Your guide to lifelong healthHealth and wellness or prevention informationWinter 2020-2021

STARM-6282 747366.0121

COVID-19: At Blue Cross and Blue Shield of Texas (BCBSTX), the health, safety and well-being of our members is our top priority. We want to help you stay informed about coronavirus disease 2019 (COVID-19) and get the care you need. For more information about COVID-19, visit www.bcbstx.com/medicaid/coronavirus-information.

Did You Get Your Flu Shot? It Is Not Too Late.The flu virus and COVID-19 will impact our communities this winter. That is why getting a flu shot is more important than ever. A flu shot will not protect against COVID-19, but it will cut the risk of getting the flu and the health risks it brings.

The Centers for Disease Control and Prevention (CDC) advises a yearly flu shot for most people ages 6 months and older. A yearly flu shot is the best way to help protect against the flu. Getting vaccinated protects you and those around you. An infected person can spread the flu even before symptoms appear. Your shot will lower the chances of becoming infected or infecting others. To find doctors, health clinics and drugstores near you, call Customer Service at 1-888-657-6061 (TTY: 7-1-1).

BCBSTX covers flu shots for members ages 6 months and older when they visit their Primary Care Physician (PCP).

Members ages 7 and older can also visit an in-network pharmacy to get a flu shot at no cost.

Source: Centers for Disease Control and Prevention (CDC)

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Helping Children Cope Children and teens react, in part, to what they see from the adults around them. When parents and caregivers deal with COVID-19 calmly and confidently, they can provide the best support for their children. Parents can be more supportive to others around them, especially children, if they are better prepared.

Watch for behavior changes in your childNot all children and teens respond to stress the same way. Common changes to watch are:

• A lot of crying or irritation in younger children • Going back to behaviors they have outgrown, such as toileting accidents or bedwetting

• Frequent worrying or sadness • Poor eating or sleeping habits • Irritability and ‘acting out’ behaviors in teens • Getting bad grades or not going to school • Problems focusing • Not taking part in activities enjoyed in the past • Unexplained headaches or body pain • Using alcohol, tobacco or drugs

Ways to support your child • Talk with your children about the COVID-19 pandemic.

• Answer questions and share facts about COVID-19 in a way children can understand.

• Make sure children know they are safe. Let them know it is OK if they feel upset. Share with them how you deal with your own stress, so they can learn from you how to cope with stress.

• Limit your family’s access to news coverage of the pandemic, as well as social media. Children may mistake what they hear and can be scared about something they do not understand.

• Keep up with normal routines. If schools are closed, make a schedule for learning activities and relaxing or fun activities.

• Be a role model. Take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members.

• Spend time with your children. Read, work out, and play board games together.

Take care of your mental healthChildren may feel more stress during this pandemic. Fear and anxiety can be hard to handle and cause strong emotions. If your child needs mental health help, you can:

• Plan a visit with the PCP (in person or via telehealth), who can help you find specialists.

• Call Magellan Behavioral Health at 1-800-327-7390 (TTY: 1-800-735-2988) to talk about mental health issues.

• Call the 24-Hour Nurse Advice Line at 1-844-971-8906 (TTY: 7-1-1). Nurses are available anytime, day or night.

• Call Customer Service at 1-888-657-6061 (TTY: 7-1-1). You can reach us from 8 a.m. to 8 p.m. Central Time, Monday through Friday for help finding a mental health provider.

Source: Centers for Disease Control and Prevention (CDC)

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What You Should Know Before Going to the ERIt is important to know where to go when you need care. If you are not having an emergency, knowing your options may save you a lot of time. These options can help you decide where to go based on your health care needs:

24-Hour Nurse Advice Line Average wait time: 17 seconds

1-844-971-8906 (TTY: 7-1-1)If you have an unexpected health problem, a nurse can help you decide if you should call your doctor, visit the ER or urgent care, or treat the problem yourself.

Behavioral Health Services Hotline

1-800-327-7390 (TTY: 1-800-735-2988)Registered nurses are on call to answer your health questions, 24 hours a day, seven days a week.

Doctor’s Office/Counselor’s Office Average wait time: 18 minutes

• Checkups or physicals • Ear or sinus pain • Eating disorders

• Feeling sad or lonely • Medication refills or changes • Sore throat

• Stomach ache • Struggling with an addiction

Your doctor is the best person to treat illnesses and health concerns that are not emergencies or immediately life-threatening.

Urgent Care Average wait time: 16-24 minutes

For immediate medical care when you cannot see your doctor. • Asthma with constant wheezing not resolved with your inhaler

• Back pain

• Burning with urination • Cuts that need stitches • Flu or cold-like symptoms

• Minor fractures • Pink eye • Rash without fever

Emergency Room Average wait time: 3 hours

If you have an emergency, call 911 immediately.

• Chest pain • Drug or alcohol overdose • Having thoughts of harming self or others

• Shortness of breath or severe trouble breathing

• Severe vomiting, diarrhea • Severe injuries, broken bones

• Stroke (sudden weakness of one side, slurring of speech, trouble swallowing, blurred vision)

• Uncontrolled bleedingWhen you need to go to an urgent care clinic or emergency room, follow up with your doctor after the visit.

Sources: Vitals Annual Wait Time Report, 2018.; Wait Time Trends in Urgent Care and Their Impact on Patient Satisfaction, 2017.; ER Wait Watcher Texas, 2019

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How to Stay Active in Cold WeatherWhen cooler weather blows in, you can pull the blankets over your head and go back to sleep — or you can suit up and head out for an outdoor winter adventure. The American Heart Association offers these tips for working out in colder months.

There is no reason to take a break from physical activity when the temperature drops.

Try these outdoor activities: • Walking or hiking • Jogging or running • Doing yard work • Biking

• Picking up trash around your neighborhood

• Playing frisbee at a park

Stay warm, stay safeStaying warm and dry when heading out to exercise in cold weather is all about layers. A little preparation can keep you safe from cold weather hazards like hypothermia and frostbite.

Cold temperatures, strong winds and wet conditions steal your body heat. That is why layering your clothes is so important. Clothes help trap the heat and form a kind of insulation against severe weather.

Avoid starting to layer with cotton clothing. Once cotton becomes wet with sweat or snow, the moisture is trapped and will actually make you feel colder (and heavier). For your first layer, you want something that pulls moisture away from your skin, like the moisture-wicking fabrics used in sportswear. Next, add a layer of fleece. Finally, top with a thin waterproof layer.

Know the signsHypothermia means the body temperature has fallen below 35 degrees Celsius or about 95 degrees Fahrenheit. It occurs when your body cannot produce enough energy to keep the internal body temperature warm enough. This can lead to death. Signs can include:

• Lack of coordination

• Mental confusion • Slowed reactions • Slurred speech

• Cold feet and hands

• Shivering • Sleepiness

Drink waterDo not forget to drink water when exercising in cooler weather.

Indoor workoutIf the winter weather stops you from getting outside, do not just reach for the remote. Make your time inside count. There are many ways to get physical activity indoors. Free weights or resistance bands are a great addition, but not necessary. You can also wear a heavy backpack to add intensity to your workout.

Try these indoor activities: • Home workout with free weights or canned goods

• Dancing • Active housework like vacuuming and sweeping • Mall walking • Bowling • Yoga or other fun group classes at your local gym, studio, or community center

• Stair climbing

Source: American Heart Association

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Telehealth: Health Care from Your HomeHave you visited your PCP recently? If not, telehealth may be an option for you. Telehealth is a ‘visit’ to your doctor by telephone call or face-to-face video call. Whether you are healthy or sick, your health can be managed by your PCP for the following services over the phone or web:

• Sick visits − Pediatric care − Respiratory issues − Stomach issues and more

• Chronic care management − Diabetes- Your PCP may be able to monitor your blood sugar remotely. Ask your PCP about scheduling lab work to monitor your hemoglobin A1c (HgbA1c) level and kidney functions. − Asthma or COPD- Schedule a visit to talk about your respiratory medications.

• Behavioral health − Virtual counseling by video or telephone call − Child behavior/learning issues − Stress management − Prescription medication monitoring

• Prescription refills

• General questions and referrals

• Follow-up appointments

Take control of your physical and mental health today! There are several ways you can find out if your PCP offers telehealth services:

• Call your PCP’s office or BCBSTX Customer Service.

• Use Provider Finder®.

− Click the ‘Provider Finder’ link on the STAR member homepage (www.bcbstx.com/star). − Enter your PCP’s name in the ‘Search by provider name or specialty’ search box. − Click ‘View Profile’ to see more information about the PCP. In the ‘Specialties and Expertise’ tab, it will say ‘Telehealth’ if your provider offers these services.

• Look in your printed directory. Your PCP will have a next to their name if he or she offers telehealth services.

If you prefer to see your PCP in person, you can always schedule a face-to-face visit. There are some appointments that need to be done in person such as those that require a physical exam. This includes some prenatal and postpartum checkups. Ask your doctor if you are unsure whether your appointment should be done in person or not.

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Do You Have a Complaint?If you are unhappy with BCBSTX or the care you have received from one of our providers, we want to hear about it. You or someone you choose, such as a parent or guardian, can file a complaint for you in one of the following ways:

• Call Customer Service toll-free. • Call a STAR Member Advocate. You can also ask your Member Advocate for an update on a previous complaint.

• Fill out a Complaint Request Form and mail it to BCBSTX. You can find the Complaint Request Form at www.bcbstx.com/star.

Community-Based Organization Spotlight: Bienestar Latino Mental Health CoalitionCommunity-Based Organizations (CBOs) are nonprofit groups that work to improve the lives of residents in their communities.

Bienestar Latino Mental Health Coalition is a growing group of mental health experts, pastors, church staff, social workers, artists, activists, case workers and social work professors who care about and are invested in the Latino and Spanish-speaking community in Waco, Texas.

This group meets routinely to raise awareness about mental health in the Latino community. Many members identify as part of this community and share a passion for creating access to services and advocating for fairness for the Latino community, especially the Spanish-speaking community.

Bienestar offers training for pastors and mental health workshops and educational panels for churches. All events are available in both Spanish and English.

Source: Baylor University, www.baylor.edu/externalaffairs/news.php?action=story&story=219123, 2020

Rights and ResponsibilitiesAs a BCBSTX STAR member, you will be involved in every decision about your health care. We also want to make sure your rights as a member are respected. You can find your member rights and responsibilities on the STAR member website at www.bcbstx.com/star/ member-resources/ member-rights-and-responsibilities.

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Not Happy with the BCBSTX Appeal Decision?If you do not agree with BCBSTX’s decision on your appeal, you have the right to ask for a state fair hearing from the Health and Human Services Commission (HHSC) Office of the Ombudsman. The BCBSTX appeals process must be completed before you can ask for a fair hearing. You can ask for a fair hearing in one of the following ways:

• Call the STAR Member Advocate. • Call the Medicaid Managed Care Helpline toll-free at 1-866-566-8989. • Fill out the online complaint form at http://bit.ly/ComplaintSubmission.

If you do not speak English, BCBSTX Customer Service or a BCBSTX Member Advocate will get a translator to help you file your complaint or appeal. For more information about complaints, appeals, and state fair hearings, please see Your Rights for an Appeal of an Adverse Determination on the member website and the Complaints and Appeals section of your member handbook.

Do You Want Us to Take Another Look at Your Complaint? File an Appeal.If you filed a complaint with BCBSTX and you are not happy with the decision that was made, you can file an appeal. We will take another look at your case and see if there is something more we can do to help. You can file an appeal if:

• You are not getting a service you wanted. • You did not get all the services approved that you asked for.

• You had a service approved before, but now it is ending.

• It is taking a long time to get the service you asked for.

We can help you file your request for an appeal. You can also ask your health care provider, a friend, a relative, lawyer or anyone else you choose to help you ask for an appeal. You can file an appeal in one of the following ways:

• Call Customer Service toll-free. • Call a STAR Member Advocate. • Fill out a Member Appeal Request Form and mail it to BCBSTX. You can find the Member Appeal Request Form at www.bcbstx.com/star.

File Your Complaint or Appeal with BCBSTXCustomer Service 1-888-657-6061 (TTY: 7-1-1)

Member Advocate 1-877-375-9097 (TTY: 7-1-1)

Where to mail your Complaint Request or Member Appeal Request Form

Blue Cross and Blue Shield of Texas Attn: Complaints and Appeals Department P.O. Box 660717 Dallas, Texas 75266-0717

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Staying Emotionally HealthyThis pandemic has generated a lot of talk about how to stay physically healthy. Less has been mentioned about how to stay emotionally well. Often times when stress levels are too high, things become harder.

Shame can keep many people from working on their mental health in the same way they work on their physical health. You may be afraid people will not like you or say that you are not thinking or acting in a normal or rational way if you tell them that you:

• Cry a lot and do not know why • Have trouble sleeping because you have negative thoughts that will not stop

• Are easily irritated about things others may think are not a big deal

• Cannot stop worrying about things you cannot control

It is important to take proactive steps to stay physically healthy, such as eating a healthy diet, exercising, and washing your hands often. And if you are sick, talk with your doctor and follow his or her advice. Emotional problems can be handled in a similar way. Here are ways to be proactive about emotional health:

• Take care of your body. Our physical health plays a big role in how we feel emotionally. So, taking care of your body is also a great way to take care of your mind.

• Invest in relationships. People who have supportive relationships live more fulfilling, longer, and healthier lives. Having social support is a key part in how well we handle life’s challenges.

• Choose gratitude. Routinely notice things you are grateful for, even if they are normal things like your morning coffee, nice weather, or a comfy pillow. Doing this can help you think more positively and keep you from feeling overwhelmed. You can choose to keep a gratitude journal, say a gratitude prayer, or write a thank you note to someone.

Get care when needed:

• Do not feel bad about feeling bad. Mental illness is very common. In the U.S., one in five adults and one in six children ages 6-17 deal with mental illness each year.

• Learn more about mental health and/or take an online screening at https://screening.mhanational.org.

• Call your doctor. Talk to your doctor and/or a behavioral health provider about your symptoms. Most mental illnesses can be treated with therapy and/or medication.

Emotional pain is as real as physical pain, and it is nothing to be ashamed of. If left untreated, mental illnesses can worsen over time. But when approached with self-compassion and professional help, recovery is possible.

Written by: Ana Chatham, LCSW

Bienestar Latino Mental Health Coalition

Sources: Harvard Health Publishing, health.harvard.edu/newsletter_article/the-health-benefits-of-strong-relatio

nships, 2019; Harvard Health Publishing, health.harvard.edu/mind-and-mood/in-praise-of-gratitude, 2019; National Alliance on Mental Health, nami.org/mhstats, 2019; Mental

Health America, screening.mhanational.org, 2020

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Get STAR Updates Sent Straight to Your Phone! STAR members can get text messages with plan benefit updates, notices about STAR meetings, events in your area and health care tips.

You can opt in to get text messages sent to your phone by texting STAR to 33633. Once you join the program, you may get up to four text messages per month.*

To cancel STAR text messages, text STOP to 33633.

To learn more about our texting program, call Member Outreach at 1-877-375-9097 (TTY: 7-1-1).

Tell Us What You Think!Community Advisory Committee (CAC) – now online or by phoneEvery three months, we invite STAR members to attend a CAC meeting to give us feedback on our member education materials and Value-Added Services, and get health plan program updates. One $25 gift card per member family will be given for each meeting attended. A member family can get up to four gift cards each year, for a total of $100 worth of gift cards. CAC meetings are now offered by phone and online meetings.

You can visit www.bcbstx.com/star to see a schedule of CAC meetings or call a BCBSTX Member Advocate at 1-877-375-9097 for details and to register for a meeting.

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To get auxiliary aids and services, or to get written or oral interpretation to understand the information given to you, including materials in alternative formats such as large print, braille or other languages, please call BCBSTX STAR Customer Service at 1-888-657-6061 (TTY/TDD 7-1-1).

Blue Cross and Blue Shield of Texas complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross and Blue Shield of Texas does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Blue Cross and Blue Shield of Texas:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:o Qualified sign language interpreterso Written information in other formats (large print, audio, accessible electronic formats, other

formats)• Provides free language services to people whose primary language is not English, such as:

o Qualified interpreterso Information written in other languages

If you need these services, contact Civil Rights Coordinator.

If you believe that Blue Cross and Blue Shield of Texas has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, Office of Civil Rights Coordinator, 300 E. Randolph St., 35th floor, Chicago, Illinois 60601, 1-855-664-7270, TTY/TDD: 1-855-661-6965, Fax: 1-855-661-6960, Civilrightscoordinator@hcsc.net. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services200 Independence Avenue, SW

Room 509F, HHH BuildingWashington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

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ATTENTION: If you speak English, language assistance services, free of charge, are available to you.Call 1-855-710-6984 (TTY: 711).

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1-855-710-6984 (TTY: 711) 번으로 전화해 주십시오.

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Your guide to lifelong health

LifeTimes is published for BCBSTX STAR members. Each issue brings you news about your health plan and staying healthy, along with important phone numbers for you to cut out and keep. If you have questions or need help, call our Customer Service.

Articles in LifeTimes are meant to educate. They are not meant as medical advice. Please check with your doctor for any advice about your health.

Helpful Phone Numbers Toll-Free Number TTY Line (hearing/speech loss)

BCBSTX STAR Customer Service 1-888-657-6061 7-1-1

Behavioral Health Services Hotline 1-800-327-7390 1-800-735-2988

BCBSTX Member Advocate 1-877-375-9097 7-1-1

24-Hour Nurse Advice Line 1-844-971-8906 7-1-1

Maximus Enrollment Broker 1-877-847-8377 7-1-1

Medicaid Managed Care Helpline 1-866-566-8989 7-1-1

Service Management/Disease Management 1-877-214-5630 7-1-1

*Message and data rates may apply. Terms and conditions and privacy policy at www.bcbstx.com/mobile/text-messaging.Blue Cross and Blue Shield of Texas contracts with Magellan Behavioral Health, Inc. (“Magellan”), an independent company, to administer BCBSTX’s managed mental health program.

Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association