Member Newsletter – Spring 2020

spring-2020

Welcome

Thank you for your continued support! Umpqua Health Alliance strives to keep our members up-to-date on what’s happening in the community as well as within our company. If you have any questions or have suggestions for our next newsletter, please contact us! Call 541-229-4842 or email us at info@umpquahealth.com. To sign up for our Member Newsletter, please follow this link: https://signup.e2ma.net/signup/1907516/1716984/.

Umpqua Health News

Member Services is still open! With the spread of COVID-19 (Coronavirus), we have been forced to close our physical office availability. However, we are still available Monday through Friday from 8:00 AM to 5:00 PM. You can still reach us through the following resources:

UHA is still operating to make sure you are still able to receive the covered services that are available.  Primary Care Doctors are still being assigned and changed when requested, we are still sending out Member ID Cards, Handbooks, and other important communications as needed.

The Prior Authorization department is still working diligently to get all incoming requests completed.

Case Management is in full force working with members who need extra help receiving the services we offer.

Claims department is still providing support to our providers and doctors. We look forward to opening up our doors again once the executive order has been lifted.

Your Oregon Health Plan (OHP) and the Novel Coronavirus (COVID-19)

  • Testing and treatment for COVID-19 is also covered for all eligible OHP members. Even if you have to stay in the hospital because of COVID-19, you are covered at no cost to you.
  • Are you worried about your coverage ending because you forgot to reenroll with everything else going on? Starting March 18th, 2020, if you are currently eligible on OHP (or one of the CCO’s) you are covered.
    • Even if you get a letter in the mail that says your OHP is terming or you no longer qualify, your OHP will not end.
    • The federal government funded stimulus checks and increased unemployment benefits during this emergency will not affect your coverage eligibility.
  • Do you need your prescriptions filled soon? Go ahead and get them early. It’s important to keep taking your medications as prescribed. During this time, we are approving refills two weeks early. Simply let your pharmacy know you need to fill early due to the COVID-19 emergency.
    • If you don’t want to go into public to fill your prescriptions, you can get them through the mail. Ask your pharmacy if they can mail them to you for free. If you need help finding a mail-order pharmacy, please see the Postal Prescription Service section of the Service Spotlight in this newsletter.
  • Pandemics like COVID-19 can cause a lot of stress and anxiety. There is so much uncertainty. How long is this going to last? What will happen when my work shuts down and I don’t get paid? You are not alone. Millions of Americans are wondering the same thing.
    • On March 29th, the CARES act was signed into law.
      • This expands the Unemployment Insurance benefits as well as providing a one-time direct deposit $1,200-$2,400 for households and $500 per child for qualified incomes. According to Forbes.com, the payments will be available for incomes up to $75,000 a year for individuals and up to $150,000 for married couples.
      • They are determining people’s eligibility by their 2019 tax return. If you haven’t filed for 2019 yet, they will look into your 2018 tax return.
    • For those who have filed or are trying to file for Unemployment due to the COVID-19, according to the State of Oregon Employment Department, under the current guidelines, anyone who lost their job due to the virus can be eligible for up to 26 weeks of unemployment compensation.
    • If you’re waiting on your Unemployment to be issued and you’re worried about how you will pay rent or mortgage, Governor Kate Brown issued the Executive Order 20-11. This places a temporary waiting period on evictions for nonpayment. What that means is that your landlord cannot forcibly evict you for nonpayment due to losing your job because of the COVID-19.

Healthy Habits

As you saw in our previous special edition Member Newsletter, (found here: https://www.umpquahealth.com/ohp/ under UHA Member Resources) washing your hands is a very important part in helping to keep your family safe from getting sick.

  • New CDC guidelines suggest wearing a homemade mask may help reduce your risk and the risk of others from COVID-19. N95 – Surgical Masks are preferred for healthcare workers. Please only use homemade masks when going into public.
  • Here are some hand washing tips from the CDC:
    • Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
    • Avoid touching your eyes, nose, and mouth with unwashed hands.

Telehealth – The health and well-being of UHA’s members is of the highest priority. UHA is committed to help prevent the spread of the coronavirus strain COVID-19 by encouraging members to use telehealth appointment options to limit the amount of in-person health care service. This reduces the risk of exposure to contagious viruses or further illness.

The telehealth visits options available include, 2-way, live interactive telephone communication and digital video consultations. This options allows you to get the care you need during the coronavirus (COVID-19) pandemic. To schedule a telehealth visit, call your providers office and ask if a telehealth visit is an option. Most health providers have telehealth visits available.

Telehealth visits and all other in-person visits for covered services are free and do not have a cost-share or copay required. If you have any questions about the coverage of telehealth services, please contact UHA Member Services.

If your doctor thinks it’s appropriate, stay safe and use Telehealth. Due to changes in the OHP rules for telehealth, UHA is able to make it an option for everyone during the pandemic. Expanding telehealth benefits is UHA’s way of helping the community.

May is Mental Health Awareness Month. Due to the social isolation order put on by the Governor, here are some supports for your wellbeing:

  • With rising tension and anxiety from staying at home, domestic violence can become more prevalent. No matter what the status of your relationship is, it’s extremely important to plan for your emotional and physical safety. If you or someone you know is going through Domestic Violence, please reach out. There are many resources to help you.
    • Peace at Home – 24-Hour Crisis Line: (541) 673-7867 or 1-800-464-6543
    • Futures Without Violence – They have multiple resources available specific to the increased danger due to the isolation from COVID-19. Please visit https://www.futureswithoutviolence.org/get-updates-information-covid-19/
    • National Domestic Violence Hotline – 1-800-799-SAFE (7233). They also have a chat option available if you can’t talk on the phone. They offer support, resources, and hope. Please visit their website at https://www.thehotline.org/help/
  • As always, if you are having mental health issues and need immediate help, please contact 911 or the 24 Hour Crisis Line at 1-800-866-9780.
  • Previously mentioned before, we are covering Telehealth. Please contact your Mental Health Provider to see if they are set up to do Telehealth. Set up an appointment as soon as possible.
  • To find a list of Mental/Behavioral Health providers, please go to our website at: https://www.physicianehs.com/searchProvider.cfm

Smoking Cessation is available. Increasing evidence is suggesting that smokers are at higher risk of severe COVID-19 than those who don’t smoke, but it is not too late to quit. People who quit for even a short time may see an improvement in lung health.  For most smokers who don’t already have serious lung injury, they may see immediate improvement in their health, and less opportunity for severe disease including COVID-19.

People turn to things because it’s a coping tool, especially during stressful times. But, maybe try and flex other coping muscles, there is a real opportunity to break routines – even taking a short break from smoking improves lung function.

A time of crisis is a time of opportunity. If you’ve been looking for a reason to quit, this is it.

For more information on how to quit smoking or get help, please follow the links below:

Oregon Health Authority (OHA) has created a website for all information and resources related to COVID-19. They cover information about what the Coronavirus is, the latest news in closures and Executive Orders, as well as things to do to help with your child’s education while they are out of school. They also provide resources if you have concerns about food and shelter. Please visit their website at https://govstatus.egov.com/or-covid-19

forks

Eating healthy helps promote good health by providing key nutrients and vitamins into your body. Choose My Plate created by the U.S. Department of Agriculture (USDA) is a program that helps you create the right meal proportions for you. It is available online at choosemyplate.gov, or on their app which can be found in the Android Google Play or App Store for iOS systems.

Service Spotlight

pps-logo

A new mail-order pharmacy has been added to our pharmacy network! Postal Prescription Services (PPS) is now available to all of our members so that you can receive your prescriptions through the mail.

  • Please visit their website at ppsrx.com
  • Call at 1-800-552-6694
bay-cities

Do you need to go to the doctor but are worried about getting a ride? Bay Cities Brokerage is our contracted Non-Emergent Medical Transportation (NEMT). This includes going to your regular scheduled doctors’ visits and urgent care visits. They provide rides as well as mileage reimbursement for covered medical appointments. If you don’t want to be in close proximity to others, you can call them in advanced to schedule your mileage reimbursement.

Call Bay Cities Brokerage Monday-Friday 8:00 AM – 5:00 PM at 1-877-324-8109 to request a copy of their reimbursement form and rules.

For the safety of members and providers, please understand that BCB drivers are allowed to refuse a ride if you show symptoms of the Coronavirus. If this happens, BCB will secure other transportation for you.

this-is-not-a-bill

Have you received a letter in the mail indicating that your doctor sent us a bill and UHA denied payment? This is called a Notice of Action Benefit Denial (NOABD). This means that for one reason or another, we could not pay the bill that your doctor submitted to UHA. This could be due to them not getting a prior authorization before your appointment, or that they did not bill your primary insurance before billing us. The letter tells you what services were billed and why we denied it. THIS IS NOT A BILL.

Here are a few common questions being asked about these NOABD’s

What is being denied?

  • This is not a letter to tell you that you are losing your insurance coverage. The Oregon Health Plan (OHP) tells us what services or items are covered as your health plan. OHP also requires us to tell you when your provider requests us to pay for something and it has been denied. When receiving a letter from UHA that states “Notice of Action Benefit Denial”, we are telling you that we will not pay for these requests. We deny these requests if you are not eligible to receive them, if you have another primary insurance that will pay for it, if the request is not a covered service, if it is not medically appropriate/necessary, or if there is another provider that is in our network that you can see instead.

Can I be billed for this?

  • A member cannot be billed for non-covered services or treatments that have been denied unless you knowingly and voluntarily agree to pay for the non-covered service before you received it and you completed an Agreement to Pay waiver (form OHP 3165 or 3166). In addition, a member cannot be billed for services that were denied due to provider error.

Does this mean my OHP coverage is going to end?

  • UHA will not send a letter if your coverage has ended. This letter would come directly from OHP not UHA.

Does this mean I cannot go to my future appointments with this provider?

  • Just because a past claim was denied, does not mean that future appointments have been denied or that this provider will no longer see you.

Do I need to contact my provider about this?

  • Please contact your provider to be sure that they have the correct insurance information to process your bill and be sure you will not receive a bill from them.

What do I do if I receive a bill or am told I am responsible for this?

  • If you receive a bill, please contact your provider. If your provider tells you that you must pay, please contact our Member Services department at 541-229-4842.

Will I get more like this in the future?

  • You will receive a letter from UHA for every claim or prior authorization that has been denied. We send you this letter so you are aware that it has been denied in case the provider bills you incorrectly in the future.

Community Resources and Events

Due to the COVID-19, most community events have been cancelled or delayed for the safety of the community and to prevent further spread of the virus.

Did You Know?

Excersise is very important part of having a healthy mind and healthy body. With that being said, what do you do when you and your children are stuck at home? Here are a few fun ideas to keep your children off the electronics, and getting some exercise!

  • Hallway Laser Maze
    • Teach your child how to be a spy by setting up a “Laser Maze” in a hallway. All you need is crepe paper (paper streamers) and some tape!

Simply zig-zag the streamers all over the hallway. Make sure to not make it to easy! The point is to get through the maze without “tripping the alarm” and breaking the streamers.

streamers

Are your kids wanting to go outside? How about a Backyard Obstacle Course!

  • This helps with their movement skills like balancing, jumping, and climbing. This is great for children of any age. You can adjust the difficulty level depending on their age.
  • Best part is that you can use just about anything lying around the house to do it!

Pool noodles or hula hoops can be used as a “quick step” course

hula
  • Have some 2×4’s? these can be used as balancing beams
  • Kids Play Tunnels are great for army crawling through the course
  • You can use a jump rope or just a plain rope to create a zig-zag. The children walk along the rope and follow it no matter where it goes.

As the weather gets warmer, there are loads of activities you can do with your children. For more ideas, please follow this link: https://listotic.com/32-best-diy-backyard-games/34/

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