MS-05-216

Living with diabetes

How time heals

Power foods

Managingyour back pain

healthy mindhealthy body

S P R I N G 2 0 0 5 YO U R OX FO R D®

G U I DE TO LIVI NG WELL

Did you know?As of October 1, 2004, 100 percent of primary carephysicians (PCPs) participating in Oxford’s network in the tri-state

service area are either board certified or board eligible (89 percent board

certified and 11 percent board eligible). In addition, 99.9 percentof specialists in Oxford’s tri-state network are either board certified

or board eligible (85.6 percent board certified and 14.3 percent board eligible).

Board certification is the medical profession’s formal recognition of a physician’s

advanced expertise in a medical specialty or subspecialty (e.g., pediatrics,

neurology, dermatology, orthopedics). To earn this certification, a physician

must complete extensive additional training in an accredited, university-affiliated postgraduate program and pass

comprehensive examinations in his or her chosen specialty. Board eligible physicians have five years in which to

complete the board certification process. O

Olive oil has joined nuts, fish and omega-3 fatty acids in the Food and Drug

Administration’s (FDA) carefully considered list of “heart healthy”foods permitted to use a qualified health claim on their labels.

Specifically, the FDA has declared there is “limited and not conclusive

evidence” that substituting about two tablespoons (23 grams) of

monounsaturated olive oil daily for saturated fats (butter or other vegetable

oils) “may reduce the risk of coronary heart disease.” Olive oil, which is basic

to the culinary traditions of Italy, France, Spain, and virtually every other

Mediterranean country, has long been thought to play an important role in

the lower incidence of heart disease among these populations. O

Raising bilingual children may have benefits beyond giving them the

ability to communicate in two languages. In a recent issue of the journal

Psychology and Aging, researcher Ellen Bialystok described the results

of tests conducted on over 100 older people. She found that people

who have been fluent in two languages from an early age tend to have

quicker minds than those who speak one language. She

concluded that the challenges involved in a lifetime of juggling two

languages make bilingual people more elastic in their thinking, a habit

that continues in their later years when the tendency is to become

somewhat more rigid in processing thoughts and memories. O

healthy mindhealthy body

S P R I N G 2 0 0 5 YO U R OX FO R D®

G U I DE TO LIVI NG WELL

President and CEO Charles G. BergChief Medical Officer and EVP Alan M. Muney, MD, MHAVice President, Marketing Chuck GreenVice President, Marketing Communications Rebecca MadsenSenior Marketing Manager Meg DedmanCopy Editor Starlet ColemanEditor Justin Colby

Healthy Mind Healthy Body® is published exclusively for Oxford Health Plans by:Onward Publishing, Inc.10 Lewis Road, Northport, NY 11768Fax 631-754-0522

Publisher Jeffrey BaraschCreative Director Melissa BaraschEditorial Director Wendy MurphyArt Director Bruce McGowinDesigner Lisanne SchnellAssociate Creative Director Tamyra ZieranProject Director Bret BaraschBusiness Manager Liz Lynch

Oxford Health Plans, LLC and Onward Publishing, Inc., are not responsible for typographical errors.

This magazine provides general health information and, as such, is neither intended to replace the advice of yourphysician nor to imply coverage of referenced treatments or medications. Please consult with your physician regarding any treatment or medication that could impactyour health before proceeding with it, and refer to your benefit documents for specific coverage information.

© 2005 Onward Publishing, Inc. All rights reserved.

C O V E R S T O R Y

Managing your back pain

F E E D B A C K

Member Satisfaction Survey results

O F V A L U E

Do you know your A-B-Cs?

P R O V I D E R P R O F I L E

Living with diabetes

M E R G E R U P D A T E

New Oxford ID cards

L I V I N G W E L L

Power foods

N E W S Y O U C A N U S E

Oxford benefits update

S P E C I A L T O P I C

Helping time heal

W E L L N E S S

Bone basics

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10

12

15

16

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C O N T E N T S

Healthy Mind Healthy Body, which is designed to give you the latest information on a wide range of health topics

and your plan benefits, is available on our web site. Simply log in to your personalized account page at www.oxfordhealth.com.

As always, we encourage you to e-mail your comments to us at publications@oxfordhealth.com, or write to: Oxford Health

Plans, c/o Member Publications, 55 Corporate Drive, Trumbull, CT 06611.

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C O V E R S T O R Y 4

Managing

If prizes were given out for most common medical disorders, back

pain would surely be a winner. Statistics show that back pain is

second only to persistent cough as the reason Americans seek medical

care at physicans’ offices and hospital emergency rooms. It ranks

right after the common cold as a frequent cause of lost work time.

And it’s the leading cause of disability among Americans age 45

and under. Eight out of 10 adults will have a back pain problem

at some time in their life, and most will have more than one episode.

As common as it is, back pain remains one of the more

difficult conditions to diagnose and treat. While most

bouts of back pain resolve in a few days, with or without

medical intervention, none of the treatments currently

available for chronic conditions can promise to eliminate

pain in every case. Rehabilitation rather than cure must

be the goal in those instances.

At Oxford, we are convinced that when it comes to

managing back pain, knowledge is power. The better you

understand the challenges and realities of back pain, the

more effective you can be in teaming up with your med-

ical care givers to find the most appropriate treatment.

Let’s start by examining the structure of the back itself.

Anatomy 101Your back is a miracle of bioengineering: a complicated

system of nerves, muscles, soft tissue, and vertebrae. The

33 vertebrae stack to form a strong but flexible column

that surrounds and protects your spinal cord, a thick

bundle of many specialized nerves running from the

base of your skull to your extremities. Although every

part of the back is important, it’s the upper 24 vertebrae

that do most of the work. Grouped into three sections,

they are labeled as follows:

• Cervical vertebrae (C1-C7) support the neck and head

• Thoracic vertebrae (T1-T12) connect to the ribs

protecting the heart and lungs

• Lumbar vertebrae (L1-L5) form the lower back

The back’s complex anatomy can make it difficult to

pinpoint the origins of your back trouble. Poor posture,

weak muscle tone, a sports-related injury, sitting for long

periods, excess body weight, and ordinary aging can all

contribute to backache. Less likely causes are a number of

underlying illnesses that incidentally trigger inflammation

and pain in the back area. Smoking and psychological

stress are still other potential factors that may play into

the mix. Diagnosis begins with defining the problem.

Targeting the painBack ailments are typically classified as acute or chronic.

Any back disorder is considered acute if it lasts only a few

days to several weeks. Fortunately, about 90 percent of

patients with acute pain episodes recover spontaneously

within a month, with or without seeking the aid of

their physician. A back problem that continues to cause

symptoms of pain and weakness longer than three

months, or which recurs with regularity is considered

chronic. Such episodes may call for a closer look —

comprehensive diagnostic testing, sophisticated pain relief

methods and the collaborative care of several specialists.

Identifying the source of the discomfort is important

to determining the diagnosis. Symptoms of stiff neck and

shoulder muscles, occasional weakness or numbness in the

arms and hands, usually indicate a problem in the cervical

region. Short of genuine trauma to the cervical spine such

as whiplash, cervical pain events are most often muscular

in origin and heal quickly with rest and mild painkillers.

Thoracic problems are rare, thanks to the stability of the

upper back and the fact that relatively limited muscular

movement takes place here. It’s the lumbar region

(L1-L5) that is most vulnerable. Here is where the

greatest variety of back problems settle.

5

your back pain

Below are a few of the most common causes of back

pain (for additional causes, see the box on page 8):

Strains develop in the lower back from excess lifting

or twisting; they can often be traced to a single incident

such as moving a heavy piece of furniture, shoveling snow

or playing a sport too aggressively. For someone who is

less than fit, strains can also occur when reaching for

something or sneezing particularly hard. Pain can erupt

within minutes or many hours later when it is felt as a

massive involuntary contraction of back muscles known

as a spasm. A spasm, which temporarily immobilizes the

region, actually protects the back from further stress

much as a splint protects a broken bone. But don’t try

to tell anyone experiencing a back spasm that it’s a good

thing — it can be agonizing.

Osteoarthritis, a natural condition associated with the

wear and tear of aging, is most often diagnosed in people

over 50, though the condition may be asymptomic for

years before it causes pain. Cartilage on the ends of

vertebral joints become pitted, frayed or worn away.

Tiny bone spurs form to impede flexibility. The discs

separating the segments of the lumbar spine become

progressively drier, thinner and less flexible. The lower

back may consequently stiffen along its length, causing

friction and pain as it moves.

Nerve root disorders in the region of L5 often begin

with a ruptured or collapsed disc. Nerve root pain is highly

variable, with tingling, burning, aching, and stabbing

sensations reported, either intermittently or continuously.

The pain, a response to compression of nerve roots, may

be felt in the lower back only, or may travel along the

sciatic nerve to the buttocks, thigh, calf, and foot. Painful

nerve problems can also occur deep in the buttock as the

result of nerve entrapment; in some instances the small

piriformis muscle behind the gluteus maximus presses

on or surrounds the sciatic nerve, causing pain virtually

indistinguishable from the pain of a ruptured disc.

In rarer instances, a lesion or tumor can cause the

entrapment. And in some cases, irritation caused by a

chemical (phospholipase A2) leaking from the ruptured

disc may be a source of nerve pain in the lower back.

When to call your doctorMany people who develop low back discomfort may

not need to see a physician right away. If the symptoms

are mild, if modest improvement begins within a few

days, and if the back pain is not part of a recurring

pattern or the result of a significant trauma, it’s quite

all right to take a wait-and-see approach. If any of the

following symptoms are present, call your primary

care physician (PCP) promptly:

• The pain keeps you from normal everyday activities

• Discomfort persists more than a few days

• Bowel or bladder control is affected

• Numbness is experienced in the groin or rectal area

• One or both legs feels weak or unsteady

Your PCP will examine you to rule out any pathological

condition that could be causing your back problem;

C O V E R S T O R Y 6

7

fortunately, statistics show that only about one patient in

200 has low back pain symptoms that trace to a serious

medical illness.

In arriving at an initial diagnosis, the PCP must rely in

part on information you provide. You will be asked to

describe your pain and its intensity; a pain-rating scale of

1-10 is a favored method. You will also be asked to locate

the discomfort and to recall what you were doing when

the pain first started. Your PCP will examine your gait

and posture, check your reflexes and look for tender

points on your back. He or she may ask what routine

activities make the pain worse or better, what recent

illnesses you may have had, or whether you have

experienced any recent weight loss.

Unless your PCP uncovers a “red flag” (something

that might indicate the need for further testing right

away), the standard for acute back pain is conservative

treatment that addresses symptoms while allowing time

to see if the condition heals itself. This may include

instructions for applying periodic cold packs during

the first 24 hours; intermittent heat on days thereafter.

A few days of limited (not strict) bed rest may also be

in order, followed by a gentle return to normal activities.

Over-the-counter or prescription pain relievers may

help alleviate local discomfort.

Be sure to discuss with your doctor any physical

limitations you should adhere to during the healing

phase. Find out what kinds of exercises you should be

doing to strengthen weakened muscles. (Following some

back injuries, muscle atrophy begins almost immediately

unless addressed with exercise.) Ask about possible side

effects of pain medications (nausea, vomiting, dizziness,

sleepiness) or contraindications (no driving, no operating

machinery, no alcohol). And learn what to do if the pain

worsens or continues beyond a measured time.

Stepped up treatmentWhen conservative treatment does not bring expected

relief in a reasonable time, you and your PCP may want

to consider more advanced diagnostic imaging (MRI or

CT scans, for example) or one of several alternative and

complementary treatments, including physical therapy,

acupuncture, massage therapy, chiropractic, biofeedback,

and transcutaneous nerve stimulation (TENS).

The latter, which involves the delivery of low-level

electrical impulses over the skin of the affected area,

can be self-administered at home using a portable

TENS device. It produces a numbing or vibrating

sensation that releases the body’s own pain-modulating

chemicals (endorphins) and overloads nerve paths.

TENS interrupts pain sensations in some, but not all,

patients. (For more information on complementary

and alternative treatments, see the box on page 8.)

More potent medications may also be indicated

when non-narcotic medications are insufficient; your

physician may try a short-term regimen of opioid drugs

(morphine, codeine and other narcotic substances)

while your body heals.

Another possible course of action is referral to a

specialist in orthopedics, neurology or physiatry,

especially in a chronic pain situation. One approach

to treating severe back pain that these specialists

occasionally use is the epidural injection. A mixture

of corticosteroids and anesthetics are injected by

needle into the layer surrounding the spinal cord

at the site of a swollen and irritated nerve; the steroids

reduce the inflammation while the anesthetic provides

local pain relief.

C O V E R S T O R Y 8

C o m m o n s o u r c e s o f l o w b a c k p a i n

• Muscular weakness; poor coordination of “core” muscles

• Tear in muscles and ligaments that support the back

• Muscle spasm

• Injuries and small fractures in the spine

• Rupture or bulging (herniation) in a weakened disc

• Misalignment of vertebrae due to instability or deteriorated vertebral surfaces (spondylolisthesis)

• Narrowed spinal canal (stenosis)

• Scar tissue that entraps and presses upon nerves

• Long-term postural deformities (scoliosis, lordosis, etc.)

Surgery to repair or fuse damaged sections of the spine,

common as it was a decade ago, is seen increasingly as an

intervention of last resort. Recent studies show that spinal

surgery provides long-term relief in only one in 100 cases of

low back problems. And it can sometimes make the condition

worse. If your healthcare provider recommends surgery, be

sure you fully understand his or her reasons, as well as the

inherent risks and benefits of the recommended procedure.

Although back pain is a complicated condition to diagnose

and treat, it’s still very important for you to take responsibility

for the care you receive. If your doctor sticks to a single

conservative treatment over a prolonged period, without your

experiencing significant relief, you may want to seek a second

opinion. And, if you and your doctors have tried several

approaches over an extended period and none of them yields

“a cure,” you may have to accept the fact that some back pain

is never going to be fully resolvable. In such instances,

effective pain management and the healing effects of physical

and psychological adaptation may offer you your best hope.

Prevention The good news is that prevention and self-care will go a

long way in reducing your lifetime risks of back pain. Start

with a serious effort to stay fit and trim. If you aren’t there

yet, keep working at it. Ask your PCP to recommend exercises

that condition the muscles in your body, especially those

supporting your back and abdomen. Make these and ordinary

walking exercises part of your weekly routine. Pay attention

to good nutrition and maintain appropriate levels of calcium

and Vitamin D in your diet to keep your bones strong and

resilient. And learn the fundamental physics of back safety:

• Lift objects close to your body rather than at

arm’s length

• Lift with your back straight and knees bent rather

than bending over with knees straight

• Lift only when your feet are securely positioned

and your path is clear

• Use slow, steady movements rather than hurried,

jerky movements

• Don’t rely on back belts; there’s no proof as yet

that they offer protection

• Know your personal limits; never ask your back

to do more than it should O

C o m p l e m e n t a r y a n d a l t e r a t i v e t r e a t m e n t s f o r b a c k p a i n

Back pain is your body’s way of telling you that you’ve

been neglecting your back’s health. So part of rehabilitation

should include a closer look at your lifestyle, including diet,

physical activity and levels of mental stress. Below are just

some of the many mind-body therapies that can help ease

the pain. Before beginning any of these, however, discuss

the idea with your physician. Some specific activities may be

contraindicated where stretching and bending are involved,

or in the case of back instability.

Acupuncture, acupressure and transcutaneous nerve

stimulation are all forms of pain distraction. They can help

in defusing a painful flare-up by stimulating the release of

endorphins, chemicals naturally produced in the body to

block pain signals.

Bodywork, including the Alexander Technique, Pilates

Method, Feldenkrais Method, and Heller Method, can do

wonders for back pain that stems from poor posture and

lack of physical conditioning.

Heat and cold therapies can bring temporary relief. For acute

“hot” pain, try a cold pack. For a stiff lower back, a heat pack

can be a comforting way to loosen up tight, tense back muscles.

Spinal manipulation therapies, practiced by chiropractors

and osteopaths, have been shown to improve acute flare-ups

of low back pain. In most cases, such treatments should be

accompanied by stretching and other routine forms of exercise.

Yoga works to stretch and loosen muscle tightness while

easing the mind to cope with pain. If pain is severe, find a

class in rehabilitative yoga; these classes are offered by

many hospitals and private studios.

Oxford Members have access to a credentialed network of

complementary medicine providers including chiropractors,

massage therapists, acupuncturists, naturopaths, and yoga

instructors that can help to manage pain, or to help to prevent

the onset of chronic back pain. To find a complementary

medicine provider in your area, log into www.oxfordhealth.com

and use our Doctor Search tool, or call our Customer Service

Department at the number on your Oxford ID card and request

a Roster of Participating Physicians and Providers.

F E E D B A C K 9

How are we doing?

Your satisfaction is important to us. As part of Oxford’s

commitment to quality healthcare, we strive to provide you

with a positive experience, from your contact with our Customer

Service Department to your ongoing encounters with the

physicians and hospitals in our provider network. And we know

from objective reports that our overall efforts are working well.

Again this past year, the National Committee for Quality

Assurance (NCQA), the most respected independent

rating organization in the healthcare industry, awarded

Oxford ratings of “Excellent,” NCQA’s highest level of

accreditation, in three of our service areas — New York,

New Jersey and Connecticut. Although pleased with this

rating, we know there is always room for improvement,

so we will continue to ask you for feedback on ways to

enhance specific details of your healthcare experience.

In our latest annual surveys, conducted among 1,100

Members by independent research organizations, we

received a number of helpful suggestions. You can expect

improvements in your healthcare in 2005, and beyond,

based on these suggestions.

One area on which we are now focused is processing

claims and appeals more quickly. We are also making

improvements in our Member education efforts, both

in our written materials and on our Internet site,

www.oxfordhealth.com, by giving you more information

regarding how your plan works and how you can make

the most of it, in language that is clearly understandable.

Lastly, we’re working with our providers — your

physicians and their office staffs — to improve patient-

doctor communication, all of which should help ensure

that you get the care you need at the right time and place.

We will keep you informed through Healthy Mind

Healthy Body and www.oxfordhealth.com about the

steps that we are taking to provide you with a better

healthcare experience. And please continue to let us

know how we can serve you better. We’re listening!

If you have a suggestion about how we can improve

your satisfaction with Oxford, contact us via e-mail

at membersatisfaction@oxfordhealth.com or at the

address below:

Member Satisfaction Oxford Health Plans QM Department44 South BroadwayWhite Plains, NY 10601

O F V A L U E 10

ABCDo you know your

A varied, balanced diet of whole foods is always going

to be your best source of vitamins and minerals, but

surveys show that most people’s eating habits do not

provide adequate amounts of several nutrients considered

essential to good health. Meeting the recommended

daily allowances (RDAs) for these nutrients is very

important not just to help us feel good today, but to

prevent and manage a wide range of chronic diseases —

from heart disease and osteoporosis to macular

degeneration and diabetes — that may develop over time.

An estimated 40 percent of Americans take at least

one vitamin or mineral supplement as a form of

“nutrition insurance.” Far and away the most popular

forms of supplementation are multivitamin and multi-

mineral compounds. Each pill or tablet typically contains

microamounts of as many as two dozen active ingredients,

including vitamins A, B2, B6, B12, C, D, E, folic acid,

niacin, and thiamin, at levels approaching or exceeding

RDAs for adults or, for some formulations, a more

targeted audience, such as children, seniors or women.

Many of the same vitamins and minerals are also widely

taken as single-ingredient products, mostly by people

who have specific risks or deficiencies. Calcium and

iron are recommended at levels too great to include at

100 percent of their RDA in multivitamins, so additional

amounts may be taken as single ingredient supplements.

The good, the bad and the unessential Selecting a course of supplements can be tricky. First,

there is the matter of which supplements and the amount

of each that is appropriate for your age, gender and

health situation. While vitamin and mineral supplements

are generally beneficial, some of them can interfere with

medications or interact with an existing medical condition

to make it worse. And contrary to some advertising claims,

taking megadoses of anything has risks even for healthy

people; too much of one nutrient can cause

a deficiency in another. It is always best to

talk to your physician before embarking

on a new regimen of nutritional supple-

mentation. For any vitamin or mineral,

never exceed the “upper limit” (UL)

that may appear on the label, which

indicates that more of this ingredient

poses a risk of adverse health effects.

There is also the question of product quality and

consistency. Because vitamins, minerals, herbs, and other

nutritional boosters are not classified as prescription

drugs by the Food and Drug Administration, their

labeling, contents and manufacturing practices are not

government-regulated. Some studies have shown that

among multivitamin and multimineral compounds in

the United States, one in three fail to deliver on one or

more of their claims, frequently containing substances

well above or below the amounts listed on their labels.

Information is just a click awayFortunately, Oxford Members can get objective

information on all these matters from ConsumerLab.com,

which provides Oxford Members with independent

evaluations of nearly all nutritional supplements sold

in the United States. To access these resources, and to

sign up for a newsletter exclusive to Oxford Members,

simply log in to your personalized account page at

www.oxfordhealth.com. For an overview of nutritional

supplements, see the chart at right.

Most importantly, you should try to eat a healthy,

well-balanced diet. Nothing in a bottle or a pill can

match the health benefits of a diet rich in brightly

colored fresh fruits, deeply pigmented vegetables and

fiber-filled grains. O

A-B-Cs?

11

RR E S O U R C E S

Read more about nutritional supplements inConsumerLab.com’s Guide to Buying Vitamins &Supplements, available to Oxford Members throughthe Healthy Bonus® program. Call 1-800-431-1579and mention the promotional code Oxford to receive20 percent off on the $17.95 cover price of this veryinformative paperback. Oxford Members can also receive a 10 percent discount on all products from Puritan’s Pride,®

including vitamin and mineral supplements throughOxford’s Healthy Bonus program. Just visitwww.puritan.com and enter coupon code EOX8JUat the checkout page.

D e c i p h e r i n g t h e l a b e l

The terminology used on supplement labels may take several forms. Here are some common tags and what they mean:

Recommended Daily Intake (RDI) Newest estimate of safe and adequate nutrient intakes.

Recommended Daily Allowances (RDA) The average daily dietary intake level sufficient to meet the nutrient needs of most healthy individuals. These numbersmay vary based on gender and age.

Adequate Intake (AI) The best estimate of an RDA when a specific RDA cannotbe determined.

Upper Intake Level (UL) The highest level of daily nutrients intake likely to poseno risk of adverse health effects for almost all people. ULs for some nutrients are yet to be established, so if you do not see one listed, it does not mean that megadoses are necessarily safe.

V i t a m i n s a n d m i n e r a l s

Name/RDA Function Food Sources CommentB-1 Nervous system functions; promotes Whole grains or enriched, fortified grainThiamin 1.5mg appetite and digestion products, such as bread, pasta, cereals

B-2 Healthy skin and eyes; protein, fat Dairy products, organ meats; smaller Riboflavin 1.7mg and carbohydrate metabolism amounts found in enriched white flour, nuts

B-3 Helps lower levels of cholesterol; Enriched white flour, peanuts, fish, meatNiacin or nicotinic nervous and digestive system functions; acid 2 mg healthy skin and tongue

B-9 Reduces risk of spina bifida birth Dark green leafy vegetables Supplements recommended Folic acid defect; possibly childhood leukemia and oranges for women who are or may400 mcg and heart disease become pregnant

B-12 Promotes normal growth; Abundant in meats, poultry, fish Supplements recommended for 6 mcg prevents anemia vegetarians, substance abusers,burn patients,

patients with certain cancers

C Antioxidant; wound healing and blood Citrus fruits, red berries, tomatoes, Ascorbic acid vessel repair; strong bones and teeth; potatoes, broccoli, cauliflower, brussels 60 mg iron absorption; collagen production, sprouts, bell peppers, cabbage, spinach

brain chemicals

D Assists in absorption and metabolism Egg yolks, salmon, and fortified milk, Called the “Sunshine Vitamin” because 400 IU of phosphorus and calcium for cheese and cereals; natural sunlight deficiencies are rare in sunny climates,

strong bones and teeth though “shut-ins” and city dwellers canbecome deficient anyway

E Antioxidant that helps rid body of Leafy green vegetables, almonds, A supplement thought to be useful in 30 IU free radicals — molecules that have hazelnuts; canola, sunflower warding off Alzheimer’s Disease and

been linked to cancer and heart disease and soybean oils other diseases of aging, now under review

K Blood-clotting and bone health Broccoli, parsley, chard and kale; Can interact with beneficial effects of No RDA estab. olive, canola and soybean oils coumadin, a blood-thinner

Calcium Helps build strong bones and teeth Dairy products, broccoli, dark leafy Girls and women need higher levels, up to 1000 mg greens like spinach and rhubarb, 1,500 mg daily; over half of girls and women

plus fortified products such consume less than half their RDA, which as orange juice heightens the risk of osteoporosis

Iron Manufactures hemoglobin essential in Leafy green vegetables, beans, shellfish, Iron deficiency is associated with 18 mg transporting oxygen throughout body; red meats, poultry, soy foods, egg yolks, anemia and lowered immune response.

iron deficiency causes anemia, and some fortified foods Iron is especially useful for women who lowered immunity menstruate heavily, for pregnant women,

endurance athletes, vegetarians

Magnesium Helps muscles and nerves function Oat bran and other whole grains, Especially recommended for people with 400 mg properly, steadies heart rhythm, brown rice, leafy green vegetables, heart disease, but also for chronic muscle

maintains bone strength by enhancing almonds, peanuts, hazelnuts, black-eyed cramps, headaches, muscle pain; calcium absorption, helps metabolism peas and lima beans, avocados, contraindicated when taking certain

bananas, kiwis, apricots, chocolate medications, so ask your doctor first

Zinc Boosts immune function and protein Lean meats, dairy products, beans, Popular to the contrary belief, zinc has not15 m synthesis; helps maintain taste acuity, peanut butter, grain products been proven to lower the risk of the common40 mg UL sperm production common cold; excess amounts can lower

levels of other minerals

P R O V I D E R P R O F I L E12

“My central task with diabetes patients,”

Dr. George Liu explains, “is education. I

spend a lot of time talking to my patients

because I have to make them understand

that their future with this disease depends as

much on them as on what I do as a doctor.”

“Some patients get very discouraged at the outset,”

Dr. Liu continues. “Others are determined to keep

a certain emotional distance from their disease, hoping

to leave everything to their doctor to solve. But no

doctor can make them better single-handedly. I tell

them that the best outcome is possible only when

they get fully involved and take responsibility for their

care every day.” (For more information on diabetes,

see Just what is diabetes? on page 14.)

Dr. Liu’s commitment to patient self-management and

education is based on years of experience observing

which patients do well and which patients succumb to

the complications associated with uncontrolled diabetes.

His record of success has won him the respect of his

medical peers and of his patients alike. A board certified

specialist in internal medicine with a sub-specialty in

endocrinology, Dr. Liu is also one of 30 physicians in the

New York region who have been selected to participate

in Oxford’s Diabetes Best Practices Network. This network

is the key component to Oxford’s Diabetes Best Practices

Program. The program works with PCPs to match high-

risk diabetic Members with endocrinologists who have

received, or will soon apply for, recognition from the

National Committee for Quality Assurance (NCQA) for

the quality of care they provide to patients with diabetes.

A balancing act“Living successfully with diabetes is a constant balancing

act, for the patient and the doctor” says Dr. Liu. People

with diabetes are usually advised to eat meals on a regular

schedule, to have a snack before bedtime, and to take

medications at precise dosages and hours. Change any one

of the elements of diet, exercise and insulin supply, stray

far from the well-regulated routine, and the patient’s blood

glucose levels may soar (hyperglycemia), or drop suddenly

and dangerously, causing insulin shock (hypoglycemia).

“Handling all these requirements is especially trouble-

some for adolescents,” Dr. Liu continues. “Their lives

aren’t normally geared to so much regularity nor do they

like to dwell on their health.” By way of example, he cites

a 16 year-old patient named Akeem King. “Akeem has type

1 diabetes, so he needs replacement insulin daily. He plays

Living withdiabetes

Dr. George Liu

13varsity basketball at his school, which requires intense physical

activity. Like most young men his age, he’s self-conscious about

doing anything that might be perceived by his teammates as

‘different.’ Ideally, Akeem is a great candidate for an insulin

pump, but he doesn’t want to wear one because of the way it

looks under his team jersey. He also doesn’t want to be seen at

school injecting himself with a needle, as his previous doctor

wanted him to do. Akeem often skipped his insulin rather

than interrupt his activities. He was not doing well at all.”

“Akeem was referred to me as someone who needed to

come to better terms with his disease,” Dr. Liu explains.

“After getting to know him, I was able to develop a treat-

ment plan that Akeem is willing to follow. It took some time

to get it right, but now he’s able to self-inject his medications

just twice a day — before he goes to school and when he

gets home. He’s also paying closer attention to what he

eats. I’ve told him that so long as he can show me that he’s

managing his blood sugar levels safely, we can continue to

do it his way. I’ve also told him, I feel good when he

feels good, so we have a kind of pact.”

Akeem’s judgment is more direct: “Dr. Liu

is cool. He talks to me and my parents a

lot about what can happen when I mess up.

He makes me come in to his office often

to see how I’m doing. He makes me show

him my test results for each day and

lets me know right away when I’m

not scoring points with him. I

was angry at first about all the

rules he gave me to follow

and, in the beginning, I

tried faking the blood sugar

numbers sometimes, but

now I’m getting so I

really understand why

I have to be careful.

My goal is to play

competitive

basketball and

so far I’m

doing it.

Dr. Liu

doesn’t let me

get away with

much, but I’m not

complaining.” O

A r e y o u a t r i s k f o r

t y p e 2 d i a b e t e s ?

You may be at an elevated risk for type 2 diabetes if:

• You are overweight

• You are age 65 or older

• You have a parent, brother or sister with diabetes

• Your family background is African American, AmericanIndian, Asian American, Pacific Islander, or HispanicAmerican/Latino

• You have had gestational diabetes, or have given birth to at least one baby weighing more than 9 pounds

• Your blood pressure is 140/90 or higher, or you have beentold that you have high blood pressure

• Your cholesterol levels are not normal; your HDL cholesterol(“good” cholesterol) is 35 or lower, or your triglyceride levelis 250 or higher

• You are fairly inactive; exercising fewer than three times a week

The more factors that apply to you, the higher your risk. Some factors are, of course, beyond your control, but weight,exercise and diet are all factors you can change for the better.

If you are concerned that you may be at risk for diabetes, or have other questions about the disease, speak with yourprimary care physician.

Healthy Bonus ® resources

for managing diabetes

This year, Oxford’s Healthy Bonus program has beenexpanded to include many offers that can help Memberswith diabetes manage their condition, including no-sugaradded candies, snacks and foods, cooking supplies and

much more. Here are a few of the offers available:

Diabetic Express Save 10 percent on all sugar-free candies, foods, cooking supplies, lotions and creams, and carrying cases.

Diabetic Candy.com Save 10 percenton all items.

Foot Solutions Receive 10 percent off on products, including specialfootwear for people with foot and lower leg conditions

Russell Stover 10 percent on all sugar-free candies

TCBY® Save $1.00 on any no-sugaradded menu item

Active Forever Save 10 percent on a selection of products to help make living with special conditions easier

For information on how to obtain these and other Healthy Bonus offers available to Oxford Members, visitwww.oxfordhealth.com or call ourCustomer Service Department at the number on your Oxford ID card.

P R O V I D E R P R O F I L E14

Diabetes has the potential to trigger a host of serious

complications, from skin ulcerations, foot infections

and periodontal disease, to high blood pressure, high

cholesterol, heart disease, stroke, kidney malfunction,

damage to the eyes (diabetic retinopathy), and extensive

nerve damage. These factors all add up to a chronic

disease that can be devastating. Under the right circum-

stances, however, diabetes can sometimes be prevented,

sometimes delayed and most certainly managed.

The Centers for Disease Control (CDC), which broadly

tracks America’s health, reports that type 2 diabetes, once

known as adult-onset diabetes, is rising sharply among

Americans; a situation related to the growing incidence

of overweight and obesity in all age groups. The most

recent survey reports that in the last 20 years, the number

of Americans with diagnosed diabetes has more than

doubled, from 5.8 million to 13.3 million, and another

5.2 million people have diabetes but do not know it.

More than 90 percent of these people have type 2

diabetes. Older Americans are especially hard hit, with

more than 18 percent of Americans over 65 being treated

for diabetes. Type 1 diabetes, formerly known as juvenile

diabetes, is far less common, accounting for roughly five

percent of the entire diabetes community. But type 1

takes a substantial toll, nonetheless, in that it usually

develops in the formative childhood years, becoming

a chronic condition that must be lived with for many

decades. A third kind of diabetes, known as “gestational,”

occurs infrequently during pregnancy and disappears

after the pregnancy is completed. More than 50,000

pregnant women have gestational diabetes each year,

and, although temporary, it signals a heightened risk for

developing type 2 diabetes within 10 years.

Doctors now screen for diabetes as part of routine

physicals and obstetric care. A blood screening for

diabetes may also be done on a patient presenting

unexplained symptoms of extreme thirst, urination,

persistent hunger, weakness and fatigue, frequent

infections, or slow wound healing. Certain known risk

factors (See Are you at risk for type 2 diabetes? on page

13) may also prompt a blood test for blood sugar levels.

A test result that indicates blood sugar levels higher than

the 70 to 110 milligrams per deciliter (mg/dL) range is

a standard indicator of diabetes for people under 50;

only slightly higher numbers in people above that age.

For more information on diabetes, visit the American

Diabetes Association’s web site at www.diabetes.org. O

Just what is diabetes?

OOX F O R D I N F O

Oxford’s Living with DiabetesSM program offers educationalmaterials and case management support to help Membersunderstand and improve control of their diabetes. For moreinformation about the program, please call 1-800-665-4686,Monday through Friday, 8:00 AM to 4:30 PM.

Diabetes is a condition in which the body’s pancreas either fails to produce a sufficient supply of the hormone insulin (type 1 diabetes), or the bodybecomes resistant to the insulin that is available (type 2 diabetes). The resultis that the simple sugars and carbohydrates taken in as food and turnedinto glucose cannot be fully metabolized, and the millions of cells within the body that depend on them for energy cannot do their work. The unusedglucose builds up in the bloodstream and urine, creating dangerously highlevels of blood glucose, the principal markers of diabetic disease.

M E R G E R U P D A T E 15

New OxfordID Cards

In the Fall 2004 issue of Healthy Mind Healthy

Body, we announced the merger between Oxford

Health Plans and UnitedHealthcare, and promised

to keep you posted in future issues about what this

merger means to you.

Throughout the months of April and May 2005, new

identification cards will be mailed to Oxford Members.

You will notice that key information is clearly displayed

on the cards and the new color of the ID cards will

make photocopying easier for your providers. The

merger of Oxford Health Plans and UnitedHealthcare

has produced a new corporate logo, which is also

prominently displayed on the new cards.

If you are a Member of a PPO or POS plan,

your card may indicate that you have access to

UnitedHealthcare’s Choice Plus network, outside

of the tri-state area. The Choice Plus network provides

nationwide in-network access to care, and will be

available on May 1, 2005 to eligible Members.

There are various versions of identification cards,

dependent upon the plan design that you or your

employer have selected. Pictured at left is a sample

of a new identification card for your reference. The

elements contained on this card may or may not be

applicable to your plan, but give you a general sense

of how your new card will look.

If you have any questions about your new Oxford

identification card or covered benefits, please log on

to our web site at www.oxfordhealth.com, or contact

Oxford’s Customer Service Department at the number

on your ID card. Your satisfaction is important to us

and we hope this makes your interactions with Oxford

and your providers easier. O

PlanName

OxfordMember ID Number

PharmacyMember IDNumber

CopaymentAmounts

ReferralIndicator

AncillaryNetwork

(if applicable)

PharmacyBenefit

Manager

NewCorporateLogo

NationalNetwork (if applicable)

L I V I N G W E L L16

B l u e b e r r y P o w e r M u f f i n s

w i t h A l m o n d S t r e u s e l

These are called “power” muffins because they’re

loaded with B vitamins from whole wheat flour, calcium

from milk and yogurt, antioxidants from blueberries,

and heart-friendly monounsaturated fat from almonds

and canola oil. You can freeze the muffins for up to

a month, then thaw them at room temperature, or

microwave each muffin at HIGH 15 to 20 seconds.

Muffins:

1 1⁄2 cups all-purpose flour, divided

1 cup whole wheat flour

1 cup quick-cooking oats

1 cup granulated sugar

1 tablespoon baking powder

1 teaspoon baking soda1⁄4 teaspoon salt

2 cups vanilla low-fat yogurt1⁄2 cup 2% reduced-fat milk

3 tablespoons canola oil

2 teaspoons vanilla extract

1 large egg

1 1⁄2 cups fresh blueberries

Cooking spray

Streusel:1⁄4 cup all-purpose flour1⁄4 cup slivered almonds, chopped

1 tablespoon brown sugar

1 tablespoon butter, melted

Directions:

Preheat oven to 400°.

To prepare muffins, lightly spoon flours into dry

measuring cups; level with a knife. Combine 1 1⁄2 cups

all-purpose flour, whole wheat flour, oats, granulated

sugar, baking powder, baking soda, and salt in a large

bowl, stirring with a whisk. Make a well in center of

mixture. Combine yogurt, milk, oil, vanilla, and egg,

stirring with a whisk. Add yogurt mixture to flour

mixture; stir just until moist. Fold in blueberries.

Spoon 2 rounded tablespoons batter into each of

30 muffin cups coated with cooking spray.

To prepare streusel, combine 1⁄4 cup all-purpose flour,

almonds, brown sugar, and butter. Sprinkle evenly over

batter. Bake at 400° for 15 minutes or until muffins

spring back when touched lightly in center. Cool in

pans 10 minutes on a wire rack; remove from pans.

Serve warm or at room temperature.

Yield: 15 servings (serving size: 2 muffins)

Nutrition per serving

CALORIES 244 (23% from fat); FAT 6.1g (sat 1.3g, mono 2.9g, poly

1.4g); PROTEIN 6.1g; CHOLESTEROL 18mg; CALCIUM 136mg;

SODIUM 260mg; FIBER 2.5g; IRON 1.5mg; CARBOHYDRATE 42.3g

Enjoying a healthy diet means more than just including foods low in fat and sodium. Since weeat so many processed foods, it is important to make sure that our diets include whole, fresh foodsrich in vitamins and minerals — “power foods.” To get you started, we have included two deliciousrecipes from Cooking Light magazine: both include high levels of many important vitamins andminerals. To find out the potential benefits of some of these nutrients, consult the chart on page 11.

Power foods

17

S i z z l i n g S a l m o n - a n d - S p i n a c h

S a l a d w i t h S o y V i n a i g r e t t e

The spinach in this recipe provides folic acid while the

salmon is an excellent source of heart-healthy Omega-3

oil and vitamins A and B.

Dressing:

3 tablespoons thinly sliced green onions

3 tablespoons rice vinegar

3 tablespoons low-sodium soy sauce

1 tablespoon water

1 teaspoon sesame seeds, toasted

1 teaspoon bottled minced garlic

1 teaspoon dark sesame oil1⁄2 teaspoon chile paste with garlic or 1⁄4 teaspoon crushed red pepper

Salad:

2 teaspoons dark sesame oil, divided

4 cups thinly sliced shiitake or button mushroom caps (about 8 ounces)

1 cup (1-inch) sliced green onions

1 cup fresh or frozen corn kernels, thawed

4 (6-ounce) salmon fillets (about 1 inch thick)

8 cups baby spinach

1 cup fresh bean sprouts

1 cup red bell pepper strips

Directions:

Preheat broiler.

To prepare dressing, combine first 8 ingredients in a small

bowl, and stir well with a whisk.

To prepare salad, heat 1 teaspoon oil in a large nonstick

skillet over medium-high heat. Add mushrooms and 1 cup

onions; sauté 8 minutes. Stir in corn; remove from heat.

Place the fish on a foil-lined baking sheet; brush evenly

with 1 teaspoon oil. Broil 8 minutes or until fish flakes

easily when tested with a fork.

Place 2 cups spinach on each of 4 plates; top each serving

with 1⁄4 cup bean sprouts, 1⁄4 cup red bell pepper, 1⁄2 cup

mushroom mixture, and 1 fish fillet. Drizzle about 2

tablespoons dressing over each salad.

Yield: 4 servings

Nutrition per serving

CALORIES 418 (40% from fat); FAT 18.8g (sat 3.2g, mono 8.3g, poly

5.1g); PROTEIN 42.9g; CHOLESTEROL 111mg; CALCIUM 163mg;

SODIUM 549mg; FIBER 7.8g; IRON 6.1mg; CARBOHYDRATE 21.8g

Healthy Bonus® savings

As an Oxford Member, you can

receive 11 issues of Cooking

Light for only $16, a savings of

more than 65 percent off the

cover price. To order your

subscription, available at this

price for Oxford Members only,

call toll-free at 1-877-300-7177

and mention the promotional

code OXHP. Or, log on to

www.cookinglight.com/oxhp.

*Offers are valid through June 30, 2005. These discounts are offered in addition to, and separate from, your benefit coverage through Oxford HealthPlans. These arrangements have been made for the benefit of Members, and do not represent an endorsement or guarantee on the part of Oxford.Discounts may change from time to time and without notice and are applicable to the items referenced only. Oxford Health Plans cannot assumeany responsibility for the products or services provided by vendors or the failure of vendors referenced to make available discounts negotiated withOxford; however, any failure to receive discounts should be reported to Oxford Customer Service by calling the number on your Oxford ID card.

OOX F O R D I N F O

To find out more about the array of Healthy Bonus offers availableto Oxford Members, including savings on weight loss programs,fitness, nutrition, and publications, visit www.oxfordhealth.com, orcall Customer Service at the number on your Oxford ID card.*

© 2005 Cooking Light Magazine

N E W S Y O U C A N U S E18

Subimo Hospital Advisor™

now available in Spanish Subimo’s Hospital Advisor is a fast and easy way for you

to get important information that will help you make

informed decisions when choosing a hospital. With this

tool, Oxford Members can research information about

patient safety measures, outcomes, complications, and

the total number of beds at hospitals in their area.

Now, the Hospital Advisor is available to our Spanish-

speaking Members in a Spanish-language format that

is easy to use and understand. The Spanish Language

Hospital Advisor™ also provides access to critical

information on the availability of maternity services,

cardiac procedures and intensive care units. To access

the Hospital Advisor, register for a user name and

password on www.oxfordhealth.com.

Privacy notice concerning financial information

At Oxford, protecting the privacy of the personal

information we have about our customers and Members

is of paramount importance, and we take this responsibility

very seriously. The following notice describes our policy

regarding the confidentiality and disclosure of customer

and Member personal financial information that

Oxford collects in the course of conducting its business.

Our policy applies to both current and former customers

and Members.

The information Oxford collects

We collect non-public, personal financial information

about Members from the following sources:

• Information we receive from you on applications or

other forms (e.g., name, address, Social Security

number, and date of birth)

• Information about your transactions with us, our affiliates (companies under common ownership with, controlled by, or owned by Oxford) or others

• Information we receive from consumer reportingagencies concerning large group customers

The information Oxford discloses

We do not disclose any non-public, personal financial

information about our current and former customers

OO X F O R D | B E N E F I T S U P D A T E

19

and Members to anyone except as permitted by law.

For example, we may disclose information to affiliates

and other third parties to service or process an insurance

transaction, or provide information to insurance

regulators or law enforcement authorities upon request.

Oxford security practices

We emphasize the importance of confidentiality

through employee training, the implementation of

procedures designed to protect the security of our

records, and our privacy policy. We restrict access to

personal financial information of our customers and

Members to those employees who need to know that

information to perform their job responsibilities. We

maintain physical, electronic and procedural safeguards

that comply with federal and state regulations to guard

your non-public, personal financial information.

This notice is being provided on behalf of the following

Oxford affiliates: Oxford Health Plans LLC, Oxford

Health Plans (CT), Inc., Oxford Health Plans (NJ), Inc.,

Oxford Health Plans (NY), Inc., Oxford Health

Insurance, Inc., Investors Guaranty Life Insurance

Company, and Oxford Benefit Management, Inc.

Please note: A copy of Oxford’s Notice of Privacy Practices

can be obtained by logging on to www.oxfordhealth.com.

To request a written copy, please call our Customer Service

Department at the number on your Oxford ID card. You

can also contact us by mail at:

Oxford Health Plans

HIPAA Member Rights Unit

48 Monroe Turnpike

Trumbull, CT 06611

New Jersey primary care physician (PCP)and OB/GYN disenrollment process

If you are a New Jersey Member and your Oxford

PCP or OB/GYN is disenrolled from Oxford’s provider

network, we will provide you with a 30-day advanced

written notification. The notification will inform you of

the disenrollment date and advise you of the procedures

for selecting a new participating PCP or OB/GYN.

Please note: Advance notice is not required if your

PCP or OB/GYN is terminated due to quality of care

concerns, fraud or breach of the Oxford participating

provider agreement.

N E W S Y O U C A N U S E20

New Jersey Independent ConsumerSatisfaction Survey results

If you are a New Jersey Member and would like to

request New Jersey Independent Consumer Satisfaction

Survey results and an analysis of quality outcomes of

healthcare services of managed care plans in the State

you may contact:

Office of Health Care Quality AssessmentNew Jersey Department of Health and Senior ServicesP.O. Box 360Trenton, NJ 08625-03601-800-418-1397

Oxford’s radiology network Radiology services, such as MRI, PET scans and CT

scans, are some of the most expensive services in health-

care today. Fortunately, Oxford has contracted with

numerous freestanding radiology facilities. We require all

freestanding radiology facilities to be accredited by the

American College of Radiology. If you are in need of a

radiology procedure, such as an MRI, PET or CT scan,

ask your doctor about Oxford participating freestanding

facilities nearby. Because a freestanding facility does not

share the same overhead as a hospital, generally the cost

per service is less than the cost charged by a hospital.

Chest x-ray policy updateSeveral medical professional associations, including the

American College of Chest Physicians, the U.S. Preventive

Services Task Force, the National Cancer Institute, and

the American Cancer Society, have concluded that chest

x-rays for screening should not be a part of a routine

periodic physical examination. Please be aware that,

as of July 1, 2004, chest x-rays performed routinely

for screening purposes as part of a periodic health

maintenance examination by your PCP in the absence

of symptoms, signs or disease states are not covered.

Please note: Oxford will continue to provide coveragefor chest x-rays that are medically necessary based onsymptoms, signs or disease states.

Updated Member Handbooks for New York Members

If you are a New York Member and have coverage

through your employer or purchase individual coverage

directly from Oxford, we would like to inform you

that an updated electronic version of your Member

Handbook is available on www.oxfordhealth.com. The

new Member Handbook may contain some language that

differs from the provisions in your current Certificate of

Coverage and Member Handbook (or your individual

contract) and replaces certain sections of your Certificate

of Coverage.

To request a printed copy, please call our Customer

Service Department at the number on your Oxford ID

card. You can also contact us by mail at:

Oxford Health PlansManaged Care Act Request48 Monroe TurnpikeTrumbull, CT 06611

Oxford cares about qualityOxford Health Plans’ Quality Management (QM)

program is devoted to making sure that you have

access to quality healthcare. Our QM program is led

by an Executive Quality Management Committee and

consists of various regional committees in which QM

staff and network providers participate.

Functions include:

• Identifying the scope of care and services availablethrough Oxford

• Developing clinical practice guidelines (e.g., guide-lines regarding treating heart disease) and servicestandards (e.g., processing precertification requests)to measure performance

• Verifying the medical qualifications of providers who participate in Oxford’s network

• Monitoring and evaluating the quality and appropriateness of the services and medical carereceived by Oxford Members (i.e., via ongoingMember satisfaction surveys)

• Pursuing opportunities to improve patient safety and customer service

• Resolving identified quality issues or concerns

If you would like to request more information about

Oxford’s QM program and goals, please call our

Customer Service Department at the number on your

Oxford ID card.

21

Promoting appropriate careThrough the media or your own research, you may have

become aware that some managed care organizations

offer rewards or bonuses to providers who limit and/or

deny care. Please note that decisions about the care you

receive are based only on appropriateness of care, service

and existence of coverage. Oxford does not compensate

providers for denials of service, nor do we offer incentives

to encourage denials. We do encourage the use of

appropriate care and services to prevent and/or treat

illnesses. For details about your specific benefit coverage,

please refer to your Certificate of Coverage.

Commercial Member rights and responsibilities

As an Oxford Member, you have certain National

Committee for Quality Assurance (NCQA) rights and

responsibilities related to your coverage. The following

information is provided for your reference:

Oxford commercial Members have the right to:• Receive information about Oxford, its services,

its practitioners and providers, and Members’ rights and responsibilities

• Be treated with respect and recognition of their dignity and right to privacy

• Participate with practitioners in decision makingregarding their healthcare

• Have candid discussions about appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage

• Voice complaints or appeals about Oxford or the care provided by participating providers

• Make recommendations regarding the organization’sMember rights and responsibilities policies

Oxford commercial Members have the responsibility to:• Provide, to the extent possible, information that

Oxford and its practitioners and providers need in order to care for them

• Follow the plans and instructions for care that theyhave agreed on with their practitioners

• Understand their health problems and participate in developing mutually agreed upon treatment goalsto the degree possible

In addition to the previously noted information,

Members are also entitled to rights and responsibilities

subject to applicable state law. These rights and

responsibilities are outlined in your Certificate of

Coverage. If you have questions concerning your rights

and responsibilities, please call our Customer Service

Department at the number on your Oxford ID card.

Adopting the latest technologiesNew treatment methods are constantly being developed

for conditions ranging from asthma to skin cancer. The

following information will help you understand how

Oxford evaluates these new medical technologies and

how decisions are made regarding their use.

What is new medical technology? New medical

technology is defined as a newly approved drug or

medication, a new surgical procedure or new medical

equipment. Oxford continually assesses new medical

technologies. Two examples of new medical technologies

that were recently approved for coverage by Oxford are

intranasal influenza vaccine (FluMist™) and the wearable

external cardioverter defibrillator (WCD).

What is the evaluation process? Oxford’s Healthcare

Services Department, led by experienced physicians

representing multiple specialties, is responsible for

evaluating new medical technology. The process begins

with a review of the medical literature and other technical

research. The clinical staff also seeks opinions from

leading physicians and specialists in the community —

providers who have knowledge and expertise regarding

how new medical technology will be used on a day-to-day

basis. Once a thorough review of the available informa-

tion has been conducted, Oxford’s senior medical staff

meets to decide whether or not to cover the new medical

technology. They base their decision on the strength of

the scientific evidence published in medical journals.

Representatives from all department areas then meet to

create a policy that outlines the conditions for which the

technology will be covered. Once the policy is finalized,

front-line Oxford employees are trained regarding

precertification, review, benefit application, and claims

payment. When a new policy is implemented, Oxford

notifies physicians through a quarterly publication called

the Provider Program and Policy Update (PPU) and on

our web site, www.oxfordhealth.com.

N E W S Y O U C A N U S E22

As a Member, you are notified of important new policies

through this News You Can Use section in Healthy Mind

Healthy Body® magazine. All policies are re-evaluated on

a periodic basis.

Access to careWe recognize that timely access to medical services is

important — whether you need a physical, a colonoscopy

or an appointment to be treated for an unexpected illness.

That’s why we’ve developed provider service standards and

regularly monitor our provider network for compliance

with these standards.

As an Oxford Member, you can expect to see a provider

for urgent care within 24 hours, routine symptomatic care

(non-urgent, but in need of attention) within 72 hours or

a regular physical exam within six weeks. Your wait in a

provider’s office or for a response to an after-hours urgent

phone call should be no more than 30 minutes. We also

set standards for the maximum number of appointments

a primary care physician should have scheduled per

hour, and how many patients he or she can care for in

the practice. Measures like these are designed to help

promote quality care.

An important research study*We would like to make you aware of an ongoing research

study called Action to Control Cardiovascular Risk in

Diabetes (ACCORD), which is looking for adults with type

2 diabetes. This eight-year study, sponsored by the National

Institutes of Health, will be conducted at more than 75

medical facilities throughout the United States and Canada.

Currently, about 17 million Americans have been

diagnosed with diabetes, and more than 90 percent of

those cases are type 2 diabetes (formerly called “adult

onset” or “non-insulin dependent diabetes”). People

with type 2 diabetes are more likely experience high

blood pressure and/or high cholesterol than the general

population. In combination, these factors produce a

higher risk of heart disease and stroke.

The ACCORD study will test the best approaches to

lowering the risk of cardiovascular events for patients

with type 2 diabetes, such as heart attack or stroke.

This is not a study of a new medication.

All ACCORD participants will obtain their diabetes

care and medications, as well as cholesterol or high blood

pressure medications from the study at no cost. Study

participants will continue to receive all other medical

care from their current physicians.

If you are an adult with type 2 diabetes and would

like to be considered for this study, or for further

information, please call the ACCORD central recruiting

number for New York/New Jersey at 212-305-6357 or

visit the web site for the Northeastern Network of

ACCORD, www.accord-ne.org.

* This notice is intended for informational purposes only. Oxford is not a sponsor of this study and is not responsible for its conduct. If you have anyquestions or concerns regarding this study, please consult your physician.

2005 Drug Formulary UpdateEffective January 1, 2005, Oxford has transitioned to

UnitedHealthcare’s Prescription Drug List, which impacts

the tier placement of certain drugs. For a complete

listing of the new Prescription Drug List, please log on to

www.oxfordhealth.com. The Pharmacy and Therapeutics

(P&T) Committee reviews new drug products approved

by the Food and Drug Administration (FDA) and reviews

current products when new information becomes

available. Coverage for the listed items may be limited or

excluded based on a Member’s eligibility or plan design.

23

Endocrine drugs

• Anadrol — 50

• Androderm patches

• Androgel

• Android

• Calderol

• Deca Durabolin

• Delatestryl

• Depo Testosterone

• DHT

• Halotestin

• Hytakerol

• Methyltestosterone

• Oxandrin

• Rocaltrol

• Somavert1

• Striant

• Testim

• Testoderm

• Testosterone

• Testred

• Winstrol

• Zavesca1

Growth hormones

• Serostim

OB/GYN drugs

• Lupron (3.75 mg and 11.25 mg)

Dermatological drugs

• Avita2

• Differin2

• Elidel

• Protopic

• Raptiva1

• Retin A2

Gastrointestinal drugs

• Aciphex

• Lotronex

• Nexium

• Prevacid

• Prilosec

• Protonix

• Zegerid

• Zelnorm

Musculoskeletal and

Rheumatological drugs

• Bextra

• Celebrex

• Enbrel1

• Forteo

• Humira

• Kineret

Psychotherapeutic drugs

• Adderall3

• Concerta3

• Desoxyn3

• Dexedrine3

• Dextrostat3

• Provigil

• Strattera

Pulmonary drugs

• Singulair4

Urological drugs

• Caverject

• Cialis

• Edex

• Levitra

• Muse

• Viagra

Vitamins/Nutritional products

• Drisdol

• Hectorol

• Nutritional therapies1

1 For coverage information, Members shouldcall our Customer Service Department at the number on their Oxford ID card.

2 Applies only to Members age 40 or older.

3 Applies only to Members age 19 or older.

4 Applies only to Members age 12 or older.

Medications requiring precertification

To obtain precertification, please have your physician call Medco Health Solutions, Inc. directly at 1-800-753-2851,

Monday through Friday between 8 AM and 9 PM. This list is subject to change without notice. For the most up-to-date

information, please call Pharmacy Customer Service at 1-800-905-0201. Or log on to www.oxfordhealth.com.

Please note: Precertification requirements may vary, depending on the Member’s benefit. O

S P E C I A L T O P I C24

Ways you can help Whether you have personally experienced a profound

loss or not, it’s normal to feel awkward and unsure of

what to do or say when someone else needs your help.

Here are suggestions from the National Mental Health

Association to guide you at such a time:

Listen patiently and compassionately. Allow the

grieving person to talk freely about feelings of loss

without fear of disapproval or embarrassment.

Share your own memories of the deceased, especially

those memories which may shed a new and loving light on

the person remembered.

Be accepting of tears. Tears will almost certainly come

at some point in the grieving process; they are nature’s

way of literally washing away some of the toxic chemicals

associated with emotional stress and restoring a measure

of balance.

Avoid false comfort. Avoid clichés such as “It was for

the best,” “You’ll get over it in time,” “It was God’s will,” or

“At least she isn’t suffering any more.” Don’t say you know

how it feels to have suffered such a loss. For each person

bereavement is a unique experience.

Offer to take over some simple task that might ease the

grieving person’s burdens, and be sure to follow up with

action. It might be helping to sort out business papers or

taking care of a housekeeping chore around the house

for a few weeks.

Remember holidays and anniversaries, when recent

loss is most likely to make people feel isolated and

abandoned. Look for thoughtful ways to share your

home, yourself and your activities in these especially

difficult times.

Pay attention to signs that the grieving person is in

greater distress than he or she can handle. Dramatic

weight loss or loss of appetite, substance abuse, depression,

excessive sleeping, physical problems, personal neglect,

even talk of suicide, should be taken seriously. If you do

not feel close enough to the individual to raise your

concerns directly, tell a friend or family member who is.

HelpingThe death of a loved one understandably generates feelings of loss and

bereavement, but many other changes in life can also cause us to grieve, from

divorce to the estrangement of a child, to the experience of serious illness and

the uncertain future it brings. Grieving is a natural, inescapable response that

engages our entire being — physically, emotionally and spiritually. If someone

you care about is going through this passage, be patient, tolerant and supportive.

Grieving cannot be rushed. It takes everyone time to adjust to new circumstances

and to heal, each in his or her own way, at his or her own pace.

25

When children grieveIt is important to remember that adults aren’t the only ones who

experience grief. Children deal with very similar feelings, and in most cases,

are less equipped to express them. Children typically experience grief in

ways more appropriate to their age and emotional development:

Children younger than age seven perceive death as separation and they

tend to act out their feelings rather than put them in words. They fear being

alone and worry that when other members of the family leave, even for a

short time, that they too, may not return. Youngsters may refuse to go to

school or to daycare for the same reason. Eating, sleeping, bed-wetting, or

temper tantrums may also erupt.

Children between seven and 12 are more likely to view a loved one’s

death as a threat to their personal safety and dwell on fears that they, too,

may die. Some may want to stay close to a protector while others may

withdraw. Some in this age group will act very brave, while others may

be disruptive. Problems with concentration, following directions or carrying

out familiar tasks are not unusual. This older child frequently imagines that

he or she is somehow responsible for the death of the loved one, through

something done or said.

Teenagers, depending on their level of maturity, may grieve much like

adults. Or they may be drawn to dramatic behavior — embracing religion

with a fervor not previously seen or taking on reckless acts as though to defy

death, or even contemplating suicide.

Overwhelming griefWhile most adults adjust well to the changes that bereavement or other

major loss brings, it must be acknowledged that some may feel truly

overwhelmed. Their grief can rise to the level of clinical depression and

post-traumatic stress disorder. For people undergoing the more severe

responses of traumatic grief, the sooner professional counseling is sought

the better. For some, severe suffering may be as natural as other expressions

of loss, but because it undermines a person’s innate capacity to recover,

those who suffer traumatic stress need skilled support on the road to making

a healthful, life-affirming adjustment. Whatever the situation, your support

will likely go far in making a loved one’s experience with grief easier. O

time heal

W E L L N E S S26

When you are young, it usually takes

something as severe as a major sports

injury, a bad fall or a serious car accident,

to break one of your bones. That’s because

young bones are resilient and strong —

almost rubbery. And given proper nutrition,

exercise, favorable genetics, and no major

accidents, they will continue to serve you

well for years to come. But it’s important

to never take your bones for granted.

Bones are living tissue. They consist of a flexible porous

framework of a protein substance known as collagen and

a lot of mineral filler — calcium phosphate — that gives

connective tissue its strength and hardness. They are

constantly in the process of renewal. Old bone dissolves

and new bone is formed from a steady supply of dietary

calcium — ideally about 1,000 milligrams (mg) daily for

adults, 1,300 mg for adolescents — plus supporting

vitamins and other nutrients. This daily calcium boost,

which comes from dairy products, fortified cereals, green

leafy vegetables, and other foods, is especially critical

during the formative years when young bodies are at

maximum capacity to “bone up.” Unfortunately, studies

show that many of today’s adolescents, especially girls,

consume barely half (650 mg) of what they need to

achieve adequate bone mass in adult life.

Growing bones are also responsive to physical activity.

Bones thrive on weight-bearing exercises, such as jumping,

running and walking, and on the mechanical pressure that

muscle pulling against muscle (isometrics) exerts on them.

That’s why it’s especially important to be physically active

during the teen years, ironically the time when many

young people choose to be less active. Whichever pattern

of activity they choose, young women reach their peak

bone mass and density between ages 25 and 30; young

men arrive at maximum strength about five years later.

After that, bones begin their inevitable decline, losing

more minerals year by year than are naturally added.

For those of us who start with substantial bone mass and

continue to exercise and eat a healthy diet throughout

life, the demineralization process has little or no effect

on our ability to get around as we age. But for people

who reach adulthood with less than sturdy bone mass and

density, health problems in the form of osteoporosis or

porous bone are likely to begin showing up in middle age.

Something as seemingly innocent as a bump or stumble

can cause increasingly fragile bones to develop hairline

fractures or to snap clean through. These people may

actually lose a couple of inches in stature, and may develop

a gradual curvature of the back or “widow’s hump”— a

Bone basics

Microscopic bone Osteoporosis from an 89-year old female.

27

condition that can cause chronic discomfort and back pain. Other

circumstances can also set the stage for frequent fractures as people

age. Certain disorders such as type 1 diabetes, as well as gastrointestinal

diseases, can interfere with absorption of calcium and weaken bones.

While any bone break can be a nuisance, the consequences of hip

injury — far and away the most common location in older people —

can go well beyond the bother of wearing a temporary cast. Hip

fractures most often occur at the upper end of the femur or thighbone

where it fits into the pelvic hip socket. Repair typically involves invasive

surgery to align and pin the sides of the break. Severely damaged bone

may require partial or total hip replacement with artificial parts. The

surgery and short hospital stay usually go smoothly. Fully successful

recovery depends to a large degree on the ability of the patient to carry

out the demanding rehabilitation that follows, which usually entails an

extended period of supervised exercise and physical therapy at a live-in

rehabilitation center. Patients may also have to adopt new nutritional

patterns and other habits that support better health.

Is there anything to be done to reduce your risk of fragile bones?

Absolutely. Ideally, begin when you are young, and do what it takes

to keep your bones as strong as possible. If you have children, pay

close attention to their stepped up nutritional needs, and as they

become old enough to understand, remind them regularly why good

nutrition and exercise really matter. For your own bone health, include

recommended levels of calcium appropriate to your age and health

in your diet, and ask your primary care physician (PCP) if you should

take supplemental calcium and Vitamin D. (See Do you know your

A-B-Cs? on page 10.) Also, know your individual risk for osteoporosis

before it develops. Your PCP has reliable methods of predicting risk

and screening for bone density in your 30s or 40s; if you turn out to

be at high risk, your PCP may recommend you take one of the

therapeutic drugs available — including Fosamax®, Actonel® and

Evista® — that slow and, in some cases, stop continued bone loss.

Calcitonin, an injectable natural hormone that enhances bone

formation, is another option for some patients.

With a little attention, your bones will carry you into your golden

years without trouble. But remember, when it comes to bone health,

the sooner you begin treating your bones with the respect they

deserve, the better. O

Osteoporosis facts

and f igures

• Over 44 million Americans have osteoporosis,68 percent of them women

• Incidence increases dramatically with age;between ages 55 and 64, 16 percent ofwomen tested have some degree of bonefragility; over 65 the incidence rises to 35 percent and upwards with increasing years;bone loss is most rapid in the first few yearsafter menopause

• One in two women and one in four men over50 will have an osteoporosis-related fracturein their lifetime

• Osteoporosis is responsible for more than 1.5million fractures annually, including 300,000hip fractures, 700,000 vertebral fractures,250,000 wrist fractures, and more than300,000 fractures at other sites

• Risk factors vary with age, gender and ethnicity; small, thin-boned older Caucasianand Asian women are at highest risk; so are people who lose two or more inches inheight as they age, people whose posturetends to be bent with aging, or who have afamily history of osteoporosis or frequent bone breaks; people whose diets are low in calcium, who smoke, who consume alcohol to excess, who are inactive physically, whomust undergo extended bed rest, who havehad eating disorders such as anorexia andbulimia, or who use certain therapeutic medications such as corticosteroids, are also at higher risk

Sources: National Osteoporosis Foundation, The NationalInstitutes of Health and The U.S. Food and Drug Administration

OOX F O R D I N F O

Oxford Members can take advantage of discounted memberships to theWellQuest network of fitness facilities through Oxford’s Healthy Bonus®

program. A WellQuest membership includes a consultation with a fitnessinstructor, and access to Miavita, an online nutrition guidance program. To find out more about WellQuest, including a listing of participating facilities in your area, visit www.wellquestonline.com, or call 1-800-595-8448.

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