Free Preventive Care and Services – The UT SELECT Medical plan has always offered robust preventive care benefits including 100% preventive colonoscopy and no cost immunizations for children under 6 years of age. Now, certain additional preventive care and services will be available to you with no copayment or coinsurance as long as you see a network provider and meet certain screening eligibility requirements. Some examples of services covered under this provision include:
- Routine physical exam
- Well-woman exam
- Immunizations- all ages
- Osteoporosis screening
- Prostate (PSA) screening
Please be aware that you may incur some cost if the preventive service is not the primary purpose of the visit or if your doctor bills for services that are not preventive. Eligible services are outlined in the Federal Regulations based on U.S. Preventive Service Task Force Recommendations. You may find more information about the covered preventive services here.
The Wellness Guide to Preventive Care
A recent government study showed that more than half of all Americans do not receive many of the important preventive services they need—that is, immunizations, screening tests for early detection of disease, and education about healthy habits and injury prevention. Why not?
- Many Americans—44 million—have no health insurance.
- Many people do not get continuity of care. They may have to switch doctors as they switch from one insurer to another, making it hard to keep track of what services they've had.
- Patients may not insist on getting preventive services. They may be confused about which tests to ask for. They may not know that Medicare (and some other insurance plans) covers some of the pricier items, such as mammograms and colonoscopies, as well as the cheaper ones. They may not know that prevention is usually the most economical form of medicine—well worth budgeting for, even if insurance doesn't cover it.
- With tests for some cancers, there's the embarrassment factor. Some people may dread being tested for colon, prostate, or breast cancer and be relieved if the doctor fails to mention it. Some people would rather not know.
- Both doctors and patients may be confused by contradictory recommendations. What should a medical checkup consist of? Does everybody need an annual physical? Should all men get a PSA test? At what age should a woman start having mammograms? (See below for answers to such questions.)
- Doctors may fail to ask patients about smoking and drinking, not to mention exercise habits and diet. Some HMOs don't encourage their doctors to counsel people. Some doctors think their job is to treat illness, not prevent it.
- The watchword among insurers now is cost containment. Yet medical technologies and consumer demand for services are expanding daily. Thus, we all have to make choices. Will patients in a big HMO get more benefit from an additional MRI machine or from having their doctors take time to counsel them about exercise and a heart-healthy diet? The new MRI machine will be easier to justify, in terms of immediate, measurable benefits.
How about that annual physical?
It used to seem simple: people were advised to undergo a standardized annual or biannual "complete physical." But in the 1980s, at the request of the government, an independent committee of physicians known as the U.S. Preventive Services Task Force reviewed all evidence and evaluated the benefits and drawbacks of common screening tests and came up with recommendations. (A similar group, the Canadian Task Force on Preventive Health Care, does the same work in Canada.) That head-to-toe physical exam has now been discarded for seemingly healthy people, since it yields too few benefits for its cost. Over the long run, it doesn't pay off in terms of better health and longer life.
Some tests that used to be routinely done, such as chest X-rays, electrocardiograms (EKGs), urine tests, and complete blood counts, are now reserved for people with symptoms or risk factors. In other words, they are not general "screening" tests and are not done routinely in everyone (and as such are not covered in this article).
The U.S. and Canadian Task Forces continue to update and re-evaluate their advice, reviewing thousands of studies every year and consulting hundreds of scientific reviewers.
- Blood pressure measurement (to detect hypertension)
Who needs: All adults.
How often: Once every 2 years for those with normal blood pressure.
Comments: More frequent monitoring for those with readings of greater than 130/85 or higher—consult your doctor.
- Cholesterol measurement
Who needs: All adults.
How often: Once every 5 years. More often if total or LDL ("bad") cholesterol is high, HDL ("good") is low, and/or you have risk factors.
Comments: Those at high risk for heart disease need medical advice about life-style changes and possibly drug therapy—consult your doctor.
- Pap smear (for early detection of cervical cancer)
Who needs: All women with a cervix, starting at age 18, or earlier if sexually active.
How often: If 3 annual tests are normal, then once every 3 years. More often if you smoke or have multiple sex partners or other risk factors.
Comments: Some experts advise that woman who have never had an abnormal result can stop being screened after age 65—consult your doctor.
- Breast cancer screening (mammography)
Who needs: All women 50 and over; those 40-49 should discuss risk factors with a doctor.
How often: Annually. Medicare reimburses for it.
Comments: Clinical breast exams are also important—consult your doctor.
- Colonoscopy screening (fecal occult blood test, sigmoidoscopy, colonoscopy)
Who needs: Everyone 50 and over; earlier for those at high risk.
How often: Occult blood test annually; sigmoidoscopy every 5 years or colonoscopy every 10 years.
Comments: Digital rectal exam and X-ray with barium enema may also be done. Medicare now pays for colonoscopy—consult your doctor.
- Prostate cancer screening (prostate specific antigen, or PSA, test; and digital rectal exam, or DRE)
Who needs: African Americans and men with family history, DRE and PSA starting at age 40. For others, DRE, and possibly PSA, starting at 50.
How often: DRE annually; PSA on professional advice.
Comments: Usefulness of PSA screening for all men remains controversial—consult your doctor.
- Diabetes screening (fasting blood glucose test)
Who needs: Everyone 45 and older; earlier for those at high risk.
How often: Every 3 years.
Comments: African Americans, Hispanics, Asians, Native Americans, obese people, and those with a strong family history need more frequent screening, starting at age 30—consult your doctor.
- Thyroid disease screening
Who needs: Women 50 and over; those with high cholesterol or family history of thyroid disease.
How often: On professional advice.
Comments: Routine screening remains controversial. Talk to your doctor about risk factors.
- Chlamydia screening
Who needs: Women 25 and younger, if sexually active.
How often: Annually, or more often.
Comments: Men and women of any age who are at risk for STDs (chlamydia, gonorrhea, syphilis, and HIV) should be tested—consult your doctor.
- Glaucoma screening
Who needs: People at high risk: those over 65, very nearsighted, or diabetic; blacks over 40; those with sleep apnea or family history of glaucoma.
How often: On professional advice of eye specialist.
Comments: Many eye specialists advise screening all adults every 3-5 years, starting at age 39—consult your doctor.
- Dental checkup
Who needs: All adults.
How often: Every 6 months, or on professional advice.
Comments: Should include cleaning and exam for oral cancer—consult your doctor.
- Tetanus/diphtheria booster
Who needs: All adults.
How often: Every 10 years.
Comments: People over 50 are least likely to be adequately immunized—consult your doctor.
- Influenza vaccine
Who needs: Everyone 50 and over, people with lung or heart disease or cancer, and others at high risk.
How often: Annually, in autumn.
Comments: Even healthy younger adults can benefit and should consider getting the shot—consult your doctor.
- Pneumococcal vaccine
Who needs: Everyone 65 and over, and others at high risk for complications.
How often: At least once.
Comments: Effective against most strains of pneumococcal pneumonia; lasts at least 5-10 years—consult your doctor.
- Rubella vaccine
Who needs: All women of childbearing age.
How often: Once.
Comments: Avoid during pregnancy—consult your doctor.
- Hepatitis B vaccine
Who needs: All young adults, as well as adults at high risk.
How often: On professional advice.
Comments: All newborns should be vaccinated—consult your doctor.
- Chickenpox vaccine
Who needs: Anyone who has never had chickenpox.
How often: Once. But above age 13 it requires two shots.
Comments: Not recommended for pregnant women or those with compromised immunity—consult your doctor.
- The National Coalition on Health Care. www.nchc.org
Pharmacist Specialist available through the Medco Therapeutic Resource Center. If you have been diagnosed with high cholesterol, diabetes or any other condition, this program offers improvements in the quality and affordability of pharmacy care. For more information, call 1-800-818-0155.
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We believe that an understanding of the relationship between health and cost of care and better communication with your Health Care Practitioner will ultimately increase use of self care practices. Below we have listed several top questions to ask your doctor based on top modifiable/preventable conditions:
Questions to ask your Health Care Practitioner about Blood Pressure
- What is my blood pressure?
- What should my blood pressure be?
- How much should I weigh?
- Can you recommend a diet or eating plan to help me reach that weight?
- What kind of diet should I be following to help control my blood pressure?
- How much exercise should I be doing?
- What is the name of my blood pressure medication?
- What are the side effects of this medication?
- What drug interactions may occur between the medications I am taking?
10 Questions to ask your Health Care Practitioner about Cholesterol
- Do I already have atherosclerosis? Am I at risk for a heart attack?
- Do I have any other risk factors for heart disease?
- Should I see a nutritionist to help me change my diet?
- Can I control my cholesterol through lifestyle changes alone?
- In my case, which lifestyle changes will be particularly helpful?
- Do I need cholesterol-lowering drugs?
- What side effects can I expect from such medication?
- How low can I realistically expect my cholesterol to go? What should I aim for?
- Will it ever be safe for me to stop taking the medication?
- How often should I have my cholesterol checked? Should members of my family be tested?
10 Questions to ask your Health Care Practitioner about Diabetes
- Does having diabetes mean that I am at higher risk for other medical problems?
- Should I start seeing other doctors regularly, such as an eye doctor?
- How often should I test my blood sugar and what should I do if it is too high or too low?
- Are there any new medications that could be used to help manage my diabetes?
- Does diabetes mean I have to stop eating the foods I like best?
- How can exercise make a difference in my diabetes?
- If I'm overweight, how many pounds do I have to lose to make a difference in my health?
- Are my children at increased risk for the disease?
- What is the importance of diet in diabetes?
- Do I need to take my medications even on days that I feel fine?
Important Questions to Ask Your Health Care Practitioner about Depression
Going to the doctor can be intimidating. You might feel rushed and forget to ask questions that are important. It's always a good idea to know what to ask beforehand and to take notes when with the doctor. Some of the questions below may be worth asking. Print out this page and take it with you to your next appointment.
- What caused this depression?
- Is there an effective treatment that doesn't involve medication?
- What are the side effects and long-term effects of the medication?
- Are antidepressants addictive?
- I've heard that medication for depression will affect my sex life. Is this true?
- How long will it take for the treatment to work?
- What can be done to prevent my depression from recurring?
- Does depression run in families? Will my children be depressed?
- Do St. John's wort and other herbal therapies help with depression?
- What are the different types of psychotherapy and are any of them appropriate for me?
11 Questions About Metabolic Syndrome
Metabolic syndrome is a group of risk factors -- unhealthy cholesterol levels, high blood pressure, high blood sugar, and excess belly fat -- that may raise your risks of serious illness, such as diabetes, and blood vessel and heart disease. If you've been diagnosed with metabolic syndrome -- or are worried you might have it -- here are some questions to ask your doctor. Print them out before your next appointment.
- Do I have any metabolic syndrome risk factors?
- Will I need medicine to control them? If so, how will the medicine help? What are the side effects?
- Do I need to have blood tests to see if I have a higher risk of blood clots and inflammation?
- What is my BMI (body mass index)?
- Should I lose weight? What's a reasonable weight goal for me?
- What changes should I make to my diet? Do I need to take any special precautions?
- Should I consider seeing a nutritionist to talk about improving my diet?
- Do you have suggestions for how I could get more physical activity?
- Could any medicines I'm taking be affecting my metabolic syndrome risk factors?
- How might my family history affect my risk of getting metabolic syndrome and having cardiovascular problems?
- Should I be taking aspirin therapy?
Remember that when you meet with your doctor, tell him or her about all of the medicines, herbs, and supplements you use. "Natural" medicines can be powerful, and they can interfere with the effectiveness of other drugs. You could also keep a food diary for about a week before your next appointment. Just jot down the foods you eat each day. Then, you and your doctor can go over it together and talk about ways of improving your eating habits.
FREE Weight Management Program
Sometimes a little extra support is all it takes to stay on track with weight loss goals. The UT SELECT Weight Management Program provides just that. When our members decide to make positive lifestyle changes by managing their weight, we’re ready with resources to help make the journey successful!
Call: 1-800-462-3275. *Program available to all UT SELECT members.
If you have a chronic condition, you don’t have to go it alone. Now you can find personalized help and support with the UT SELECT Condition Management Program for UT SELECT members. Whether you have diabetes, asthma, high blood pressure or another chronic disease, the Condition Management Program available through BCBSTX can help. To learn more about this voluntary health improvement program, call 1-800-462-3275.
A staff of trained, experienced registered nurse counselors is available 24/7 to answer health care questions and provide information about a wide variety of health care issues and medical non-emergencies. To talk to a nurse, call this toll-free number: 1-888-315-9473. Click here to view and print a 24/7 Nurse line refrigerator card.
Every year in the U.S. over 392,000 people die from tobacco-caused disease, making it the leading cause of preventable death. Another 50,000 people die from exposure to secondhand smoke. Tragically, each day thousands of kids still pick up a cigarette for the first time. The cycle of addiction, illness and death continues. What can be done to stop smoking? The University of Texas System is committed to helping smokers quit by offering our UT SELECT medical covered members with Free Smoking/Tobacco Cessation Programs, Pharmaceutical Therapy and Nicotine Replacement Therapy (NRT).
Using these pharmaceutical therapy and nicotine replacement therapy (NRT) in conjunction with professional counseling can double your chances of quitting for good. Ask your doctor for help. But remember: Medicine alone can't do all the work. It can help with cravings and withdrawal, but quitting will still be hard at times.
See details of resources available:
- NEW for Plan Year 2011-2012! The UT SELECT Prescription Drug plan covers the following medications at a $0 copayment when they are used for prevention as noted. To receive these medications at a $0 copayment, you must have an authorized prescription for the product and it must be dispensed by a participating mail or retail pharmacy.
- Nicotrol NS: 90-day supply in any 365-day period.
- Nicotrol Inhaler: 90-day supply in any 365-day period.
- Zyban: 90-day supply in any 365-day period.
- Nicorette Gum /Lozenge: 90-day supply in any 365-day period.
- Nicotine Transdermal System: 90-day supply in any 365-day period.
- Chantix: 180-days supply in any 365-day period. For clients who cover OTC nicotine gum, lozenges and patches.
- Talking to an Expert (Professional Counseling) and Online Resource available for FREE!
By instant messaging, by phone or online, we know that every member of our plan is different, this is why we have serveral ways to work with an expert. See what works for you.
- Learn more about medications to help you quit. When you quit smoking, you may feel strange at first. You may feel dull, tense, and not yourself. These are signs that your body is getting used to life without nicotine.
Learn more about all resources available to you and your dependents at our dedicated tobacco/smoking education page at www.livingwell.utsystem.edu/tobacco.htm.
Fitness Over Forty, a series of video presentations targeting the increasing "over Forty” population, addresses health and fitness issues that are specific to men and women ages 25 to 54 and older. Dr. David Di Paolo, radiologist at The University of Texas Health Science Center at Tyler and nationally-certified fitness trainer, hosts the series featuring UT Health Science Center medical professionals who inform viewers about the benefits of a healthy diet and active lifestyle. Just go to http://www.uthct.edu/fitnessoverforty/archive.asp, and search for a topic that you are interested in.