diet with plenty of grain products,

vegetables and fruits.4. Choose a diet low in fat, saturated fat and cholesterol.5. Choose a diet moderate in sugars, salt and sodium.6. If you drink alcoholic beverages, do it in moderation.

The Food Guide Pyramid, which was developed bythe U.S. Department of Agriculture and supported by theDepartment of Health and Human Services, is a generalguide to help you choose a healthful diet that is right foryou. The Food Guide Pyramid recommends the followingdaily essentials: 6-11 servings of breads, cereals, rice andpasta; 3-5 servings of vegetables; 2-4 servings of fruits;2-3 servings of milk, yogurt, cheese; 2-3 servings ofmeat, poultry, fish, dry beans, eggs and nuts; and theuse of fats, oils and sweets sparingly.

Make the commitmentA weight loss of just 5 to 10 percent of your total

weight can do much to promote your overall health. Thebest way to lose weight is to make a lifelong commit-ment to your health — eat healthy, exercise and getplenty of sleep.

Extra pounds can lead toextra problems

Why is fiber importantto your digestive system?10 Why is fiber importantto your digestive system?

— Sources: American Dietetic Association and theNational Institutes of Health

Whether you call it roughage, bulk or bran, it all means fiber, and it is important toyour digestive health. Fiber is found in breads, fruit, cereals, vegetables and grains. It isthe part of the plant foods that cannot be digested by humans. So, if fiber can’t bedigested, why do you need it?

Everyone needs fiber because it helps keeps your bowels working regularly andhelps reduce your risk for diseases associated with the bowels (diverticulosis, constipa-tion, hemorrhoids and more). Some fiber may have a cholesterol-lowering effect andmay be helpful in controlling diabetes.

Fiber comes in two basic forms: soluble and insoluble fiber. Soluble fiber dissolvesin water and is found in fruits, vegetables, oat bran, barley and some beans. Insolublefiber retains water and is used by the body to soften and build up stool and can befound in vegetables, whole grains and wheat bran.

It is recommended that Americans eat 20-35 grams of fiber per day. Eating fiberkeeps your bowels working regularly. Increasing food fiber gives your brain more time torealize that your body is no longer hungry and helps prevent overeating. It is alsoimportant to eat a variety of fiber-rich foods; achieving balance in eating is a keyconcept. It is also important to drink six to eight glasses of fluid per day along with yourfiber intake.

Here are some examples of food with fiber and grams per serving (this will help youget started on creating a healthier you):

Food Serving Size Total Fiber Soluble fiber Insoluble fiber(grams) (grams) (grams)

Oatmeal 1 cup 4.45 1.64 2.81Apple (with skin) 1 medium 2.76 .28 2.48Banana 1 medium 1.94 .57 1.37Orange 1 medium 2.49 .79 1.70Grapes 20 1 .10 .90Green beans 1/2 cup 1.27 .34 .94Cabbage 1/2 cup 1.19 .07 1.12Potato (with skin) 1 medium 5.05 1.21 3.84Turnip greens 1/2 cup 2.05 .08 1.97Kidney beans 1/2 cup 6.66 1.41 5.25Green peas 1/2 cup 2.80 .24 2.56Pork and beans 1/2 cup 5.63 1.79 3.84White bread 1 slice .65 .15 .50Wheat bread 1 slice 2.59 .57 2.02Rice (cooked) 1/2 cup .41 .10 .31Spaghetti (cooked) 1 cup 2.10 .56 1.54

11Q. What is diverticulosis?A. Diverticulosis is tiny pouches or sacs that protrude

through weak points in the colon.

Q. How many Americans are affected by diverticulosis?A. Nearly 50 percent of all Americans between the ages

of 60 and 80 have it, and almost everyone over 80has diverticulosis.

Q. What causes diverticulosis?A. Medical experts believe the main cause of diverticular

disease is a low-fiber diet.

Q. How is a low-fiber diet related to diverticulardisease?

A. Diverticular disease is more common in industrializedcountries, such as the United States, England andAustralia, where low-fiber diets are common. Thiscondition is rare in places such as Asia and Africa,where the people eat high-fiber diets.

Q. What are the symptoms of diverticulosis?A. Generally, none. However, symptoms may include

mild cramps, bloating and constipation. You shouldvisit your doctor if you have these troublingsymptoms.

Q. Why should I be concerned about diverticulosis?A. Fifteen to 20 percent of people with diverticulosis will

develop diverticulitis.

Q. What is diverticulitis?A. Diverticulitis is inflammation of the pouches or sacs

that will sometimes develop into abscesses.

Q. What causes this inflammation?A. The cause is unknown, but medical experts believe it

is related to infection in the sac.

Q. What are the symptoms of diverticulitis?A. The most common sign is tenderness around the left

side of the lower abdomen. If infection is the cause ofthe pain — fever, nausea, vomiting, chills, crampingand constipation may occur as well.

Q. Can diverticulitis lead to other complications?A. Diverticulitis can lead to complications such as

infections, perforations ortears, blockages or bleeding.These complications alwaysrequire treatment to preventthem from progressing andcausing serious illness.

Q. What is the treatment for diverticulitis?A. For mild cases: oral antibiotics, rest and a liquid diet.

For more severe cases, hospitalization with IVantibiotics. Your doctor should make that decision.

Q. What happens if diverticulitis is nottreated?

A. The outcomes can be very similar toappendicitis because if the abscessruptures, then peritonitis can ensuewith major complications, includingdeath. For severe episodes, surgeryalso may be required.

Q. How do I prevent diverticulitis?A. It is recommended that you eat 25 to

30 grams of fiber each day and drink atleast 8 cups of fluid a day to avoidconstipation. In addition, manyphysicians have recommended avoiding foods withvery small seeds such as strawberries and tomatoes,or even very hard foods, such as nuts and popcorn,because of the belief that these particles could lodgein the sacs and cause inflammation. This point isbeing debated. The bottom line is to increase the fiberin the diet.

Q. How do I prevent diverticulosis in the first place?A. Increase the fiber in the diet and drink more fluids.

Q. Will diverticulosis ever go away?A. No. Once you have been diagnosed with it, it is yours

for life, but with proper preventative measures, thereis an excellent chance you never will have problemsfrom this.

Q. Is diverticulosis/diverticulitis associated withcolon cancer?

A. No, but the symptoms of these two may be similar.Always check with your doctor if youhave a prolonged unexplainedchange in bowel habits.

Q. Where may I get moreinformation about this?

A. Contact your physician.

— Source: National Institute ofDiabetes, Digestive and KidneyDiseases

Questions & Answers about diverticulosis and diverticulitis

Questions & Answers about diverticulosis and diverticulitis

12Bathroom humor aside, constipation is no laughing

matter. At some point or another, everyone gets consti-pated — even children. Constipation is simply this:bowel movements that are hard, dry and difficult to pass.

More likely than not, poor diet and lack of exerciseusually are the causes of constipation. In most cases, itis temporary and not serious. Understanding the causes,prevention and treatment will help almost everyonefind relief.

Remember, just because you don’t have a bowelmovement every day does not mean you are constipated.Normal may be three times a day or three times a week,depending on the person. Signs of constipation includedifficulty in having a bowel movement or feeling bloated,uncomfortable or sluggish.

What causes constipation?The most common causes of constipation are: not

enough fiber or fluids in the diet; lack of exercise; certainmedications; changes in life orroutine, such as pregnancy,older age and travel; irritablebowel syndrome; abuse oflaxatives; ignoring the urge tohave a bowel movement;specific diseases, such as lupusand multiple sclerosis; andproblems with the colon,rectum or intestinal function.

In most cases, constipationcan be treated through diet and

exercise (see article on Page 9 for more information onfiber). In some cases, constipation can lead to complica-tions and should be treated by a doctor. Complicationsinclude hemorrhoids and anal fissures (tears in tissue

around the anus).

Constipation in childrenAs with adults, it is important for children to drink

plenty of fluids, have fiber in their diet and get plenty ofexercise to avoid constipation. Children also may becomeconstipated because they ignore the “urge” when theyare playing, don’t want to use a public restroom, or lackconfidence if a parent is absent. Medications or diseasealso may cause constipation.

Symptoms of constipation in children include: nobowel movement for several days or daily bowel move-ments that are hard and dry; cramping; abdominal pain;nausea; vomiting; weight loss; or liquid or solid, clay-likestool in the child’s under clothes (an indication that stoolis backed up).

Usually, eating more fiber, drinking more fluids andgetting more exercise will alleviate the problem. How-ever, a child should see a physician if any of the follow-ing occur:1. Episodes of constipation lasting more than three

weeks.2. Child is unable to participate in normal activities.3. Small, painful tears around the anus.4. Hemorrhoids appear.5. Normal pushing is not enough to expel stool.6. Liquid or soft stool leaks out

of the anus.Although constipation

is a common healthproblem that almosteveryone experiences atsome point, you canhelp prevent it througha proper dietand exercise.

— Source: NationalDigestive DiseasesInformationClearinghouse

Constipation is no laughing matter

13Irritable bowel syndrome (IBS) is a common

disorder of the intestines that leads to cramping,gassiness, bloating, and changes in bowel habits,including constipation, diarrhea or both. Occasionally,the person with IBS has a crampy urge to move thebowels but cannot do so. For most people, IBS is just amild annoyance, but for some, it canbe disabling. Most people with IBS,however, are able to control theirsymptoms through medicationsprescribed by their physicians, diet,and stress management.

IBS sometimes has been referredto by other names — colitis, mucouscolitis, spastic colon, spastic bowel,and functional bowel disease;however, most of these terms aremisleading. Colitis, for example, is theinflammation of the large intestine(colon). IBS, on the other hand, doesnot cause inflammation and should not be confused withanother disorder, ulcerative colitis.

However, IBS does affect the colon, which is aboutsix feet long and connects the small intestine with therectum and anus. The colon’s major function is to absorbwater and salts from digestive products that enter fromthe small intestine and then help the remaining stoolmove through until a bowel movement occurs.

What causes IBS?Although it is a common disorder, the cause of IBS is

not known, and, to date, there is no cure. Experts havelabeled it as a functional disorder because there is nosign of disease when the colon is examined. IBS cancause a tremendous amount of discomfort and distress,but it does not cause permanent harm to the intestinesand does not lead to intestinal bleeding of the bowel orto a serious disease such as cancer.

It is thought that the cause of IBS may be rooted inemotional conflict or stress, because doctors have yet tofind an organic cause. Also, researchers have found thatthe colon muscle of a person with IBS begins to spasm

after only mild stimulation, which leads to theassumption that this person’s colon is more sensitive andreactive than usual, so it responds strongly to stimuli thatwould not bother most people.

Does a good diet help IBS?Relaxation and stress reduction techniques,

counseling and support can help relieve IBS symptoms insome people; and for others, eating a proper diet withplenty of dietary fiber may help. Whole-grain breads andcereals, beans, fruits, and vegetables are good sources offiber. High-fiber diets keep the colon mildly distended,which may help to prevent spasms from developing. Thiskind of diet also helps keep water in the stools, therebypreventing hard stools that are difficult to pass. Be awarethat high-fiber diets may cause gas and bloating, butwithin a few weeks, these symptoms often go away asyour body adjusts to the diet. Doctors generallyrecommend that you eat just enough fiber to producesoft, easily passed and painless bowel movements.

Can Medicines Relieve IBS Symptoms?Your doctor may prescribe fiber supplements or

occasional laxatives if you are constipated. Other optionsare prescribed drugs that control colon muscle spasms,drugs that slow the movement of food through thedigestive system, tranquilizers or antidepressantmedications, all of which may relieve symptoms.

— Source: National Institute of Diabetes and Digestiveand Kidney Diseases

Experts have

labeled it as a

functional

disorder

because there

is no sign of

disease when

the colon is

examined.

Irritable Bowel

SyndromeIrritable Bowel

Syndrome

When a good colon goes badWhen a good colon goes bad

14Ever felt as though

something strange wasbrewing in your tummy? Well,you’re not alone. Indigestion,sometimes called upsetstomach or dyspepsia, is acommon condition oftenaccompanied by nausea,abdominal bloating, belching,and sometimes vomiting.

While the painful orburning feeling in the upperabdomen might be caused bya disease or an ulcer in thedigestive tract, it most oftenresults from eating too much,eating too quickly, eatinghigh-fat foods or eating duringstressful situations.

Other factors contributingto indigestion are smoking,drinking too much alcohol,using medications that irritatethe stomach lining, and beingtired. Even having ongoingstress can cause indigestion ormake it worse.

So, how is indigestiondiagnosed? The doctor firstrules out other problems, like

ulcers. This process of diagnosismay include X-rays of thestomach and small intestine orendoscopy, in which the doctoruses an instrument to lookclosely at the inside of the patient’s stomach.

The most successful way to treat this particular typeof tummy trouble is by avoiding the foods and situationsthat seem to cause indigestion. If you’re a smoker,quitting smoking or at least not smoking right before ameal can ease your indigestion.

Believe it or not, your mother may have been right,exercising with a full stomach may cause indigestion, soscheduling exercise before a meal or at least an hourafterward might help. Everybody out of the pool!

To treat indigestion caused by a functional problemin the digestive tract, the doctor may prescribe medicinethat affects stomach movement.

Because indigestion can indicate or imitate a moreserious disease, you should see a doctor if you have:• Vomiting, weight loss or appetite loss;• Black tarry stools or blood in vomit;• Severe pain in the upper right abdomen;• Discomfort unrelated to eating; and• Indigestion accompanied by shortness of breath,

sweating, or pain radiating to the jaw, neck or arm.

— Source: National Institute of Diabetes and Digestiveand Kidney Diseases

lymphatics) or reformed fat are carried to the veins ofthe chest, and the blood carries the fat to storagedepots in different parts of the body.

• Vitamins — Another part of food that is absorbedfrom the small intestine is the class of chemicals calledvitamins. There are water soluble vitamins (all the Bvitamins and vitamin C) and fat-soluble vitamins(vitamins A, D, and K).

• Water and Salt — In a healthy adult, more than agallon of water containing an ounce of salt is absorbedfrom the intestine every 24 hours. Most of the materialabsorbed from the cavity of the small intestine is

water in which salt is dissolved. The salt andwater come from the food and liquid weswallow and the juices secreted by the manydigestive glands.

HormonesThe hormones that control digestion are

gastrin, secretin and cholecystokinin (CCK).These hormones are the digestive system’s ownregulators and are released into the blood of the digestivetract, travel back to the heart and through the arteriesand return to the digestive system, where they stimulatedigestive juices and cause organ movement.

(Inside Tract, continued from Page 5)

Bubble, bubble, toil and tummy troublesBubble, bubble, toil and tummy troublesBubble, bubble, toil and tummy troubles

15That cookie dough may taste good

going down, but is it worth the chancethat the eggs you used might contain

the harmful bacteria Salmonella? Youwon’t think so if abdominal cramps, nausea,

vomiting, diarrhea, fever, and dehydration are the resultof your weakness for cookie dough.

Harmful bacteria are the most common causes offoodborne illness. Bacteria may be present on food whenyou purchase items at the grocery store, so remember,raw foods are not sterile.

Chew on these facts.• Raw meat and poultry may become contaminated at

any point during the processing.• Seafood may become contaminated during harvest or

through processing.• One in 20,000 eggs may be contaminated with Salmo-

nella inside the eggshell.• Produce (lettuce, tomatoes, melons, etc.) can be

contaminated during growing, harvesting, processing,storing, shipping or final preparation.

• Food contamination can occur in a restaurant or inyour very own kitchen.

The good news is that most cases of food poisoningare mild and can be treated by increasing fluid intake.A doctor should be contacted if there are signs of shock(such as a weak or rapid pulse; shallow breathing; and/or chest pain); signs of severe dehydration (such as drymouth, dizziness, and/or low blood pressure); and/orconfusion or difficulty reasoning.

Here are some tips to help you avoid the discomfortof foodborne illnesses.1. Refrigerate food promptly. Set your refrigerator at

40 degrees Fahrenheit and lower your freezer tozero degrees Fahrenheit.

2. Cook food to the appropriate temperature to kill theharmful bacteria (145 degrees for roasts, steaks andchops of beef, veal and lamb; 160 degrees for pork,ground veal and ground beef; 165 degrees forground poultry; and 180 degrees forwhole poultry).

3. Prevent cross contamination. Keepfoods away from each other duringpreparation.

4. Handle food properly. Wash yourhands; clean surfaces.

5. Keep cold food cold and hot food hot.6. Maintain hot cooked food at 140 degrees or higher.7. Reheat cooked food to at least 165 degrees.8. Refrigerate or freeze perishables, prepared food and

leftovers within two hours.9. Do not defrost food on the kitchen counter; use cold

water, the microwave or the refrigerator.10. Do not marinate food at room temperature; always

use the refrigerator.11. Do not pack the refrigerator. Cool air must circulate

to keep food safe.

— Sources: U.S. Department of Agriculture and theNational Institute of Diabetes, Digestive and KidneyDiseases

NervesTwo types of nerves help to control the action of the

digestive system: extrinsic (outside) nerves and intrinsic(inside) nerves. Extrinsic nerves come to the digestiveorgans from the unconscious part of the brain and fromthe spinal cord and release chemicals called acetylcholineand adrenaline. Acetylcholine causes the muscle of thedigestive organs to squeeze and increases the push offood and juice through the digestive tract. It also causesthe stomach and pancreas to produce more digestivejuice. Adrenaline relaxes the muscle of the stomach andintestine and decreases the flow of blood to these organs.

Intrinsic nerves make up a very dense network embed-ded in the walls of the esophagus, stomach, smallintestine, and colon and are triggered to act when thewalls of the hollow organs are stretched by food. Intrin-sic nerves release different substances that speed up ordelay the movement of food and the production of juicesby the digestive organs.

— Sources: National Digestive Disease InformationClearinghouse/National Institutes of Health, theAmerican Medical Association, and the Crohn’s &Colitis Foundation of America, Inc.

(and other tips to avoid foodborne illnesses)(and other tips to avoid foodborne illnesses)

Don’t eatraw cookie dough!

Don’t eatraw cookie dough!

161. Spicy food, stress and depression can cause stomach ulcers.

True or False?

2. Smoking a cigarette is a sure way to relieve heartburn.

True or False?

3. “Regular” bowel movements means at least once a day.

True or False?

4. Using enemas regularly to relieve constipation is good for you.

True or False?

5. Diverticulosis is a rare and serious problem. True or False?

6. Roughage is another name for fiber. True or False?

7. Americans should eat between 20 and 35 grams of fiber per day.

True or False?

8. Approximately 25 percent of Americans are overweight.

True or False?

9. Obesity has been linked to cancer, gallstones and osteoarthritis.

True or False?

10. Almost everyone experiences constipation during his or her lifetime.

True or False?

11. You can get food poisoning from meats and vegetables.

True or False?

Answers.

1.False. Almost all stomach ulcers are caused by infection or use of pain

medications.

2.False. Cigarette smoking contributes to heartburn.

3.False. Bowel movements vary in normal, healthy people.

4.False. Enemas can impair the natural action of the intestines.

5.False. The majority of Americans older than 60 have diverticulosis.

6.True. Fiber also is called bulk and bran.

7.True. Fiber is good for your digestive system.

8.False. Approximately 60 percent of Americans are overweight.

9.True. Obesity is linked to many diseases.

10.True. It is a common health problem.

11.True. Harmful bacteria are found in many foods.

How much do you know about digestive health? Take our quiz and test your knowledge!How much do you know about digestive health? Take our quiz and test your knowledge!

D i g e s t i v e 17Crohn’s Disease

Crohn’s disease is aninflammatory bowel disease (IBD)and is a chronic illness requiringlong-term medical therapy. Crohn’sdisease causes inflammation in thesmall intestine and usually occurs inthe lower part of the small intestine(called the ileum), but it can affectany part of the digestive tract.

The inflammation of Crohn’sdisease extends deep into the liningof the affected organ, can cause painand can make the intestines emptyfrequently, resulting in diarrhea.Crohn’s can be difficult to diagnosebecause its symptoms are similar toother intestinal disorders such asirritable bowel syndrome and anothertype of IBD called ulcerative colitis.

Crohn’s disease affects men andwomen equally and seems to run insome families. In fact, about 20percent of people with Crohn’sdisease have a blood relative withsome form of IBD. The most commonsymptoms of Crohn’s disease areabdominal pain (often in the lowerright area) and diarrhea. In addition,rectal bleeding, weight loss and fevermay also occur. Sometimes bleedingmay be serious and persistent,leading to anemia. Children withCrohn’s disease may suffer delayeddevelopment and stunted growth.

Although there is no knowncause for Crohn’s disease, the mostpopular theory is that the body’simmune system reacts to a virus or abacterium by causing ongoinginflammation in the intestine. Athorough physical exam and a seriesof tests may be required to diagnoseCrohn’s disease, including bloodtests, stool sample tests, upper

gastrointestinal (GI) series,colonoscopy and/or X-rays of thedigestive tract.

Currently there is no cure forCrohn’s disease. Treatment for thedisease depends on the location andseverity of the disease, complicationsand response to previous treatment.Treatment may include medication,nutrition supplements, surgery or acombination of these options.

GERDGastroesophageal reflux disease

(better known as GERD) occurs whenthe lower esophageal sphincter (LES)does not close properly and thecontents in your stomach may splashback (or reflux) into the esophagus.When refluxed stomach acid touchesthe lining of the esophagus, it causesa burning feeling in the throat or thechest (heartburn) or the fluid may betasted in the back of your mouth(acid indigestion).

Most everyone (including infants,children and pregnant women)experiences heartburn occasionally. Ifheartburn occurs more than twice aweek, it may be considered GERD,which may lead to more seriousproblems. The main symptoms arepersistent heartburn and acidregurgitation. Others may experiencepain in the chest, hoarseness ortrouble swallowing. GERD also maycause a dry cough and bad breath.

In infants and children, GERDmay cause repeated vomiting,coughing and other respiratoryproblems. Most babies outgrow GERDby their first birthday. Simplestrategies such as burping the babyseveral times during feeding orkeeping the baby upright for

30 minutes after feeding may work toavoid reflux.

Medical experts cannot pinpointone particular reason why people getGERD, however there are things thatmay contribute to GERD:1. A hiatal hernia (when the upper

part of the stomach is above thediaphragm);

2. Alcohol use;3. Being overweight;4. Pregnancy;5. Smoking; and6. Foods such as citrus fruits,

chocolate, beverages with caffeine,fatty and fried foods, garlic andonions, mint flavorings, spicyfoods, and tomato-based foodssuch as chili.

If you suspect you have GERD,consult your physician. Yourphysician may recommend lifestylechanges such as quitting smoking,losing weight, eating small meals,avoiding alcohol, wearing loose-fitting clothing, avoiding lying downfor three hours after a meal, andraising the head of your bed six toeight inches. He also may recommendsome over-the-counter medicationsthat stop acid production or help themuscles empty the stomach.

— Sources: National DigestiveDiseases Information Clearinghouse/National Institutesof Health, andthe Crohn’s& ColitisFoundationofAmerica,Inc.

The Pharmacist is inDo you have any questions?

The Pharmacist is inDo you have any questions?

Arkansas Blue Cross and BlueShield continually investigates newopportunities for “wellness” discountswith health clubs, fitness centers andmore — specifically for our members.

The Upper Room Yoga inRussellville, Russellville Yoga Center, Bryant FitnessZone, The Gym & Café in Little Rock, and Lady ofAmerica Fitness Club in Little Rock are the newest fitnesscenters in Arkansas to offer discounts to our members.

More member discounts for you!If you are curious about whether your favorite fitness

spot offers a discount, visit the Arkansas Blue Cross Website at www.ArkansasBlueCross.com for a complete listof participating fitness vendors. If you don’t see yourwork-out site on the list but would like Arkansas BlueCross to contact it about offering a discount to ourmembers, just send the name and location of your fitnesscenter to BNY-Ed@arkbluecross.com, and we’ll take itfrom there.

“The Pharmacist is in” is featured on a regular basisin Blue & You. The Arkansas Blue Cross and Blue Shieldpharmacy director answers questions submitted bymembers and employers.

Q: What can be done about the high cost ofmedications used for indigestion and gastritis? IfPrilosec® and Nexium® cost almost $150 for onemonth’s supply, how can I lower this expense?A: Indigestion and gastritis both present a burning,painful sensation in the throat or esophagus, usuallycaused by a reflux of acid from the stomach into thelower part of the esophagus. This may result fromvarious causes (see article on Page 14), and yourphysician should determine the origin of the problem ifthis is a chronic condition.

Fortunately, there have been many drug discoveriesthat make our lives more comfortable and enjoyable, andsome people believe that medications are always theanswer to problems related to our health. As a health-conscious society, we are becoming more attuned tofixing problems with medications rather than throughpreventive measures. However, due to the steeply risingcosts of drugs, and for our own good health, we mustreadjust our thinking to try to reduce the cause orseverity of gastric problems where possible, rather thantaking stronger prescription medications.

The secretion of acid from cells in the lining of thestomach is necessary to establish a condition whereenzymes work best to begin the breakdown or digestiveprocess. A little acid is helpful in aiding digestion, but alot of acid may cause some pain. Before turning toexpensive acid reducers, or even in addition to the use of

prescriptionmedication, we mustalso do our part tomaintain our health.

Consider the following for a healthier digestivesystem:

• Eat more frequent but smaller meals during the dayrather than one or two;

• Lean toward bland foods and drinks;• Avoid highly seasoned food or food that is known to

cause indigestion;• Avoid overeating;• Drink adequate amounts of water and fluids;• Eat your evening meal as early as possible; and• Raise the head of your bed six to eight inches if you

have a hiatal hernia.

These are simple disciplines, but they require somerestraint. Expense is secondary to proper care of ourbody, but it may take an effect on our pocketbook torefocus our attention on taking better care of ourselves.Remember, “an ounce of prevention is worth a poundof cure.”

Arkansas Blue Cross is dedicated to working closelywith our members to help them understand more aboutwhat is transpiring in the area of pharmacy and whyparticular things are happening with medications. If youhave a question about medications or drug coveragepolicies, please submit your question via e-mail to BNY-Ed@arkbluecross.com. Questions submitted bycustomers will be answered in this column in futureissues of Blue & You as space permits.

Health Advantage ID CardIf you are a Health Advantage

member and have received a newHealth Advantage identification (ID) card, please reviewthe card and verify that the correct information appearson your card. Please ask your physician and any facilityyou receive services from, to make a copy of your card.The provider should file your claim exactly as theinformation appears on the card. Incorrect informationon your claim form will cause the claim to be rejected bythe system, and then it will not be processed.

If you received ID cards for only certain members ofyour family and believe other cards should have beenissued, please call Customer Service at (501) 227-3133 or1-800-843-1329 so they can verify the person’s eligibilityand re-issue the card, if appropriate. If you wait and callfrom the provider’s office during an appointment (andinformation has not been received from the employer orthere is a problem), the customer service representativemay not be able to verify the benefits to the provider,and the provider may ask you to pay for the servicesreceived that day.

OB CareIf you currently are receiving care from an obstetri-

cian and have had a plan change in the middle of yourcare, please note that your benefits may have changed.Please make sure your OB/GYN is aware of the benefitchange. If you have questions regarding your benefits,please call Customer Service at (501) 227-3133 or1-800-843-1329.

Incorrect billsIf you receive a bill from a provider and believe it is

incorrect, please contact the provider for the followinginformation before calling Health Advantage:

• Individual physician’s name if the statement is from aclinic;

• Date of service for each procedure;• Individual amount for each procedure billed; and• Referral number if applicable.

After you know the details of the statement, pleasecall the Customer Service Department with any ques-tions. Without the detailed information, the customerservice representative may not be able to appropriatelyassist you.

Referral informationHealth Advantage does not issue

referrals to participating providers. Yourprimary care provider (PCP) has a script referral pad andwill issue the referral. If you or the specialist needs toknow the referral number, contact the PCP. HealthAdvantage encourages members to take a copy of thereferral to the specialist’s office or have your PCP mail orfax a copy to them prior to the visit. Referrals to non-participating providers for the in-network benefit levelmust be requested by your PCP in advance for approvalby Health Advantage. If not prior approved, the servicemay be ineligible, or if you have a Point-of-Serviceproduct, it will be paid at the lower out-of-networkbenefit level.

Dependent living out-of-state?If you have a dependent living or attending school

outside of Arkansas, contact Customer Service at (501)227-3133 or 1-800-843-1329 and ask about an Away FromHome Care Guest Membership. These memberships areavailable in most states and could provide savings to you.

Oral contraceptive list updatedSince 1996, Health Advantage has offered a preferred

list of oral contraceptives for members. Recently, the listof covered oral contraceptives has been updated and,beginning May 1, 2002, the following will be the pre-ferred list of covered oral contraceptives:Ortho-CyclenOrtho-Tri-cyclenOrtho-CeptOrtho-Novum 7-7-7Ortho-Novum 1/35Ortho-Novum 1/50Ortho-Novum 10/11Modicon

If you are a Health Advantage member currentlytaking oral contraceptives, you will need to consult withyour physician to change to one of the preferred oralcontraceptives mentioned or self-pay for oral contracep-tives not on the preferred list. If generic forms of theabove-mentioned oral contraceptives are available, thegeneric will be covered. No other contraceptives will becovered. If you currently are taking an oral contraceptive,you will be notified of this change again through apersonal letter from Health Advantage.

MicronorOrtho-Evra patchLoestrinLoestrin FeEstrostepTri-NorinylYasmin

19Health Advantage

members —

take note!

“Don’t Start” Gets Started

20At Arkansas Blue Cross and Blue Shield, we

continually work to find ways to save our membersmoney, and one of those ways is through our DiscountWellness Program.

Through this program, members of Arkansas BlueCross, Health Advantage and USAble Administrators cansave money in retail outlets, fitness centers, health clubsand more. For more information about the discountsavailable, log on to one of our Web sites atwww.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com or www.USAbleAdminArkansas.com.

Expecting a baby or needing to childproof your home?One of our newest discount programs is with Safe

Beginnings — a company committed to keeping familiessafe and making parenting more enjoyable with a largeselection of well-designed, durable, childproofingproducts, popular baby care accessories and home safetyitems. Members may access Safe Beginnings through theArkansas Blue Cross and affiliated companies Web sites,and receive a 20 percent discount automatically (you

don’t need a code and the discount shows up on thescreen so you can see exactly how much money you aresaving). You will find Safe Beginnings in a new section ofthe wellness discounts listings, “Statewide and InternetDiscounts.”

No Internet access? No problem! Members maysimply call Safe Beginnings toll-free at 1-800-598-8911(Monday-Friday, 8 a.m. – 9 p.m. EST and Saturday,9 a.m. – 3 p.m. EST) to place an order or request acatalog. Every time a member orders an item from SafeBeginnings, the member will receive a 20 percentdiscount. Just use the special discount code, BCAR, toreceive your discount.

To access Safe Beginnings directly, members can findit on-line at www.safebeginnings.com. However, thediscount does not show up automatically as it will whenmembers enter the Web site through the links on theArkansas Blue Cross, Health Advantage and USAbleAdministrators Web sites, so remember to enter the code,BCAR, to receive your discount.

ON-LINE DISCOUNTS & YOU

Arkansas Blue Cross and Blue Shield is againjoining the American Lung Association and the ArkansasDepartment of Education to encourage kids to not startsmoking. Media partners UPN Channel 38 and FOXChannel 16 will be helping spread the word. In March,BlueAnn Ewe will help launch the new “Don’t Start”Smoking Storyboard Contest, which will give kids inkindergarten through fifth-grade an opportunity to writea story about why it’s important to never begin smoking.

“Don’t Start” Smoking Storyboard Contest sheets willbe available beginning March 18 and are free to kids inthis age category. Then kids will have until April 26 to“draw their way” to some great prizes and an opportu-nity to have their story transformed into a real televisionpublic service announcement (PSA) to be broadcast inArkansas during the summer and fall of 2002 on FOX16and UPN38 television.

The object of the program is to get kids thinkingabout why they should not use tobacco products andwhat they can do because they aren’t sick from smoking.Kids simply use storyboard sheets to write a story anddraw pictures depicting their story. They can draw

animals, people, cartoon characters or anything theircreative minds can think of to tell their story.

A panel of judges will select three finalists in eachgrade level. From those 18 finalists, judges will select anoverall winner, who will receive a $100 savings bond inaddition to having his/her story turned into a PSA. Allfinalists will receive fun prizes.

Storyboard Contest sheets will be mailed to elemen-tary schools throughout Arkansas. In addition,Storyboard Contest sheets can be picked up at anyArkansas Blue Cross location statewide, at the AmericanLung Association and at Clear Channel Communicationsin Little Rock, or may be requested directly by complet-ing and returning the Business Reply Card found insidethis issue of Blue & You.

Parents may request individual contest sheets fortheir children, or teachers may request enough sheets fortheir entire class. The contest is open to public schools,private schools and homeschoolers.

Request a “Don’t Start” Smoking Storyboard Contestsheet today and have your kids draw a healthy message... as well as a good breath ... for life.

“Don’t Start” Gets Started

21Readership survey

Thanks to plenty of health-and-wellness and healthinsurance information, Blue & You readers told ArkansasBlue Cross and Shield loud and clear that Blue & You issomething they appreciate and find helpful. The Winter2001 issue had a readership survey (an annual process)enclosed for members to return with comments, andcustomers gave Blue & You an average rating of 4.4 on afive-point scale (with five being the highest rating). The3,339 survey respondents gave Blue & You a meansatisfaction rate of 4.62 in the category of Design; a 4.71in the category of Easy to Read; a 4.54 in the category ofContent; and a 4.44 in the category of Value to You.

Internet SurveyA total of 2,363 members responded to the 2001

Internet Survey mailed with the Autumn 2001 issue ofBlue & You.

“We were pleased that the number of responses wasmore than adequate for a valid sample to aid us inplanning for our sites,” said Patrick O’Sullivan, vicepresident of advertising and communications for Arkan-sas Blue Cross.

Members indicated that the top three Web featuresthey would most like to see on their health plan sites are:

• Check claims status;• Review my benefits; and• View health and wellness information.

A substantial number of members (41 percent) whoresponded said that they do not have Internet access. Ofthose members indicating that they have access, 29percent said that they were aware of the Web sites, while58 percent said they were not. Of those who indicatedthey had visited the Web sites, roughly 88 percentthought the Web sites were valuable.

Survey results and comments will be used forimproving current content and planning for additionalcustomer self-service features for the Web sites ofArkansas Blue Cross, Health Advantage and USAbleAdministrators.

Gift certificate winners!From the Blue & You satisfaction survey, we ran-

domly selected three winners who each received a $50gift certificate to Wal-Mart. The winners were SonyaMcCaslin of Greenwood, Lena Evans of Bentonville andDorothy Parker of Pine Bluff.

From the Web site satisfaction survey respondents,we also randomly selected three winners who eachreceived a $50 gift certificate to Best Buy. The winnerswere Linda Henry of Pine Bluff, A.W. Waldo Jr. ofNorth Little Rock and Sheila Williams of Malvern.

Arkansas Blue Cross and Blue Shield entered intoan agreement, effective April 1, 2001, with Health DataManagement (HDM) Corporation to begin electronicallysubmitting our members’ Medicare Part A and B supple-mental claims. These claims will be submitted fromMedicare Fiscal Intermediaries/Carriers throughout theUnited States directly to Arkansas Blue Cross. (HDM isa national clearinghouse for Medicare Part A andB claims.)

This agreement will allow HDM to electronicallysubmit Medicare Part A and B supplemental claims fromproviders nationwide. This means that Providers fromstates other than Arkansas no longer have to submitpaper claims to Arkansas Blue Cross. They only need tocomplete the “other insurance” information on theirclaims submitted to Medicare, which includes the

Arkansas Blue Cross member’s identification number,and the claims will be electronically submitted to Arkan-sas Blue Cross.

Arkansas Blue Cross remains committed to continu-ally finding more efficient ways to serve our customers,such as our new electronic claims process. If you haveany questions, please call Customer Service at(501) 378-2010 or 1-800-238-8379.

Medi-Pak and Retiree InformationMedi-Pak and Retiree Information

Blue & You surveys showmembers pleased withmagazine, Internet

Blue & You surveys showmembers pleased withmagazine, Internet

Member rights and responsibilities22A member has a right to:

1. Information about Health Advantage, its services andproviders, and members’ rights and responsibilities.

2. Access to a Plan physician.3. An Explanation of Benefits (EOB) as applicable.4. Be treated with respect and recognition of their

dignity and right to privacy.5. Confidential treatment of medical information.6. Participate with practitioners in decision-making

regarding their health care.7. A candid discussion of appropriate or medically

necessary treatment options for their conditions,regardless of cost or benefit coverage.

8. Change primary care physicians.9. Voice complaints or appeals about Health Advantage

or the care provided.10. Provide, to the extent possible, information that

Health Advantage and its practitioners and providersneed in order to care for them.

11. Decide, for Point-of-Service plans, whether to accessplan providers or out-of-network providers.

A member has the responsibility to:

1. Become familiar with their Evidence of Coverage(policy) and the requirements and procedures ofHealth Advantage.

2. Present member ID card to the health care providerwhen seeking care.

3. Select a primary care physician.4. Maintain health levels by living a healthy lifestyle

(for example, stopping smoking).5. Coordinate all health care through the primary care

physician.6. Provide information to health care providers to assist

them in the care needed to achieve healthy outcomes.7. Follow all instructions given by health care providers

to achieve maximum benefits of the care.8. Meet all co-payment, deductibles and co-insurance

obligations and any billed charges in excess ofallowable charges.

9. Notify Health Advantage of any status change.10. Communicate any complaint or grievance immedi-

ately to Health Advantage.11. Ensure all claims for services provided by non-Plan

providers are filed within 60 days.

Member rights and responsibilities

BAPTIST HEALTH will be sponsoring its annualMaternity & Baby Fair on Saturday, April 27, 2002, from10 a.m. until 3 p.m. in the J.A. Gilbreath ConferenceCenter at BAPTIST HEALTH, located at 9601 Interstate630, Exit 7, in Little Rock.

The free event will feature numerous exhibit boothswhere parents and parents-to-be may find helpfulinformation or purchase baby supplies. Scheduledexhibitors include Coleman Dairy, MyKidsClothes.com,Gary Alan Strain Photography, Trademarks, StorkSisters, Junior League, Creative Memories andmany more. Besides the booths, there will be doorprizes, free food (popcorn, Pepsi products, pickles,ice cream, and cotton candy) and aspecial area just for the kids. As partof the fun, there will be stageshows for all to enjoy, featuringthe River City Cheer All-Stars,the Magic of Derrick Rose andMelissa’s School of Dance.

Annual Maternity & Baby Fair Sponsored by BAPTIST HEALTH

Free immunizations will be offered throughout theday. Parents simply need to bring individual immuniza-tion records for each child to be immunized. Also, from10 a.m. until 1 p.m., there will be car seat safety checksat the Hickingbotham Outpatient Center, located behindthe hospital. Additionally, special informational sessionswill be held throughout the day to help parents copewith having a new baby in their lives. Scheduled ses-sions and speakers are:

The BAPTIST HEALTH Annual Maternity & Baby Fairis sponsored by BAPTIST HEALTH Women’s & Children’sServices, Alice 107.7, B98.5 and Today’s THV, Channel 11.For more information, please call BAPTIST HEALTHHealthLine at B-A-P-T-I-S-T (227-8478) or1-888-B-A-P-T-I-S-T, or visit their Web site atwww.baptist-health.com.

10-10:45 a.m. The Labor & Delivery Experience Certified Childbirth Educators11-11:45 a.m. Breastfeeding Sharon Houston, RNC, IBCLC1-1:45 p.m. Infant & Child Development Susan Averitt, M.D.2-2:45 p.m. Baby Slings: How to “Tie One On” Jessica Donahue, RN, IBCLC

23Arkansas Blue Cross and Blue Shield strives to be a

good corporate citizen. Our employees raise money andspend many hours helping those causes near and dear tothe hearts of Arkansans.

Pinnacle Mountain RendezvousGolden leaves and teepees were the backdrop for the

annual Pinnacle Mountain State Park Rendezvous inOctober. Thousands of people attended the weekendevent to learn a little about American heritage and takepart in fun activities including a settler’s reenactment,Indian dances and native crafts. Again last year,BlueAnn Ewe took a stroll down the midway to meetand greet hundreds of kids enjoying the festivities.BlueAnn greeted kids and distributed stickers and hercoloring book.

East End FallFestBatman on the right. Super Woman on the left.

BlueAnn in the middle ... of hundreds of costume-cladkids that is ... at the East End Elementary School FallFestin October. Hundreds of residents from the East Endcommunity in Pulaski County got a chance to try outtheir Halloween costumes early and enjoy lots of gamesand activities at the school cafeteria and gym. BlueAnnwas surrounded by princesses and Power Rangers, geniesand gypsies, super heroes and local heroes, clowns andcowboys, ghosts and goblins. It was a fun day to play ...and learn a little about health and safety too!

Northeast Fall FestivalThe Craighead County Fairground was the place to

be in November for the Ridgefield Christian Schoolannual Fall Festivalfund-raiser. Childrenand families enjoyedgames, food, autumnactivities and a silentauction. BlueAnn Ewelent a helping hoof toraise money for scholar-ships and to purchaseequipment for thechemistry and com-puter labs.

Blue basketballThe Arkansas Blue Cross Southeast Regional Office

in Pine Bluff recently sponsored a youth basketball team(fifth and sixthgrade boys)through theSeabrook YMCA inPine Bluff.Michael Mozeak,financial riskmanager for theregion, served asvolunteer headcoach for theteam. CoachMozeak said thatcoaching is a very rewarding experience and encouragesothers to get involved with young people.

BlueAnn makes new buddies.

BlueAnn Ewe made a visit to cheer onthe youth basketball team during theirleague tournament.

Arkansas Blue Cross and Blue Shield’s SouthwestRegional Office recently moved to a new locationin Texarkana.

Since the ice storm of 2001 damaged the previouslocation on Arkansas Boulevard, the Southwest RegionalOffice staff has operated from a temporary location. Thenew office now is located on the Fourth Floor of theRegions Bank Building in downtown Texarkana.

The mailing address will remain P.O. Box 2018,Texarkana, Ark., 75504-2018. The telephone and faxnumbers will stay the same: (870) 773-2584 or toll-free1-800-470-9621; fax number, (870) 779-9138.

The Southwest Region consists of 11 counties:Calhoun, Columbia, Hempstead, Howard, Lafayette,Little River, Miller, Nevada, Ouachita, Sevier, and Union.

“We appreciate the trust and confidence our cus-tomers have placed in Arkansas Blue Cross and thepatience they have shown as we operated in our tempo-rary facilities,” said Jason Mann, regional executive.“We are pleased to have secured new office space to putus back in a permanent home in southwest Arkansasand look forward to serving the health insurance needsof our customers for many years to come.”

Southwest Regional Officemoves to new location in Texarkana

www.ArkansasBlueCross.com&

www.HealthAdvantage-hmo.com&

www.USAbleAdminArkansas.com

Arkansas Blue Cross and Blue ShieldP.O. Box 2181Little Rock, AR 72203-2181

USAbleAdminArkansas.com goes liveUSAbleAdminArkansas.com, the Web site for USAble

Administrators customers who have health plans thatinclude products branded with the Blue Cross and BlueShield, made its Internet debut Jan. 31. A second site,USAbleAdmin.com, which serves customers who do nothave Blue-branded products, went live Feb. 20.

Operated by a wholly owned subsidiary of ArkansasBlue Cross and Blue Shield, USAble Administratorsserves more than 120,000 employees and their familymembers. USAble Administrators processes claims andmanages enrollment and benefits for self-funded groups.

The USAble Administrators sites are similar in designand navigation to ArkansasBlueCross.com andHealthAdvantage-hmo.com. Members, employers, provid-ers and guests have customized portals with entrybuttons on the home page.

Features for MembersA major feature of the USAble Administrators site is

the “Benefits” section under “Customer Service.” Mem-bers may type in their ID number to obtain a summary oftheir health plan benefits.

Additional features of interest to members andaccessible from their portal page include:• Frequently Asked Questions (FAQ), answers to

common questions about USAble Administratorsproducts and services;

• How To File a Claim, a description of how to file aclaim for health care services;

• Referral Process for PCN, how to use the referralprocess to lower out-of-pocket costs in a primary carenetwork (PCN) if your health plan offers the PrimaryCare Network program;

• Understanding Your EOB, help in interpreting theExplanation of Benefits (EOB), a statement mailed tothe member after a claim is processed;

• Glossary of health insurance terms; and• Wellness Discounts, a list of health clubs and fitness

equipment companies and other vendors that offerdiscounts to members.

Features for EmployersA “Products and Services” section explains options

employers may include in their health plans administered

by USAble Administrators, including:• Arkansas’ FirstSource PPO• USAble PCN• BlueCard®

• Blue & Youth Health Program• Case Management• Coordination of Benefits (COB)

Company InformationCompany information is located in sections called

“About Us” and “Contact Us.” The “Contact Us” sectioncontains a regional office map and directory.

Customized Provider DirectoriesOne section of the site that is not available now will

go live by April 1. The “Provider Directories” will featuredirectories customized to match the member’s ID num-ber. When a member enters the member number fromthe USAble Administrators ID card, he or she will see apage that lists all the networks accessible through thatmember’s health plan. The menu of networks will beordered from the highest benefit level to the lowest.

Navigation HelpOther areas of the new site that should be helpful to

members and other site visitors are “Search” and “SiteMap.” The “Search” section allows keyword searches ofthe site (excluding databases), and the “Site Map” giveslinks to all sections of the site.

• Excess Loss• Hospital Bill Audits• Managed Pharmacy• Subrogation• Utilization Management

When health insurance pays for your medical care, youtend to think that “someone else” is paying for it. But it’s yourmoney. When you, your family and your co-workers use moreand more medical services, you pay for it in higher insurancepremium costs, and through higher co-payments anddeductibles. Unfortunately, the total cost of health care —how much it really costs — is often invisible to individuals,because they usually think only about the portion they paywhen they go to the doctor or hospital.

Whether you buy your own health insurance or are coveredthrough a group health plan provided by your employer, youshould be concerned about the rising cost of health care. Ascosts go up, employers have few options. Companies can eitherreduce wages for their employees, reduce company profits, passalong the cost to their customers, ask their employees to pay alarger share of the insurance cost, cut benefits or discontinueproviding health insurance to employees altogether.

Everyone can play a part in helping to hold down healthcare costs. Here are some things you can do:

Take Care of Yourself• The most effective way of keeping medical problems and

health care costs under control is to develop a healthylifestyle, with lifelong habits that keep you healthy. A

recent study suggests that the average adult could add four-to-seven years to his or her life expectancy by adopting ahealthier lifestyle.

• Exercise regularly.• Eat a balanced diet that is low in fat and

high in fiber.• Observe and teach all family members good

dental hygiene.• Maintain a healthy weight.• Stay mentally active and involved with self,

family and community.• Keep a sense of humor about life.• Get adequate sleep.• Keep stress to a minimum.• Limit the amount of alcohol you drink.• Wear a seat belt.• Never drink and drive.• Eliminate unsafe conditions at home and work.• Keep guns locked up.• Install smoke detectors and fire extinguishers.• Wear a sunscreen.• If you smoke, stop. You’ll reduce heart, lung and circulatory

problems.• If you won’t stop smoking for your sake — try to stop for

others. Exposure to cigarette smoke in the householdincreases your child’s likelihood of developing asthma,pneumonia, ear infections, sudden death syndrome,meningitis and learning problems.

Practice Prevention• Ask your physician to recommend a medical guide you can

use to recognize early signs, symptoms and remedies forroutine illness.

• Use self-care health remedies wheneverpossible. You can reduce the cost ofhealth care for yourself and others bysolving health problems at home whenappropriate. Eight out of 10 healthproblems can be treated at home.

• Learn the early warning signs of potential health problemsand consult a physician when needed. If you have apersistent problem, get it taken care of as soon as possible.

• Get regular checkups and physical exams.• Visit a dentist regularly for checkups.• Check public health centers in your area. They usually give

immunizations free of charge or for very little cost. Sharethe results with your physician.

• Schedule the health screening tests recommended for yourage, sex and risk group. It’s important that you keep up todate with blood pressure and cholesterol screenings, Papsmears and mammograms.

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Know Your Benefits• Read and understand what’s covered by your health

insurance policy.• For maximum cost savings, use participating or in-network

providers for your medical care. Choose your doctors orhospital from your health plan’s provider directory (avail-able on-line or in a printed form).

• If you are covered by an HMO, coordinate your carethrough your chosen Primary Care Physician (PCP). Obtainreferrals to specialists through your PCP.

• To save money on your prescriptionmedications, become familiar withyour health plan’s drug formulary. Itlists generic drugs, preferred brand-name drugs, non-preferred drugs andnon-covered drugs.

• For more information about your covered benefits, drugformulary and provider directories, call your health plan’sCustomer Service area or visit our Web sites(www.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com, www.USAbleAdminArkansas.com).

• If you develop a medical condition that requires extensivemedical treatment, contact one of our registered nurse casemanagers at the Arkansas Blue Cross office nearest yourhome to see if you qualify for case management services.

• Don’t encourage the state legislature to pass insurancemandates. When insurance companies are required to coveradditional treatments and services, costs go up for everyone.Consider what level of care should be mandated by the stateand whether you can afford it.

Take an Active Role in Your Care• Choose a family doctor. Coordinating your care through a

family doctor has been shown to improve individual health.• Be prepared before you see a specialist. Specialists have in-

depth training and experience in particular areas ofmedicine and can give you the care and information youneed for a major medical problem in their specialty area.Specialty care is usually more expensive.You can help get the most out of specialtycare through good communication andpreparation.

• Before you see a specialist, understandwhat your primary doctor’s diagnosis isand what your primary doctor wants thespecialist to do. Bring any X-rays or testresults with you when you visit thespecialist. Ask about your options fortreatment, keep your regular doctor involved and have testresults sent to both you and your PCP.

• Take an active role in health caredecision-making. Take the time to builda good relationship with your doctor.Making sure that your doctor under-stands your expectations and needs canresult in a more effective treatment plan.

• Ask your doctor about every prescribedmedication and medical test. Also askwhat will happen if you choose not totake a drug or have a test. Each test anddrug has some risk involved. Your doctor may be able tosuggest an alternative that is less risky.

• You have the right to be involved in your care and treat-ment. Have questions ready ahead of time to ask yourdoctor, insurance representative and hospital:¤ What do my symptoms mean?¤ What tests do I need, and why do I need them?¤ What risks are involved if I have surgery?¤ How long does the surgery take, and how long do I

need to stay in the hospital?¤ How much of the cost will my insurance cover?¤ Which items and services are included in the hospital

charges?¤ What kind of recovery may I expect?¤ How soon can I return to my normal activities?

• Avoid unnecessary medical tests. In certain situations thecost and risk of medical tests can outweigh the benefits.Sometimes tests are given simply as standard procedure.You do not have to take any test. Before consenting to atest, ask:¤ What is this test for?¤ How will it help me get better?¤ How much will the test cost?¤ Could it be done for less somewhere else?¤ Is there a less costly test that could provide the same

information?• Avoid unnecessary treatment. Your doctor’s decisions about

your care can account for as much as three-quarters of yourmedical bills. You can save time and money by seeking thebest treatment for your needs. You can be more confident ofyour treatment and reduce unforeseen costs if you choose agood insurance plan, use preferred providers, and getsecond opinions. Find out your options by asking questionssuch as:¤ Is a surgery or medication necessary? Why?¤ Can my tests or surgery be done somewhere else

besides the hospital?¤ Does my health insurance plan cover services outside of

the hospital setting?¤ What other treatments are available?

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¤ Can I make any changes, such as diet and exercise, thatmight help my condition?

• Avoid hospitalization whenever possible. Over half of allhealth care costs are for inpatient and outpatient hospital-izations. Consider outpatient services or same day surgery.Find out if there are alternatives to surgery.

• Learn as much as you can about your medical needs. Byconducting your own medicalresearch, you may discover moreoptions and be better prepared todecide which course of action isbest for you. You can start yourresearch by asking your doctor forinformation or calling the hospital’smedical library or using medicalresources (such as Web sites)recommended by your physician orother health care professional. Steerclear of health Web sites not endorsed by a national healthresearcher such as the Centers for Disease Control or theNational Institutes of Health.

• If it’s safe, wait. Sometimes physicians are afraid patientswill think they’re not doing their best if they don’t takeaction right away. But, in many situations the old standby“take two aspirin and call me in the morning” is validadvice. On the other hand, waiting until a mild conditionbecomes serious can be both unpleasant and costly. Letyour doctor know you’re willing to wait if that’s appropri-ate. He or she may consider it helpful to know you’rewilling to let time and nature take their course, but only ifit’s safe to do so.

Use the Emergency Room (ER) Only for Emergencies• An emergency medical condition is one of recent onset and

severity, including severe pain, that would lead a prudentlayperson, acting reasonably and possessing an averageknowledge of health and medicine, to believe that theabsence of immediate medical attention could reasonablybe expected to result in one of the following:¤ Placing the health of the individual — or with respect

to a pregnant woman, the health of the woman or herunborn child — in serious jeopardy.

¤ Serious impairment to bodily function.¤ Serious dysfunction of any bodily organ or part.

• Emergencies often include the following:¤ Severe bleeding that does not stop after 15 minutes of

direct pressure.¤ Sudden severe pain and swelling in a joint.¤ Blacking out (fainting).¤ Swallowing poison.¤ Choking.

¤ A gaping wound (the edges don’t come together).¤ A broken bone.¤ Suddenly not being able to speak or move.¤ Chest pain, especially if associated with sweating,

shortness of breath, spreading pain, nausea (feelingsick to your stomach), vomiting (throwing up), dizzi-ness or a fast or irregular heartbeat.

• More than half of all ER visits are for minor, non-urgentproblems. These visits can be two to three times moreexpensive than a visit to the doctor’s office. If you get sickand believe that it is something that will not go away on itsown, try first to see your doctor rather than going to theER. Call your doctor as early in the day as possible so youcan be seen as soon as possible.

• Tell your doctor’s nurse about your symptoms and ask herto speak to the doctor regarding the need for immediatemedical care. Many emergency symptoms may be relievedwith self-care if the individual is able to share pertinentinformation with your physician’s medical staff. If yoursymptoms are unresolved, your physician can provide youwith the best directions for receiving the appropriate levelof care at the appropriate time. Your physician arranges foranother physician to care for you when your doctor is outof the office. In the ER, you may see a physician who is notfamiliar with your current treatment or medical history and,therefore, medical testing may be ordered that is a duplica-tion of the testing your physician already has done for you.

• The ER is one of the most expensive units in the hospitaland often one of the busiest. You’ll be paying top dollar,and if your symptoms aren’t severe, you could wait forseveral hours in the ER beforeyou receive any treatment.

• Modern emergency servicesare invaluable in trauma orlife-threatening situations butare inefficient for routine care.When deciding whether to goto the emergency room, useyour best judgment. In case of a true emergency, goimmediately to the emergency room. Call ahead to let themknow you’re coming and notify your regular doctor, ifpossible. Your family doctor can provide the emergencyroom staff with important medical information.

Reduce Your Doctor Bills• If you have minor medical problems, phone your doctor

rather than scheduling a visit. When an Arkansan sees aphysician for a common cold, for example, an average of$200 is spent, including the doctor’s fee, lab/X-rays andprescriptions. In reality, there is usually nothing a doctor

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can do to speed yourrecovery from a cold. Inall likelihood, he or shewill simply recommendover-the-counter medi-cations and plenty of restand fluids.

• Before you walk intoyour doctor’s office, write down issues you want todiscuss and questions you want to ask. You may wantto note:¤ Your symptoms or changes in your condition.¤ Medications you’re currently taking, including

complementary and alternative medications(herbs, vitamins, etc.).

¤ Changes in your life, such as more stress at workor changes in your home life.

¤ Questions regarding Web sites or articles you’veread about your illness and how it’s treated.

• Ask for the following during your appointment to helpyou make the right decisions about your care:¤ Explanations of tests and procedures.¤ Clarifications of any treatment you don’t

understand.• Take notes so you can remember the details later.• Do your part. Answer the doctor’s questions com-

pletely and truthfully. If you believe you’ll havetrouble sticking with a suggested treatment, say so.

• Don’t expect a prescription for medicine each timeyou visit the doctor. You can help keep costs low byfinding out how the medication will help you,whether there is a generic or similar, less-expensiveversion of the drug, and whether you can try a freesample first.

• Ask your doctor aboutthe value of comple-mentary or alternativemedicine treatments,such as herbal medi-cine, meditation oracupuncture.

• Avoid defensive medicine. Defensive medicine refersto tests and services performed primarily to protectphysicians from possible malpractice suits. Ask lots ofquestions about why the tests are being done, if theyare really necessary and what your options are. Youmay decide to take a more conservative approach.

• After the visit, take responsibility for your careoutside the doctor’s office. You should:¤ Follow through with the recommended treatment.

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¤ Take all medications as directed for as long asrequired.

¤ Practice preventive care; it’s the best way toreduce your health care costs.

• Don’t repeat medical tests needlessly. If you shouldchange doctors, don’t waste your time and money ontests that you’ve already had done. Simply get yourprevious practitioner to forward your records to yournew doctor.

Lower Your Hospital Costs• Before you’re admitted to the hospital, read your

health insurance policy thoroughly, and be sure tounderstand exactly what is andisn’t covered by the policy.

• If you need to go to a hospital,try to save on an extra night’sstay by checking in the day ofyour surgery. Avoid beingadmitted on a weekend, becausemost procedures will be put onhold until Monday.

• Keep a log. If at all possible, youor a family member should try tokeep a daily record of all theservices, medications and other supplies you receive.That way, you’ll have a record with which to comparethe final bill.

• Look over your bill carefully before you check out.Make sure that you are given a detailed bill thatitemizes every procedure, service and medication.

• Be on the lookout for duplicate billings, inaccurateadmission or check-out dates, and the billing ofsupplies, medications and tests that you didn’treceive. Be suspicious of any charges that are labeled“miscellaneous” on your bill. Always ask for anexplanation of what they are.

• If you notice an error on your bill, call the hospital’saccounting office immediately and explain the detailsof the error to them. Next, notify your insurancecompany of the error. Put everything in writing andkeep copies.

• Save all medical-related receipts.If you itemize deductions onyour income tax return, you candeduct non-reimbursed expensesthat exceed 7.5 percent of youradjusted gross income.Deductible expenses are thosenot covered by insurance.

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Cut Your Medication Bills• Discuss prescriptions with your doctor. Ask if you really

need a particular prescription or whether an alternative dietor exercise regimen couldprovide the same results.

• Ask your doctor about over-the-counter medications.They’re usually less expen-sive than prescription drugsand can be as effective forminor health problems.

• Ask your doctor if a generic drug is appropriate for yourcondition. Generic drugs are safe, and most are as effectiveas their brand-name equivalents; they generally costconsiderably less.

• If your doctor writes a prescription for a brand-name drug,ask the pharmacist to check on the difference between thebrand-name drug and the generic substitute, which is lessexpensive. If the two are medically equivalent, ask forthe generic.

• Request samples when trying a new medication. You’rewasting money and medicine if you can’t tolerate a newmedication and must stop taking it after only a few doses.Ask your doctor if he or she has samples you can try beforefilling your prescription.

• If you’re prescribed a drug that’s been on the market forfewer than five years, ask your doctor if it offers distinctadvantages in cost, effectiveness or reduced side effects.If not, ask if an older drug is more suitable. That way,you’ll avoid possible toxic effects that may not have shownup yet.

• Avoid overuse of antibiotics. The American Academy ofFamily Physicians estimates that Americans take 50 millionunnecessary prescriptions for antibiotics each year. Antibi-otics do not help viral infections. Viruses commonly causecolds, bronchitis, sore throats, flu and sinusitis. Usingunnecessary antibiotics can cause bacterial resistance(super bugs), as well as side effects from the drug.

• When you receive aprescription for anantibiotic, it never hurts toask your doctor if theantibiotic is absolutelynecessary. Only 15 percentof sore throats are causedby strep and thereforerequire an antibiotic. Often a common cold will start with asore throat. If you have a sore throat, you can take over-the-counter medications such as acetaminophen, ibuprofen ornaproxen for the pain. If the soreness in your throat does

not feel better after two days, call your doctor. He or shecan then run tests to determine if you need an antibiotic orother treatment.

• Have one pharmacy fill all your prescriptions. This willkeep your drug profile updated, and your pharmacist cantrack drug interactions. Over-the-counter products also cancause interactions, so check with the pharmacist beforeusing them if you regularly take a prescription drug.

• Store drugs properly in a cool, dry place. Don’t store themin your car’s glove compartment or in your bathroomcloset, where excessive levels of heat and humidity canaffect them. Be sure to keep all medications and vitaminsout of the reach of children and pets.

• Take your medicine the right way. Fifty percent of Ameri-cans take their medicines incorrectly. Ask your doctor thefollowing questions when you’re given a new prescription:¤ What is the name of the medicine, and what is it

supposed to do?¤ How much of the medicine should I take, when should

I take it and for how long?¤ What are the possible side

effects, and what should I do ifthey occur?

¤ What foods, beverages, otherprescriptions and nonprescrip-tion medications should I avoid?

¤ Can you provide me with written information aboutthis medicine?

• Monitor your use of medications:¤ Tell your doctor and pharmacist which other medicines

— including nonprescription drugs — you are taking.¤ Discuss with your doctor any problems, such as allergic

reactions or side effects, you’ve had with medications.¤ Ask your doctor to review all the medications you take

to help you determine which ones are necessary andwhich ones may not be.

¤ Don’t take another person’s prescription medicine, evenif your symptoms are similar.

¤ Take all the medication in a prescription if you’reinstructed to do so.

¤ Don’t combine different drugs in one container. Drugscan react with one another, making them ineffective.

¤ Check the label each time you take your medication toverify the drug and the dosage you’re about to take.

This is the third in a series of articles on understanding healthcare costs. The first (Autumn 2001) was “Why are health carecosts so high?” The second (Winter 2001) was “What are wedoing to help hold down health care costs?” The fourth(Summer 2002) will be “How is Arkansas Blue Cross differentfrom other health insurers?”