Tricare Health Matters Spring 2013

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Urgent or Emergency?
Combating the "Deadly Quartet" of Health Problems
Fighting Health Care Fraud and Abuse
The Truth About When To Get Your Pap Test

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Tricare Health Matters Spring 2013

  1. 1. S P R I N G 2 013 A P U B L I C AT I O N F O R T R I C A R E ® P R I M E B E N E F I C I A R I E S The Doctor is in ... • Difficulty breathing or shortness of breath Urgent or Emergency? • Sudden dizziness, weakness or changes in vision • Severe or persistent vomiting or diarrhea W. Bryan Gamble, M.D., FACS • Changes in mental status, such as confusion Brigadier General, US Army You do not need authorization for emergency care before Deputy Director, TRICARE Management Activity receiving treatment. However, if you’re enrolled in a TRICARE Prime plan you must contact your primary care I f you or your child gets sick or injured, your first instinct may be to go to the emergency room (ER) manager (PCM) or regional contractor within 24 hours or the next business day after you receive emergency care. right away or call 911. These are good Urgent care is when an illness or injury is serious enough instincts in an emergency, but many to seek health care right away, but not so severe as to people use the ER when it is not an require emergency room care. Some examples include actual emergency. This contributes earache, toothache, joint sprain, muscle pull or urinary to long ER wait times, high costs tract infection. You can get urgent care from your PCM and unnecessary medical care. or from an urgent care center if your PCM is inaccessible. Sometimes, using an urgent care clinic may be your best Urgent care can be quicker, with a lower cost and better choice and can help responsibly preserve the TRICARE results, compared to a crowded ER that may require benefit for future generations of military families. unnecessary tests or hospital stays. It can be difficult to know whether an illness or injury is Many urgent care centers are open after normal business really an emergency, but the judgment is yours to make. hours and on the weekend, so you can go at a time that fits If the condition is obviously life threatening or causing with your schedule, or when a health problem warrants. severe pain and distress, then the need for an ER is clear. If you have TRICARE Prime, you need to get prior TRICARE views an emergency as a medical, maternity authorization from your PCM or your regional contractor or psychiatric condition you believe could threaten your to avoid additional costs for visiting an urgent care center. life, limb or sight without immediate medical attention. If you are traveling, you need to contact your home region Other emergencies include severe, painful symptoms for authorization. You can find contact information for requiring immediate attention, or when a person may your regional contractor at www.tricare.mil/contacts. be an immediate risk to self or others. According to the Urgent Care Association of America, If you or a family member experience any of the following 57 percent of visits to an urgent care facility have a wait symptoms, go to the ER immediately: time of 15 minutes or less. By comparison, the Centers for • Chest pain or pressure … continued on page 3 • Uncontrolled bleeding • Sudden or severe pain Inside This Issue ... • Coughing or vomiting blood • Combating the “Deadly Quartet” of Health Problems • Fighting Health Care Fraud and Abuse • The Truth about When To Get Your Pap Test An Important Note About TRICARE Program Information: At the time of printing, this information is current. It is important to remember that TRICARE policies and benefits are governed by public law and federal regulations. Changes to TRICARE programs are continually made as public law and/or federal regulations are amended. Military treatment facility guidelines and policies may be different than those outlined in this publication. For the most recent information, contact your TRICARE regional contractor, TRICARE Service Center, or local military treatment facility.
  2. 2. Combating the “Deadly Quartet” of Health ProblemsT he “deadly quartet” refers to the four chronic conditions—high blood pressure, high cholesterol,obesity and diabetes—that are particularly harmful to your Avoid the “Deadly Quartet” Some simple lifestyle changes can help you prevent—andhealth. These conditions contribute to the leading causes of even reverse—these conditions. Here are some changesdeath and disability in men and women in the United States. to consider: • Eat more fruits and vegetablesHigh Blood Pressure • Consume smaller portions (for example, a single serving of meat is about the size of your palm)If left untreated, high blood pressure can cause a stroke,heart disease, kidney failure or other problems. Strokes may • Eat leaner meats, such as chicken and fishlead to many other problems, including being paralyzed. • Increase regular physical activity (just 30 minutes ofHeart disease is the number-one killer of men and women walking a day four or five days per week can makein the United States. High blood pressure often has no a positive difference)symptoms, so you should have yours checked yearly at yourroutine doctor visits. For more tips on living a healthy life, visit TriWest.com/HealthyLiving or www.tricare.mil/getfit. nHigh Cholesterol 1. http://www.cdc.gov/obesity/childhood/High cholesterol, which may not present any symptoms,increases plaque buildup in your arteries. This buildup cancause a heart attack; it is also a major risk factor for heartdisease. TRICARE covers your cholesterol tests at least onceevery five years beginning at age 20. People with diabetes,regardless of age, should have their cholesterol checked atleast once each year.ObesityObesity is caused primarily by poor eating habits and lackof exercise. Obesity will strain your heart, joints and bones,and can cause other diseases common in adults, such astype 2 diabetes.Obesity has become widespread in children, too. Accordingto the Centers for Disease Control and Prevention, obesitynow affects 17 percent of all U.S. kids and teenagers.1Childhood obesity often carries into adulthood, causing highblood pressure, arthritis, sleep apnea and low self-esteem,among other problems.DiabetesDiabetes is a disease in which your blood glucose levelsare above normal and your body either does not makeenough insulin or cannot process it properly. A major causeof type 2 diabetes is obesity. Diabetes is a major risk factorfor heart disease and is the leading cause of kidney failureand new cases of blindness.2 TriWest.com Spring 2013
  3. 3. The Doctor is in ... Urgent or Emergency? … continued from page 1 Disease Control and Prevention reports only 22 percent of visits to an emergency room have wait times of 15 minutes or less. Getting urgent care instead of visiting the ER can also save money. ERs are required to run expensive diagnostic tests that may not be necessary if your condition is less serious. Being judicious with your health care spending can make your household budget go further, and cost-efficient urgent care will help protect your TRICARE benefit in these uncertain financial times. Correction: “The Doctor is in” column that ran in the It’s a good idea to be aware of nearby urgent care facilities Health Matters Winter 2012 newsletter was written by in the TRICARE network, just as you would with the closest Barclay P. Butler, Ph.D. The article did not identify Dr. Butler as the author and as Director, Department of ER. To find an urgent care facility near you in the TRICARE Defense/Department of Veterans Affairs Interagency network, visit www.tricare.mil/findaprovider and select the Program Office. search tool for your regional contractor. nFighting Health Care Fraud and AbuseH ealth care fraud and abuse cost American taxpayers billions of dollars each year. TRICARE and TriWestHealthcare Alliance (TriWest) are committed to ensuring • If you notice any differences between the services reflected on your EOB and the services you received, call the toll- free number listed on the EOB.you receive care from trustworthy providers and that Differences do not always indicate fraud, but they cantaxpayer money is used appropriately. indicate mistakes that may result in improper claims reimbursement from TRICARE or cause your medicalWhat Are Fraud and Abuse? record to be incorrect.Health care fraud is intentional deception or misrepresentation If you have any concerns about your medical record, youthat enables someone to obtain an unauthorized benefit or should follow up with your health care provider to ensurepayment. Health care abuse occurs when providers supply the services you received are reflected properly. To learnservices or products that are medically unnecessary or that more about how TRICARE and TriWest combat frauddo not meet professional standards. You are an important and abuse, visit the TRICARE Fraud & Abuse website atpartner in the ongoing fight against fraud and abuse within www.tricare.mil/fraud or visit TriWest.com.the TRICARE program. To report fraud or abuse regarding the TRICARE PharmacyHow You Can Help: Program, contact Express Scripts, Inc. at 1-800-332-5455, ext. 367079, or by e-mail at fraudtip@express-scripts.com. n• Always review the explanation of benefits (EOB) you receive after health care services. The EOB should list the services and supplies you received.Spring 2013 1-888-TRIWEST 3
  4. 4. TRICARE Generous coverage Superior health careTriWest Healthcare AllianceP.O. Box 42049 Decisions are healthPhoenix, AZ 85080 driven, not insurance driven High satisfaction with care Low out-of-pocket costs Easy access“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.The Truth about When To Get Your Pap TestA midst the recent media buzz debating when women should get their Pap tests, you may be wondering whenexactly you should be going to the doctor. New guidelines 3. Clinical breast exam: A doctor will physically examine your breasts for unusual bumps or growths, which could indicate breast cancer. Think of the clinical breast examissued by the United States Preventive Services Task Force like your monthly self-examination, but by a professionalin March 2012 recommend that women should have a Pap who can detect abnormalities you cannot.test to screen for cervical cancer every three years beginningat age 21. But while you may only need a Pap test once every How Often Should I Visit the Doctor?three years, you will need the other parts of your well- Regardless of recommendations about how often youwoman exam every year.1 should get a Pap test, you should still visit your doctor for a complete well-woman exam every year, so that you can getWhat Happens During a Well-Woman Exam? a pelvic exam, breast exam and other screenings or care youA complete well-woman exam includes three main parts: may need. TRICARE covers these well-woman exams at no cost to you as long as you visit a civilian network provider or1. Pelvic exam: During this exam, the doctor visually military treatment facility. and manually checks your reproductive organs and your general pelvic area for abnormalities. This includes For more tips on healthy living, visit TriWest.com’s Healthy checking your ovaries and uterus. The pelvic exam is Living portal at TriWest.com/HealthyLiving. n important because it can detect other signs of cancer 1. http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/ besides cervical. cervcancerrs.htm#clinical2. Pap test: This is the actual cervical cancer screening, NE311BEW12123 where the doctor will remove cells from the surface of your cervix to test for cancer.4 Spring 2013

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