True Health New Mexico | true to your health | Summer 2018

2 { TRUE TO YOUR HEALTH } H ave you visited truehealth newmexico.com lately? You can find a wealth of helpful informa- tion to read or download. If you have questions about your plan, chances are you can find the answers here. Get informed What do you need to know? Our site offers information on the following topics: • Drug coverage. Learn about: Our phar- macy procedures and coverage of drugs including copayments. • True Health’s drug list along with restrictions and preferences. • How to use our pharmacy procedures. • An explanation of limits and quotas. • How to receive coverage for nonformulary drugs and an explanation of how practitio- ners can provide information to support an exception. • True Health’s processes for ge- neric substitution, therapeutic interchange and step therapy. • Provider details. Explore network practi- tioners and their professional qualifications, including specialty, medical school attended, residency completed and board certification status. • Benefits and services. Find out what’s in- cluded in, and excluded from, coverage. • Charges. Learn about copayments and other charges for which you are responsible. • Out-of-area care. Get information about restrictions on benefits that apply to services obtained outside True Health’s system or service area. • Rights and responsibilities. Read True Health’s statement online. • True Health’s Quality Improvement Pro- gram. Explore goals, processes and outcomes as related to care and service. • Utilization Management (UM) financial policy. Read about True Health’s policy prohibiting financial incentives for UM decision-makers. • New technology coverage. Learn how True Health evaluates new technology for inclu- sion as a covered benefit. Learn how Need to get something done? Our website can show you how to: • Obtain primary care services, including how to choose and access a primary care practitioner. • Receive specialty care, behavioral health services and hospital services. • Obtain care after normal office hours. • Get emergency care and explore True Health’s policy on when to directly access emergency care or use 911 services. • Find care and coverage when you are out of True Health’s service area. • Appeal a decision that adversely affects coverage, benefits or your relationship with True Health. You’ll also find a description of the availability of an independent external appeals process for UM decisions made by True Health. • Voice a complaint. • Submit a claim for covered services, if applicable. • Contact staff if you have questions about how we manage care and services (UM) and the toll-free number to call to contact staff. • Self-refer to True Health’s Case Management Program and Disease Management Pro- grams. Your caregiver can also self-refer. • Get language assistance to talk with us about how we manage care and services or to obtain information about benefits, access to services and other issues. • Access TDD/TTY services. More helpful tools There is other useful information about True Health and our services at truehealthnewmexico.com . Provider directory. Our physician and hos- pital directories allow you to select a physician or hospital that best meets your needs. You can search for a physician by specific characteristics such as gender or language spoken. You can search for a hospital by location and name. Health improvement. Our website also contains information and interesting tools to help you better understand what you can do to improve your health. If you would like more information about these items, please call Customer Service at 855-769-6642 . The most recent information about True Health, our services and coverage of drugs is always available on our website. 2 weeks– 15 BLOOD PRESSURE & HEART RATE DROP . 12 hours Nonsmoker Risk of stroke can fall to about the same level as a nonsmoker . 5 years without smoking • The risk of heart attack decreases. • Lungs are working better. Respiratory problems have started to decrease . after 1 year after Excess risk of heart disease decreases to half that of a current smoker. 50 % BENEFITS QUITTING OF 10 years after 1–9 months after after years nonsmoker . O 2 CO after 20 min. after Risk of stroke goes down. 3 months after after 2 years 5 years Sources: American Cancer Society; American Lung Association; Centers for Disease Control and Prevention When you give up smoking NEED HELP QUITTING SMOKING? Go to truehealthnewmexico.com/smoking-cessation.aspx . OUR WEBSITE Your source for complete member information { M E M B E R N E W S }