2004 - spring

Spring 2004

~ benefits & claims questions? my blueline, P. 18 ~~ benefits & claims questions? my blueline, P. 18 ~

from the files from the filesHEALTH

n e w s s t o r i e s f r o m a c r o s s t h e c o u n t r y

Blue & You Spring 2004

Coming Soon: health savings accountsConsumer-directed health insurance —

based on the idea that people will avoidunnecessary care if they’re required to payfor it themselves — has taken a big stepforward. When President George W. Bushrecently signed the high-profile bill adding aprescription drug benefit to Medicare lastmonth, he also authorized the creation ofhealth savings accounts (HSAs). HSAs areavailable to people under age 65 covered byhigh-deductible insurance policies. Theseaccounts allow individuals to set aside up to$2,600 per year ($5,200 for families) inuntaxed money that can be used to pay medicalexpenses. Any money that is not spent may

be carried forward indefinitely. (Arkansas BlueCross and Blue Shield and BlueAdvantageAdministrators of Arkansas will offer HSAplans later this year.)

Health care spending rises to record levelSpending for health care services and

products accounts for nearly 15 percent ofthe nation’s economy — a record level —according to the U.S. Department of Healthand Human Services. Health care spendingshot up 9.3 percent in 2002, the largestincrease in 11 years, to a total of $1.55 trillion.That represents an average of $5,440 for eachperson in the United States.

HealthConnect Blue is a new, value-added telephoneand Web-based information program. The confidentialtelephone line is staffed by Health Coaches (nurses,dietitians and respiratory therapists) who are speciallytrained to provide tools and information that teach self-management and decision-making skills, enabling you toplay a more active role in the management of your health.

As an automatic member of this program, you can:• Speak one-on-one with a Health Coach

24 hours a day, 7 days a week.• Visit the Health Advantage Web site

(www.HealthAdvantage-hmo.com) to review a healthencyclopedia containing in-depth health informationon more than 1,900 clinical topics.

Watch your Mail. Additional information will bemailed to Health Advantage member homes aroundMay 3. Stay tuned …

* Includes all Health Advantage commercial HMO membersstatewide, BlueChoice PPO, Open Access PPO andFort Smith Choice members. Does not include stateand school employees.

Your 24-hour health information resourceYour 24-hour health information resource

Coming May 3 for Health Advantage members —Coming May 3 for Health Advantage members —

If you are an Arkansas Blue Cross and Blue Shield,Health Advantage, BlueAdvantage Administrators ofArkansas or Federal Employee Program member and youare receiving services for covered benefits, be sure topresent your current health insurance ID card to thephysician, health care professional, hospital or facility atthe time of services.

If you do not present your ID card at the time ofservices, the provider may not file the claim or mayincorrectly file the claim. If the claim is not filed within180 days from the time of service, as required in yourpolicy or summary plan description, it is no longer aneligible claim and payment for services becomes yourresponsibility.

Members: Show your insurance ID cardwhen receiving health care services

*

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is published four times a year byArkansas Blue Cross and Blue Shieldfor the company’s members, healthcare professionals and otherpersons interested in health careand wellness.

Vice President of Advertising and Communications:Patrick O’Sullivan

Editor: Kelly Whitehorn — [email protected]

Designer: Gio Bruno

Contributors: Chip Bayer, Tammi Bradley, Janice Drennan,Damona Fisher and Kathy Luzietti

Customer Service Numbers

Little Rock Toll-freeCategory Number (501) Number

State/Public School Employees 378-2364 1-800-482-8416

e-mail: [email protected] [email protected]

Medi-Pak (Medicare supplement) 378-3062 1-800-338-2312

Medicare (for beneficiaries only): Part A (hospital benefits) 1-877-356-2368 Part B (physician benefits) 1-800-482-5525

UniqueCare, UniqueCare Blue, Blue Select®,BlueCare PPO & PPO Plus (individual products),BlueCare Dental 378-2010 1-800-238-8379

Group Services 378-3070 1-800-421-1112

BlueCard® 378-2127 1-800-880-0918

Federal Employee Program (FEP) 312-7931 1-800-482-6655

Health Advantage 378-2363 1-800-843-1329

BlueAdvantage Administrators 378-3600 1-800-522-9878

Pharmacy Customer Service: Arkansas Blue Cross and Blue Shield 1-800-863-5561 Health Advantage 1-800-863-5567 BlueAdvantage Administrators 1-888-293-3748 Specialty Rx 1-866-295-2779

For information about obtaining coverage, call:Little Rock Toll-free

Category Number (501) Number

Medi-Pak (Medicare supplement) 378-2937 1-800-392-2583

BasicBlue®, BlueCare PPO & PPO Plus (individual products) 378-2937 1-800-392-2583

Regional Office locations are: Central, Little Rock;Northeast, Jonesboro; Northwest, Fayetteville; South Central,Hot Springs; Southeast, Pine Bluff; Southwest, Texarkana;and West Central, Fort Smith.

Customers who live in these regions may contact the regional offices orcall the appropriate toll-free telephone numbers above.

Web sites: www.ArkansasBlueCross.comwww.HealthAdvantage-hmo.com

www.BlueAdvantageArkansas.comwww.BlueAndYouFoundationArkansas.org

www.BlueAnnEwe-ark.com

INSIDETHIS ISSUE

~Spring 2004~


From the Health files ................................... 2It’s new! HealthConnect Blue ...................... 2Member alert: show ID card ......................... 2The human life-control center .................. 4-6Myths about the brain.................................. 6Exercise your brain ...................................... 7Managing with cerebral palsy ..................... 8Early signs of multiple sclerosis .................. 9Understanding Alzheimer’s disease ...... 10-11Encephalitis and meningitis ...................... 12Facts on Parkinson’s disease .................... 13Epilepsy: disrupting brain activity ............. 14Myths about epilepsy................................. 14Stroke — what are your risks? .................. 15Preventing traumatic brain injuries ........... 16Health Advantage customer service Q&A .. 17My BlueLine at your service ...................... 18The pharmacist is in .................................. 19New pharmacy vendor, new ID cards ......... 20HEDIS survey reveals happy customers...... 20Blue & You and Web sites get high marks . 21In Memory: Louis Ramsay .......................... 22Blue & Your Community ............................. 23Blue Online ................................................ 24

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T he human central nervous system (CNS),consisting of the brain and spinal cord, distin-guishes us from other life forms. It makes ushuman. This intricate network allows us toperceive, think, respond and create.It enables us to talk, laugh, cry,love and hate.

To understand more abouthow your body works (andhow things go wrong), youneed to understand thebiology of how yourCNS works.

Neurons: Bodymessengers

The basiccomponent of theCNS is the neuron(nerve cell). The braincontains about 100 billionneurons. You are born withalmost all the neurons youwill ever have, but your braindoes continue to grow afterbirth. At age 2, you haveachieved about 80 percent ofyour total brain growth. Braindevelopment, mostly in theform of new “connections,”continues past this initialgrowth period.

Neurons are similar instructure to other body cells. Because some partsof neurons are covered by an insulating sheathcontaining myelin, a fatty substance with a whiteappearance, they are sometimes referred to as“white matter.”

Unlike other cells, neurons have extensions(fibers) called axons and dendrites. Theseextensions come into play when neurons do

something other cells don’t — they communi-cate with each other through electrochemi-cal signals. All sensations, thoughts,movements, memories and feelings are theresult of signals that pass through neurons.

Neurons rely on axons to send electri-cal signals and dendrites to receive them.

Many smaller branches, varying in length,originate from the main axon in each neuron.These small branches end at nerve terminals,where chemical messengers called neurotrans-mitters are released from tiny containerscalled vesicles.

The gap between two neurons where theinformation transfer takes place is called asynapse. An axon of one cell sends signalsacross a synapse to a dendrite of another

cell. The dendrites look like branches ofa tree, reaching out to receive signalsfrom axons. The electrical impulses

transmitted from the axons maytravel a distance of only afraction of an inch to as far asthree or more feet. Thiscommunication process is so

precise that the chemical mes-sengers (neurotransmitters) com-

municate only with the type of cell forwhich they have an exact fit, much as akey fits into a lock.

Brain: Command centerThe brain is a soft, spongy mass of

tissue, which weighs about three pounds.In addition to neurons, it containssupport cells called glia. Glia provideneurons with nourishment, protectionand structural support. The part of theskull that protects the brain is called thecranium. In addition to brain tissue, the

cranium contains three thin, covering mem-branes called meninges and a cushioning, wateryfluid called cere-brospinal fluid. This fluid flowsthrough spaces within the brain called ventricles,where it is produced.

The three major functional parts of the brainare the cerebrum, cerebellum and brain stem.

1. Cerebrum (forebrain): The largest part of thebrain, located at the top of the cranium, pro-cesses information from our senses to tell uswhat is going on and how to respond. It is thecenter for reading, thinking, learning, speechand emotions. A fissure or groove separates thecerebrum into two hemispheres, which arejoined by the corpus callosum, where a thick

Brain and spinal cord form

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tract of nerve fibers allows the two halves to communi-cate with each other. The left hemisphere is dominant forlanguage in most people. The right half helps us interpretvisual and spatial information. The left hemispherecontrols primarily theright side of the body, andthe right hemispherecontrols primarily the leftside of the body.

The cerebral hemi-spheres are furtherdivided into four lobes bysulci (grooves) and gyri(bumps), resulting in afolded look.

The four lobes thatappear in each hemi-sphere and theirfunctions are:• Frontal: reasoning,

planning, movement,emotions and problem-solving;

• Parietal: perception of stimuli related to touch,pressure, temperature, taste, smell and pain;

• Temporal: hearing, memory (hippocampus), speechand language;

• Occipital: associated with vision. The occipital lobesprocess images from the eyes, linking those withimages stored in memory.

2. Cerebellum: Located under the cerebrum at the backof the brain, the cerebellum controls balance and com-plex actions such as walking and talking.

3. Brain stem: Connecting the brain with the spinal cord,the brain stem controls hunger and thirst, breathing,body temperature, blood pressure and other basic bodyfunctions. The brain stem consists of the midbrain, ponsand medulla oblongata. The midbrain is responsibleprimarily for eye movement. The pons relays messagesbetween the higher regions of the brain and the cerebel-lum. The medulla oblongata controls involuntary func-tions, such as breathing, blood pressure and swallowing.A layer of gray tissue about the thickness of a stack oftwo or three dimes coats the surface of the cerebrum andcerebellum. From the Latin word for bark, this layer iscalled the cortex and is often referred to as “gray matter.”The folds of the brain increase the amount of gray matter

that can fit into the protective skull. If unfolded, thetotal surface area of the cerebral cortex would be about324 square inches or about the size of a full-size news-paper page.

Deep within thebrain are other smallbut important structuresthat come in pairs, withone on each side of thebrain. The hypothala-mus, about the size of apearl, sends messagesto the pituitary gland,which controls hor-monal functions. Thehypothalamus alsoreceives informationfrom the autonomicnervous system. Behav-ior related to eating,sex, sleeping and

emotions are affected by the hypothalamus. It alsoregulates body temperature.

The thalamus serves as a relay station for informa-tion going to and coming from the cerebral cortex.Pain sensation, attention and alertness are affected bythe thalamus.

Spinal cord: Vital communicationThe spinal cord, an extension of the brain, coordi-

nates movement and sensation. It contains neurons,supporting cells and long nerve fibers (axons) that run toand from the brain. Many of the axons are covered withinsulating myelin. The center of the spinal cord, with abutterfly shape, houses the neurons, which along withtheir branch-like dendrites, make up the “gray matter.”Like the brain, the spinal cord is surrounded by cere-brospinal fluid and covered with meninges.

The spinal cord has 31 segments. A pair of spinalnerves, which connect to specific parts of the body, exitfrom each segment. Higher segments controlmovement and sensation in upperparts of the body, and lower seg-ments control lower parts of thebody. The back bone (vertebralcolumn) protects the segmentedspinal cord, which is much shorter

Cerebral Cortex(Cerebrum)

Pons

Medulla

Cerebellum

Midbrain

MRI picture ofthe human brain

human life-control center

(Brain, continued on Page 6)

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MYTH: Most people only use 10 percent of their brain.FACT: There is no evidence to suggest that people onlyuse 10 percent of their brain. That is false; a myth.People use all of their brain.

MYTH: Men have bigger brains than women, and thatmeans they are smarter.FACT: Although men may have bigger brains, it isbecause they are usually bigger in overall body size,giving them larger skulls. It doesn’t make them smarter.

MYTH: Women are better in certain language abilitiesand men are better in certain spatial abilities.FACT: Research has found very few meaningfuldifferences within the brains of men and women.

MYTH: Adults cannot learn certain skills after childhood.FACT: There are certain prime times in developmentwhen learning is easier. Learning may be moredifficult when the prime times have passed, but it canstill happen.

MYTH: Children need specialhelp and expensive toys todevelop their brain power.FACT: What children need mostare loving care and new experiences.

MYTH: Everyone’s memory fades as theyget older.FACT: Studies show that memory loss is not a normalpart of aging. Keeping your mind active is the keyingredient to maintaining brain function.

MYTH: Dietary supplements such as gingko biloba andvitamins can improve memory.FACT: Although gingko has been shown to increaseblood circulation, which in turn has been shown to aidbrain function, the exact role of using gingko beyondsome placebo effects is not known.

MYTH: Television stunts the growth of the brain. It zapsa child’s brain waves.FACT: Brainwave patterns during television viewing aresimilar to brain activity during other activities.

— Sources: National Institutes of Health,www.executiveparent.com, http://faculty.washington.edu/chudler/neurok.html — Neuroscience for Kids, and TheSmart Parent’s Guide to Kids TV by Milton Chen, Ph.D.

than the back bone itself. The spinal cord functions as the main pathway for information connecting the brain and peripheral nervous system. The

peripheral nervous system sends messages to skeletalmuscles, internal organs, glands and the gastrointestinaltract. All the messages going from the brain to the limbstravel through the spinal cord. Bladder functions, sensoryfunctions and movement all are dependent on informa-tion traveling up and down the spinal cord.

Neuroscience: Understanding this complex systemThe study of the nervous system is called neuro-

science. Because of the accelerating pace of research anddevelopment ofnew techniquesin recent years,neuroscientistshave learnedmore about thebrain in thepast 10 yearsthan in allpreviouscenturies.Understanding the nervous system is critical becauseabout 50 million people in the United States alone sufferfrom some form of damage to the nervous system. Themore we know about the brain and spinal cord, the morewe can help people who endure often devastatingphysical and mental illnesses and disability related to thenervous system. A healthy nervous system enables themiracle of life.

— Sources: “Anatomy of the Brain,” Health Resources:Neurosurgery://On-Call®, American Association of Neuro-logical Surgeons and Congress of Neurological Surgeons;“Anatomy of the Spine,” Health Resources: Neurosurgery://On-Call®, American Association of Neurological Surgeonsand Congress of Neurological Surgeons; “Brain Basics:Know Your Brain,” National Institute of NeurologicalDisorders and Stroke; “Brain Facts, A Primer on the Brainand Nervous System,” Society for Neuroscience;“Neuroscience for Kids,” University of Washington,

Seattle, Eric Chudler, Ph.D.; “Spinal CordInjury: Emerging Concepts,” National

Institute of Neurological Disordersand Stroke; and “What You Needto Know AboutTM Brain Tumors,”Cancer.gov, National CancerInstitute

(Brain, continued from Page 5) Myths aboutthe brain

Myths aboutthe brain

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In a classic Charles Atlas advertisement, featured incountless comic books and magazines, a beach bullykicks sand in the face of a “97-pound weakling” namedMac and yells, “Hey, skinny” in front of his girlfriend.Mac orders Charles Atlas’ workout program through themail, bulks up, and returns to the beach for a littlepayback. Being publicly humiliated on the beach,according to the ad, was the “insult that made a man outof Mac.” And, of course, his girlfriend swooned.

It may not be the case that members of the scienceclub have ridiculed you for not being able to articulateEinstein’s theory of relativity. You may have never hadEnglish Lit majors kick manuscripts of Shakespeare inyour face. But you may have been asked a question andfound the answer right on the “tip of your tongue.”Perhaps you’ve wasted time searching for a misplaceditem that you know you had right in your hand onlymoments ago. You probably are not the intellectualequivalent of the “97-pound weakling,” but perhaps youwould benefit from a little cerebral “beefing-up.”

While it has long been known that physical activityand exercise will strengthen muscles, it is only with morerecent studies that the same can be said of the brain.While it is not a muscle, the brain can benefit greatlyfrom increased use. In the same way aerobic exercise willstrengthen a person’s heart and lungs, “neurobic”exercise (using one’s brain in challenging new ways) will

strengthen the branches ofnerve cells responsible forreceiving and processinginformation. Unfortunately,the converse also is true.

According to a reportin the New EnglandJournal of Medicine, if youdo not use your mindregularly throughactivities like reading,

playing cards, doing puzzles, playing musicalinstruments and the like, you risk losing some of yourcognitive abilities as you get older. The old adage “use itor lose it,” long attributed to your muscles, now isapplicable to your mind as well.

Studies have shown that middle-age people whoregularly used their brains in games of logic andreasoning maintained better short-term memory, mathskills and verbal skills than those who did not. These

The intellectual equivalentof the “97-pound weakling”

types of activities keep the connections in thebrain strong.

Research has shown that the reason many peoplehave an answer right on the “tip of their tongue” is notbecause the information is missing in their brain. It isstored there just fine. The reason is the connectionsbetween brain cells that create the path to get thatinformation are weak. The path is not one well traveled.Working out our brains can keep those connectionsstrong and those paths fresh.

A variety of activities can be considered “neurobic”in nature, and performing just a few of these on a dailybasis can keep yourmind sharp.Researchersrecommend playingboard games,reading, doingcrossword puzzlesand writing forpleasure as ways ofpumping up the old graymatter. For a more vigorous workout, try learning a newlanguage or writing with the wrong hand.

In order to be considered “neurobic,” an exerciseshould contain one or more of the following aspects:1. Involve one or more of your senses in a manner out of

the ordinary for you.2. The activity should engage your attention.3. The activity should break your normal routine in an

unexpected way.A lifestyle that includes “neurobic” exercise will

provide you with a sharper mind and the ability to focusbetter. It also can reduce the risk of Alzheimer’s anddementia later in life. It probably won’t help you looklike the people in the Charles Atlas ad, but a steadyregimen of neurobics can help you staymentally “buff.”

— Sources: Popular ScienceMagazine, National Instituteon Aging, http://www.meridianhealth.com,American PsychologicalAssociation, http://www.neurobics.com

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Although cerebral palsy cannot be cured, those withthe chronic disorder can enjoy near-normal lives if theirneurological problems are properly managed.

Cerebral palsy is an “umbrella” term used to describea group of chronic disorders that impact the brain’scontrol of body movement. Thedisorder usually appears earlyin life and does not worsenwith time. The disorders arecaused by a problem in thedevelopment of (or by damageto) the motor areas of thebrain. These problems ordamage disrupt the brain’sability to control posture andmovement. Symptoms includedifficulty with fine motor skills(such as writing or usingscissors), and difficultywalking and maintainingbalance. These disorders alsomay cause involuntary bodymovements. Some people withcerebral palsy also may haveother medical complicationssuch as seizures or mentalimpairment.

However, having cerebralpalsy doesn’t mean a personcannot have a normal life; itisn’t always a profoundhandicap.

Early signs of the disorder usually appear before 3years of age. Babies with cerebral palsy may developmore slowly than others their age; they are frequentlyslow to reach development milestones such as learningto roll over, sit up, crawl, smile or walk. Cerebral palsymay be congenital or acquired after birth.

Several of the causes of cerebral palsy (identifiedthrough research) are preventable and/or

treatable: head injury, jaundice, Rhincompatibility and Germanmeasles (rubella).

Doctors can diagnose cerebralpalsy by testing motor skills andreflexes, reviewing the patient’s

medical history and employing a

variety of specialized tests. And, although the symptomsof cerebral palsy may change over time, the disease isnot progressive. If a patient shows increasing problemsor impairments, the problem may be something otherthan cerebral palsy.

Treatment optionsThere is no standard

treatment for everyone withcerebral palsy. Drugs may beused to control seizures andmuscle spasms, and specialbraces may be worn to helppatients control muscleimbalance. Other helpfultherapies may include surgery,mechanical aids to helpovercome impairments, andspeech, physical andoccupational therapy. There isno cure for cerebral palsy atthis time.

ResearchResearch suggests that one

of the causes of cerebral palsyis the result of incorrect celldevelopment early inpregnancy. Researchers alsoare studying how other events,such as bleeding in the brain,seizures, breathing andcirculation problems, and low-

birth weight affect the brain of a newborn baby.Although a diagnosis of cerebral palsy in their young

child may be startling or upsetting for parents, parentscan learn to cope with the situation. A 1997 study inNorth Carolina by researchers at Wake Forest Universityfound that 90 percent of parents who have children withcerebral palsy reported that learning to manage theirchild’s disabilities increased their own self esteem, and itbrought the family closer together.

— Sources: United Cerebral Palsy (UCP National) andNational Institutes of Health

Near-normal lives enjoyedby those with cerebral palsy

Near-normal lives enjoyedby those with cerebral palsy

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Currently in the United States, there are350,000 to 500,00 people who have beendiagnosed with multiple sclerosis (MS). It ismore common in men than women andappears more frequently in whites thanminority groups. Approximately 90 percent ofMS patients are diagnosed between the agesof 16 and 60, but it can be diagnosed in earlychildhood or after age 60.

Although a diagnosis of MS may soundforeboding, there are treatment options with earlydiagnosis, and most patients live full lives after adiagnosis. The vast majority of MS patients are mildlyaffected, but in the worst cases, MS can cause a personto be unable to write, speak or walk.

SymptomsThe most common symptoms of MS include fatigue,

weakness, spasticity, balance problems, bladder andbowel problems, numbness, vision loss, tremors andvertigo. MS patients may not experience all symptoms,

and symptoms may be constant or may ceaseoccasionally. Although there is no cure for MS, mostpeople with MS have a normal life expectancy and aregainfully employed. MS is not contagious or fatal.

What is MS?MS is a chronic disease usually diagnosed in young

adults. During an MS attack, inflammation occurs inareas of the white matter of the central nervous system(nerve fibers that are at the site of MS lesions) in randompatches called plaques. This process is followed bydestruction of myelin, which insulates nerve cell fibers inthe brain and the spinal cord. Myelin assists in thesmooth, high-speed transmission of electrochemicalmessages between the brain, spinal cord and the rest ofthe body. The destruction of myelin disrupts nervecommunication. As a result, a person with MSexperiences varying degrees of neurological impairment.MS is an “autoimmune” disease, in which, for unknownreasons, the body’s immune system begins to attacknormal body tissue.

Diagnosis of MSThe diagnosis of MS usually emerges after

discussions between the physician andthe patient, and after a careful medicalhistory has been taken. Symptoms andsigns are reviewed and other illnessesmust be ruled out. Sometimes thediagnosis is obvious, and sometimes it maybe more difficult. The physician must be ableto find neurological evidence of lesions orplaques in the central nervous system. Forsome patients, no tests beyond medical

history and neurologic exam are necessary to diagnose.

Causes of MSA specific cause of MS has not been determined, but

several theories are now considered plausible. Somestudies suggest that viruses, environmental factors orgenetic factors (such as susceptibility to autoimmunediseases) may play a role in the development of MS.

MS TreatmentsThe earlier a person receives treatment for MS the

better. Early treatment seems to delay disability by

decreasing the injuries to the nervous system. Treatmentoptions usually include prescription medications andalternative healing remedies. It is up to the patient andthe physician to create the appropriate treatment. Also,remember that a well-balanced diet is vital to treatmentplans to reduce complications from MS.

ResearchScientists are looking into the body’s own immune

system, infectious agents and genetics as possible culpritsbehind MS. Studies have shown that MS has no adverseeffects on the course of pregnancy, labor or delivery.

As with all disorders and diseases, an early diagnosisis beneficial. Regular check-ups and opencommunication with theirphysicians are important for allpatients, including those with adiagnosis of MS.

— Sources: Multiple SclerosisFoundation and TheNational Institute of Neuro-logical Disorders and Stroke

Fatigue, weakness, vision loss:

Early signs of MSFatigue, weakness, vision loss:

Early signs of MS

UNDERSTANDING

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In a normal day, any of us can forget anotherperson’s name, where we left our wallet, the item wewent into the other room to get, the right word to say oreven how to do a simple math problem. For most of us,it’s a temporary condition. But for an estimated 4.5million Americans with Alzheimer’s disease (pronouncedAHLZ-hi-merz), it is a way of life that becomes progres-sively worse.

Alzheimer’s disease is one of several disorders thatcause the gradual loss of brain cells. German physicianDr. Alois Alzheimer first described the disease in 1906.Once considered rare, research has shown thatAlzheimer’s disease now is the leading cause of dementia.

Dementia is an umbrella term for several symptomsrelated to a decline in thinking skills, according to theAlzheimer’s Association. Common symptoms include agradual loss of memory, problems with reasoning orjudgment, disorientation, difficulty in learning, loss oflanguage skills, and decline in the ability to performroutine tasks.

People with dementia also experience changes intheir personalities and behavioral problems, such asagitation, anxiety, delusions (believing in a reality thatdoes not exist), and hallucinations (seeing things that donot exist).

Several disorders that are similar to Alzheimer’sdisease can cause dementia. These include fronto-temporal dementia, dementia with Lewy bodies,Parkinson’s disease, Creutzfeldt-Jakob disease andHuntington’s disease. All of these disorders involvedisease processes that destroy brain cells. Vasculardementia is a disorder caused by the disruption of blood

flow to the brain. This may be theresult of a massive stroke or several

tiny strokes.Some treatable conditions —

such as depression, drug interac-tions and thyroid problems — can

cause dementia, but the effects canbe reversed.

UNDERSTANDING

Progression of Alzheimer’s diseaseAs with many diseases, Alzheimer’s disease ad-

vances at different rates with different people. The areasof the brain that control memory and thinking skills areaffected first, but as the disease progresses, cells die inother regions of the brain. Eventually, the person withAlzheimer’s will require complete care. If the individualhas no other serious illness, the loss of brain functionitself will cause death.

Causes and Risk FactorsMost researchers agree that the

cause of Alzheimer’s disease may bea complex set of factors, but no oneknows exactly what causes it.

There are two abnormal structures in the brainassociated with Alzheimer’s disease — amyloid plaques(clumps of protein fragments that accumulate outside ofcells), and neurofibrillary tangles (clumps of alteredproteins inside cells). Scientists have not determinedexactly what role plaques and tangles play in the diseaseprocess and whether they are key factors, but they mayprovide clues about why cells die.

The greatest known risk for developing Alzheimer’sis increasing age. As many as 10 percent of all people 65years of age and older have Alzheimer’s. As many as 50percent of all people 85 and older have the disease.Family history of the disease is another known risk. Inaddition, scientists have identified three genes thatcause rare, inherited forms of the disease that tend tooccur before age 65, and have identified one gene thatraises the risk of the more common form of Alzheimer’sthat affects older people.

Much dementia research has focused on vascularrisk factors, which are factors related to the bloodcirculation system. A great deal of evidence shows thatdisorders such as high cholesterol and high bloodpressure — factors that cause strokes and heart disease— also may increase the risk for developing Alzheimer’s.

ALZHEIMER’S DISEASE

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Ten Warning SignsSome change in memory is normal as we grow older,

but the symptoms of Alzheimer’s disease are more thansimple lapses in memory. People with Alzheimer’sexperience difficulties communicating, learning, thinkingand reasoning — problems severe enough to have animpact on an individual’s work, social activities andfamily life. The Alzheimer’s Association has developed achecklist of common symptoms:1. Memory loss.2. Difficulty performing familiar tasks.3. Problems with language.4. Disorientation to time and place.5. Poor or decreased judgment.6. Problems with abstract thinking.7. Misplacing things.8. Changes in mood or behavior.9. Changes in personality.10. Loss of initiative.

Early diagnosis of Alzheimer’s disease or otherdisorders causing dementia is an important step ingetting appropriate treatment, care and support services.Should you recognize any of the signs in yourself or aloved one, please consult a physician.

Stages of Alzheimer’s DiseaseExperts have documented common patterns of

symptom progression that occur in many individualswith Alzheimer’s disease and have developed a GlobalDeterioration Scale to use as a framework for determin-ing the progression of Alzheimer’s disease. Stagingsystems provide useful frames of reference for under-standing how the disease may unfold and for makingfuture plans, but it is important to note that these areartificial benchmarks in a process that varies from oneperson to another.

Stage 1 — No cognitive impairmentStage 2 — Very mild cognitive decline

Stage 3 — Mild cognitive decline(Early-stage Alzheimer’s disease can be diagnosed insome but not all people)Stage 4 — Moderate cognitive decline(Mild or early-stage Alzheimer’s disease)Stage 5 — Moderately severe cognitive decline(Moderate or mid-stage Alzheimer’s disease)Stage 6 — Severe cognitive decline(Moderately severe or mid-stage Alzheimer’s disease)Stage 7 — Very severe cognitive decline(Severe or late-stage Alzheimer’s disease)

Not everyone will experience every symptom andsymptoms may occur at different times in differentindividuals. Progression of symptoms generally corre-sponds to the underlying nerve cell degeneration thatoccurs in Alzheimer’s disease. Nerve cell damage usuallybegins with cells involved in learning and memory, andgradually spreads to cells that control every aspect ofthinking, judgment and behavior. The damage eventuallyaffects cells that control and coordinate movement.

People with Alzheimer’s live an average of 8 yearsafter diagnosis but may survive from 3 to 20 years.

There is no cure for Alzheimer’s disease; however,there are several drug treatments that may improve orstabilize symptoms and several care strategies andactivities that may minimize or prevent behavioralproblems.

The Alzheimer’s Association believes that it isessential for people with dementia and their families toreceive information, care and support as early as pos-sible. For more information about Alzheimer’s diseaseand support for families, visit its Website at www.alz.org.

— Sources: Alzheimer’s Associa-tion; www.alz.org; Alzheimer’sDisease Education and ReferralCenter (a service of the NationalInstitute on Aging)

ALZHEIMER’S DISEASE

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Encephalitis and meningitis are inflammatorydiseases of the brain and the membranes that surroundthe brain and are caused by bacterial or viral infections.While very similar in symptoms and causes, encephalitisand meningitis are two different diseases.

Encephalitis, which means literally “inflammation of thebrain,” is severe and potentially life threatening. It iscategorized in two ways, according to how infectionreaches the brain.1. Primary encephalitis is when a virus directly invades

the brain and spinal cord.2. Secondary encephalitis is

when a virus first attacksanother part of the body andthen enters the brain.

The primary form of thedisease is more serious, but thesecondary version is morecommon. Some instances whereencephalitis may occur as asecondary infection includeoccurrences after childhooddiseases like measles, mumps andrubella. A much more common cause of encephalitisresults from viruses transmitted by mosquitoesand ticks.

In the United States, there are five primary forms ofthis type of encephalitis:

1. Eastern equine encephalitis2. Western equine encephalitis3. St. Louis encephalitis4. La Crosse encephalitis5. West Nile encephalitis

Most people infected with viral encephalitis haveonly mild symptoms; however, more serious cases caninclude drowsiness, confusion, seizures, sudden fever,severe headache, nausea, vomiting, convulsions, stiffneck and a bulging in the soft spot of the skull in infants.The disease also is more likely to strike young children or

older adults. It typically will be worse inpeople with weakened immune

systems as a result of other healthproblems.

Experts encourage everyone toseek professional medical help

immediately if symptoms of themore severe condition develop.

Meningitis, while similar toencephalitis, is actually aninflammation of themembranes (meninges) andfluid (cerebrospinal fluid)surrounding the brain and spinal cord. In the UnitedStates, approximately 300 people die of meningococcalmeningitis. Most of these cases occur in children underthe age of 5.

Meningitis is most often caused by a bacteria orvirus. The bacterial form of the disease is typically muchworse than the viral form. It usually develops as a resultof an infection in some other part of the body thattraveled to the brain through the bloodstream. Butbacteria also can spread directly to the brain as a resultof a severe head injury or from an infection in the nose,ears or teeth.

The symptoms of meningitis are similar to those ofthe flu and can be mistaken for the flu. But meningitiscan be fatal within a matter of hours, so paying closeattention to symptoms is vital. Symptoms of meningitisinclude a high fever that prevents you from eating ordrinking, severe headache, vomiting, confusion, seizures,drowsiness, stiff neck, a skin rash (especially near thearmpits or on hands and feet), rapid progression of smallhemorrhages under the skin and a sensitivity to light.

As the disease progresses, the brain swells and maybegin to bleed. The disease is fatal in about 10 percent ofcases. In many other cases it can cause serious long-termcomplications like deafness, blindness and loss of speech.

While the disease is most common in children underthe age of 5, it is becoming increasingly common inyoung people between the ages of 18 and 24. Collegestudents living in dormitories, personnel on militarybases and children in daycare centers are at an increasedrisk of infection.

Treatments for encephalitis and meningitis includethe prescribing of antibiotics for bacterial infections andcorticosteroids for swelling and inflammation. Over-the-counter drugs are often used for pain and fever. Peoplewith encephalitis or bacterial meningitis are oftenhospitalized for treatment.

— Sources: National Institute of Neurological Disordersand Stroke, http://www.mayoclinic.com, http://www.neurologychannel.com and National MeningitisAssociation

Potentially deadly diseases attack the brain and spinal cordPotentially deadly diseases attack the brain and spinal cord

13


Parkinson’s disease is a chronic neurologicalcondition. It is a progressive disease that affects a smallarea of cells in the midbrain known as the substantianigra, where dopamine is produced. Dopamine is achemical messenger, or neurotransmitter, that the brainuses to help direct and control movement. This decreasein dopamine can produce one or more of the classic signsof Parkinson’s disease including resting tremor on oneside of the body, slowness of movement, stiffness of

limbs and gait or balanceproblems.

Although the involun-tary shaking that is oftenseen in patients whodevelop resting tremors isupsetting (because it isvisible to others), thissymptom rarely leads toserious disability. And, infact, 25 percent ofParkinson’s patients do notdevelop tremors.

Other symptoms ofParkinson’s, which vary

greatly from person to person, may include:• Small cramped handwriting.• Lack of arm swing on the affected side.• Decreased facial expression.• Lowered voice volume.• Feelings of depression or anxiety.• Episodes of feeling “stuck in place” when initiating a

step ... called “freezing.”• Slight foot drag on the affected side.• Increase in dandruff or oily skin.• Less frequent blinking and swallowing.

It is estimated that up to 1.5 million Americans (onein every 100 people age 65 and older) are affected byParkinson’s. However, the cause of this condition still is amystery. Most people who develop symptoms of primaryParkinson’s have “idiopathic” Parkinson’s disease(idiopathic meaning that the exact cause is unknown).

Some people who have Parkinson’s may attempt tolink the onset of their symptoms with some acutetrauma, such as an accident, surgery or extreme emo-tional distress. But most neurologists discount any directlink; a traumatic event might trigger symptoms beforethey would otherwise manifest; however, this should not

be confused with actually causing Parkinson’s. After all,not everyone who experiences these traumatic eventsdevelops a movement disorder such as Parkinson’s.

While there is, as yet, no cure for this condition,progressive treatments, including medication, diet andexercise allow many patients to maintain a high level offunction throughout their lifetimes. It is vital to notethat Parkinson’s disease is not a fatal illness.

If you are a patient with Parkinson’s, some othersuggestions to help manage and control the diseaseinclude:1. Consciously lift your feet to avoid shuffling and falling

due to the slight foot drag common to Parkinson’s.2. Avoid prolonged standing with your feet too close

together because this increases the risk for falls.3. Avoid the instinctive “pivot” maneuver; instead,

practice reversing your directionby using a forward-facing wideU-turn pattern.

4. Is balance a problem for you?Learn to use a single point canewith a large rubber tip. It takespractice to use a cane with ease,but be persistent; once mas-tered, the classic “walkingstick” is portable, affordableand invaluable.

5. If your feet feel frozen or “gluedto the floor” when initiatingmovement, practice thesephysical strategies to help breakthe pattern: Step over an actual or imaginary obstaclethat is in your way to continue forward motion, androck from side to side to help break the sense of being“stuck in place.” Understand that it is not helpful foryour companion to pull you forward or urge you to“hurry up” because this will often prolong thefreezing episode.

6. Never carry objects in bothhands while walking becausethis affects your ability tomaintain your balance.

— Sources: The NationalParkinson Foundation, Inc.,Parkinsonscare.com andWebMD.com

Get the facts onParkinson’s Disease

Get the facts onParkinson’s Disease

14


Epilepsy is a neurological condition in whichgroups of brain cells, called neurons, sometimessignal abnormally. In epilepsy, also known asseizure disorder, the normal pattern ofneurological activity is disrupted bya sudden surge of electricalactivity resulting in strangesensations, emotions, behaviorand sometimes in seizures.

Seizures are not a disease, butrather a symptom of some otherdisorder. They can take a number of formsbut typically include the stiffening andjerking of the arms and legs, slurred speech,facial distortions, falling, rapid blinking and even lossof consciousness.

Having a seizure does not necessarily indicate thepresence of epilepsy. Only when a person has had two ormore seizures is he or she considered to have epilepsy. Inmost cases, the cause for the development of thecondition is completely unknown.

However, there are certain factors that can make aperson more at risk for having epilepsy. Some of theseinclude brain tumors, abnormal collections of bloodvessels in the brain, bleeding in the brain or lack ofoxygen or blood flow to the brain. Other factors, likebrain infections, cerebral palsy, Alzheimer’s disease,stroke resulting from blockage of arteries or veins,alcohol abuse or the use of illegal drugs, make it morelikely a person will develop the condition.

A family history of epilepsy also can increase the riskthat a person will develop the condition. This isparticularly true if the types of seizures experiencedoriginate in both sides of the brain at once rather than ifthe seizure begins in a limited portion of the brain.Even so, heredity only slightly raises the risk ofdeveloping epilepsy.

Regardless of the cause, once a doctor has diagnosedepilepsy, it is important to begin treatment immediately.

For approximately 80 percent of people withepilepsy, the seizures can be

effectively controlled with medicineor surgery. Two-thirds of thosewith the condition, wheneffectively treated, can stay free ofseizures for up to five years. Many

may never experience seizures again.

The longer a person goes withouthaving a seizure the greater the chances

that he or she will not have anotherone. Many children diagnosed with

epilepsy will outgrow the conditionwhen they reach adulthood.

Scientists continue to studythe benefits of drugs for enhancing

the treatment of epilepsy. Researchcontinues on how neurotransmitters in the

brain interact with brain cells. This is providingvaluable insight into the prevention of seizures.

The bad news is that more than 1.5 millionAmericans have suffered from epilepsy in the past fiveyears. The good news is that with ongoing research andthe improvements in available treatments, most of themare leading outwardly normal lives.

Myths about epilepsy

Hippocrates, the famous Greek doctor, recognized along time ago that epilepsy is a brain disorder and wrotea book about it. His book, entitled “On the SacredDisease,” refuted a number of myths about epilepsy,including the ideas that epilepsy was a curse from thegods or that people with the disorder were prophets. Butmyths have always abounded about epilepsy andcontinue even today. Here are some more common mythsabout epilepsy:• People with epilepsy are brain damaged. They

are not.• People with epilepsy are mentally handicapped.

They are not.• People with epilepsy are violent or crazy. They

are not.• Seizures cause brain damage. They may be a result of

brain damage but don’t usually cause it.• Epilepsy is inherited. Having a family history of

epilepsy may increase the risk of developing thecondition but only slightly.

• Epilepsy is a life-long disorder. Most people withepilepsy require medication for only a small portion oftheir lives.

Epilepsy: a disruption of

normal brain activity

— Sources: National Institute of Neurological Disordersand Stroke, http://www.epilepsy.com

15


Stroke, or cerebrovasculardisease, is the third leading cause of

death and disability in the United States, behind diseasesof the heart and cancer. Stroke strikes about 700,000Americans each year, but the vast majority of peoplesurvive. It is estimated that someone in the United Stateshas a stroke every 45 seconds.

A stroke occurs when a blood vessel (artery) thatsupplies blood to the brain bursts or is blocked by ablood clot. Within minutes, the nerve cells in that area ofthe brain become damaged and die. Because of this, thepart of the body controlled by the damaged section of thebrain cannot function properly. One type of stroke isischemic stroke, and it is caused by a blocked or nar-rowed artery. Another, hemorrhagic stroke, occurs whenan artery in the brain leaks or bursts and causes bleedinginside the brain tissue or near the surface of the brain.

The symptoms of a stroke begin suddenly andinclude numbness and weakness or paralysis of the face,arm or leg (especially on one side of the body). Othersymptoms include:• Difficulty seeing in one or both eyes, for instance,

dimness, blurring, double vision or loss of vision.• Confusion, trouble speaking or understanding.• Difficulty walking, dizziness, loss of balance or

coordination.• Severe headache with no known cause.

If you have symptoms of a stroke, seek emergencycare, just as if you were having a heart attack. Thesooner you seek medical care after symptoms are no-ticed, fewer brain cells are likely to be permanentlydamaged.

The major risk factors for stroke are tobacco use anduncontrolled hypertension. Preventing stroke and con-trolling its risk factors are fundamental to reducinghealth care costs and improving the quality of life amongolder Americans. The good news is that while there aresome risk factors for stroke you cannot prevent, there aresome that you can.

Those risk factors you cannot change include your age,race, gender, family history and any prior history ofstroke or transient ischemic attack (TIA), often calledmini-strokes.

The risk for stroke increases with age, and riskdoubles every 10 years after age 55. At least 66 percent ofall people who have a stroke are age 65 or older.

African-Americans and Hispanics are at a higher riskfor stroke than people of other races. In comparison toCaucasians, young African-Americans have twice to threetimes the risk of ischemic stroke, and African-Americanmen and women are more likely to die from stroke.• Gender is a risk factor that you cannot change. Stroke

is more common in men than women until age 75,then more women than men have strokes. At all ages,more women than men die of stroke.

• The risk for stroke is greater if you have a familyhistory (parent, brother or sister) of stroke or TIA.

• Your risk for stroke alsoincreases if you have aprior history of stroke orTIA, which is a tempo-rary interruption of theblood flow to an area ofthe brain. The symptomsare like those of a stroke,however, unlike a stroke,a TIA does not causelasting symptoms.Symptoms usually goaway after 10 to 20minutes, but they canlast up to 24 hours.

Controllable risk factors include high blood pressure,diabetes and high cholesterol.

Lifestyle choices are perhaps the most controllable ofall stroke risk factors. Smoking and secondhand smokeincrease your chances of having a stroke, as does lack ofphysical activity and obesity.

Certain diseases — lupus, peripheral vasculardisease, syphilis, hemophilia, pneumonia and periodon-tal disease — increase the risk for stroke. By controllingthe disease, you lower the risk.

If you experience symptoms of a stroke, do not takea “wait and see” approach. Emergency medical care iscritical to prevent or treat any possible life-threateningcomplications. Immediate treatmentmay prevent extensive damage tothe brain and decrease permanentdisabilities from the stroke.

— Sources: http://www.cdc.gov/cvh/fs-stroke.htm and WebMD.com

Stroke — What are your risks?

16


Each year in the United States, approximately 1.5million people sustain a traumatic brain injury — that’seight times the number of people diagnosed with breastcancer each year and 34 times the number of new casesof HIV/AIDS.

A traumatic brain injury — usually a jolt or blow tothe head — can disrupt the normal function of the brainand can range from mild to severe. A mild injury may bea brief change in mental status or consciousness, while asevere injury may result in extended unconsciousness(30 minutes or more), prolonged amnesia or braindamage resulting in short- or long-term disabilities.

The physical, behavioral or mental changes that mayresult from head trauma depend on the areas of the brainthat are damaged. Most traumatic brain injuries causefocal brain damage (damage to a small area of the brain).The focal damage is usually at the point of impact —where the head hits an object or where an object entersthe brain. In addition to focal brain damage, closed headinjuries frequently cause diffuse brain damage, ordamage to several areas of the brain. The diffuse damageoccurs when the impact of the injury causes the brain tomove back and forth against the skull. The frontal andtemporal lobes of the brain and the major speech andlanguage areas usually receive the most damage. Otherproblems that may occur with a head injury includedifficulty swallowing and walking, as well as changes inthe ability to smell and in the memory and cognitive (orthinking) skills.

Approximately 50,000 people die each year from atraumatic brain injury, and each year 80,000 to 90,000people experience the beginnings of long-term or lifelongdisabilities associated with a traumatic brain injury.Among children from birth to age 14, traumatic braininjury results in an estimated 3,000 deaths, 29,000hospitalizations and 400,000 emergency room visits. Inthe United States, the total cost of traumatic brain injuryis an estimated $37.8 billion each year.

Based on statistics from the Centers for DiseaseControl and Prevention (CDC) for 2000,

Arkansas ranked 44th in the rate (per100,000 people) of fatalities fromtraumatic brain injury whencompared to all other U.S. states.Massachusetts ranked first withthe lowest rate of fatal injuries

from brain trauma, while Wyoming

had the highest rate.According to the CDC, inArkansas in 2000 therewere 750 fatalitiesresulting from traumaticbrain injury, 2,878 peoplewere hospitalized as aresult of brain trauma,and 1,019 people weredisabled from abrain injury.

The leading causes of traumatic brain injuries areauto accidents, firearms and falls. Accidents involvingmotor vehicles, bicycles, pedestrians and recreationalvehicles are the primary causes of traumatic brain injury.The use of firearms is the leading cause of death inrelation to traumatic brain injury, and nearly two-thirdsof firearm-related traumatic brain injuries are suicidal inintent. Falls around the home are the leading cause ofinjury for infants, toddlers and elderly people. Violentshaking of an infant or toddler is another significantcause. Males are twice as likely as females to sustain atraumatic brain injury, and people age 15 to 24 and thoseabove age 75 are the two age groups at the highest risk.

The bad news is that a traumatic brain injury can bedevastating, but the good news is that many braininjuries can be prevented. With the followingpreventative measures, it’s possible to reduce theincidence of traumatic brain injuries.1. Increasing helmet use during recreation and sports

activities. Note to parents: Make sure your childrenare wearing safety helmets that fit when they areriding their bicycles, skateboarding, etc.

2. Buckle up when driving or riding in a motor vehicle.3. To prevent falls among children and older adults,

change the environment to reduce fall hazards. (Forexample, make sure toys are picked up or sharp edgesare covered, and for older adults, place non-slip matsin the bathtub and on the shower floor.)

4. Enhance violence-prevention programs designed todecrease the occurrence of self-inflicted gunshotwounds and violent firearm acts aimed at others.Keep firearms stored unloaded in a locked cabinet orsafe, and store bullets in a separate location.

5. Improve use of child safety seats.6. Do not drive if you are under the influence of drugs or

(Injury, continued on Page 17)

HEAD STRONG: You can prevent traumatic brain injuries

17


Q. What do I do if I am away from home (but still in Arkansas) and need medical care?A. If you have an emergency, seek care from the nearest hospital facility. If you are visiting another town in Arkansasand can’t make it back to see your primary care physician (PCP), you may see any Health Advantage participating PCPin the area where you are located at the time. Please call Health Advantage Customer Service with the name of the PCPthat will be treating you so that it can be documented. Claims are subject to review when received, based on yourbenefit plan. Note: If you have the Open Access health plan, you may visit any Health Advantage participating provider.

Q. How can I get current provider information?A. To receive the most current provider information, please remember that you can access thisinformation from the provider directory listed at www.HealthAdvantage-hmo.com.

Q. What’s the difference between a copayment and coinsurance?A. Coinsurance is the percentage of allowable charges for covered services that you are responsiblefor paying. Coinsurance that you pay is applied to your out-of-pocket maximum. When you have metyour annual maximum out-of-pocket, coinsurance will no longer be applied to your claim. Pleasenote that mental health/substance abuse copayment/coinsurance do not apply to the annual coinsurance limit.Copayment is the amount you pay to the provider for covered services. Although most copayments are a specific amount($15, $20, etc.), some benefits are listed with a percentage (for example, 50 percent copayment).

Q. What if there is something wrong on my Health Advantage ID card?A. Please review your ID card as soon as you receive it, and make sure the information that appears on it is correct.Please call Customer Service or access My Blueprint on our Web site to report any errors and to request a corrected card.Providers file claims according to the information on the ID card, and incorrect information could cause a delayin payment.

Q. How do I order covered supplies if I have diabetes?A. Health Advantage has participating providers who carry most diabetic supplies. If you preferto purchase your diabetic supplies from a pharmacy or non-participating provider, please remember that you mustsubmit the itemized receipt to Health Advantage in order to be reimbursed. If a non-participating provider is used, youare subject to pay the difference in the billed and allowed amount in addition to the applicable coinsurance/copaymentbased on your benefit plan.

Customer Service Q & A

from Health Advantage

alcohol. Do not let others drive who are under theinfluence of drugs or alcohol. If you suspect someone in your family has sustained

a traumatic brain injury, watch for the followingsymptoms:1. Low-grade headache or neck pain that won’t go away.2. Problems with memory, concentration, etc.3. Slowness in speaking, thinking, acting or reading.4. Getting lost or easily confused.5. Feeling tired all the time, lacking energy or

motivation.6. Change in sleeping patterns (sleeping more than usual

or having trouble going to sleep).7. Feeling light-headed or dizzy, loss of balance.8. Blurred vision, eyes that tire easily, increased

sensitivity to light.

9. Loss of the sense of smell or taste.10.Ringing in the ears.11. Mood changes (feeling sad or angry for no reason).

Some general tips to aid in recovery after a mildbrain injury include getting lots of rest, avoidinganything that might cause another jolt or blow to thehead, following your physician’s orders when it comes toeveryday activities, and taking only the medicationsprescribed by your physician. If the brain injury wassevere, the injured person may need therapy to learnskills that were lost, such as speaking or walking.

— Sources: National Institute on Deafness and OtherCommunication Disorders, Centers for Disease Controland Prevention and the National Center for InjuryPrevention and Control

(Injury, continued from Page 16)

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A t Arkansas Blue Cross and Blue Shield, we want tomake sure that you get the information you need whenyou need it. With My BlueLine, you have access tocustomer service 24 hours a day, seven days a week. Thisenhanced benefit, designed specifically with yourconvenience in mind, makes your personal healthinsurance information available with a simple telephonecall. Many customers asked for telephone self-service —now it’s here.

If you are a customer of Arkansas Blue Cross,Health Advantage or BlueAdvantage Administratorsof Arkansas, you can get the answers to yourquestions anytime, day or night.

“My BlueLine has been a tremendous help to usand our customers,” said Betty Chadduck, managerof Customer Service for Health Advantage.“Approximately 20 percent of the calls that come inare being handled by My BlueLine. This gives ourcustomers access to information immediately, seven daysa week, 24 hours a day. And, of course, the customersalways have the option of speaking to a customer servicerepresentative during business hours. We have receivedmany positive comments from callers. If a customer hassuggestions for improvement of the system, we willconsider them also.”

Just a few of thecustomers commentshave been:

“I called afterhours to check on thestatus of my son’sclaim and was veryimpressed with howeasy it was to use.”

“The menu optionson My BlueLine arevery good.”

My BlueLine is aninteractive voiceresponse (IVR) systemthat recognizes speechpatterns to help answerquestions when you callcurrent customer servicetelephone lines. When you call a customer service line,My BlueLine will immediately answer the call (nowaiting!). My BlueLine will prompt you with a question,and all you have to do is simply respond to the question.

There are no buttons to push.With My BlueLine you can get numerous questions

answered quickly and easily anytime. The new systemcan help you if you have questions about status of claimsand premium payments, and help you order a new IDcard, provider directory or claim form. Benefit

information also is available throughMy BlueLine for Arkansas Blue Crossand Health Advantage customers.

When you call, remember to haveyour ID card on hand. For privacypurposes, the system will ask youquestions to verify your identity as thecaller — such as your member IDnumber as it is listed on yourmembership card. If Arkansas Blue

Cross does not have up-to-date information on yourhome address, there could be a delay, or the system maynot be able to provide the requested information. In thatcase, the call will be transferred to a customer servicerepresentative during business hours or a voice mailbox

(Arkansas Blue Cross and Health Advantage) afterregular business hours.

Try it, you’ll like it. If, during your telephone call toMy BlueLine, you have trouble understanding what thesystem is asking, simply say “help” and My BlueLinewill rephrase the question. During regular businesshours, at any time during the telephone call, you canrequest to speak to the next available customer servicerepresentative by simply saying “customer service.” ForArkansas Blue Cross and Health Advantage customerswho request customer service after hours, the call will beforwarded to a voice message mailbox to leave amessage, and your call will be returned during regularbusiness hours.

My BlueLine is a new member benefit to help you getanswers to your personal health insurance questions.However, because My BlueLine can’t help customers withall of their needs, Arkansas Blue Cross and its family ofcompanies will always have customer servicerepresentatives available during regular business hours.And, don’t forget, if you prefer to get your answers onthe Web, you have another self-service option byaccessing the secure My BluePrint section on ourWeb sites (see Page 24).

My BlueLine never sleeps,so you can rest easy

My BlueLine never sleeps,so you can rest easy

Get answers to your questions anytime

New voice recognitiontechnology answersyour questions 24/7

• Check your eligibility• Check your benefits• Check the status of

your claims• Check the status of

your premiumpayment

• Order a new ID card• Order a provider

directory• Order a claim form

New voice recognitiontechnology answersyour questions 24/7

The Pharmacist is inDo you have any questions?

The Pharmacist is inDo you have any questions? 19

How well do you know yourpharmacist? Some people select a pharmacy for theirpharmaceutical services but do not select a particularpharmacist. However, a personal relationship with yourpharmacist is becoming even more important as changesoccur regarding medication availability.

The U.S. Food and Drug Administration (FDA)recently began approving some medications for over-the-counter (OTC) use that have historically required aphysician’s prescription. This trend began with Zantac®,Pepcid®, and Tagamet® (for indigestion and heartburn),then moved on to antihistamines with Claritin® andfinally, Prilosec OTC®. This trend will continue. As brand-name medications lose their patent life, themanufacturers are finding another productive market bygaining FDA approval to sell medications OTC withoutphysician supervision while significantly lowering theprice. This marketing strategy allows these brand-name

products to survive generic competition through a newmarketing approach. This will become more common asadditional patents expire. The consumers benefit fromthis marketing strategy since OTC prices are lower thanmost copayments.

As the FDA relaxes these restrictions, allowing moreprescription medications to be available OTC, it will beimportant for consumers to seek professional medical/pharmacy help to ensure their safe use. Your pharmacist,having your other medication records, will be able tooffer valuable assistance regarding medicationinteractions. While Prilosec® and Claritin® are now muchless expensive, are just as effective and can be obtainedwithout a doctor’s prescription, remember that self-medication carries an element of risk because thephysician is removed from the picture. That’s why theadvice of your pharmacist can help.


(Blue On-Line, continued from Page 24)

Replacement cards are mailed to the policyholder’saddress. Finally, you can update your password, secretquestions, secret answers or an e-mail address by goingto “Update My Blueprint Registration Information.”

For each page, a “Help” section offers an overview,keyword definitions and answers to frequently askedquestions.” You will see “Contact Technical Support” atthe bottom of the registration page of My Blueprint.When you submit the linked form, the Help Desk willrespond to answer questions or resolve problems. Youwill see “Trouble-shooting Tips” on the page thatcontains the form. These tips might solve your problemimmediately. Once you log in, you will see a link to“Contact Customer Service” for any questions aboutyour account information. You should receive an answerto your question by the next business day.

Registration“First-time users” will need to register before they

can access their health plan information. For now, onlythe policyholder (or group subscriber) may register, butthat person can see information for a covered spouse ordependents. The following information from your healthplan ID card is needed to register:

• Member ID number• First and last name and middle

name or initial• Date of birth

The only other informationrequired is selection of two secretquestions and answers to be usedif you forget your ID or password. Save your secretanswers in a safe place in case you need them later.

When you successfully complete the on-line registra-tion form, you will receive a log-in ID on screen. Youshould print this screen and save it in a safe placebecause you will need this computer-generated ID anytime you enter My Blueprint. To comply with HIPAAprivacy regulations, your password will be sent throughthe U.S. Postal Service to the address we have on recordfor the policyholder. Once you receive your password,you are set to go to the log-in page.

After registering, you must enter your log-in ID andthe password you received by mail to activate youraccount. Then you can change your password to some-thing easier to remember, but you will always need tosave that initial log-in ID.

20


New pharmacy vendor, new ID cards for members

Health Advantage continues to score well with itscommercial health maintenance organization (HMO)members, according to the results of the 2003 HealthPlan Employer Data Information Set (HEDIS) membersatisfaction survey. This information also is available atwww.HealthAdvantage-hmo.com.

As with the HEDIS surveys conducted in both 2001and 2002, members who responded to the 2003 surveygave excellent ratings in several categories includingrating of personal doctor, rating of specialist and rating ofall health care services. Health Advantage receivedhigher marks in numerous categories (includingcustomer service, claims processing and the ratings foroverall satisfaction of the health plan) than similar local,national and regional health insurance companies thatparticipated in the survey.

Only 2 percent of those surveyed said that it was abig problem to get the care, tests or treatment that themember or their doctor believed was necessary, and only3 percent reported a big problem with delays in waitingfor approval from the health plan for services. Only 6percent of respondents reported a big problem getting thehelp they needed from their health plan when callingcustomer service, and not one respondent said there wasa big problem with paperwork at Health Advantage.

The survey, a requirement of the National Committeefor Quality Assurance (NCQA), alsorevealed the following results:

• 94 percent of members were satisfied that their claimswere handled in a reasonable amount of time

• 91 percent of members were satisfied that their claimswere handled correctly.

• 97 percent of members felt that the office staff treatedthem with courtesy and respect.

• 92 percent of members felt that the office staff was ashelpful as they thought they should be.

• 92 percent of members felt that their doctors listenedcarefully to them.

• 96 percent of members felt that their doctors explainedthings in an understandable way.

• 93 percent of members felt that the doctors showedrespect for what they had to say.

• 88 percent of members felt that doctors spent enoughtime with them.

• 92 percent of members felt that their claims werealways or usually processed in a reasonable time.

• 94 percent of members felt their claims were always orusually handled correctly.

• 90 percent of members felt they always or usuallyreceived the help or advice they needed when theycalled the doctor’s office during regular office hours.

• 86 percent of members felt they always or usuallyreceived the appointment for health care they neededas soon as they wanted it.

• 92 percent of members felt they always or usuallyreceived care quickly for an illness or injury.

Customers express satisfaction with Health AdvantageCustomers express satisfaction with Health Advantage

Effective April 1, 2004, Arkansas Blue Cross andBlue Shield will be changing vendors for pharmacyclaims processing from Advance PCS to Argus HealthSystems, Inc.. Argus will provide claims processing, callcenter services and decision support assistance for thepharmacy program.

As a result of the change, customers of ArkansasBlue Cross, Health Advantage and BlueAdvantageAdministrators of Arkansas will be receiving new IDcards in March. The only change on the ID cards will bea new Bank Identification Number (BIN) to direct theclaims to the new claims processor.

What does having a new pharmacy vendor mean forour customers? Customers will see no changes in theirpharmacy benefits, the Preferred Drug List or thepharmacy network due to this transition. Also, the

pharmacy customer service numbers will remainthe same.

Besides the new ID cards, customers will notice veryfew other changes. There will be a new Pharmacy Website that resembles the current Web site.

This change to a new vendor will allow the ArkansasBlue Cross family of companies to better serve ourcustomers and providers. Although there is a new vendorbehind the scenes, the pharmacy program isadministered by Arkansas Blue Cross, with support fromArgus. The pharmacy program is a benefit to ourcustomers developed and coordinated by the ArkansasBlue Cross pharmacy team.

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Readership SurveyThanks to in-depth health-and-wellness and health

insurance information, Blue & You readers sent amessage to Arkansas Blue Cross and Blue Shield thatthey appreciate Blue & You, and have made changes intheir lifestyle due to the information they have receivedin Blue & You.

The Autumn 2003 issue contained a readershipsurvey (an annual process) for members to return withcomments, and customers gave Blue & You an average of4.34 on a five-point scale (with five being the highestrating). Survey respondents gave Blue & You asatisfaction rate of 4.43 in the “Helpful” category and4.36 in the “Attractive” category.

This year, we asked an additional question of ourmembers: “Have you made a healthy change in yourbehavior because of something you’ve read in Blue &You?” Seventy-five percent of survey respondentsanswered “yes” to that question.

More members visit Web sites, find information usefulThe results of the 2003 Internet Survey showed that

Arkansas Blue Cross, Health Advantage andBlueAdvantage Administrators of Arkansas membershave an increasing awareness of the companies’ Websites and find them useful.

A survey card was enclosed in the Autumn 2003issue of Blue & You. Those who responded found themost useful sections of the sites to be “ProviderDirectory,” “Prescription Drug Information” and “HealthPlans and Services.”

When asked to rate self-service features they wouldmost like to see on the site, the top three were:

1. Review benefits.2. View health and wellness information.3. See out-of-pocket expense accumulation.

Blue & You readersgive high marksto magazine,Internet services

This question addressed features not currently on thesites today but under consideration for development inthe near future. Several of the features listed in the 2001and 2002 surveys already have been added to the sites,so those were removed from the 2003 survey. Oneexample is “check claims status,” which is available nowon the Arkansas Blue Cross, Health Advantage andBlueAdvantage sites in the My Blueprint section.

The number of respondents who said they haveInternet access decreased from 79 percent in 2002 to64 percent in 2003. The number who have visited theWeb sites jumped from 44 percent in 2003 to 54 percentin 2003. Seventy-seven percent of those responding ratedthe value of the site at 4 or 5 on a five-point scale, with 5being the highest. This was up from 63 percent in 2002.

Gift certificate winners!From the Blue & You satisfaction survey, we

randomly selected three winners who each received a$50 gift certificate to Wal-Mart. The winners were MarieArnold of Jonesboro, Robin Selman of Fayetteville andClifford Tribble of Little Rock.

From the Web site satisfaction survey respondents,we also randomly selected three winners who eachreceived a $50 gift certificate to Best Buy. The winnerswere Helen Jones of Prescott, Levona Morrison of Roverand Mildred Poindexter of Morrilton.

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22


Louis Ramsay, 85, a long-time member of theArkansas Blue Cross and Blue Shield board of directors,died on Sunday, Jan. 4, 2004, after a two-year battle withliver cancer. Ramsay was Of Counsel to the Pine Blufflaw firm of Ramsay, Bridgforth, Harrelson & Starling. Hewas chairman of the executive committeeand emeritus director of Simmons FirstNational Corp., and the past chairmanand chief executive officer of SimmonsFirst National Corp.

“Mr. Ramsay was so very special inso many ways … a trusted friend,mentor, valued business colleague andenergetic community leader,” said BobShoptaw, chief executive officer ofArkansas Blue Cross.

“He was truly a caring person withevery fiber of his being. He never reallymet a stranger nor encountered anyonethat he couldn’t find something positiveto comment about. His optimism, his zestfor life, and his love for the state ofArkansas and its people were infectious.”

Mr. Ramsay was born on Oct. 11,1918, in Fordyce. He attended the FordycePublic Schools and received an athletic scholarship fromthe University of Arkansas at Fayetteville. He playedquarterback for the Razorback football team, lettering in1940 and 1941. After graduating from the University ofArkansas, he served as a pilot in the U.S. Army Air Corpsin World War II and was awarded four Oak Leaf Clusters.He received his juris doctor degree from the University ofArkansas School of Law in 1947. After graduating fromlaw school, he joined the law firm of Coleman and Gantt,the firm that now bears his name. In 1970, he wasnamed president of Simmons First National Bank, wherehe also served as chairman and chief executive officerfrom 1973 to 1983.

Mr. Ramsay joined the Arkansas Blue Cross board ofdirectors in 1978 and served as chairman of the boardfrom 1981 to 1997. He served as chairman of the execu-tive committee of the board from 1997 until his death. Healso served on numerous boards throughout the stateincluding the Board of Trustees for the University ofArkansas, Razorback Foundation, Inc., Arkansas BarAssociation, Jefferson County Bar Association, ArkansasBankers’ Association, the University of Arkansas Alumni

Association and many more.He was the recipient of the Arkansas

Bar Association and Arkansas Bar Founda-tion Outstanding Lawyer Award in 1966. Heis the second person in Arkansas history to

have been elected and serveas president of both theArkansas Bar Associationand the Arkansas Bankers’Association.

In 2003, he has in-ducted into the WaltonSchool of Business ArkansasBusiness Hall of Fame. OnOct. 13, 2003, Simmons andArkansas Blue Crossestablished a $250,000faculty fund at the Univer-sity of Arkansas WaltonCollege of Business inhonor of Mr. Ramsay andhis wife.

Mr. Ramsay is survivedby his wife of 58 years, JoyBond Ramsay; daughter and

son-in-law, Joy and Ron Blankenship ofPine Bluff; son and daughter-in-law, Rickand Clair Ramsay of Little Rock; sister,Frances Holcombe of Texarkana, Texas; andgrandchildren, Drew, Ben and KateBlankenship; Jimbo and Liz Ramsay; andAlex and Clancy Graham.

Services were held on Wednesday,Jan. 7, 2004, at the First United MethodistChurch in Pine Bluff.

“Mr. Ramsay added ‘quality of life’ toeveryone with whom he came in contact.We have lost a true friend and an untiringambassador for our state,” Shoptaw said.

Louis Ramsay

in Memoryin Memory

23Arkansas Blue Cross and Blue Shield strives to be a

good corporate citizen. Our employees raise money andspend many hours helping those causes near and dear tothe hearts of Arkansans.

“Don’t Start” SmokingWith more than 3,000 kids in the United States startingto “light up” every day, Arkansas Blue Cross and BlueShield has teamed up with the American Lung Associa-tion, the ArkansasDepartment of Educa-tion, KASN-TV/UPNChannel 38 and KLRT-TV/FOX Channel 16for the third year toencourage kids not tostart smoking. The“Don’t Start” SmokingStoryboard Contest,which runs throughMarch 26, gives kidsin kindergartenthrough fifth grade anopportunity to write a story about why it’s important tonever begin this dangerous habit. Kids can “draw theirway” to some great prizes and an opportunity to havetheir story transformed into an actual television PublicService Announcement (PSA) to be broadcast in Arkan-sas in the summer and fall of 2004. (In 2003, more than10,000 students participated in the contest.) StoryboardContest sheets and educational videos have been distrib-uted to all public schools through the Department ofEducation and have been mailed to private schools andhome-school programs. For more information, visitBlueAnn’s Web site at www.BlueAnnEwe-ark.com. The“Don’t Start” Smoking Storyboard Contest will help yourkids draw a healthy message today ... as well as a goodbreath ... for life.

“Stomp” out SmokingFrom the Rock to the Prairie to the Delta, BlueAnn Ewehas been hanging out with some cool kids and treadingon a stinky habit. The blue, woolly health ambassadorhas been performing with cape-less crusaders (a.k.a.High School Heroes) from McGehee High School, HallHigh School in Little Rock and Lakeside High School in

Lake Village to show middle-schoolers that smoking isnot hot. These High School Heroes are specially trainedhigh school students who present an anti-smokingprogram targeted to fourth-, fifth- and sixth-graders intheir school district. High School Heroes serve as rolemodels for the kids, pledging to remain smoke-free, anddelivering a strong testimony about the dangers ofsmoking and the appeals of tobacco advertising. BlueAnnEwe was able to join the Heroes recently and performthe “BlueAnn Stomp,” a rap-dance about saying “no”to cigarettes.

Body Walk gets on the InsideOak Grove Elementary School students got to take a walkon the “inside” recently to learn about how their bodiesfunction and how the things they put into their bodiesaffect their health. The Arkansas Body Walk, a programfunded by the Blue & You Foundation for a HealthierArkansas, teaches healthy behaviors to Arkansas chil-dren, grades K-4, to help reduce the incidence of obesityand chronic disease resulting from poor eating habits,substance abuse andlack of physicalexercise. The hands-on walk-throughexhibit represents thehuman body andprovides students anentertaining activitythat teaches andreinforces the skillsand choices for ahealthier lifestyle.The goal is to reach30,000 students inArkansas in 2004.The Arkansas BodyWalk made one of itsfirst appearances atOak Grove Elemen-tary in PulaskiCounty, and BlueAnn was on hand to take a walk withthe students through the brain, the tummy, the skeletalsystem, the circulatory system and more.


BlueAnn learns about the skeletalsystem from Oak Grove Elementarystudents.

Students from Central ArkansasChristian School in Sherwood visitwith Jason Harper during “GoodMorning Arkansas” on KATV-TV.

www.ArkansasBlueCross.comwww.HealthAdvantage-hmo.com

www.BlueAdvantageArkansas.comwww.BlueAndYouFoundationArkansas.org

www.BlueAnnEwe-ark.com

Arkansas Blue Cross and Blue ShieldP.O. Box 2181Little Rock, AR 72203-2181

(Blue On-Line, continued on Page 19)


Personal Benefits and Claims TrackerAlmost 10,000 Arkansas Blue Cross and Blue Shield,

Health Advantage and BlueAdvantage Administrators ofArkansas members have registered to use My Blueprint,our Web-based, member self-service center. My Blueprintprovides secure, 24-hour access to eligibility and claimsinformation, and several new features that will make theservice even more useful are under development.

My Blueprint is available onwww.ArkansasBlueCross.com,www.HealthAdvantage-hmo.com andwww.BlueAdvantageArkansas.com. Click on theMy Blueprint buttonon the home page ofthe site of the com-pany you see listedon your health planID card.

When you havesuccessfully loggedin, you will see a“Welcome to MyBlueprint” page,displaying your nameand containing amenu of self-service links. Current selections on all threesites include:• Check member eligibility;• Check claim status (including your claims history);• Order replacement ID card;• Update My Blueprint registration information.

The menus on each company site differ somewhat.On the Health Advantage site, members may review theirprimary care physician (PCP) history; and on theBlueAdvantage site, they may review a benefit summaryor search their customized provider directories.

Health Advantage and BlueAdvantage members havebeen able to review and print their Explanation ofBenefits statements (EOBs) for some time. Soon, mostArkansas Blue Cross members (except Medi-Pak mem-bers) will be able to view their EOBs.

To access an EOB, click on Check claim status on the“Welcome” page, select the member to whom the claimapplies, and click on complete in the “status” column for

the claim for which you want to see an EOB. EOBs are inportable document format (PDF).

Health Advantage members will gain two newfeatures this year. They will be able to order a certificateof coverage (COC), which contains information useful forproof of prior coverage when changing jobs. They alsowill be able to access benefit summaries, which willoutline what is covered under their health plan.

Self-Service FeaturesThe “Check Member Eligibility” section allows you

to see who is eligible for coverage under the registeredhealth plan. The member name, date of birth, membernumber, relationship to policyholder, effective date andtermination date are displayed for each covered member.

“Check Medical Claim Status” allows you to selectthe member and a time range for claims to be viewed.Selection of “all claims” pulls the member’s claimshistory. The status will be either complete or in process.Click on complete to pull up an EOB. Not all EOBs areavailable on-line at this time.

“Check Primary Care Physician” allows you toselect a member to see each PCP that member haschosen, the physician’s provider number, date selectedand date terminated.

“Order Replacement ID Card” allows you to select amember or all members enrolled under your ID number.

2004 - spring

Documents

health care services

health advantage members

health advantage web

health care professional

health care spendingshot

health coaches nurses

health coach24 hours

indepth health informationon