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  • Teladoc: 24/7 care for all Home Care members

    Teladoc: 24/7 care for all Home Care members

    Teladoc: 24/7 care for all Home Care members

    Teladoc Primary360

    If you or your child is sick and need help right away, you can get the care you need from the comfort of your home 24 hours a day, 7 days a week, with Teladoc, a telehealth service.

    No matter how you get your health benefits, Teladoc 24/7 is available to all Home Care members. When you’re not feeling well, quality care is just a phone call or click away.

    With Teladoc, you can:

    • Get a diagnosis and recommended treatment for conditions such as cold and flu, fever, sprains and strains, backaches, rashes and more
    • Get a prescription for medication, if necessary

    Go to www.Teladoc.com to set up an account and get started, or call (800) TELADOC (835-2362).

    To learn more about building a relationship with your doctor, visit our Healthy Relationships page.

  • See why 1199ers are joining WeightWatchers!

    See why 1199ers are joining WeightWatchers!

    See why 1199ers are joining WeightWatchers!

    There’s a reason why over 5,100 1199ers have signed up—because WeightWatchers has a proven track record of helping members reach their goals. This science-backed program provides meal planning, an award-winning app, and more than 12,000 nutritious and tasty recipes. Now, there are even 1199ers-only workshops and our own social network, the 1199ers Group, to help our community support each other and exchange information. And the best part is when you join through the Benefit Fund, you can take advantage of our discounted—or no-cost—premium membership!

    Already a WW member? Join the 1199ers Group!

    It’s time for you to join the 1199ers Group in the Connect section of the WeightWatchers app. If you’re a WW member, it’s easy to become a part of this fun, supportive, judgment-free zone and start chatting with other 1199ers. When you join, you can share your story, get tips and inspiration, and exchange advice with other members who may be on a journey similar to yours. Get connected—you never know who might show up!

    WHY are you taking your health journey?

    Whether you are just starting out or you have been at it for a while, ask yourself, WHY am I on this journey? Your WHY is the reason you’ve been courageous enough to begin your health journey—and it’s the thing that motivates you to achieve your goals.

    WeightWatchers’ Potato and Pepper Frittata

    Serves 4

    4 points per serving

    This frittata is the ultimate easy-on-the-cook egg dish for breakfast or brunch. It’s impressive-looking enough to serve a crowd, but simple enough to put together for a quick breakfast. Also, the recipe is extremely versatile. You can substitute other vegetables, such as zucchini, chopped broccoli or tomatoes, and other cheeses, such as feta or Monterey Jack, instead of what the recipe calls for here.

    Ingredients

    • 1 tablespoon of canola oil
    • 2 cups of frozen shredded hash brown potatoes
    • 8 medium scallions, chopped
    • 1 medium red bell pepper, seeded and chopped
    • A pinch of salt
    • ¼ cup of fresh, flat-leaf parsley, chopped
    • 2 cups of liquid egg substitute
    • ½ cup of shredded fat-free cheddar cheese
    • 1 tablespoon of shredded Parmesan cheese
    • ½ teaspoon of coarsely ground black pepper

    Instructions

    1. Heat the oil in a medium non-stick skillet over medium heat. Add the hash browns, scallions, bell pepper and salt; cook, stirring frequently, until the vegetables are tender and golden, 8 to 10 minutes. Stir in the parsley.

    2. Meanwhile, spray a large non-stick skillet with non-stick spray and set over medium heat. Add the egg substitute and cook until set, 7 to 8 minutes, lifting the edges often with a spatula to let the uncooked egg substitute flow underneath.

    3. Spoon the potato mixture over the frittata, then sprinkle with the cheddar cheese, Parmesan cheese and ground pepper. Cover the skillet and cook until the cheese melts, about 3 minutes.

  • Legendary duos: Romeo and Juliet. The beach and sand. Cake and ice cream.

    Legendary duos: Romeo and Juliet. The beach and sand. Cake and ice cream.

    Legendary duos: Romeo and Juliet. The beach and sand. Cake and ice cream.

    You can’t make a list of life’s most legendary duos without hypertension and diabetes. According to the National Institutes of Health, an estimated 73 percent of people in the U.S. who have diabetes also have hypertension. Although they’re often found together, the good news is that both are manageable and may even be completely reversible when you take some small steps.

    Breaking up a bad combo!

    How did diabetes and hypertension become such fast friends? Over time, diabetes can cause inflammation and damage to small blood vessels and kidneys. These changes contribute to high blood pressure. So, let’s get to know these BFFs a little bit better.

    Diabetes stops your body from making enough insulin or using it as well as it should, resulting in too much sugar in your bloodstream. Over time, diabetes also sets you up for kidney failure and heart disease. A person is considered diabetic when their A1C level is 6.5% or higher.

    Hypertension, or high blood pressure, makes your heart work harder to pump blood through your body. Left unchecked, it can cause strokes, as well as kidney and heart disease. High blood pressure is a consistent reading of 140/90 or higher. Start to fight back by scheduling a checkup with your doctor. With a physical exam, your doctor will be able to assess your health and let you know about any tests you should have. This will provide the basis for your plan of action—if you need it.

    Approximately 73% of the 34 million people in the U.S. with diabetes also have hypertension.

    The one-two punch: Healthy eating and movement!

    Making changes to your lifestyle is easier to achieve if you start small. Start with healthy swaps you can make in your food choices and add a 10-minute walk to your activity today. Weight loss is a superhero when fighting this bad combo. Eating healthier food and adding more movement to your day can dramatically affect your health. And remember: Every little change you make counts.

    We can help! Check out this wellness workshop on nutrition and diabetes.

    Stay active doing what you love!

    Many basic activities can be aerobically effective when the intensity and frequency are increased.
  • You won’t know until you go! Protect your health with regular screenings

    You won’t know until you go! Protect your health with regular screenings

    You won’t know until you go! Protect your health with regular screenings

    Health Screenings

    We’ve all seen scary movies, where you hold your breath wondering what will jump out from every dark corner. But if you approach going to the doctor with the same fears, it’s time to rethink your feelings. Many people avoid health screenings because they’re afraid of the results. While being nervous is understandable, the truth is: You won’t know until you go. Whether you get peace of mind or a head start on treatment, scheduling a screening with your doctor is potentially lifesaving.

    Our Chief Medical Officer, Dr. Van H. Dunn, recommends the following screenings to help you maintain a healthier, fuller life. Check with your primary care physician to find out which screenings are right for you.

    Schedule Your Screenings for the Year

    These screenings are also an excellent way to check how well you are managing an already diagnosed condition. To get screened, visit your doctor or go to an 1199SEIU health fair at your worksite.

    Your Benefit Fund’s Chief Medical Officer recommends that you follow these screening guidelines.

    Screening Beginning at age How often?
    Physical Exam All ages At least every year
    Eye Exam Age 40+ Every 2 to 4 years
    Blood Pressure Screening Age 18+ At least every year
    Cholesterol*
    Age 18+
    If your initial test results were abnormal, or if you’re at higher risk of heart disease
    Every 5 years
    As directed per your doctor
    Glucose/Blood Sugar Screening for Diabetes*
    Age 45+ With every annual checkup
    Bone Density (osteoporosis screening)
    Women: age 65+, as well as younger postmenopausal women who have risk factors or who have had a fracture as an adult
    Men: 65+
    Women: Once, then as directed per your doctor
    Men: Discuss with your doctor

    Cancer Screenings

    Colorectal Cancer
    Age 45+
    Colonoscopy every 10 years or Fecal occult blood test every year or Cologuard every 3 years
    Ask your doctor which test is best for you.
    Cervical Cancer: PAP test
    Women age 21–65
    Every 3 years
    Cervical Cancer: HPV and PAP test Women age 30–65 Every 5 years, or just Pap test every 3 years (If an HPV test is positive, screenings should be annual)††
    Breast Cancer: Clinical Breast Exam
    Women age 20+
    At your regular checkup
    Breast Cancer: Mammography Women age 40+ Every year
    Prostate Cancer Men: Discuss with your doctor Discuss with your doctor
    Lung Cancer Current/former smokers within the past 15 years, age 50 to 80, who smoked 1 pack/day for 20 years or 2 packs/day for 10 years. Annual


    * Talk to your doctor if you smoke; are overweight; have high blood pressure, diabetes or a history of gestational diabetes; have a family history of diabetes, heart disease or stroke; or are at risk for coronary artery disease.

    † For all cancer screenings, talk to your doctor about your history and see if you need to get additional tests at an earlier age.

    † For all cancer screenings, talk to your doctor about your history and see if you need to get additional tests at an earlier age.

     

    †† The HPV test looks for infections that are likely to cause cervical cancer, and can be used alone or at the same time as the Pap test.

    †† The HPV test looks for infections that are likely to cause cervical cancer, and can be used alone or at the same time as the Pap test.

    Sources: American Academy of Family Physicians; American Cancer Society; U.S. Department of Health and Human Services

    This screening is easier than ever!

    The good news is colorectal cancer diagnoses have dropped in the U.S. in the last few decades. This is mainly because more people are getting screened.* There are now several options for screening, which makes it easier for people to do. Another contributing factor could be that there has been a change in attitude toward healthy eating and exercise. The U.S. Preventive Services Task Force recommends that everyone ages 45 to 75 be screened for colorectal cancer, so make an appointment to be screened. And if you have a family history of cancer, you should check with your doctor to see if you should be tested sooner.

    The Women’s Health and Cancer Rights Act

    If you’re battling breast cancer, we’re here to support you every step of the way, from mammogram to cancer care. Your health benefits give you access to quality oncology care with many of the top cancer treatment centers in the New York metropolitan area, so you won’t have to go outside of your network for care.

    We also provide coverage for reconstructive surgery, prostheses and other mastectomy-related services, including:
    • Reconstruction of the breast on which a mastectomy was performed;
    • Surgery and reconstruction of the other breast to achieve a symmetrical appearance;
    • Prostheses; and
    • Treatment for physical complications associated with all stages of the mastectomy, including lymphedema.

  • Alice Barnett

    Alice Barnett

    Alice Barnett

    WHY is being healthy so important to Alice? Having her mind at ease about her health allows her to have fun with her daughter.

    “I enjoy spending time with my daughter—that’s what makes it all worthwhile.”

    Alice Barnett is a home health aide with Alliance Homecare, where she enjoys helping clients with daily activities like housekeeping and shopping. “I really love what I do,” she said. “My client is so easy to get along with, I’m very happy to be here to help.”

    In addition to her work, Alice’s health is important to her. That’s why she has made sure to have regular checkups for nearly 25 years. “Having health benefits means that if there are issues that need to be addressed, I can see a doctor who will talk with me and advise me on a treatment plan,” she said.

    Seeing a doctor became especially important to Alice about eight years ago. She felt feverish and lightheaded. Frightened, her mother called an ambulance. She was taken to a nearby hospital and told her blood pressure was extremely high—180 over 120­—and she was at risk of having a stroke or heart attack. She immediately saw her doctor, who confirmed that she needed treatment. Alice took the advice seriously. “I have a young daughter at home who depends on me,” she recalled thinking. “I have to be healthy to be there for her.”

    Her doctor prescribed medication and carefully reviewed its usage with her. He also advised that she could keep her condition under control through healthy eating. Since then, Alice reads the ingredients on everything she buys, checking labels carefully for sodium content. “If I see something has too much salt, I don’t buy it,” she explained.

    Alice now enjoys eating plenty of fruits and salads, which she’s used to replace fast food. “I aways try to bring my leftovers with me for lunch,” she said. “That way, I can avoid the unhealthy delis and restaurants near me.”

    Having had some success following the plan her doctor gave her, Alice knows that regular follow-up visits are important. Although her blood pressure has improved, her doctor told her she still has work to do. She also believes in the value of regular screenings. “A doctor can help me get precautionary tests, like a mammogram,” Alice explained. “I like the security of knowing that everything else is okay.”

    Having her mind at ease about her health allows Alice and her daughter to spend quality time together, including their favorite pastime, catching the latest scary movie at the nearby theater. “I enjoy spending time with my daughter—that’s what makes it all worthwhile,” she says.

    Home Care For Your Benefit Archive

  • Healthy Finances: Understanding Your Paycheck

    Healthy Finances: Understanding Your Paycheck

    Healthy Finances

    • Banking Basics

      Wednesday, October 22, at 6:00 pm

      Banking Basics teaches you how to open accounts, make deposits and withdrawals, monitor fees, maintain balances, conduct transactions remotely safely, and more.

    • Understanding Your Paycheck

      Wednesday, November 19, at 6:00 pm

      In this webinar, you’ll learn about payroll and tax deductions, social security, Medicare, FICA and more.

    • How Credit Works

      Wednesday, December 10, at 6:00 pm

      Utilizing credit, credit reporting, credit scores and credit impact. Understand credit and learn how lenders determine your credit worthiness and more in this webinar.

    Other Healthy Finances Courses

    Understanding Your Paycheck

    Saving Strategies Part One

    Next Live Video:
    Wednesday, March 1, 2023 at 6:00 pm

    Saving Strategies Part Two

    Next Live Video:
    Wednesday, March 15, 2023 at 6:00 pm

    Give Me Some Credit

    Next Live Video:
    Wednesday, March 29, 2023 at 6:00 pm

    Recovering from Financial Hardship: It’s Not Over!

    Next Live Video:
    Wednesday, April 12, 2023 at 6:00 pm

    Working Toward Retirement, Part One

    Next Live Video:
    Wednesday, April 26, 2023 at 6:00 pm

    Working Toward Retirement, Part Two

    Next Live Video:
    Wednesday, May 10, 2023 at 6:00 pm

    Growing Your Money

    Next Live Video:
    Wednesday, May 24, 2023 at 6:00 pm

  • Healthy Finances: How Credit Works

    Healthy Finances: How Credit Works

    Healthy Finances

    • Banking Basics

      at

      Banking Basics teaches you how to open accounts, make deposits and withdrawals, monitor fees, maintain balances, conduct transactions remotely safely, and more.

    • Understanding Your Paycheck

      at

      In this webinar, you’ll learn about payroll and tax deductions, social security, Medicare, FICA and more.

    • How Credit Works

      at

      Utilizing credit, credit reporting, credit scores and credit impact. Understand credit and learn how lenders determine your credit worthiness and more in this webinar.

    Other Healthy Finances Courses

    Understanding Your Paycheck

    Saving Strategies Part One

    Next Live Video:
    Wednesday, March 1, 2023 at 6:00 pm

    Saving Strategies Part Two

    Next Live Video:
    Wednesday, March 15, 2023 at 6:00 pm

    Give Me Some Credit

    Next Live Video:
    Wednesday, March 29, 2023 at 6:00 pm

    Recovering from Financial Hardship: It’s Not Over!

    Next Live Video:
    Wednesday, April 12, 2023 at 6:00 pm

    Working Toward Retirement, Part One

    Next Live Video:
    Wednesday, April 26, 2023 at 6:00 pm

    Working Toward Retirement, Part Two

    Next Live Video:
    Wednesday, May 10, 2023 at 6:00 pm

    Growing Your Money

    Next Live Video:
    Wednesday, May 24, 2023 at 6:00 pm

  • Provider Notice: Update to COVID-19 Benefits

    During the federal COVID-19 public health emergency (PHE), the Benefit Funds temporarily changed specific policies to ensure that your 1199SEIU patients had access to medical services during that challenging time.

    Following the recent expiration of the PHE declaration by the Secretary of the Department of Health and Human Services under Section 319 of the Public Health Service Act, the Benefit Funds are reinstating suspended member cost sharing for COVID-19-related visits and diagnostic services. In addition, the Benefit Funds are continuing to cover certain communication technology-based services and telehealth services, as set forth in more detail below.

    Reinstating the Member Cost Share

    As of January 1, 2024, the Benefit Funds’ reimbursement for the following services will be reduced by the applicable co-pay amounts:

    • Home Care Benefit Fund Plan B Network members: $5/$10 co-pays for office visits (PCPs/specialists), $25 inpatient co-pay
    • Greater New York Benefit Fund members: $75 co-pay for emergency room visits

    Please review your patients’ Health Benefits ID cards for applicable co-pays.

    Continuing Coverage of Certain Communication Technology-Based Services/Telehealth Services

    The Benefit Funds will continue to cover technology-based/telehealth services based on the Benefit Funds’ telehealth policy, which considers the following:

    • Setting and place of service necessary for service
    • Provider type and specialty
    • Appropriateness of CPT vs. HCPCS codes
    • CMS’ expanded coverage rules and guidelines
    • Other relevant Benefit Funds coverage determination and policies

    The following communication technology-based services/telehealth services continue to remain non-covered by the Funds:

    • Services performed in a setting that is not covered by the Benefit Funds, such as nursing facilities, domiciliary and rest homes
    • In-person contact
    • On-site settings, such as inpatient, bedside and in-facility services
    • Services provided at urgent care centers
  • Ensure Faster Claims Processing by Using Correct Billing Codes

    Ensure Faster Claims Processing by Using Correct Billing Codes

    The National Correct Coding Initiative (NCCI), which promotes national correct coding methodologies and controls improper coding and incorrect payments for medical services, includes three types of edits:

    1. NCCI Procedure-to-Procedure Edits prevent inappropriate payment of services that should not be reported together.
    2. Add-on Code Edits consist of a listing of Healthcare Common Procedure Coding System and Current Procedural Terminology (CPT) add-on codes with their respective primary codes.
    3. Medically Unlikely Edits (MUEs) prevent payment for an inappropriate number/quantity of the same service on a single day.

    When billing for services involving both sides of the body, include modifier 50 (bilateral procedure) or RT/LT, as applicable, based on correct coding guidelines. If you use modifier 50, do not add two units as the modifier 50 already applies two units to any CPT code. If the definition of a CPT code indicates multiple views, the claim line should be billed with one unit. If a code/service that can be performed on two sides has an MUE limit of one, bilateral modifier 50 must be used. A second claim line with either modifier RT or LT will be denied for exceeding the allowed MUEs or units.

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  • ClaimsXTen Select Is Now Lyric

    ClaimsXTen Select Is Now Lyric

    The Benefit Funds’ claims auditing software ClaimsXten Select is now Lyric. Only the name—not the software—has changed. Lyric will continue to assess the appropriateness of professional and outpatient hospital claims against clinically based coding rules and edits, incorporating customized Benefit Funds’ policies that will result in accurate and faster provider reimbursement.

    More Provider Connections

    Archive