Proteja a los niños GH OD LQƮXHQ]D

AETNA BETTER HEALTH
®
Otoño 2015
Segunda opinión
¿Tiene diabetes? Tenga presente estas pruebas clave
7DOYH]GHVHHXQDVHJXQGD
RSLQLÎQVREUHXQDHQIHUPHGDG
RXQDFLUXJÈDSDUDFRQƬUPDU
HOWUDWDPLHQWRRODDWHQFLÎQ
TXHVXSURYHHGRUGLFHTXH
XVWHGQHFHVLWD&RPXQÈTXHVH
FRQVXSURYHHGRURFRQ
6HUYLFLRVSDUD0LHPEURV
GH$HWQD%HWWHU+HDOWKDO
1-888-784-269377<711 o
7''1-800-833-0920SDUD
UHFLELUD\XGD\REWHQHUXQD
VHJXQGDRSLQLÎQ
8QGLDJQÎVWLFRGHGLDEHWHVVLJQLƬFDTXHKD\
PXFKDVFRVDVTXHQRGHEHSHUGHUGHYLVWD<DTXÈ
HVW¼QDOJXQDVSUXHEDVGHGHWHFFLÎQFODYH
1RKD\XQFRVWRDGLFLRQDOSRU
UHFLELUXQDVHJXQGDRSLQLÎQGH
XQSURYHHGRUGH$HWQD%HWWHU
+HDOWKRI1HEUDVND7DOYH]
WHQJDXQFRSDJR/DVVHJXQGDV
RSLQLRQHVGHXQSURYHHGRU
IXHUDGHODUHGUHTXLHUHQ
XQDSUHDXWRUL]DFLÎQGH
$HWQD%HWWHU+HDOWK
La prueba de A1C.0XHVWUDVXVQLYHOHVGHD]ÕFDU
HQVDQJUHGXUDQWHORVÕOWLPRVWUHVPHVHV$OWRV
QLYHOHVGHD]ÕFDUHQVDQJUHSXHGHQGDÌDUHO
FRUD]ÎQORVYDVRVVDQJXÈQHRVORVULÌRQHV\ORV
RMRV/DPHWDGH$&SDUDPXFKDVSHUVRQDVFRQ
GLDEHWHVHVXQYDORULQIHULRUDOSRUFLHQWR
La presión arterial./DSUHVLÎQDUWHULDODOWDKDFH
TXHVXFRUD]ÎQVHHVIXHUFHGHPDVLDGR(OHYD
HOULHVJRGHTXHVXIUDXQDWDTXHDOFRUD]ÎQ\
XQDFFLGHQWHFHUHEURYDVFXODU7DPELÄQFDXVD
HQIHUPHGDGHVUHQDOHV/DPD\RUÈDGHODVSHUVRQDV
FRQGLDEHWHVGHEHQPDQWHQHUVXSUHVLÎQDUWHULDO
SRUGHEDMRGH
El colesterol.(O/'/tHOFROHVWHUROPDORt
REVWUX\HVXVDUWHULDV&DXVDDWDTXHVDOFRUD]ÎQ
\DFFLGHQWHVFHUHEURYDVFXODUHV3RURWURODGRHO
+'/tHOFROHVWHUROEXHQRtD\XGDDSURWHJHUHO
FRUD]ÎQ/RVYDORUHVREMHWLYRVGHFROHVWHUROYDUÈDQ
VHJÕQODSHUVRQDSRUORWDQWRWUDEDMHMXQWRFRQ
VXSURYHHGRUGHDWHQFLÎQPÄGLFDSDUDSRGHU
WHQHUHOVX\RGHQWURGHXQUDQJRVDOXGDEOH
5HFXHUGHSUHJXQWDUOHDVXSURYHHGRU
• &X¼OHVVRQVXVYDORUHVGH$&SUHVLÎQDUWHULDO
\FROHVWHURO
• &X¼OHVGHEHUÈDQVHUVXVYDORUHV
• /RTXHSXHGHKDFHUSDUDDOFDQ]DUORV
YDORUHVREMHWLYRV
)XHQWHV$PHULFDQ'LDEHWHV$VVRFLDWLRQ1DWLRQDO'LDEHWHV
(GXFDWLRQ3URJUDP
Mantenga a los niños
en movimiento
,GHDVGLYHUWLGDVSDUD
D\XGDUDORVQLÌRVDHVWDU
VDOXGDEOHV\DFWLYRV
/RÕOWLPRHQMXJXHWHVRMXHJRVQRWLHQHOD
PHQRULPSRUWDQFLD(OPHMRUUHJDORTXHSXHGH
GDUOHVDVXVKLMRVHVXQHVWLORGHYLGDDFWLYR
(OHMHUFLFLRD\XGDDORVQLÌRVDPDQWHQHUVH
VDOXGDEOHV/RVQLÌRVDFWLYRVWLHQHQPHQRV
SUREDELOLGDGHVGHWHQHUVREUHSHVR
/DVOLEUDVH[WUDVSXHGHQJHQHUDUSUREOHPDV
GHVDOXGJUDYHVFRPRHQIHUPHGDGFDUGÈDFD
GLDEHWHV\SUHVLÎQDUWHULDODOWD
Dé el ejemplo
6HUXQEXHQPRGHORDVHJXLUHVODPHMRUIRUPD
GHTXHVXVKLMRVVHSRQJDQHQPRYLPLHQWR
6LORVQLÌRVYHQTXHXVWHGHVDFWLYRHVP¼V
SUREDEOHTXHVHDQDFWLYRVWDPELÄQ
7UDWHGHTXHHOWLHPSRTXHSDVDHQIDPLOLD
VHDXQWLHPSRDFWLYR$VHJÕUHVHGHTXHOD
DFWLYLGDGTXHHOLMDVHDEXHQDSDUDWRGRVORV
PLHPEURVGHODIDPLOLD
%XVTXHGLIHUHQWHVIRUPDV
SDUDTXHHOWLHPSRHQ
IDPLOLDVHDXQWLHPSRDFWLYR
0XÄYDQVH\GLYLÄUWDQVHDOPLVPRWLHPSR&XDQWR
P¼VGLVIUXWHQODDFWLYLGDGVXVKLMRVP¼VSUREDEOH
VHU¼TXHWHQJDQJDQDVGHYROYHUDKDFHUOD
Divertirse, estar en forma
(QOXJDUGHLUDOFLQHVDOJDGHH[FXUVLÎQHQIDPLOLD
7DPELÄQSXHGH
• ,UDOSDUTXH\MXJDUFRQODSHORWD
• -XJDUDODPDQFKD
• ,UDQDGDU
• 5HPRQWDUXQEDUULOHWH\GHMDUTXHORVQLÌRV
FRUUDQFRQÄO
• $QGDUHQELFLFOHWDHQIDPLOLD
• /DYDUHODXWRMXQWRV
• ,UDOFHQWURFRPHUFLDO\FDPLQDUGHXQDSXQWDD
ODRWUD
• 3DUWLFLSDUHQXQDOLJDGHSRUWLYD,QYLWHDVXVKLMRVD
TXHORYHDQSUDFWLFDUGHSRUWHV\YD\DDDOHQWDUORV
FXDQGRMXHJXHQHQORVHYHQWRVGHSRUWLYRV
7DPELÄQHVLPSRUWDQWHOLPLWDUHOWLHPSR
TXHSDVDQYLHQGRWHOHYLVLÎQMXJDQGRDORV
YLGHRMXHJRVRXVDQGRODFRPSXWDGRUD/RLGHDO
HVQRP¼VGHGRVKRUDVSRUGÈD0XFKRVQLÌRV
SDVDQGHPDVLDGRWLHPSRIUHQWHDXQDSDQWDOOD
&XDQGRVXVKLMRVYHDQWHOHYLVLÎQSURSÎQJDOHV
TXHKDJDQDOJXQDVSDXVDVDFWLYDV3XHGHQKDFHU
HVWLUDPLHQWRVRVDOWRVGHWLMHUDSRUHMHPSOR
6HUDFWLYRVDKRUDSXHGHKDFHUTXHDVXVKLMRVOHV
JXVWHHOHMHUFLFLRWRGDODYLGD
)XHQWHV$PHULFDQ$FDGHP\RI3HGLDWULFV86'HSDUWPHQWRI
+HDOWKDQG+XPDQ6HUYLFHV
Proceso de preaprobación y autorización previa
3DUDUHFLELUDOJXQRVVHUYLFLRVWDOYH]QHFHVLWHXQDSUHDSUREDFLÎQR
DXWRUL]DFLÎQSUHYLD(VWRLQFOX\HWRGRVORVVHUYLFLRVGHSURYHHGRUHV
IXHUDGHQXHVWUDUHG6XSURYHHGRUSXHGHWUDEDMDUFRQQRVRWURV\
VROLFLWDUXQDSUHDSUREDFLÎQRDXWRUL]DFLÎQSUHYLD5HYLVDUHPRVOD
VROLFLWXG\GHWHUPLQDUHPRVVLORVVHUYLFLRVVRQQHFHVDULRVGHVGHHO
SXQWRGHYLVWDPÄGLFR
/RVSDVRVSDUDODSUHDSUREDFLÎQVRQORVVLJXLHQWHV
6XSURYHHGRUVROLFLWDHOVHUYLFLR'HEHSURSRUFLRQDUQRV
LQIRUPDFLÎQVREUHORVVHUYLFLRVTXHXVWHGQHFHVLWD\UHJLVWURV
PÄGLFRVFRPSOHPHQWDULRV
5HYLVDUHPRVODLQIRUPDFLÎQ
8QPÄGLFRGH$HWQD%HWWHU+HDOWKUHYLVDU¼ODVROLFLWXGVLHVWDQR
SXHGHVHUDSUREDGD
2
8VWHG\VXSURYHHGRUUHFLELU¼QXQDFDUWDFXDQGRHOVHUYLFLRVHD
GHQHJDGRRDSUREDGR
6LODVROLFLWXGHVGHQHJDGDOHHQYLDU¼QXQDFDUWDDXVWHG\DVX
SURYHHGRUHQGRVGÈDVK¼ELOHVDPHQRVTXHQHFHVLWHPRVP¼V
LQIRUPDFLÎQ/DFDUWDGLU¼SRUTXÄOHGHQHJDPRVHOVHUYLFLR6L
GHQHJDPRVXQVHUYLFLRXVWHGRVXSURYHHGRUSXHGHQSUHVHQWDU
XQUHFODPRRDSHODFLÎQ7DPELÄQSXHGHQSHGLUXQD$XGLHQFLD
,PSDUFLDOGHO(VWDGR
%DVDPRVQXHVWUDGHFLVLÎQVRODPHQWHHQODDGHFXDFLÎQGHODDWHQFLÎQ
\HOVHUYLFLR\HQODH[LVWHQFLDGHFREHUWXUD1RUHFRPSHQVDPRVD
ORVSURYHHGRUHVGHDWHQFLÎQPÄGLFDSRUQHJDUOLPLWDURUHWUDVDUORV
EHQHƬFLRVRORVVHUYLFLRVGHDWHQFLÎQPÄGLFDSDUDQXHVWURVPLHPEURV
7DPSRFRGDPRVLQFHQWLYRVDQXHVWURSHUVRQDOSRUWRPDUGHFLVLRQHVGH
RIUHFHUPHQRVVHUYLFLRV\FREHUWXUDGHDWHQFLÎQPÄGLFDFRQUHODFLÎQD
VHUYLFLRVREHQHƬFLRVQHFHVDULRVGHVGHHOSXQWRGHYLVWDPÄGLFR
1-888-784-2693
NCQA: Una ayuda
para que usted reciba
atención de calidad
4XHUHPRVRIUHFHUOHODPHMRUDWHQFLÎQPÄGLFDSRVLEOH<
QXHVWURVHOORGHO&RPLWÄ1DFLRQDOGH*DUDQWÈDGH&DOLGDG
1DWLRQDO&RPPLWWHHIRU4XDOLW\$VVXUDQFH1&4$
UHSUHVHQWDHVHHVW¼QGDU
(O1&4$HVXQSURJUDPDTXHHYDOÕDORVSODQHVGH
DWHQFLÎQPÄGLFD<HVHOP¼VUHVSHWDGRGHOSDÈV(OVHOOR
VLJQLƬFDTXHDSUREDPRVVXLQWHQVRSURFHVRGHUHYLVLÎQ
Ayude a sus hijos a
estresarse menos
(OHVWUÄVHVSDUWHGHODYLGDLQFOXVR
SDUDORVQLÌRV'HVGHODYLGDGLDULD
HQFDVDKDVWDORVGHEHUHVHVFRODUHV
GHVGHKDFHUDPLJRVKDVWDFXPSOLUFRQ
ODVH[SHFWDWLYDVHQWRGRKD\SUHVLÎQ
$XQTXHTXLHUDSURWHJHUDVXVQLÌRV
GHWRGRVORVSUREOHPDVGHODYLGD
HVRHVVHQFLOODPHQWHLPSRVLEOH
3HURSRGHPRVD\XGDUOHVDDSUHQGHU
DHQIUHQWDUORTXHODYLGDQRVYD
SUHVHQWDQGR(VWDVLGHDVSXHGHQ
VHUYLUOHGHD\XGD
• 'HVDUUROOHODFRQƬDQ]D$\XGHD
VXVKLMRVDLGHQWLƬFDUVXVIRUWDOH]DV
<DFHQWUDUVHHQORPHMRUTXH
WLHQHQ(VWLPÕOHORV\HOÎJLHORVFRQ
KRQHVWLGDGVLQH[DJHUDU
Cómo somos evaluados
8QJUXSRGHPÄGLFRV\RWURVH[SHUWRVHYDOÕDQXHVWUR
SURJUDPD/RHYDOÕDQHQIXQFLÎQGHP¼VGH
HVW¼QGDUHV/RVHVW¼QGDUHVVHFODVLƬFDQHQ
JUDQGHVFDWHJRUÈDV
• $FFHVR\VHUYLFLR
• 1LYHOGHFDSDFLWDFLÎQGHORVSURYHHGRUHV
• 0DQWHQHUDORVPLHPEURVVDOXGDEOHV
• $\XGDUDTXHORVPLHPEURVTXHHVW¼QHQIHUPRV
VHUHFXSHUHQ
• $\XGDUDORVPLHPEURVDPDQHMDUHQIHUPHGDGHVFUÎQLFDV
• Ayúdelos a sentirse protegidos,
seguros y amados.+¼JDOHVVDEHU
TXHORVDPD\FUHHHQHOORVVLQ
LPSRUWDUODVFLUFXQVWDQFLDV
• Oriéntelos para que tomen buenas
decisiones.$OPLVPRWLHPSR
GÄMHORVTXHWRPHQP¼VGHFLVLRQHV
SRUVXFXHQWD(VRSXHGHLPSOLFDU
TXHFRPHWDQHUURUHVGHYH]HQ
FXDQGR3HURWDPELÄQOHVGHPXHVWUD
TXHXVWHGFRQIÈDHQVXFDSDFLGDG
SDUDPDQHMDUODVFRVDV
• Muéstreles cómo maneja usted
el estrés.+DFHUHMHUFLFLROOHYDU
XQGLDULRRKDEODUDOUHVSHFWRKD\
PXFKDVPDQHUDVGHSRQHUDOHVWUÄV
HQVXOXJDU7UDQVPLWDDVXVKLMRV
VXVKDELOLGDGHVSRVLWLYDVSDUDKDFHU
IUHQWHDODVFRVDV
)XHQWH$PHULFDQ$FDGHP\RI3HGLDWULFV
8QSRFRGHHVWUÄVSXHGHVHUEXHQR$OJRGH
SUHVLÎQSDUDDSUREDUHVHH[DPHQRFDOLƬFDUSDUD
IRUPDUSDUWHGHOHTXLSRSXHGHVHUXQHVWÈPXOR
SDUDTXHVXKLMRKDJDORPHMRUTXHSXHGH
www.aetnabetterhealth.com/nebraska
(VWDHYDOXDFLÎQQRVD\XGDDPHMRUDUODDWHQFLÎQ\D
UHGXFLUORVFRVWRV
Comparar manzanas con manzanas: HEDIS
/DHYDOXDFLÎQGHO1&4$HQSDUWHHVW¼EDVDGDHQXQD
VHULHGHLQGLFDGRUHVOODPDGRV+(',6
(VWRVLQGLFDGRUHVPLGHQHOGHVHPSHÌRGHOSODQHQ
XQDVHULHGHSUREOHPDVGHVDOXGFRPRHOFXLGDGRGHOD
GLDEHWHVRHOWUDWDPLHQWRGHODSUHVLÎQDUWHULDODOWD
0¼VGHOSRUFLHQWRGHORVSODQHVGHVDOXGGHORV
(VWDGRV8QLGRVXWLOL]DQORVLQGLFDGRUHV+(',6ORTXH
UHVXOWDPX\ÕWLOSDUDFRPSDUDUSODQHVGHVDOXG\HOHJLUHO
PHMRUSDUDXVWHG
&ÎPRHVWDPRVFODVLƬFDGRV
/RVSODQHVSXHGHQUHFLELUODVVLJXLHQWHVDFUHGLWDFLRQHV
FODVLƬFDGDVGHVGHODP¼VDOWDDODP¼VEDMD
• ([FHOHQWH
• $FUHGLWDGR
• (QFRPLDEOH
• 3URYLVLRQDO
/RVSURJUDPDVTXHQRFXPSOHQFRQORVHVW¼QGDUHVGHO
1&4$VHFRQVLGHUDQ5HFKD]DGRV
1XHVWUDFODVLƬFDFLÎQGH$FUHGLWDGRSRUSDUWHGHO1&4$
PXHVWUDHOQLYHOGHVHULHGDGFRQHOTXHDERUGDPRV
VXVDOXG
3DUDREWHQHUP¼VLQIRUPDFLÎQYLVLWHreportcard.ncqa.org
3
Proteja a los niños
GHODLQƮXHQ]D
Derechos
del miembro
&XDQGROOHJDODWHPSRUDGDGHODLQƮXHQ]DQRWHQJD
GXGDVGHTXHVXVKLMRVHVW¼QHQULHVJR/RVQLÌRV
• 7LHQHQP¼VSUREDELOLGDGHVTXHORVDGXOWRVGH
FRQWUDHUODLQƮXHQ]D
• &RUUHQP¼VULHVJRGHWHQHUFRPSOLFDFLRQHVGHOD
LQƮXHQ]D(VRLQFOX\HSUREOHPDVFRPRLQIHFFLRQHV
HQORVRÈGRV\QHXPRQÈD
&RPRPLHPEURGH$HWQD
%HWWHU+HDOWKXVWHGWLHQH
PXFKRVGHUHFKRVDVÈFRPR
WDPELÄQUHVSRQVDELOLGDGHV
1XHVWUDGHFODUDFLÎQGHORV
GHUHFKRV\UHVSRQVDELOLGDGHV
GHORVPLHPEURVVHDFWXDOL]D
FDGDDÌR6XOLVWDGHGHUHFKRV
GH$HWQD%HWWHU+HDOWKHVW¼
GLVSRQLEOHHQQXHVWURVLWLRZHE
www.aetnabetterhealth.com/
nebraska\HQVXPDQXDO
SDUDPLHPEURV
/DLQƮXHQ]DKDVWDSXHGHVHUPRUWDO/RVQLÌRVFRQRWURV
SUREOHPDVGHVDOXGtFRPRDVPDRF¼QFHUtFRUUHQ
P¼VULHVJR3HURKDVWDORVQLÌRVVDQRVQRHVW¼QVHJXURV
3URWHMDDVXVSHTXHÌRVGHODLQƮXHQ]D$VHJÕUHVH
GHTXHUHFLEDQODYDFXQDFRQWUDODLQƮXHQ]D$SDUWLU
GHORV{PHVHVGHYLGDWRGRVORVQLÌRVVDQRVGHEHQ
YDFXQDUVHWRGRVORVDÌRV
3DUDORVQLÌRVGHDÌRVHQDGHODQWHKD\XQDYDFXQD
QDVDOFRQWUDODLQƮXHQ]D(QOXJDUGHDSOLFDUVHFRQXQD
LQ\HFFLÎQODYDFXQDVLPSOHPHQWHVHURFÈDHQODQDUL]
1RVHROYLGHGHHQVHÌDUOHVDVXVKLMRVDOJXQDVRWUDV
IRUPDVGHFRPEDWLUODLQƮXHQ]DHVWHLQYLHUQR
$VHJÕUHVHGHTXHVHSDQTXHGHEHQ
• /DYDUVHODVPDQRVFRQIUHFXHQFLD$\XGDDHYLWDU
TXHORVJÄUPHQHVVHGLVHPLQHQ
• (VWRUQXGDURWRVHUWDS¼QGRVHODERFDFRQXQ
SDÌXHORGHSDSHORHOFRGR
&RQVHMRGHVDOXG)LHEUH
HVFDORIUÈRVGRORUHV\PDOHVWDU
JHQHUDOVRQDOJXQRVGHORV
VÈQWRPDVGHODLQƮXHQ]D
• 7UDWDUGHHYLWDUHVWDUFRQRWUDVSHUVRQDVTXHWLHQHQ
VÈQWRPDVGHLQƮXHQ]D
)XHQWH$PHULFDQ$FDGHP\RI3HGLDWULFV
Línea Informed Health® (línea de enfermería las 24 horas)
&XDQGRWHQJDXQDSUHJXQWD
VREUHODVDOXGHOPHMRUOXJDU
SDUDFRPHQ]DUHVQXHVWUD
/ÈQHD,QIRUPHG+HDOWKJUDWXLWD
1XHVWURVDPDEOHVHQIHUPHURV
PDWULFXODGRVRIUHFHQ
DVHVRUDPLHQWRSURIHVLRQDO\
UHVSXHVWDVU¼SLGDV3XHGHQ
D\XGDUOHDGHFLGLUVLQHFHVLWD
YHUDXQPÄGLFRRLUDODVDOD
GHHPHUJHQFLDV
HQIHUPHURVKDEODQLQJOÄV\
HVSDÌRO7DPELÄQKD\LQWÄUSUHWHV
GLVSRQLEOHVSDUDRWURVLGLRPDV
/ODPHDOD/ÈQHD,QIRUPHG
+HDOWKSDUDUHFLELUD\XGDVREUH
SUHJXQWDVUHODFLRQDGDVFRQ
HVWDVVLWXDFLRQHV
• )LHEUH
• 'RORUGHRÈGRVGRORUGHGLHQWHV
/D/ÈQHD,QIRUPHG+HDOWK
1-877-620-194577<711HVW¼ • &RUWHV\TXHPDGXUDV
• Vómitos
GLVSRQLEOHSDUDORVPLHPEURVGH
$HWQD%HWWHU+HDOWKODVKRUDV • 'RORUGHJDUJDQWD
ORVGÈDVGHODVHPDQD1XHVWURV • 5HVIUÈRV\JULSH
• Medicamentos
• ,QIHFFLÎQGHYHMLJD
• 'RORU
La ayuda gratuita de un experto está a una
• /ODQWRGHOEHEÄ
llamada telefónica de distancia. Simplemente
3DUDSHGLUXQDFRSLDGHVX
PDQXDORSDUDREWHQHUP¼V
LQIRUPDFLÎQVREUHORVGHUHFKRV
\UHVSRQVDELOLGDGHVOODPHD
6HUYLFLRVSDUD0LHPEURVDO
1-888-784-269377<711
$HWQD%HWWHU+HDOWKQRWRPD
QLQJXQDPHGLGDHQFRQWUD
GHORVPLHPEURVTXHHMHUFHQ
VXVGHUHFKRV
(VWHEROHWÈQVHSXEOLFDFRPRXQVHUYLFLR
DODFRPXQLGDGSDUDORVDPLJRV\
PLHPEURVGHAetna Better Health
of Nebraska:'RGJH5RDG
2PDKD1(
,QFOX\HLQIRUPDFLÎQJHQHUDOVREUH
ODVDOXGTXHQRGHEHUHHPSOD]DUHO
DVHVRUDPLHQWRRODDWHQFLÎQTXHUHFLEH
GHVXSURYHHGRU6LHPSUHFRQVXOWHDVX
SURYHHGRUVREUHVXVQHFHVLGDGHVGH
VDOXGSHUVRQDOHV
(VSRVLEOHTXHVHKD\DQHPSOHDGR
PRGHORVHQIRWRVHLOXVWUDFLRQHV
Comuníquese con nosotros
77<R
7''
ZZZDHWQDEHWWHUKHDOWKFRP
QHEUDVND
„&RƪH\&RPPXQLFDWLRQV,QF
7RGRVORVGHUHFKRVUHVHUYDGRV
HYN31488
NE-15-08-01
llame al 1-877-620-1945 (TTY: 711).
4
1-888-784-2693