Capital Soup

Florida News Straight From the Source

You are here: Home / Archives for Capital Health Plan

Capital Health Plan

Capital Health Plan Maintains Impressive Streak of Top NCQA Ratings

Posted on

CHP continues to be recognized as a national leader in quality health care

Capital Health Plan (CHP) today learned that its streak of more than a decade remains intact, as the National Committee for Quality Assurance (NCQA) once again has awarded CHP a superior distinction. Each year NCQA rates health plans across the country, and CHP has earned superior distinction since NCQA began comparing and ranking health plans in 2005. [Read more…] about Capital Health Plan Maintains Impressive Streak of Top NCQA Ratings

How to Protect Yourself from Medicare Fraud

Posted on

Every year, Medicare fraud affects consumers and companies across the nation. Estimates say that last year alone, there was over $1 billion in fraudulent Medicare billings . Not only does Medicare fraud inflate the cost of medical care for everyone, it can also compromise your private medical information, including past Medicare statements, claims, and even confidential items like your social security number. That’s why it’s important to take steps to defend yourself from a potential identity thief, especially when it comes to your medical records. 

Dr. Ryan Curran

First and foremost, protect your confidential information. When discussing your Medicare information — such as a Medicare ID number and Health Plan details — always take precautions to ensure that your personal information is protected. If an identity thief gains access to your Health Plan ID, they can access your physicians, order prescriptions, and even file a health insurance claim.

Starting in April, the Center for Medicare and Medicaid Services will issue new Medicare ID cards with a unique alphanumeric ID number rather than your social security number, but it’s still important to “guard your card” and keep it safe like you would a credit card or your social security card.

It’s also important to always keep a close eye on your account’s activity to spot anything unusual or incorrect. In addition to reviewing receipts, dates, and billing statements, make sure the details of your Medicare claims correctly match up with the services you received. You can check at MyMedicare.gov or by calling 1-800-MEDICARE.

And don’t overlook the Explanation of Benefits form sent from your insurance company. The form details how much you have been billed for a specific claim, what your insurance covers, and the deductible amount you’re ultimately responsible for. Compare the explanation of benefits to your medical provider’s receipt to detect any discrepancies that could hint toward a potential identity theft.

Some Medicare fraud has been linked to companies or individuals offering “free services or products” in exchange for your confidential information, including your Health Plan ID number. Be wary of phone calls or emails that ask for sensitive Medicare information, such as your Medicare ID, as they could be an attempt to steal your identity. Identity thieves may also call or email pretending to be a medical insurance professional in order to obtain your confidential information. If this happens, hang up or don’t reply, then immediately report it to your health insurance provider.

Medicare fraud can complicate your financial well-being, including your insurance record and credit report. It’s crucial to report any suspicious activity as soon as possible to prevent further fraudulent activity.

You can report suspected Medicare fraud to your health insurance company, to the toll-free number at 1-800-MEDICARE, or online to the Office of the Inspector General on the official Medicare website.

Learn more about the steps you should take to report Medicare fraud here.

Ryan Curran, MD is a family medicine physician with Capital Health Plan.

Understanding Diabetes

Posted on

Diabetes is a lifelong condition, so whether you have type 1 or type 2 diabetes, proper health care and a good relationship with physicians and specialists is imperative to a happy, healthy you. A diabetes diagnosis is no longer something to be afraid of, you can learn to live with the new normal and have a satisfying, healthful life.

Dr. Hayley Scott

Type 1 Diabetes: A Lack of Insulin
Insulin is a hormone that helps your body’s cells use sugar for energy and stores extra energy in muscle, fat, and liver cells. Without it, sugar can’t get into these cells, which causes your blood sugar levels to become high. High blood sugar can cause damage to the eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health complications. Type 1 diabetes occurs when your pancreas stops making insulin. It can happen at any age, but it generally starts in childhood or young adulthood. While there is no cure for type 1 diabetes, you can live a long and active life with the proper treatment.
There is a genetic factor to type 1 diabetes. Some people who have a parent or sibling with the disease are at a higher risk of developing it. Other risk factors include being Caucasian and having islet cell antibodies in the blood. Symptoms of type 1 diabetes that can be early warning signs include:

  • Being very thirsty
  • Urinating frequently
  • Unexplained weight loss
  • Being abnormally hungry at times
  • Blurred eyesight

Treatment plans include taking insulin, eating a healthy diet in which carbohydrates are spread throughout the day, checking blood sugar levels multiple times daily, and getting exercise regularly.
Type 2 Diabetes: Misused Insulin
You can get type 2 diabetes if your body doesn’t respond to insulin appropriately or if your pancreas doesn’t make enough insulin. If you are overweight, sedentary, or have a history of type 2 diabetes in your family, you are more likely to be at risk. It can be prevented or delayed if you live a healthy lifestyle. Treating type 2 diabetes includes making healthy food choices, losing weight if you’re overweight, getting regular exercise, and taking medications if necessary. You should also see your doctor regularly, test your blood sugar levels daily, keep your blood pressure and cholesterol under control, and quit smoking.
The Emotional Toll
Living with diabetes can seem insurmountable, but the good news is that it’s not! By following doctor’s orders, managing your weight, exercising, eating right, and staying on top of your blood sugar levels, you can lead a happy, healthy life regardless of your diagnosis. It’s common to feel upset, and that’s okay – just remember that you can still live your life to the fullest.
For more information about diabetes, visit Capital Health Plans’ Healthwise® Knowledgebase at capitalhealth.com.
Hayley Scott, MD, is a family medicine physician at Capital Health Plan and is fluent in American Sign Language.

What to do to fight the flu

Posted on

Dr. Steven LaRosa

It’s that time of year again. Your body aches, your throat hurts, the thermometer says you have a fever, and you can’t stop coughing. That’s right, it’s flu season. Influenza is an infection caused by a virus, and while everyone knows it’s no fun being sick, the flu doesn’t have to be the end ofthe world. Know your symptoms, get a proper diagnosis, and seek treatment – or better yet, get vaccinated.
Know Your Symptoms 
Your body will tell you when you have the flu, so listen to it. If you are suffering from any of the following symptoms, it’s possible you may have the flu:

  • Fever
  • Body aches
  • Headaches
  • Dry cough
  • Sore or dry throat
  • Fatigue
  • Loss of appetite

These symptoms tend to be at their worst for the first three or four days, although it may take a week or two to completely rid yourself of the flu.
Don’t Delay – Get Diagnosed and Treated
If you are feeling any symptoms of the flu, you should seek a diagnosis from your physician to be certain. Your doctor will give you an exam, which may include a blood test or a sample of fluid from your nose or throat, to nail down what type of flu virus you might have.
Once you have your diagnosis, you can work on a treatment plan. Many people treat their flu symptoms at home with rest, fluids, and over-the-counter medications to lower a fever. Hospitalization may be necessary for more severe cases. If you think you have the flu, get to your doctor as soon as possible. If you see your doctor within two days of initial onset, you may be able to get started on medication that will ease your symptoms. 
Prevention is Key to a Healthy You 
Why risk getting the flu when there are preventive measures in place? The U.S. Centers for Disease Control and Prevention recommends that everyone at least six months old get a flu vaccine. Getting vaccinated for the flu each year can reduce your chances of getting the virus.
Some people are at a higher risk of getting the flu than others. At especially high risk are young children, adults age 50 and older, individuals with long-term health problems or immune disorders, and pregnant women. Those who work in health care or live with a person at high risk for the flu should get vaccinated to lower their chances of catching it.
Take Charge of Your Health
If you do come down with the flu, remember to practice proper home care so your illness doesn’t progress into something more dangerous. Be sure to see your doctor as soon as you feel flu symptoms coming on. Most of all, get vaccinated whenever it becomes available. Additional information is available from the Healthwise Knowledgebase at capitalhealth.com.
Stephen LaRosa is a Family Medicine physician at Capital Health Plan.

Capital Health Plan Celebrates 35th Anniversary With Remarkable NCQA Ratings

Posted on

Capital Health Plan Celebrates 35th Anniversary With Remarkable NCQA Ratings

~ CHP continues to be recognized as a national leader in quality health care ~

TALLAHASSEE, Fla. – Capital Health Plan (CHP) celebrates its 35th anniversary this year with impressive ratings by the National Committee for Quality Assurance (NCQA). Each year, NCQA rates health plans across the country, bestowing CHP with superior distinction for more than 10 years now.

Since NCQA began comparing and ranking health plans in 2005, CHP has consistently been recognized as the top plan in Florida and amongst the highest rated plans in the nation. According to the committee’s Private Health Insurance Plan Ratings for 2017-2018, CHP’s private Commercial plan is rated 4.5 out of 5. According to its Medicare Health Insurance Plan Ratings for 2017-2018, CHP’s Medicare plan is rated 4.5 out of 5. No other health plan in the state of Florida achieved ratings this high for both their Commercial and Medicare plans. 

“Our consistently exceptional ratings reflect CHP’s commitment to delivering quality care to our local community,” said Dr. Nancy Van Vessem, Chief Medical Officer for Capital Health Plan. “We work to prioritize the needs of our members in an effort to continually improve services and promote health.”

Ratings are calculated based on combined scores of Healthcare Effectiveness Data and Information Set (HEDIS®), Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and NCQA Accreditation standards. Scores include the results of consumer surveys and compare the success of various plans in preventing and treating medical conditions. 

“While it is wonderful to be recognized as a leading health plan, the greatest measure of success is the strong support we’ve had from our members,” said John Hogan, CEO of Capital Health Plan. “We are honored to be the Big Bend’s local, trusted health care partner, and we’re thankful for our physician partners who have been so instrumental in our success over the years.”

Since opening in 1982, CHP has been committed to offering affordable, comprehensive health care to the area. In 35 years, they have grown to more than 135,000 members – with an extensive physician network and two exclusive CHP health centers that provide preventive, primary, and specialty care services.

“Every year we are growing and finding new ways to refine our services to deliver the best value for our customers and the communities we serve,” said Ken Boutwell, Chairman of the Board. “We are proud of how far we have come and we look forward to what the future has to offer.”

For more information about Capital Health Plan, visit www.capitalhealth.com.

National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS® is the most widely used performance measurement tool in health care. NCQA’s website (www.ncqa.org) contains information to help consumers, employers and others make more informed health care choices.