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GET OUR APP FOR YOUR BENEFITS ON THE GO page 2

EARN CASH BACK THROUGH PRIORITY HEALTH MEMBER PERKSpage 4

Spring 2015

START SAVING ON YOUR HEALTH CARE WITH OUR NEW COST ESTIMATOR TOOLpage 3

Member spotlight: Shelley Irwin, host of The

WGVU Morning Show, Team Priority Health Champion,

triathlete, marathoner page 5

2 • Health Journal Spring 2015

Call the phone number on the back of your

Priority Health membership card. We’re open

Monday – Thursday, 7:30 a.m. to 7 p.m.; Friday,

9 a.m. to 5 p.m.; and Saturday, 8:30 a.m. to noon.

¿No hable inglés? Comunicarse a el 888.389.6645

y pedir un traductor.

We’re here for you when you need us.

CONTACT US

Send a secure email anytime by visiting

priorityhealth.com and clicking on “Contact us.”

We want to hear from youNot only do we care about you, but we care

about your world, too. That’s why we’re

committed to printing less paper. Soon, we’ll

be emailing you a brief online survey on your

interest in reading the Health Journal in a

digital format. Your responses are confidential

and will help us gather feedback. Make sure to

register your account on priorityhealth.com so

we have your current email address on file.

Register your online account

1. Visit priorityhealth.com and click Register

2. Select I’m a member

3. Enter your contract number found on the

front of your Priority Health membership card

(each family member has a different contract

number), plus your birth date and the last 4

digits of your Social Security number

4. Choose a username, password and

security question

5. Enter your email address

Download the Priority Health app

to your smartphone or tablet

1. Download the Priority Health app for Android

or iPhone

2. Log in by entering the username and

password you use for your online account

Download our app for benefits information on the go! The Priority Health app offers convenient ways to access your benefits anytime, anywhere online through your smartphone or tablet.

It’s easy to view your mobile membership card, personal

plan and benefit information, and tools like Cost Estimator

and Healthcare Bluebook to help you be a more informed

consumer. Plus, you can schedule a virtual doctor visit, check

claim summaries, renew prescriptions and much more.

To access: Register your account and download the app.

Health Journal Spring 2015 • 3

You wouldn’t book a

vacation or purchase a

flat screen TV without

first knowing the cost—

shouldn’t the same apply

to your health care?

Priority Health thinks so. That’s why

we partnered with Healthcare Bluebook

in 2013 to give our members access

to the cost and quality of the most

common health care services before they

receive care.

And now, we are furthering this mission

with our new Cost Estimator that

shows Priority Health members how

much they pay for a service, based

on their health plan, for hundreds of

common health care procedures like

X-rays, MRIs, lab tests and surgeries.

The Cost Estimator even recommends

lower-cost doctor/facility options to

help ensure you get the highest-quality

care at the best price. It could save you

thousands of dollars.

Don’t just take it from us. Recent media

coverage from Becker’s Hospital Review,

MLive, WXMI TV 17 and WZZM TV 13

has confirmed our role in leading Michigan

in the reduction of health care costs by

helping members make more informed

decisions through increased engagement

and transparency with the Cost Estimator.

From your phone, computer or

tablet, log into your member account

at priorityhealth.com and click

Cost Estimator to check out how

you can start saving.

savinghealth care

start

onyour

Estimate your out-of-pocket

costs with our new

Cost Estimator

GET ACTIVE WITH US!

We love to support events

where our community can get

out and be active. We believe

in improving the health and

lives of our members and all

Michiganders. Join us at the

next local race as a participant

or a volunteer. Meet us at the

Priority Health tent for a chance

to grab fitness gear giveaways

at these upcoming events:

Gazelle Girl Half

Marathon Grand Rapids

April19

Priority Health 5K Walk

(Borgess Run), Kalamazoo

Fifth Third River Bank

Run Grand Rapids

May3

9

Grand Rapids Triathlon

Grand Rapids

Gran Fondo

Grand Rapids

June14

27

Meijer Festival of

Races (Cherry Festival)

Traverse City

July11

Priority Health Arts in

Motion 5K/10K, Royal Oak

September5

Get your FREE preventive carePriority Health has covered preventive care like routine physicals,

blood pressure screenings, body mass index (BMI) and depression

screenings for nearly 30 years. Schedule your FREE yearly physical and see a full list

of covered preventive health care services today at priorityhealth.com and search:

preventive health care guidelines.



Ryan, a 38-year-old Priority Health

member, knows a busy schedule all too

well. He’s in back-to-back meetings

during the day and busy driving his

school-aged children to soccer practice

at night. Fitting in a trip to the doctor

for a severe case of poison ivy wasn’t

in the cards. He called his primary

care provider, but they didn’t have

any same-day appointments. He was

already scheduled to be out of town for

the next available appointment. Since it

wasn’t life-threatening he knew he didn’t

need to pay the extra cost for an ER or

urgent care visit. The solution: an online

or over the phone doctor visit with

Priority Health. The physician emailed a

prescription to Ryan’s local pharmacy

that he picked up on the way home

from soccer practice, putting him back

in the driver’s seat of his busy life.

Choose a virtual visit when you or a

family member has a:

Register today to access the

service before you need it

Headed for the sunshine? Or

perhaps planning a staycation

just outside of town this spring?

Wherever you go, you’re covered

for urgent care (in an urgent care

center) and emergency care—

anywhere, anytime. While we

hope you stay well, here are some

helpful tips if you or your family

should need care while on your

next vacation:

If you have an emergency, call

911 or go to the emergency

room or an urgent care center.

And if you become ill or

injured while traveling more

than 100 miles from home—

around the country or

worldwide—the Assist America

coverage included with your

Priority Health plan can help

get you medical care, provide

medical referrals, monitor

evacuations, coordinate

prescriptions and lost luggage

assistance, a compassionate

visit, care of minor children and

even arrange your travel back

home safely.

Log into your account at

priorityhealth.com and search

travel to download a reference

card to carry when you travel.

Sinus infection

Sore throat

Other non-

emergencies

Cold or flu

Fever

Respiratory

infection

Spring is finally here. So if you’re

gearing up for your next outdoor run

or treating yourself to some “you”

time, then we have a great way to

save you some green while you

stay fit. Our partnership with Benefit

Mobile, Inc. allows our members

to download the Benefit app for

Android or iPhone and every dollar

spent within the app results in money

you can use to support a healthy

lifestyle. Purchase running shoes,

exercise equipment, athletic gear, spa

treatments and more to help you be

your healthiest. Receive up to 10%

cash back when you purchase digital

gift cards from dozens of national

retailers, from Amazon to Zappos.

Visit priorityhealth.com and search

perks to access.

Earn cash back to support your healthy lifestyle with our new Member Perks program


Traveling this spring? You’re covered for emergencies—anywhere, anytime

SEEING THE DOCTOR DOESN’T ALWAYS MEAN LEAVING HOME

Create your account now so you can

quickly get the care you need the next

time you need it. Registration takes just

minutes. Visit priorityhealth.com/virtualdoc

or call 888.632.2738 to get started.

How virtual visits work:

Members can be treated by a board-

certified doctor through an online video chat

or over the phone anytime, anywhere—

including nights, weekends, holidays and

while traveling. Remember, if you have an

emergency, call 911 or go to the emergency

room, but if you’re sick and thinking about

urgent care, consider getting care from

the comfort of your home.


Shelley Irwin is an award-winning radio host/producer of The WGVU Morning Show, the local NPR radio affiliate in Grand Rapids.

Shelley wears many hats: board

member for numerous community

organizations, dog owner, triathlete,

marathoner and Priority Health

member. For the past three years,

Shelley has represented Team Priority

Health as a Champion in runs,

triathlons and bike races. She lives to

inspire others in the community to be

healthy and she is about to set one

of her greatest examples yet – she

will compete for Team USA in the

International Triathlon Union’s (ITU)

World Championships this summer in

Motala, Sweden. Here is her story.

Journey to Sweden:

How to qualify for Team USA

“Wanted: athletes to qualify

to represent Team USA in the

2015 ITU Long Course* Triathlon

World Championships! To

represent your country, you have

to be the best of the best.”

When I saw that, I somehow knew that

was a goal I could achieve. In order to

qualify I needed to enter a qualifying

race and ironically, the 2014 Qualifying

Race to participate in the ITU World

Championships (Long Course

Triathlon*) in 2015 was in Grand

Rapids, Michigan: my home court.

Starting off

As a Priority Health Champion, I’ve

always been active and motivated by

my fellow Champions, but a triathlon

requires being above average in

the skills of swimming, cycling and

running. So, to begin the process

of “being good” in all three sports,

I began with an indoor triathlon.

Indoor triathlons usually go as such:

15 minute all out swim, five minute

break, 15 minute all out bike, five

minute break, and then a 15 minute

all out run. Once spring hit, I would

take the skills I learned indoors and

continue my outdoor rituals, including

half marathons, 25ks, and yes, the

occasional marathon.

The progression

The Grand Rapids Triathlon debuted

in 2011. That race was my first time

swimming competitively in open

water, cycling with others and running

in a single event. Initially, I was the

swimmer doing the backstroke and

I was the cyclist with the purple road

bike with clip-less pedals and donning

jogging shoes. And a race belt? What

was that?

Since then my progression towards

qualifying for world championships has

continued. In the past four years there

have been countless other triathlons and

five half irons. In all that time, I haven’t

drowned yet! It was the summer of 2014

that offered the opportunity to qualify to

be on a world team. I had reservations,

but ultimately, the Grand Rapids Triathlon

race directors gave me the faith to

pursue the necessary training and to

remind me that I could very well make

this happen.

Race day: June 2014

To qualify for Team USA, an athlete

needed to finish in the top 25 of

their age group at the Grand Rapids

Triathlon long distance. I looked

around at the start line of the 1.2 mile

swim, 56 mile bike ride, and 13.1

mile run ahead and saw rock-hard

women; all experienced. I felt soft and

intimidated, but before I had too much

time to dwell on that, the air-horn blew

and we all dove in.

At the end of the day, I qualified for

Team USA. I wasn’t the first and I

wasn’t the last. On June 27, 2015

in Motala, I will be representing

our country in the World ITU Long

Distance Championships. All it took

was that first step of indoor triathlons,

having people who believed in me, and

some necessary training. I tell my story

to help motivate others. This journey

to Sweden is now in my grasp! At the

start line in Motala, there will again be

experienced, rock-hard women. And

you know what? I plan to be one of

them. Go team USA!

MEMBER SPOTLIGHT

*A long distance triathlon is a half iron (1.2 mi. swim, 56 mi. bike, 3.1 mi. run)

Image courtesy of Ian Anderson


DISEASE MANAGEMENT

PROGRAMS

Learn what programs

are available to help you

manage chronic illnesses,

how to use the services

and how to become eligible.

Keyword: programs

PRESCRIPTION DRUG

UPDATES

We regularly review new

drugs to help make sure

you’re receiving safe and

effective care. If you take

prescriptions, please

review our Approved Drug

List occasionally to note

changes or updates. We

also provide information

about our prescription

coverage and pharmacy

management procedures.

Keyword: prescriptions

PRIVACY STATEMENT

Learn how we’re

committed to keeping your

health information private.

Keyword: privacy

PLAN BASICS

Review your coverage

documents and member

handbook for information

about benefits, procedures

and much more. You’ll find

the benefits and services

included and excluded from

coverage, copayments and

other charges, restrictions

on services outside the

network, how to submit

claims and how we evaluate

new technology for inclusion

as a covered benefit. You’ll

also find information about

in-network doctors, getting

primary care and specialty

care like behavioral health

and hospital services,

getting care after normal

office hours and receiving

emergency care, including

when you’re out of our

service area. Keywords:

coverage documents,

handbook

QUALITY PERFORMANCE

Review summary

information regarding

our Quality Improvement

Program performance and

quality results. Keyword:

accreditation

RIGHTS AND

RESPONSIBILITIES

Know what you can expect

from us and what we expect

from you. Keywords:

member rights

BENEFIT DECISIONS

Our goal is to cover

care that meets high

medical standards and

is also cost-effective.

This is called utilization

management. If you have

questions regarding our

process or decisions,

contact Customer Service

at 800.446.5674, and

they’ll contact a health

management staff member

to help. Know that all

utilization management

decisions are based on

appropriateness of care

and service and that no

financial incentives exist for

issuing denials. Keyword:

utilization

GRIEVANCE PROCEDURE

Get information about how

our grievance procedure

works. Keyword:

grievance

We make important information available online and in print

to help you understand how your health plan works. Visit

priorityhealth.com and type the keyword(s) below in the search

box. For print copies, call Customer Service at 800.446.5674.

UNDERSTANDINGbenefitsyour


Health Journal Spring 2015 • 7 Health Journal Spring 2015 • 7

If you have surgery for breast cancer,

Priority Health will consult with you to

determine coverage for the

following services:

• Reconstruction of the breast

on which the mastectomy

was performed

• Surgery and reconstruction of

the other breast to produce a

symmetrical appearance

• Prostheses and treatment of

physical complications at all

stages of the mastectomy,

including Lymphedemas

This is in compliance with the Women’s

Health and Cancer Rights Act of 1998.

Information about your costs for these

benefits is included in your coverage

documents and any applicable riders

included in your Priority Health plan.

Follow Team Priority Health and be inspired

Team Priority Health is made up of

people just like you—Champions

of their own fitness and health.

They are real people (see our cover

story!) who want to inspire you

with their stories. Maybe your goal

is to get to the gym three days a

week or to complete your first 5K

run or distance bike race. Or to

be a part of Team Priority Health

and become a Champion! You can

follow the Champions to get free

tips and advice about similar goals.

Read their inspirational stories at

teampriorityhealth.com or follow

them on Facebook on the Team

Priority Health fan page.

NOW ACCEPTING BOARD MEMBER NOMINATIONSWe’re accepting nominations for

our Board of Directors. Nominees

must have Priority Health HMO/POS

coverage. Send résumés and letters

of interest by March 31, 2015, to:

Board Nominations—MS 1345

Priority Health

1231 East Beltline NE

Grand Rapids, MI 49525

HELP AVOID FRAUD, WASTE AND ABUSEOur compliance program helps us

detect and prevent fraud, waste and

abuse, which contribute to rising health

care costs. You can help by:

• Checking your medical bills and

claim activity summaries to make

sure you were only charged for

services you received

• Never giving your Social Security

number, health plan information

or banking information to

someone you don’t know

• Knowing that free services do

not require you to give your plan

number to anyone

If you have questions, or if you

suspect fraud or abuse, tell us.

You don’t have to give your name,

address or phone number.

Contact us in the way that’s

most convenient:

• Call Customer Service at

800.446.5674 Monday – Thursday

7:30 a.m. – 7 p.m.; Friday 9 a.m. –

5 p.m.; or Saturday 8:30 a.m. – noon.

• Call our Compliance Department

at 800.942.0954 from 8:30 a.m. –

5 p.m.

• Call the Compliance Helpline at

800.560.7013. This third-party

organization is open 24 hours a

day, and they’ll report your

concern to us.

• Use the Fraud, Waste and Abuse

Report form on priorityhealth.com.

• Contact us by mail at Fraud and

Abuse Program, MS 3175, 1231

E. Beltline NE, Grand Rapids, MI

49525 or fax 616.942.7916.

Reconstructive surgery following breast cancer


Health and wellness or prevention information

Health Journal is presented by Priority Health, 1231 East Beltline NE, Grand Rapids, MI 49525-4501. © 2015. All rights reserved. Health Journal and its graphic representation are trademarks. Reproduction without permission is strictly prohibited. No material in this issue may be reproduced without written permission. The publishers do not assume responsibility for unsolicited editorial material. Health Journal is an information newsletter for the customers of Priority Health. The information provided in this newsletter is intended to be used as a general guideline and should not replace the advice of your physician. Always consult your physician for individualized care. If you have any questions, please call the number on the back of your membership card. Priority Health encourages physicians to discuss all treatment options with their patients regardless of benefit level or coverage.

1231 East Beltline Ave. NE

Grand Rapids, MI 49525

©2015 Priority Health 8579A 03/15

Get the latest news, tips and information. “Like” us on Facebook or follow @PriorityHealth on Twitter and Pinterest.

ThinkHealthintroducing

Good health requires quality information every step of the way. Which is why Priority Health has launched ThinkHealth—your online resource for

You’ll find:

Ideas for improving your fitness and health

Guidance for getting quality care from your doctor

And much more

Visit priorityhealth.com Keyword: thinkhealth

HEALTHY

LIVING TIPS

INFORMATION

ON HEALTH

CARE TRENDS

HEALTH

INSURANCE

EDUCATION

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