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$0 Annual Breast Cancer Screenings

Smiling Woman

The US Family Health Plan covers a screening mammogram each year at no cost. No PCP referral is needed for this screening. Talk to your PCP about how frequently you should have this screening and take advantage of this benefit that could save your life!

Important Note about 3-D mammogram coverage under TRICARE and Medicare:

  • TRICARE/US Family Health Plan does not cover 3-D mammograms. 
  • Medicare does have some coverage for 3-D mammograms. If you are a TRICARE beneficiary who is also covered by Medicare, we recommend that you speak with your provider to see if they are willing to bill Medicare for these charges. You can also contact Medicare for more information about that coverage.
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Shingles Prevention: We’ve Got You Covered!

SHINGRIX® is a vaccine to prevent shingles (herpes zoster) in adults 50 years and older.

The US Family Health Plan covers SHINGRIX when you get it at a network pharmacy or from your primary care provider. Be sure to bring a prescription for SHINGRIX from your doctor if you plan to get the vaccine at a pharmacy.

If you have questions regarding your pharmacy coverage, please contact Member Services at 1-888-674-8734.

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DID YOU KNOW? 

Pharmacy Requirements

Did you know that US Family Health Plan members must use the Martin’s Point Mail-Order Pharmacy or one of the Martin’s Point Health Care Center Pharmacies in Portland, Maine and Portsmouth, New Hampshire for their maintenance medications? Department of Defense TRICARE policy requires that maintenance medications (prescription drugs that you take every day to treat chronic conditions) be filled through a Martin's Point Pharmacy.

Luckily for members, that means cost savings and convenience! To get up to a 90-day supply of your maintenance medications at a very low cost, simply ask your prescribing doctor to send a 90-day prescription to a Martin's Point Pharmacy.

Members may fill the following kinds of prescriptions at an in-network retail pharmacy:

  • New prescriptions 
  • Medications for urgent/acute needs (such as antibiotics)
  • Medications only taken when needed (PRN)
  • Dosage changes (Some maintenance medications require dosage adjustments to find the right dose)
  • Class II Narcotics

When you are prescribed a maintenance medication that you will be taking regularly, you may get your first fill at a local in-network retail pharmacy. For refills, please have your prescribing provider send a 90-day supply script to a Martin’s Point Pharmacy. Some restrictions apply. Some liquids, refrigerated items, and controlled substances cannot be mailed.

Please be aware that if you do not set up your maintenance medication at the Mail-Order Pharmacy or one of the Martin’s Point Health Care Center Pharmacies in Portland, Maine and Portsmouth, New Hampshire, you may be required to pay out-of-pocket for your prescriptions. If this occurs, we will not be able to reimburse your prescription costs.

Please contact one of the Martin’s Point Pharmacies to set up your prescriptions to ensure the lowest cost.

  • Martin’s Point Mail Order Pharmacy: 1-800-707-9853.
  • Martin’s Point Health Care Center, Portland, ME Pharmacy: 1-888-408-8281
  • Martin’s Point Health Care Center, Portsmouth, NH Pharmacy: 1-603-436-0562
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Cervical Cancer Screening—Important Facts for You to Know!

Did you know that, over the last 50 years, there has been a 70% decrease in deaths from cervical cancer in the US? This is largely due to prevention and early detection and treatment made possible by regular cervical cancer screenings.

What is cervical cancer screening?

There are two types of cervical cancer screenings:

  • A Pap test detects abnormal cell changes on the cervix before they have a chance to turn into cancer. 
  • A human papillomavirus (HPV) test detects “high-risk” types of HPV which can lead to cervical cancer.  

Why are cervical cancer screenings important?

Most women diagnosed with cervical cancer either have never had a Pap test or did not have one in the previous five years. Cervical cancer is completely preventable if precancerous cell changes are detected and treated early, before cervical cancer develops. Cervical cancer usually takes years to progress. Regular screening with Pap tests, supplemented by HPV testing, will detect virtually all precancerous changes and cervical changes before they progress.  

Who should have the screening?

Cervical cancer screening (a Pap smear and/or human papillomavirus (HPV) test is recommended for women:

  • ages 21–30 have a Pap smear every 3 years
  • ages 30–64 have a Pap smear every 3 years OR Pap/HPV co-testing every 5 years

Who does not need the screening?

If you have had any of the following in your medical history:

  • a hysterectomy and have no residual cervix—a complete, total, or radical abdominal or vaginal hysterectomy 
  • cervical agenesis 
  • acquired absence of cervix 

If any of these apply to you, please inform your provider of your history and provide the month and year of any of these to your best recollection.

Source: http://www.nccc-online.org/images/pdfs/HPV_fact_sheet_2015.pdf

HEDIS 2018, Volume 2 Technical Specifications

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Is Your Blood Pressure Reading Correct? 

Hypertension (high blood pressure) is the number one health condition affecting Americans’ quality of life and longevity.1 To ensure early detection and treatment, it’s important to have regular blood pressure checks. It’s also important that your blood pressure readings are as accurate as possible.

Here are a few tips on what you can do to help improve the accuracy of your blood pressure readings:
Blood Pressure diagram
 
1The Health of America Report, Blue Cross Blue Shield; www.bcbs.com/the-health-of-america/reports
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Colon Cancer CAN Be Prevented

Get the screening that’s best for you!
Each year, over 140,000 Americans are diagnosed with colorectal cancer, and more
than 50,000 die from it. The good news is that this is one of the few cancers that
can be prevented before it starts. That’s why timely screening after the age of 50 is so important.
See the table below to learn about each kind of screening and then talk with your doctor about which screening is right for you:
Colon Cancer Chart
 
*Ask your primary care provider what schedule is right for you. See your Member Handbook or contact Member Services for coverage details.
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X-Rays or MRIs for Back Pain? You may want to think twice!

If you’re like many people with back pain, you may think you need an X-ray or MRI to find out what is causing your pain. But these tests usually do not help. 

The tests will not help you feel better faster.

Most people with lower-back pain feel better in about a month, whether or not they have an imaging test.

People who get an imaging test for their back pain do not get better faster. And sometimes they feel worse than people who took over-the-counter pain medicine and followed simple steps, like walking, to help their pain.

Imaging tests can also lead to surgery and other treatments that you do not need. In one study, people who had an MRI were much more likely to have surgery than people who did not have an MRI. But the surgery did not help them get better any faster.

Imaging test have risks

X-rays and CT scans use radiation. Radiation has harmful effects that can add up. It is best to avoid radiation when you can.

Imaging tests are expensive.

Imaging tests can cost hundreds, or even thousands, of dollars depending on the test and where you have it. Why waste money on tests when they don’t help your pain? And if the tests lead to surgery, the costs can be much higher.

When are imaging tests a good idea?

In some cases, you may need an imaging test right away. Talk to your doctor if you have back pain with any of the following symptoms, as they can be signs of nerve damage or a serious problem such as cancer or an infection in the spine:

  • Weight loss that you cannot explain
  • Fever over 102° F
  • Loss of control of your bowel or bladder
  • Loss of feeling or strength in your legs
  • Problems with your reflexes
  • A history of cancer

If you do not have any of these symptoms, it is recommended to wait a few weeks. Research strongly supports conservative treatment such as physical therapy and acupuncture to treat back pain, as opposed to the high-tech approach. If one approach does not work, try a different one.

This article is not a substitute for medical advice and treatment.

Sources: http://www.choosingwisely.org/patient-resources/imaging-tests-for-back-pain/
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Sore Throats in Children

When are antibiotics the right treatment?

A sore throat—including redness, pain and swelling—is one of the most common reasons children go to the doctor’s office.  If your child’s sore throat is severe and includes difficulty swallowing, drooling, or neck swelling, you should consult a doctor immediately.

There are two main causes of sore throats—viruses and bacteria (streptococcus, or strep). Studies show that most sore throats are viral, with only 15-30% of cases caused by strep.  Most strep cases are in children who are 5-10 years old.

It is important to know if your child’s sore throat is caused by strep bacteria. It can be hard for a doctor to tell the difference between a viral sore throat and a strep throat based only on a physical exam. They may swab your child’s throat for a rapid strep test (if available in the doctor’s office). If the rapid test is positive, they may immediately prescribe an antibiotic to help prevent the complications associated with this bacteria. If it is negative, part of the swab will be kept for culture. Within two to three days, it will show if strep is present and treatment will be determined.

If your child’s sore throat is viral, there is no benefit to using antibiotics and treatment will focus on their comfort. Their doctor may recommend rest, acetaminophen (for pain), increased fluids and throat lozenges.

Sources: 

Wald, Ellen R. “Group A streptococcal tonsillopharyngitis in children and adolescents: Clinical features and diagnosis.” 

UpToDate, June 7, 2017. Accessed 8/7/2017.

https://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/pharyngitis_and_tonsillitis_in_children_90,P02069

http://www.stanfordchildrens.org/en/topic/default?id=pharyngitis-and-tonsillitis-in-children-90-P02069

https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html
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Reimbursement Tips

There are times when you may need to request reimbursement for a health care service for which you made an out-of-pocket payment. Here are some tips to ensure the timeliest processing of your request:

  • Reimbursement request forms are available https://tricare.martinspoint.org/member-toolkit 
  • Remember to completely fill out the request form. Your Martins Point US Family Health Plan Member ID, date of birth and signature are required.
  • Include procedure codes and diagnosis codes if possible and always include an itemized statement from the provider and proof of payment.
    • If you have other insurance that is a primary payer, we always need a copy of the Explanation of Benefits (EOB) document from the other insurance showing payment or denial. (Exception: We do not require this for Pharmacy copays)
  • If you are requesting reimbursement for the cost of emergency services you received while outside of the US, please call us to provide specific information about the service and reimbursement.

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Hearing Aid and Battery Discounts!

US Family Health Plan members can take advantage of substantial discounts on hearing aids and hearing aid batteries through our partnership with Amplifon. Please note that the Amplifon program should only be used to purchase hearing aids and batteries. Visit the Amplifon website for more information.

IMPORTANT NOTE: Hearing tests and medical services should be received through a US Family Health Plan network provider. Call Member Services at 1-888-674-8734 for help finding a network provider near you