A new offering from ODS gives OEBB members better coverage when they travel. Effective Oct. 1, 2011, the ODS Travel Network offers in-network benefits when members travel outside their primary service area.

The ODS Travel Network is an additional network tier. When medical members seek nonemergent care outside of their primary service area, we will review the claim to see if the providers are part of the PHCS Healthy Directions network. If so, the claim will be paid at the in-network benefit level. Emergency services are always covered at the in-network level regardless of the provider's network.   

Members will be able to search for providers quickly and easily by logging into myODS, using the Find Care tool and selecting the Travel Network option.  The ODS Travel Network network boasts nearly 70,000 hospitals and medical facilities and 658,000 primary care physicians and specialists.

In addition, the ODS Travel Network can save money for members with dependents who live out of the area. Normally, these members may be subject to balance billing. However, if an out-of-area dependent seeks care from a PHCS Healthy Directions provider, ODS will pay at the in-network benefit level, providing better coverage and savings to members.

Because the ODS Travel Network is not an alternative primary network, members should continue to seek care in their primary network whenever possible. Preauthorization is still required for inpatient services and our Healthcare Services team will direct members to in-network providers when possible.

New mail-order options

Wellpartner mail-order pharmacy will no longer be an option through ODS for OEBB members beginning Oct.1, 2011. ODS has started offering two new options for ordering prescriptions by mail: Postal Prescription Services (PPS) and BioScrip. To help make the transition from Wellpartner to PPS and BioScrip easier, these two new options are already available for members to sign up.

To begin filling prescriptions with PPS or BioScrip:

• Step 1: Members need to contact their doctor and request a new prescription for up to a 90-day supply for each medication. Generally, a doctor's visit is not required to write a prescription for a medication you already take.
• Step 2: Mail the new prescription(s) (no photocopies) to either PPS or BioScrip along with a completed order form or have your provider fax the prescription. (Faxes are not accepted for certain controlled medications.) Please allow seven to 10 business days for shipping.

Enrollment information

• Postal Prescription Services mail-order pharmacy form can be printed or you can call 800-552-6694 to enroll.
• BioScrip mail-order pharmacy form can be printed or you can call 877-316-8921 to enroll.

Value tier additions

The ODS OEBB Value Tier includes select medications that have been through a review process for evaluating clinical information and medical literature as providing safe, effective, cost-preferred treatment options for common chronic conditions. These products are available to OEBB members at a lower $4 copay through retail and $8 copay through mail-order. The Value Tier currently includes select products used to treat:

• Asthma
• Heart disease
• High blood pressure
• Cholesterol
• Diabetes  

Beginning Oct. 1, 2011, the list will be expanded to include select products for treating:  

• Depression
• Osteoporosis
• Pain/arthritis

A full list of medications on the Value Tier can found at www.odscompanies.com/oebb under the pharmacy tab.

Facts about oral cancer 

By: Cay Edwards

It's long been recognized that oral cancer kills one American every hour, but even health experts thought the primary causes were smoking and heavy drinking, and the main victims were older men. Fresh research and a new FDA-approved technology are putting a whole new light on all-too-common, and all-too-deadly oral cancer, indicating new causes and much younger male and female victims.

Johns Hopkins researchers, writing in the February 1 2008 issue of the Journal of Clinical Oncology, reported that the sexually transmitted HPV virus, a major cause of cervical cancer, causes as many cancers of the upper throat as tobacco and alcohol combined. Oral sex is the likely method of transmission. The researchers say HPV is the primary cause of some 5,600 cancers per year in the tonsils, lower tongue and upper throat. And, they found, the incidence rate for HPV-related oral cancers among males has been rising steadily for three decades. Co-author Dr. Maura Gillison told the Associated Press, "If current trends continue, within the next 10 years there may be more oral cancers in the United States caused by HPV than tobacco or alcohol."

HPV isn't the only newly identified culprit. Cell phones have been found to be a likely cause of oral cancer as well. In Israel, where mobile phones were adopted early and where use is especially intense, Tel Aviv University cancer specialist Dr. Siegal Sadetzki studied nearly 500 people diagnosed with benign and malignant salivary gland tumors. Dr. Sadetzki told the London Telegraph, "The amount of exposure to radio frequency radiation found in this study has been higher than in previous cell phone studies. This unique population has given us an indication that cell phone use is associated with cancer."

"Everyone is at risk for oral cancer," says Dr. Omer Reed, Phoenix-based dentist and international dental practice consultant, "but no one has to suffer, let alone die from this disease." Reed says dentists across the U.S., and now in Canada as well, offer a 5-minute "glow-stick" exam called ViziLite Plus that has been approved by the FDA to help dentists detect abnormal tissue that may be cancerous or pre-cancerous. After the patient rinses with a special solution, the dentist examines the mouth with a disposable wand whose chemicals emit light of a special wavelength. Under the light, abnormal tissue appears bright white; it is immediately marked with a special temporary dye called TBlue630. Research has shown that the dye reduces false positives by more 50%, while detecting 100% of cancers actually present in the mouth.

A growing number of insurance companies are covering this new glow-stick exam. More information on oral cancer is available at www.OralCancerFoundation.org

"An oral cancer exam is entirely pain-free, takes only minutes, and should be a key part of every adult's annual dental check-up," says Dr. Reed.

OEBB members are eligible to participate in the ODS Spine & Joint Care Program, a musculoskeletal pain management coaching benefit.

The Spine & Joint Care Program offers members condition-specific outreach, including email and telephone-based health coaching from a multidisciplinary team of clinicians who focus on the following spine and joint topics:

• Disorders
• Acute and chronic pain
• Informed decision support

One-on-one health coaches work actively with ODS members to help them understand spine and joint anatomy and create a plan of modified, joint-sparing activities and techniques to perform at home and work. The program emphasizes member proactivity in working with healthcare providers to find suitable therapies such as stretching and strengthening exercises, relaxation techniques, diet and weight management, smoking cessation, and medication management.

One-on-one coaching strives to motivate patients to take care of themselves. Coaches help participants make realistic and meaningful decisions that reflect their personal needs and values. We identify members needing higher levels of support by assessing members' knowledge, skills and confidence in managing their health condition. Certain members may be offered care coordination and case management services. ODS health coaches also communicate with members' healthcare provider when necessary to discuss treatment plans and goals.

In addition to the Spine & Joint Care Program, OEBB members have access to seven other care programs to help them manage individual medical concerns:

• Cardiac Care
• Diabetes Care
• Depression Care
• Respiratory Care
• Maternity Care
• Weight Care
• Lifestyle Coaching