Smoke signals. (Grand Ronde, Or.) 19??-current, May 01, 2008, Pathway To Health A Health Newsletter, Image 21

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    MAY 1, 2008
A
Health Newsletter
Brought to you by Financial Risk Management
3
As your Financial Risk and Insurance Administrator, I wanted
to give themembership an update on what to expect concern
ing the Tribal Member Health Plan in July 2008. There are a
couple of changes coming that I wanted to make sure you all
were aware of. These changes will not only help our members
use the plan more efficiently but will help us keep costs down,
save valuable resources and provide for the long-term sustain
ability of the plan.
The first change that we will see in the Tribal Member Health
Plan is a change in the qualifications for an Emergency Room
visit. Currently any visit to the Emergency Room has been cov
ered with a $100 copay, no matter what the member is seen for.
Through claims research we have discovered that many of these
visits are not actual emergencies and could have been treated
by a primary care physician or at an Urgent Care Center. For
that reason, we have asked UMR to use a standard criteria
for paying Emergency Room visits. If you are treated for an
actual emergency, your claim will be paid. If you are treated
for something that is not, your claim will automatically have a
secondary review. After review, if it was not a true emergency,
the claim could be denied.
UMR provides a 24 hour Nurse Line that can assist members if
they have questions as to what constitutes primary care, urgent
care or emergency care. If you are unsure about whether you
should seek care at the emergency room, call 1-888-867-4850.
If you are directed to the emergency room by the Nurse Line,
your visit will be covered. I have personally used the Nurse Line
and they are very helpful. In less than 1 minute I was talking
with a Registered Nurse and she answered my questions.
The second change to the plan centers around the Provider
Network provided to us by United HealthCare. Currently the
plan covers a visit to an out-of-network provider at 80 percent.
Beginning on July 1, 2008, the coverage for an out-of-network
provider will be 70 percent. This will only affect members who
see an out-of-network provider in an area where there are con
tracted providers. In the event that there are no contracted
providers within 25 miles of where you live, you will still have
your visits paid at the in-network rate.
Using-in network providers allows us to pay for visits at a
discounted rate and saves our Tribe a lot of money each year.
Contracted providers are bound by the UHC contracted rates
and cannot charge the members for anything but the copay.
A non-network provider can charge whatever they like, and
the plan must pay the billed charges. By utilizing in-network
providers, we can keep costs reasonable and save money. This
change to the plan only affects the out-of-network benefits, the
in-network coverage remains at 90 percent.
These changes will help us contain costs and allow the Tribe
to continue to provide a Health Plan for us all. We will be put
ting these changes into effect on July 1, 2008. We will be dis
cussing these changes at General Council meetings and at the
Community Meetings throughout the next couple of months. If
you have questions, please contact either myself (ext. 2221) or
The Native American
Medicine Wheel
a sacred symbol representing
the wholeness of life.
Kasl Mental I
South Spiritual
West Kmotional
North Physical
Barbara Steere (ext. 2487) and we would be happy to give you
more information. Call us toll free at (800) 422-0232. Thank
you and we hope to see you at the upcoming Community Meet
ings. Jim Holmes
Financial Risk and Insurance Administrator
While some fitness myths, such as "no pain, no gain,"
are fading fast, many misconceptions about exercise still
exist. Here are some com-
mon exercise myths and
the truth about them.
1. If you're not going
to work out hard and of
ten, exercise is a waste of
time.
This kind of thinking keeps
a lot of people from maintain
ing or starting an exercise
program, but it's not true. A
study by the National Insti
tutes of Health found that
moderate physical activity
works just as well as intense exercise when you're trying to lose
weight. Walking, bicycling and swimming are all good ways to
exercise at a modest pace. And, there may be other health ben
efits. Walking for as little as an hour a week has been shown to
reduce the risk of heart disease.
2. Yoga is a completely gentle and safe workout.
Some forms of this mind-body exercise are quite rigorous,
physically and mentally. Although injuries are rare, staying in
certain poses may cause nerve damage or back pain. Avoiding
certain postures and .modifying others can make yoga safer for
most healthy people even pregnant women. As with any form
of exercise, qualified, careful instruction is necessary for a safe,
effective workout. If you have a health condition, talk with your
doctor before trying yoga.
3. You can lose all the weight you want just by exercis
ing. Increasing your level of physical activity is just one part of a suc
cessful weight-loss plan. You need to cut calories, too. How many
pounds you lose also may depend on your genes. What works for
one person won't necessarily work for another. I lowever, exercise
is an important component of just about any weight loss program
-- and it offers many other health benefits, as well.
4. Water-fitness programs are primarily for older adults
or people with injuries.
Research has shown that exercising in water can be a chal
lenging and effective way to get fit and lose weight. And, it can
be beneficial for just about anyone.
5. If you want to lose weight, don't
strength-train because you'll "bulk
up.
Experts recommend both cardiovascular
exercise and strength training to maintain
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