Straight TeleTalk: New Member

Maxine:

Hello, and welcome to the SCAN Health Plan TeleTalk.

My name is Maxine Marcus and I'm a Senior Advocate here at SCAN. That means that I'm a member of SCAN just like you and I work part time at SCAN as well. I've been a SCAN member for five years and a senior advocate for two years so I really feel like a part of the SCAN family.

Today I would like to introduce you to a couple of people who are with SCAN who are going to tell you about themselves and what they do.

The first one is Sarah Bellefleur, Director of Network Quality.

Sarah:

Thanks, Maxine. Good morning! As Maxine said, I'm Sarah Bellefleur and I've been at SCAN for almost 13 years. In fact, my SCAN-iversary is a couple of weeks away on Valentine's Day. Maybe that explains why I love welcoming our new members to the plan.

Maxine:

Okay. The other person is Doug Buseck, Health Care Services Process Improvement Manager.

Doug:

Maxine, hey, Maxine how you doing? I've been at SCAN for 20 years, believe it or not. I work in the healthcare services team. As you had mentioned, we work very closely with Member Services and I'm very happy that we have a lot of our newer members listening in today.

Sarah:

Great! Thanks!

So if you are invited to take part in this phone call, that means you're new to SCAN Health Plan. So again welcome!

Some of you may also be completely new to Medicare. Regardless, we wanted to welcome you with a phone call that will help you make the most of your new health plan and help you stay healthy. We'll also be talking about what you can expect to receive from us in terms of ongoing communications. Because I'll tell you right now, we really like to keep in touch with our members.

Finally we're not going to go into detail about your specific benefits and co-payments. Not everyone on the call has the same benefit package, so we're going to keep it pretty general. However, if you do have specific benefit questions, you can call your member service our member services line which is 1-800-559-3500. So let's get started.

We asked ourselves if we could only tell you three things that would help you get the most out of your health plan, what would they be? And here's what we agreed upon: Connect to care, check your benefits and call with questions.

Maxine:

The other Senior Advocates and I have started calling these the “3 Cs of Care”: connect, check and call.

Sarah:

That's perfect, Maxine. Easy to remember: the 3 Cs. I'm going to use that from now on too.

Doug:

The 3 Cs. There is a reason why “Connect to Care” is number one, isn't there, Sarah? After all, research has found that people who see their doctor regularly are healthier. They get their preventive care that they need and it helps them stay out of the hospital.

Sarah:

Yes. So when we say “Connect to Care,” we mean get in to see your primary care team soon and regularly.

So who makes up your primary care team? Well that's your primary care doctor, of course, but also his or her support staff and that team includes all the people at your doctor's office who are in some way involved in your care. That can be a physician assistant, a medical assistant, the nurse, or nurse practitioner, another doctor and the front office staff.

We also consider your pharmacists to be part of the team. After all, the average SCAN member sees their pharmacists 18 times a year, which is probably a lot more than you see your doctor. So your pharmacist plays an important role on the team as well.

Maxine:

Many of the members I talk to say they only go to the doctor when they're sick. But we really want them to go when they're will too, don't we?

Sarah:

Absolutely! And here's why your primary care doctor is your central point of care even when you're very healthy. So if you have multiple medical needs or a chronic condition, you'll want to bring your new doctor up to speed and get any specialty care lined up quickly. And even if you feel great and don't have any health issues, which we hope most of you do, you should still see your doctor every year. Your doctor needs to understand what's normal for you. Also, that regular visit will help you stay on top of preventive care and screenings that we all need to stay healthy as we age. What's that saying? “An ounce of prevention is worth a pound of cure?”

Maxine:

Okay.

Doug:

You know, I'd like to point out that our members can change their doctors at any time. We want you to be comfortable with your doctor and your entire primary care team. So if your new doctor is not a good match, we will help you find one that is.

Our website has the most current information about doctors. So those of you using the web can take a look there and you can also call Member Services to make the change and to get your new ID card.

Maxine:

There are how often should we be seeing our primary care doctors?

Sarah:

Maxine, that's a good question.

The rule of thumb is to see your doctor at least once a year for routine preventive care visits. Make it early enough in the year so that you have time to schedule any follow-up care. Of, course everyone's situation is a little different but if you have an ongoing medical condition, your doctor will probably want to see you a little bit more often.

Maxine:

We have a few questions from listeners already about appointments. This one is from John and he said that he called his doctor's office a few weeks ago to schedule his annual visit and his appointment is still almost a month away. He wants to know if this sort of wait time is normal.

Sarah:

Maxine, six to eight weeks for a routine annual physical or wellness visit is normal. These tend to be longer appointments where your doctor takes a look under the hood, so to speak, and make sure that everything is running the way it should.

These appointments aren't urgent. That's why we encourage you to call now and get that appointment on the books. On the other hand, if you're feeling ill or something has started giving you trouble, then you'll need to be seen sooner. So there are those types of appointments available just for those reasons.

Make sure you're very specific when you call for an appointment so that the staff knows how to work you into the schedule. I like to think of it like servicing your car: You always want to bring your car in for routine maintenance. Right? But if something starts acting wonky, you want to take it in a little more quickly.

Maxine:

Okay. You know, I once thought I had broken my wrist. It was during office hours so I called my doctors and he said, well, come on and I'll take a look. I did and he sent me to have it X-rayed right there in the same building that same hour and it turned out to only be a sprain and I was back home. It was wonderful.

Sarah:

Well, that's good!

So it looks like we have another question, Maxine, from Marjorie. She wants to see a specialist and wonders how to go about that.

So I just want to point out that the referral process is really simple. So you always want to start with your primary care doctor. In most cases the medical group will authorize that referral and it takes about seven to 10 days, generally. So you'll receive an authorization in the mail or by phone, so generally, seven to 10 days to get a referral to a specialist is about the right amount of the right time.

Doug:

About the right time, giving of the right amount time.

Sarah:

Yeah, yeah.

Doug:

You know, I'd like to add that members should ask their doctors when they will receive the authorization. Sometimes, the doctor may have some insight into that and if you don't receive it within that time frame that Sarah mentioned, get your doctor's office on the phone to follow up. Call your doctor's office first and then if they are not able to help, then call SCAN Member Services.

Maxine:

Good to know, Doug!

Now, we have several listeners asking about urgent care, asking about urgent care centers. There are so many around – can SCAN members go to any urgent care center?

Sarah:

It does seem like there's an urgent care center on every corner these days but you need to go to the one that is affiliated with your doctor. So check with your doctor's office to get those details. Some doctors have extended office hours just for urgent care and all of them will have urgent care centers that they work with. So I recommend you find out now before you need one where to go.

Maxine:

Okay here's another question: Karen is asking how she'll know what sort of preventive care she needs.

Sarah:

Good question. Remember I said we like to communicate with our members? Well, we send reminders. So we'll start you off with something called a Health Check Record and it looks like a little checkbook. It's a booklet with a chart of recommended screenings along with some of the information we're talking about now, like referrals, when to go to urgent care, things like that.

You can expect to get those in the mail in about a month or early next March. So your doctor should let you know what care you’re due for too.

Doug:

Thanks for explaining how members can Connect to Care, Sarah. That was our first C.

Our second C is “Check Your Benefits.”

You probably know the main benefits of your SCAN coverage and it's probably one of the reasons why you joined SCAN might be your premiums, maybe the co-payments being low. I want to point out that most preventive care is covered for a zero-dollar copayment. For example, flu shots are zero dollar doesn't cost you anything.

Sarah:

That's right, Doug.

That reminds me to talk about the flu shot for a minute. It has been a rough and fierce flu season and from what I hear, it's not over yet. So I want to encourage any of our listeners who haven't gotten their flu shot this season to do so. You can get it from your primary care doctor or you can get it from a retail pharmacy.

One of the reasons I include pharmacy benefits when we talk about preventive care – or that's one of the reasons I do – but prescription drugs and taking them as prescribed is another important way people can stay healthy and keep their chronic conditions under control. But we also know that prescription drug costs can add up. So let me run down a few of our benefits that can help you save money.

We have what we call a “Preferred pharmacy network” and these are pharmacies that offer lower copayments to SCAN members – sometimes an average of $3 to $5 dollars less per prescription.

Doug:

Okay, these are the Preferred pharmacies:

• Walgreens
• Rite Aid
• Walmart
• Costco
• Ralphs
• Safeway and Albertsons

Some of those are connected together. We also have a large list of select independent pharmacies and we have our Express Scripts Home Delivery. Those are all Preferred pharmacies.

Maxine:

So basically, there are a lot of Preferred pharmacies to choose from.

Sarah:

Yes, Maxine. It's easy to switch if you want to.

Another way to save money is to do 90-day refills. So if you're taking a medication for a chronic condition, we really encourage you to “Just Say 90-Day” and get a three-month supply at one time. It's so much more convenient than going to the pharmacy every month and some SCAN plans even offer discounts on 90-day supplies.

You'll also want to check your tiers and choose generics; medications that are on Tier 1 and Tier 2 of our Formulary are the least expensive. So check to see if your medications are on those tiers. A lot of times you can talk to your doctor about what generic medications are available as well. So I see that some of those questions are coming in the queue as well.

Another thing that you can do is to sync your medications. That's not necessarily a money saver but it's very convenient if you take more than one medication. You'll just ask your pharmacist to help you synchronize or sync up your medication so you can pick up all your refills at the same time.

Doug:

That's really convenient and that's a good tip. A lot of good tips there, Sarah.

Sarah:

You can save gas going to the pharmacy.

Doug:

That's true! That saves time. Only going may be once, that's really good.

Another part of Check Your Benefits is to understand what benefits you've used. As a SCAN member, you will receive two Explanation of Benefits or what we call EOB: Explanation of Benefits. We send them out if you take any prescriptions. You'll receive a Part D EOB each month. Part D is the drug coverage. You'll get a Part D EOB each month and that lists all the prescription drugs that you filled the previous month and the Part C EOB, which is also called your monthly summary, lists the medical care and services that you received.

There are two things that you want to make note of. First of all, these EOBs, they're informational. They are not bills. They show the cost of the services you received but that's only for your information, it is not a bill. Sometimes the services listed on your monthly summary might be a couple of months old and that's because we don't always get the information right away from the vast network of doctors. If you go to the doctor once or twice a year, you'll only get a monthly summary once or twice a year. But if you're getting services throughout the year pretty regularly, you're likely to get a monthly summary every month

Maxine:

That's good to know, I've only gotten a few monthly summaries myself but I do check to make sure I actually got the services that are listed.

Doug:

You know, Maxine, that's exactly what we want you to do. If you have a question about one of the services listed – like, you don't know what it is – call your doctor's office first and they can usually answer your questions.

Maxine:

Okay, the other part of Checking Your Benefits that I really encourage you to know is what your benefits are so you can take advantage of them. For example, my SCAN plan includes free gym membership through SilverSneakers. I go to a gym called Nifty after Fifty three days a week for no-fall volleyball and it's healthy and it's fun and it's free.

Doug:

That's great!

Sarah:

That sounds great, Maxine. We think SCAN provides great values so be sure you're using it. You'll find all your benefit information spelled out in the new member packet you received soon after you joined SCAN.

Maxine:

I have to be honest I tend to put that type of information to the side when it comes in the mail. It's a little overwhelming.

Sarah:

Well, did you know that you can get a lot of your information in an email? You can go to the member page on our website and follow the directions to register an account. Our website www.scanhealthplan.com.

Maxine:

I know this is the information SCAN is required to send us, so I'd rather get it in an email than to have a big stack of paper.

Sarah:

Yes maybe save a few trees while you're at it!

Doug:

Yeah, and there are a lot of materials that Medicare says we have to send our members, including the monthly summaries, that we just talked about. But you can decide if you want them through email or a hardcopy in the mail. So if we have to send it to you, we do. But you decide how to get it.

“Call with Questions” is our third category and it's pretty self-explanatory. But have you ever called a company's customer service line and found it impossible to actually find someone to talk to?

Maxine:

Oh, yes! My internet company, my car insurance, my cell phone provider – just to name a few. I end up going around in circles pushing buttons and getting recordings and getting frustrated.

Doug:

That is crazy and that is not SCAN. We do have a recording that you'll hear at the beginning of the call but that just helps direct calls and get some of the languages were required to tell you out of the way, some of the messages that we need to give you. I can assure you: You will be connected to a member of the Member Services team, a real-live Member Service Advocate will be ready to help you.

Sarah:

That's great. Let's clarify, though, Doug: If you have questions about your healthcare, like about test results or referral information or about your medications or anything related to your health, you'll want to call your primary care team first. They're the ones that can track down those answers for you. But if you're having questions about your SCAN benefits or coverage or you're having problems with a doctor or another provider, that's when you'll contact SCAN Member Services and then we'll be able to help you with that. But you can also call or you can email. So the email address is memberservices@scanhealthplan.com.

Doug:

Nice.

Maxine:

Okay! I talk to a lot of members – all of us Advocates do – and we always get comments about how much they appreciate SCAN Member Services team. So good work!

Doug:

That is really good to hear.

Sarah:

Member Services is really terrific but nobody's perfect, not SCAN and not our medical providers. So if you ever run into an issue, call us and tell us about it and give us the opportunity to make it right.

Maxine:

It's true, Sarah. Members may think they don't want to bother us or don't think we can help but we really can.

Sarah:

With that, we've covered the three most important things that you can do to get the most out of your benefits. The Three Cs: Connect to Care, Check Your Benefits and Call with Questions.

If you've been taking notes, we've you've got a few things to do, so the first thing is to schedule your doctor's appointment if you haven't already. And you'll want to take your Health Check Record when you receive it in the mail and review any preventive tests and screenings that you might be due for. You want to find out how your doctor's office works .What are their urgent care centers? Which ones do they use? Where are they located? What do you do? What number do you call if you have a question about referrals?

You want to find all this information out from your doctor before you need it. And who do you call if you need a medication refill? So a lot of times, some groups have different services for that and make it nice and easy.

If you have a computer you'll also want to go online and sign up for your doctor's patient portal. Most of our medical groups have them and it varies but it can include information like lab results, your appointment scheduling and how to get a referral.

You'll also want to sign up for an account on the SCAN website so that you can get all of your materials at your fingertips, you'll get some reminders and messages, you can sign up for online delivery of those bulky mailings, as well as your monthly summaries will be made available online rather than sent to your home address.

Maxine:

Thank you, Sarah. So let's take a few more listener questions now. David asked, “I don't know who my primary care doctor is. How do I find out?”

Doug:

You know, most people choose a doctor when they join SCAN and they write the doctor's name on the enrollment form. But if you didn't do that, SCAN will have picked a doctor for you you'll see the doctor's name and the contact information for the doctor right there on your SCAN ID card.

Maxine:

We always get several questions about medications. This member asks, “How do I use the drug Formulary and what are the different tiers?”

Sarah:

Another good question. We use terms like Formulary and tiers and up probably a lot of other lingo too and forget that new members may not be all that familiar with them.

So the drug Formulary is the list of medications that SCAN covers. The medications are divided into different tiers, or different levels. The medications in Tiers 1 and 2, the lowest-cost drugs, account for the vast majority of the prescriptions that SCAN members take. So we try really hard to keep those commonly used medications affordable to our members. As far as how to use the Formulary, we always recommend you look up the medications you take and see which tier they fall into so you'll know what the co-payment will be ahead of time.

As a new member, I suggest you take the Formulary to your next doctor visit to make sure that your medications are on the Formulary and maybe even find a lower-cost alternative.

I saw some questions come in about how to change brand names to generic so that it can be on a lower tier. This is something you'll want to talk to your doctor about.

Maxine:

Here's an interesting question: “Why does my skin card list my doctor's name and a medical honk name?”

Sarah:

I'm glad this member asked us because our healthcare system in general can be a little bit complicated. And it gives me a chance to explain how SCAN works with our medical providers.

First thing to note is that SCAN contracts with over 40 medical groups throughout the community and each medical group has anywhere from 100 to thousands of doctors and specialists. It's important to know that your doctor works for a medical group and not directly for SCAN. So each medical group has a variety of urgent cares, clinics, health education classes and many of them have their own helpful websites as I mentioned before. So this is where you find information about doctors or even make appointments or see your lab results.

The second thing to note is that SCAN shares responsibilities related to your healthcare with the medical group. So, for example, SCAN creates the benefits – things like offering a gym membership benefit and what the copay is if you go to the emergency room. But a lot of your routine medical decisions, like what kind of medications you should take or if you need a referral to a specialist, are made by your doctor in the medical group because we think those kinds of decisions are best left to the medical experts who know your health issues and know you best.

Maxine:

That's good to know.

Doug:

Hey, Maxine, I got one from Sergio if I can take this one.

Maxine:

Alright.

Sarah:

Go ahead, Doug.

Doug:

Okay, Sergio wants to know “Why is it so difficult to get the name of an urgent care center?” And,  you know, it really isn't that difficult because we can help you out here. Members can call in to Member Services and the Member Service Advocates can look up the urgent care centers that are contracted with your medical group or provide you with the medical group's number –  or the IPA number – if there's any questions there. You know, going to your medical group first as we mentioned earlier today is the preferred way of handling it because they can steer you right to the correct urgent care center. But if you do have any issues, go ahead and call Member Services

Sarah:

Okay, well, here's an interesting question too. Isabelle has asked, “Can I go to a SCAN doctor that's not in my medical group?”

So the first answer is “No.” You want to go through your doctor in your medical group. And so you have to go to your assigned PCP and get an authorization for a specialist who is contracted with the medical group. So going to a specialist who's not in the medical group you may run the risk of paying an out-of-pocket payment or copay.

Maxine:

Okay.

Doug:

Coordinate that through the medical group.

Sarah:

Yes, and through your doctor.

Doug:

Yeah.

Maxine:

Okay here's another one about medication. “I see you're really promoting 90-day prescriptions why is that?”

Sarah:

So you've seen our 90-day information. There's a few reasons we really like 90-day, or three-month, medication refills. One, they're convenient. You only have to get your refill once every three months, like I mentioned. You're less likely to run out of your medication, which means you're more likely to take them as directed and they're often cheaper. So to find out if your medication qualifies for a 90-day refill, check the Formulary. It'll say 90-day in the chart next to the drug name.

Doug:

I want to be very clear: “90 D” means “90-day.”

Maxine:

Okay, another pharmacy-related tip is to sign up for a refill reminder program. My pharmacy calls me when my refill is ready for me to pick up. I just go down and pick it up and it was so easy.

Sarah:

Yeah, that is a really good service and if your pharmacy hasn't suggested it you should definitely ask the pharmacist if they have a refill reminder program that you can sign up for. Some pharmacies will call and leave you a message and then others will just send you a text message, which is nice and convenient too.

Doug:

I get the text; that's very, very convenient.

Maxine:

Okay, it looks like we have time for just one more question. This member is asking, “I'll be traveling next month. What happens if I get sick when I'm out of town? Am I covered?”

Doug:

That's a great question. You know, our SCAN members are covered for urgent and emergency care when they are out of the area. So depending on your benefit plan, you might also be covered anywhere in the US or have worldwide coverage. So, again, check your benefits but let me stress this coverage is not for routine preventive care. “Oh, I just want to go in and see a doctor.” No one wants to visit the doctor anyway when they're on vacation, right?

Sarah:

I don't. 

Doug:

No. So this coverage is for urgent or emergency care only.

Maxine:

That's all the questions we have time for today. If you have questions we didn't answer today or you think of something later, remember: Member Services is available until 8 p.m. tonight and over the weekend.

Doug:

You know, we had a question about this and I'll cover the best times to call. The best time to call Member Services is later in the day or in the evenings and later in the week. Monday morning is the most-busy time, as you can imagine.

The phone number for member services is on your SCAN ID card but I'll give it to you right now. It's 1-800-559-3500. And for those members that use the TTY call system, call number 711. And you can also email us at any time as Sarah had mentioned. The email address is memberservices@scanhealthplan.com.

Maxine

We also mentioned our website a few times today. It's easy to remember: scanhealthplan.com. Thank you again for joining us today and for choosing SCAN as your health plan. Bye now!

Sarah:

Bye! Thanks, everyone!

Doug:

Bye, everybody!