be smart about sunglasses

obtaining medical care: frequently asked questions

4 tips to simplify

gardening

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4 tips to simplify gardening

HealthyViewPhil Colmenares MD, MPH, Editor in Chief April Schmidt, Managing Editor

Healthy View is published by Arise Health Plan. The information contained in this publication is intended to educate about subjects pertinent to health, not to substitute for consultation with a personal physician. © 2014 Printed in U.S.A.

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

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contents3 better burgers

4 bites that bug you

5 be smart about sunglasses

6 obtaining medical care: frequently asked questions

7 avoid unneeded ER trips

8 work in workouts for kids

You just have to love a yard blooming with colorful flowers and pretty shrubs, right? According to a national survey, nearly half of Americans spent time gardening in the past year. Besides enjoying the sights and scents, tending a

garden is a great way to stay active. But tasks like digging, raking, and weeding can be challenging if you have a health condition, such as chronic obstructive pulmo-nary disease (COPD). These tips can make gardening easier on you.

| Pace YourselfStretch your muscles and warm up with gentle movements before you start. Don’t do too much at once and alternate vigorous tasks with easier ones. For instance, rake leaves for a few minutes, then switch to watering. Take frequent breaks so you don’t get fatigued. Hot weather can zap energy too, so tend your garden in the cool morning or late afternoon hours. Drink plenty of fluids and rest in the shade often.

| Mind the BodyGardening involves lots of arm action. To avoid getting breathless, try to keep your arm movements smooth and flowing rather than fast and jerky. Crouching and bending put pressure on your diaphragm, making breathing difficult. For jobs like planting and weeding, sitting on the ground or getting on all fours allows for easier breathing.

| Protect Your LungsPlanning to mow the lawn? It’s a good idea to wear a dust mask, or leave that task to someone else. Check local pollen and air quality levels in the newspaper or on the Internet and avoid gardening outdoors when pollen counts or air pollutant levels are high.

| Garden SmartThe right tools can save you a lot of energy. For instance, a portable, padded gardener’s bench or “kneeler” makes it easier to get up and down. Using lightweight gardening tools is another smart move. A rolling garden cart can keep all your gear and sup-plies within easy reach. If gardening on a smaller scale suits you, planting in raised beds, window boxes or contain-ers lets you enjoy some blooms or vegetables without the physical challenges of a large garden.

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Keep your gardening gloves

handy. Flexing your green thumb is the

perfect way to get some exercise this spring.

www.WeCareForWisconsin.com

better burgers

As warmer weather prepares to arrive, we start thinking about the beginning of grilling season. Many times we grill a plain beef burger, and while they can be tasty, they also tend to be high in fat and calories.

Opting for some alternative burger ingredients—such as turkey, salmon, whole grains, chopped vegetables, and the like—can improve the nutrition of your meal while making it more interesting.

The All-American Turkey Burgers are prepared very much like beef burgers. You can liven them up with your favorite spice mixes. The Salmon Patties have a different texture than regular burgers. Likewise, added spices can give them a flavor boost.

Grilling is a favorite American pastime. Here are some tips to keep grilling season safe and fun.

General Tips■ Keep the grill at least 10 feet from your house, garage, or anything else that can burn,such as dry shrubs. ■ Don’t leave a lighted grill unattended.■ Keep children and pets away from the grill.■ Keep a fire extinguisher nearby.

Charcoal Grill ■ Use only charcoal starter fluids to light the grill. Never use gasoline.■ Don’t add starter fluid to coals that already have been lit.

Gas Grill■ Keep the lid open during lighting. If the grill does not light after the first few tries, wait five minutes to allow the gas to disperse.■ Turn off the gas valve when the grill is not in use.

Food SafetyTo keep food poisoning from striking your outdoor event, follow these tips:■ Keep foods on ice until you’re ready to eat or prepare them. ■ Don’t leave food sitting out for more than two hours. Pack it away in an hour if thetemperature reaches 90 degrees F.■ Be sure food is cooked thoroughly. Cook whole poultry to 180 degrees F, ground poultry to 165, hamburgers to 160, and steaks and chops to 145.

The American Heart Association offers some great ideas to make your barbeque recipes heart-healthy. Visit www.americanheart.org and search for “Summer Barbeque Tips.”

all-american turkey burgers 1 lb. ground turkey 4 kaiser rolls, split½ cup chopped onion 4 lettuce leaves1 clove garlic, minced 4 slices tomato¼ cup ketchup 4 slices onion1⁄8 tsp. pepper

Preheat grill. In a medium bowl, combine ground turkey, chopped onion, garlic, ketchup, and pepper. Evenly divide mixture and shape into four burgers about 3½ inches in diameter.

Grill burgers five to six minutes per side until they’re no longer pink in the center (165 degrees checked with a food thermometer).

To serve, place each burger on the bottom half of a roll and layer with lettuce, tomato, onion, and the top half of a roll. Serves four.

Per Serving: Calories–379, fat–13 g, saturated fat–3 g, calories from fat–31%, choles-terol–59 mg, fiber–3 g, protein–26 g, sodium–561 mg, carbohydrates–37 g

salmon patties1 15-oz. can salmon, drained ½ cup 1% fat milk1 cup crushed whole grain crackers 1⁄8 tsp. black pepper 2 large eggs, lightly beaten 1 tbsp. vegetable oil

Place drained salmon in a medium bowl; use a fork to crumble it into small pieces (remove bones, if any). Add cracker crumbs, eggs, milk, and pepper. Mix, then shape mixture into four patties. Heat oil in skillet over medium heat. Carefully brown patties about four minutes per side until thoroughly cooked. Serves four.

Per Serving: Calories–110, fat–4.5 g, saturated fat–1 g, calories from fat–40%, cholesterol–20 mg, fiber–1 g, protein–12 g, sodium–270 mg, carbohydrates–5 g

Sources: National Turkey Federation, U.S. Department of Agriculture

FAST! and easy recipes

get fired up for safe grilling

3Healthy View | spring 2014

bites that bug you

Insect bites aren’t just annoying. Some can cause linger-ing symptoms and potentially fatal infections.

Lyme DiseaseOften, tiny ticks infected with B. burgdorferi bacteria

spread Lyme disease. Most cases occur in northern California, Wisconsin, Minnesota, and northeastern

states from Maine to Virginia.Untreated, Lyme disease can cause severe

symptoms that affect the joints, nervous system, and internal organs. An expanding rash that may resemble a bull’s-eye often appears a week or two after the bite. Other initial symptoms can include joint pain, fever, chills, or fatigue.

Fortunately, most people bitten by a tick don’t get the disease. In general, an infected tick must

stay attached to the skin for 24 to 36 hours before the person is infected. Early treatment with antibiotics

can often cure Lyme disease.

West Nile VirusInfected mosquitoes spread West Nile virus. Although anyone can contract the disease, older people and those with impaired immune systems are prone to more severe cases. The illness has been reported in every state.

Symptoms may appear five to 15 days after a bite. Among them: fever, headache, eye pain, muscle aches, joint pain, swollen lymph glands, and a rash. Advanced symptoms may include brain inflammation, paralysis, and coma. The condition can prove fatal. While there’s no treatment, prescription medications can control the symptoms.

Self-CareYou can prevent these illnesses by avoiding insect bites. Wear long pants, socks, and closed-toe shoes when out-doors. And spray clothes and skin with an insect repellent that contains DEET. However, remember to help apply insect repellent for younger children and supervise older children. It's very important to avoid getting insect repel-lent in the eyes or mouth. The American Academy of Pediatrics recommends using insect repellents with no more than 30% DEET, and never use insect repellent on children younger than 2 months. If you're pregnant, ask your doctor about preventing insect bites.

Remember to check yourself for ticks at the end of the day. And get rid of standing water (where mosquitoes breed) near your home.

Not letting bugs get the best of you can make for a healthy summer.

The summer months can be abuzz with insects. Keeping them off your back (and legs and arms) may help you prevent the harmful conditions they can spread.

for more information,

visit the Centers for Disease Control and

Prevention at cdc.gov.

www.WeCareForWisconsin.com4

be smart about sunglasses

Why is it so important to protect your eyes from sun damage? Because over time, exposure to the sun’s rays can cause cataracts, age-related macular degeneration,

and cancer, as well as other growths on the eye.Understanding why and how to guard your sight from sun damage can help keep you cool and protected.

Who’s At RiskAnyone who spends time outdoors is at risk for eye damage caused by the sun’s UV radiation. Factors that can increase the risk include:■ Spending long hours playing or working in the sun■ Taking certain medications, such as birth control pills, diuretics, tetracycline, tranquilizers, or sulfa drugs■ Having cataract surgery or retinal disorders

Adults aren’t the only ones who need to defend their eyes from the sun. In fact, because their eyes have less natural protection from UV radiation than adults’ eyes, children need protective sunglasses even more.

To ensure your children’s eyes are well-protected, shop for well-made kids’ sunglasses that fit their smaller faces. A pair that costs $2 is unlikely to last or provide suitable UV protection. Children who play outdoor sports should wear shades with impact-resistant lenses. Add a wide-brimmed hat to reduce the amount of UV rays that reach your child’s face by 50 percent.

Buyer’s GuideThe makers of sunglasses are free from government man-dates on the amount of UV protection their products provide. However, the American Academy of Ophthalmology and other vision associations recommend that all sunglasses should block 99 to 100 percent of UV radiation.

In addition to buying shades that provide this level of UV protection, you should also look for brands that are:■ Able to screen 75 to 90 percent of visible light■ Gray with a uniform tint■ Free of imperfections and distortion■ Dark enough (if you can easily see your eyes when looking in a mirror, shop for a darker pair)

Further ProtectionYou can further protect your eyes by:■ Wearing a brimmed hat along with your shades■ Sporting your shades in all seasons■ Insisting on adequate eye protection if you use an indoor tanning facility

Taking good care of your eyes doesn’t have to be expensive. In most cases, very costly sunglasses offer no more sight-preserving protection than those that cost a good deal less.

protect your eyes!

To learn more about sunglasses and eye

safety, visit the website of Prevent Blindness at preventblindness.org.

How to Shop For and Use Sunscreen Wisely

When picking a sunscreen, select at least SPF 30.

On the sunscreen’s label, look for the INGREDIENTS avobenzone, oxybenzone,

zinc oxide, and titanium dioxide on the label.

Try to stay in the SHADE between 10 a.m. and 4 p.m., when the sun's rays are strongest.

Healthy View | spring 2014 5

Q: How do I get care from a primary care practitioner or a specialist?

A: Arise Health Plan maintains a list of participating health care providers, including primary care practitioners (PCP), specialists, and behavioral health practitioners. For the most current list, go to www.WeCareForWisconsin.com and click on “Find a Doctor.” You also may call an Arise Health Plan Member Services repre-sentative at (toll-free) 888-711-1444 or (local) 490-6900.

If a provider participates in our network, you simply make an appointment with him or her. You do not need a Pre-Service Authorization. If the provider does not participate in our network, you may need an approved Pre-Service Authorization based on your plan type. Please call an Arise Health Plan Member Services representative at (toll-free) 888-711-1444 or (local) 490-6900 to determine whether or not a Pre-Service Authorization is required.

Q: Do I need a Pre-Service Authorization to see a specialist?A: You may seek care from a participating specialist without a Pre-Service Authorization as long as the services are a covered benefit.

If you need services from a specialist who is not in our plan or from a tertiary care specialist, a participating provider (PCP or specialist) must complete a Pre-Service Authorization requesting services from that non-participating specialist.

This request will be reviewed by Arise Health Plan’s medical director or authorized designee. The patient should not make the appointment until the request has been approved. Notification of the decision will be sent to you, the requesting provider, and the specialist you wish to see.

Q: What if I want a second opinion?A: If the provider participates in our network, you can simply make an appointment with him or her.

If the provider does not participate in our network, you may need an approved Pre-Service Authorization based on your plan type. Please call an Arise Health Plan Member Services represen-tative at (toll-free) 888-711-1444 or (local) 490-6900 to determine whether or not a Pre-Service Authorization is required.

obtaining medical care: frequently asked questions

Q: How will bills be paid if my PCP refers my specialty care to a nonparticipating specialist?A: In order to maximize your benefits, when the need for specialty care arises you should seek care from a participating specialist whenever possible.

If services from a non-participating specialist are necessary, you must have a Pre-Service Authorization approved prior to seeking services. Without prior authorization, coverage for the services will be reduced or denied, depending on your plan of benefits. Maximum Allowable Fee levels will apply to non-participating providers. This means that you will be responsible for any charges that exceed the Maximum Allowable Fee for authorized services from a non-participating provider.

Q: Who can request a Pre-Service Authorization?A: A Pre-Service Authorization is required for all non-participating providers, tertiary care specialists, and tertiary care facilities. A Pre-Service Authorization request form must be submitted to Arise Health Plan via mail or fax by the member’s PCP or participating specialist.

The request will be reviewed and a written response from Arise Health Plan will be sent to the member, the requesting provider, and the non-participating or tertiary care provider you wish to see.

Q: When do I need a Pre-Service Authorization?A: You will need a Pre-Service Authorization for the following:■ An inpatient stay in a hospital, skilled nursing facility (nursing home), or birthing center■ Transplants■ Home health care■ Hospice care■ Durable medical equipment costing more than $500, or any rentals■ Home infusions■ Prosthetics costing more than $1,000■ New medical or biomedical technology■ New surgical methods or techniques■ Non-emergency ambulance transportation■ Genetic counseling, studies and testing■ Non-participating providers■ Tertiary care (services provided by specialized hospital pro-viders that are often linked to medical schools and teaching hospitals)

questions or

comments about Arise Health Plan?

contact member services at 920-490-6900 or 888-711-1444.

6 www.WeCareForWisconsin.com

Arise Health Plan maintains a list of participating health care providers, including primary care practitioners (PCP), specialists, and behavioral health practitioners. For the most current list, go to www.WeCareForWisconsin.com

and click on “Find A Doctor.” It’s that simple!You also may call an Arise Health Plan Member Services

representative at (toll-free) 888-711-1444 or (local) 920-490-6900, option 1.

looking for a doctor?

If you go to an emergency room (ER), expect company. About 230 Americans check into an ER every minute, and it can feel like they’re all ahead of you.ERs save lives, but they’re costly—and your wait can seem endless

if your problem isn’t urgent. Here’s how to save time and money.

Find a Regular DoctorEven if you’re healthy, a family doctor can gauge your health needs while focusing on preventive medicine like shots and screenings. If you take ill, your doctor can treat most problems. Studies show hav-ing a regular doctor can reduce ER visits for not-so-urgent problems.

Manage Chronic ConditionsIllnesses like asthma, diabetes, and heart disease cause millions of ER visits. Working out a treatment plan with your doctor—and following it—reduces such trips. In one Alabama program, ER visits fell 50 percent among diabetes patients who learned more about the disease and received more routine care.

Know What’s an EmergencyReserve the ER for true emergencies. Examples include chest pain, weakness in an arm or leg, serious trouble breathing, major broken bones, allergic reactions, loss of consciousness, uncontrolled bleeding, poisoning, and head injuries. Ask your doctor (in advance, not in a potential emergency) if you aren’t sure what should send you to an ER.

Explore Other OptionsIf your doctor’s office is closed, urgent care centers and retail clinics can treat minor illnesses such as fevers, nausea, rashes, or the flu more quickly than an ER. Most urgent care centers can handle simple broken bones and cuts that need stitches.

avoid unneeded ER tripsTake Care of YourselfStaying healthy keeps you ER-free. Lose weight, eat a healthy diet, exercise regularly, and don’t smoke. Injuries cause one in three ER visits, led by falls and traffic accidents—so fall-proof your home, buckle up in the car, and take other safety precautions

7Healthy View | spring 2014

Childhood obesity is a big problem. Today, one in three children is overweight or obese. And heavy kids often become overweight adults with a higher lifetime risk for heart disease, diabetes and other major health problems.

To break that cycle, encourage kids to exercise.

How much exercise do kids need?Experts say kids and teens should exercise one hour or more each day. That should include these types of exercise:■ Aerobic activity. This should make up most of your child’s daily exercise. Kids need both moderate and vigorous aerobic exercise. Moderate exercise includes activities such as walking to school or riding a bike. Vigorous exercise is more intense, like running or playing basketball.■ Muscle-building. This includes activities like push-ups and gymnastics. ■ Bone-strengthening. Examples include running, jumping rope and hopscotch.

Kids need vigorous exercise at least three days a week. They also need muscle-building and bone-strengthening activity three days a week. One activity can count as more than one type of exercise. For example, basketball counts as vigorous activity and also makes bones stronger.

Get out and play—safely Often, kids can exercise just by playing outside in the neighborhood or a public park. If your child goes out to play without an adult, share these safety tips: ■ Use the buddy system—always go places with a friend or in a group ■ Always go with a buddy to public restrooms■ If you need help, look for uniformed police officers or security guards ■ Know where to go in an emergency— try a neighbor or relative’s home, or a local community center

Joining a sports team at school is also a safe way for kids to work out. The important thing is that you help your children find ways to work in more exercise into their day with activities that they enjoy.

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work in workouts for kids

hydratedThe amount of fluid you require depends on your activity level and the weather. Strenuous exercise or exercise in the heat and humidity can tip the balance toward dehydra-tion. Drink extra beforehand, plus ½ to 1 cup every 15 to 20 minutes. After exercise, drink at least two additional cups—more if it’s very hot.

stay

[did you know?]In 2011, about 11,000 children age 14 and younger were injured as pedestrians, according to the National Highway Traffic Safety Administration. To reduce the risk of being hit by a vehicle, tell kids to avoid playing near driveways, alleyways, or streets.

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