Sometimes, non-plan providers tell our members that they accept HNE insurance.  This “acceptance” can be misleading and can mean different things to the parties involved.  Often, to the member it means the provider is contracted with HNE. The member assumes that the services they are about to receive will be covered.  To the non-plan provider it means they are willing to bill HNE even if they are not a contracted provider.  In the latter case, the claim will most likely be denied as not authorized. The non-plan provider will then bill the member for the services.  Most HNE members have an HMO policy, which limits coverage of non-emergent services to the HNE network. Therefore, it is important to know if a provider is in-plan or out-of-plan (not contracted with HNE).

HNE therefore recommends that members contact HNE directly if they have a question about whether a provider is in-plan or not. By contacting the HNE Member Services Department, you are sure to get the most up-to-date and accurate information about a provider. The HNE Member Services Department is available Monday through Friday from 8 a.m. to 5 p.m.  Their telephone number is 413.787.4004 or 800.310.2835.  In the event you can’t call the HNE Member Services Department, you may also search for in-plan providers at HNE.com.  We also have a new mobile app that lets you search our provider directory with your smart phone. Just go to hne.com/mobile to download the free HNE Member Mobile App.

HNE members can and do receive services from non-plan providers. However, unless pre-approved by HNE, services from non-plan providers, with the exception of emergency services, will not be covered. If services with a non-plan provider are ever needed, your primary care provider or other in-plan provider must submit a prior authorization request form to HNE’s Health Services Department.  HNE will then notify you and your referring provider in writing of our decision.

 

Massachusetts Health Quality Partners (MHQP) announced today that Massachusetts primary care physicians continue to provide high-quality care overall, though notable differences in the quality of care delivered by medical groups in Massachusetts remain, according to MHQP’s annual Quality Insights: Clinical Quality in Primary Care report available at mhqp.org. Click here to view the report: http://mhqp.org/quality/clinical/cqMASumm.asp?nav=032400

Apr 102012
 

Baystate Visiting Nurse Association & Hospice (BVNAH) will hold their annual Step Out for Hospice on Saturday, June 9th from 9:30-11:30 AM at Forest Park in Springfield.  This marks the 15th year for this event, the sole fundraiser for their Hospice Program and they would like to reach the $1 million mark.

 

How can we improve our written materials so they are easier to read and understand? What have been your best and worst experiences with HNE? Would you like a chance to address these or other important issues and questions? If so, please read on …

Health New England is looking for members to form a Member Advisory Committee.

Our goal is to open and improve the lines of communication between you and Health New England, and obtain your input on issues that impact you and our entire membership. We feel it’s important to invite members to meet with us so that your health care interests are represented. We want to offer members an opportunity to provide input on matters that affect our entire region.

The Member Advisory Committee cannot be successful without the input of the individuals who need and use our health care services. We hope that you will consider joining this committee. You can provide your input on our written materials by going to http://hne.com/HNE_Members/ MaterialSurvey.html and filling out a short survey. If you would like to become a member of the Member Advisory Committee, please fill out the application form at http://www.hne.com/Member_Advisory_Committee.html.

 

At HNE we are constantly looking for ways to keep down health care costs, while continuing to provide you with the highest possible level of quality. As part of this commitment, atorvastatin, the generic formulation of Lipitor®, will be categorized as a Tier 1 medication on the HNE formulary. It will be available without prior approval to members currently receiving Lipitor®. HNE will require prior approval of atorvastatin for all other members, including those with a history of simvastatin or pravastatin use.

We have provided a summary of the tier status and member copayment for the most commonly prescribed cholesterol-lowering medications (see chart on right). The copayment will vary by your benefit package.

If you have any questions, please contact Member Services at 413.787.4004 or 800.310.2835.

Medication Status Member
Copayment
Approximate
30-day
Supply Cost*
Prior
Authorization
Required
Simvastatin
20/40 mg
Tier 1 ≤ $15 $10.70 No
Pravastatin
20/40 mg
Tier 1 ≤ $15 $9.73** No
Lipitor®
20/40 mg
Tier 3 ≤ $100 $163.34 Yes
Atorvastatin
20/40 mg
Tier 1 ≤ $15 $141.39 Yes***
Crestor®
20/40
(rosuvastatin)
Tier 2 ≤ $50 $140.00 Yes

* When a patent expires, the first company to file for a generic version of the medication gets six
months’ exclusive rights to sell this product. During this time, the price of the drug is decreased
by only 10 percent. At the end of the exclusivity period, it is anticipated that atorvastatin will
be available from additional manufacturers at a reduced cost.
** May be available at a reduced price through various retail prescription drug programs.
*** Not required for members with a previously approved prior authorization for Lipitor.

Need Stress Relief?

 Winter 2012  Comments Off
Feb 282012
 

 Try going for a walk in a labyrinth. Labyrinths are found in many cultures and religions throughout history. Their purpose is to create an atmosphere that fosters spiritual, emotional, psychological, and physical well-being. A labyrinth has a single, winding, unobstructed path from its outside to its center, unlike a maze, which has many dead ends and wrong choices designed to trick the mind.

The labyrinth is often seen as a metaphor for our spiritual life journey; many twists and turns but no dead ends. We have the opportunity to make other choices in life or turns in the labyrinth. Labyrinth users call the experience a meditation in motion, fusing movement and inner calm. If you concentrate on the course your pace slows, your breathing deepens, and your mind becomes clearer as you let go of stress.

Labyrinths exist all over the world— in churches, hospitals, wellness and rehab centers, hospice programs, nursing homes, schools, community centers, even in private backyards. There are labyrinths made out of stones, flowers, shrubs, canvas, and a variety of materials. More and more people are being drawn to the sense of renewal that labyrinths can impart. They have become a sought-after healing tool for today’s hectic times. We live in a fast-paced society and tend not to take time for ourselves. The labyrinth offers us that opportunity and each time we experience a labyrinth walk, it’s different. It depends on what is going on in our life’s journey at the time of our walk, and how open our hearts and minds are to the experience.

The walk also differs from individual to individual as we all have differing life journeys and experiences. Take advantage of this alternative stress relief tool. You will be glad you did. HNE can bring this unique meditative tool to your place of work. All you need is a 16-foot by 16-foot indoor space to accommodate our portable canvas labyrinth. Or, to find local walking labyrinths go, to www.labyrinthguild.org.

For more information or to schedule an on-site labyrinth walk, please ask your employer’s Wellness Coordinator or Benefits Manager to contact Maria Garrity, HNE’s Health Programs Event Coordinator at 413.233.3391. Please note, a minimum number is required. We look forward to sharing the labyrinth walk with you.

Feb 282012
 

Did you know that as an HNE member you get more than just great health care coverage? Be your best and pay less with the HNEPlus Discount Program. HNEPlus helps you make healthy lifestyle choices by providing discounts on products and services from local businesses. With HNEPlus, achieving good health is doable and affordable. There’s no paperwork and no added fees. To receive your discount, simply look through the list of participating vendors, and show your HNE ID at the time you purchase a product or service. There are a variety of products and services you can choose from, such as:

  • Fitness Centers
  • Massage Therapy
  • Eyewear
  • Museums
  • Sports & Outdoor activities

Take advantage of these discounts, and see how much you save while improving your health! For more information, visit hne.com/ healthydirections and click on the HNEPlus tab or contact Member Services at 413.787.4004 or 800.310.2835 Monday through Friday from 8 a.m. to 5 p.m.

Feb 282012
 

 

“The winter makes it tough on people who are trying to stay in shape. Even the most devout outdoor athletes have to contend with less daylight, extremely cold temperatures, and messy roads. However, with the proper precautions and a little creativity, walking outside in the winter is not impossible.”
Michael Gauvin
Business Development Manager

Where You Walk

  • Start your walk into the wind so you will finish with it at your back.
  • Choose parks or roads that provide shelter from the wind.
  • Select routes that are cleared of snow or ice and do not have standing puddles or mud slicks.
  • Use caution when walking on roads. Cars may have difficulty seeing you and maneuvering around you in rain or snow.
  • Check the local tracks to see if there is a good outdoor or indoor alternative to the sidewalks or streets in poor weather.

Plan for refuges along the way: Is there a store, park restroom, or other place you can duck into to warm up during your walk if needed?

Dressing in Layers

Next to the skin: Your base layer should wick sweat away from your body to keep your skin dry. Don’t wear cotton – save your T-shirts for other purposes. Wear good long underwear pieces made from fabrics such as Coolmax®, polypropylene, Thermax®, Thinsulate®, and silk.

Insulating layer: This layer will keep you warm, and you can shed it once you warm up. Some examples of good insulating layers are wool, fleece, and down in a jacket, shirt, or vest.

Outer layer: To protect you from the elements, wear a windproof and water-resistant jacket, loosely. Also, make sure there is reflective material on the jacket.

Pants: If the weather is frigid, you can wear long underwear bottoms or tights underneath another pair of pants to keep you warm. Avoid cotton and denim as they hold moisture. Running pants or running tights made of synthetics that wick moisture will keep you more comfortable in rain and snow.

A Change of Clothes: If your walking route is away from home, bring along a set of warm, dry clothes to slip into immediately after walking to keep from getting chilled by wet walking clothes.

Accessories

Hats: A hat is essential to keeping your body heat from escaping. Your hat should be made of warm materials that will also wick moisture away from your head without sacrificing warmth.

Gloves or mittens: Mittens will keep your hands the warmest as the fingers work together to build up warmth. Look for windproof mittens.

Water bottle: You need water in winter as much as in summer. Bring water along to stay hydrated.

Scarf, neck gaiter, ski mask: Having a scarf or similar item to wrap around your neck when the wind turns brisk can be very important. Sunscreen and lip protector: The lips and face can chap easily without protection.

Footwear

Waterproof shoes or boots: If your walks are wet or snowy, invest in a pair of waterproof walking or hiking shoes. Many companies have lightweight styles to keep you dry. You can coat shoes with water- repellent fabric treatments.

Traction: Don’t wear slick-soled shoes if there is wet or snowy pavement. If the conditions are difficult, wear shoes with great traction to avoid slipping.

Socks: Switch to heavier socks or wear two pair for more insulation. Test your socks with your chosen shoes to make sure there is still wiggle room for your toes.

Feb 282012
 

Whole Wheat Pasta with Puttanesca Sauce

A spicy, tangy pasta dish typical of Southern Italian cuisine!

  • 8 ounces whole wheat pasta
  • 2 tablespoons olive oil
  • 1½ cups onion, diced
  • 2 tablespoons garlic, minced or pressed (about 5 cloves)
  • ¼ teaspoon cayenne pepper
  • 2 teaspoons anchovy paste (optional)
  • 1 can (35 ounces) whole peeled tomatoes, no salt added, coarsely chopped
  • 1 tablespoon capers

Directions

  1. In a 4-quart saucepan, bring 3 quarts of water to a boil over high heat.
  2. Add pasta, and cook according to package directions for the shortest recommended time, about 10 minutes. Drain.
  3. Meanwhile, in a large nonstick pan, heat olive oil over medium heat. Add onion. Cook and stir for 5 minutes, until onion begins to soften.
  4. Add garlic, cayenne pepper, and anchovy paste. Cook and stir another 5 minutes.
  5. Add chopped tomatoes, capers, and olives. Cook and stir until heated through.
  6. Divide pasta among 4 dinner plates (about 1½ cups each). Spoon sauce over pasta. Garnish with parsley if desired.

Calories: 342 | Total Fat: 8g | Saturated Fat: 1g | Cholesterol: 9mg
Sodium: 455mg | Total Fiber: 12g | Protein: 11g | Carbohydrates: 62g

This recipe courtesy of: http://hp2010.nhlbihin.net/healthyeating/default.aspx

 

HNE is excited to introduce our new Member Mobile App. Developed in collaboration with FeedHenry (feedhenry.com) and Court Square Group (courtsquaregroup.com), our Member Mobile App is the first fully HIPAA-compliant mobile app solution.

With HNE’s Member Mobile App, you can save paper, look up providers in our network, and find a provider, urgent care facility, hospital, or pharmacy. It’s like having our award-winning Member Services team right at your fingertips. Save paper by downloading your virtual member ID card to your smart phone. At your next doctor’s visit, if the office needs a copy of your card, you can fax it right from your phone. Plus, you can use the Provider Search function to search our provider network and to get directions to the provider’s office. You can also find and get directions to the nearest urgent care facility, hospital, or pharmacy.

“HNE is an innovative and serviceoriented organization. We believe that this is an opportunity to provide our members with an even higher level of service at their fingertips,” said Phil LaCombe, HNE’s Vice President of Information Technology.

Get Our New App Now!
The app is free of charge to any smart phone user. Go to hne.com/mobile to download the app or scan the QR code!

 

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