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My Health
UM is a part of the prior authorization process (as
described in your Member Handbook) that helps decide
if certain outpatient care, an inpatient hospital stay or a
procedure is a covered service. This means that both L.A.
Care Health Plan and your PCP (or specialist) agree that the
service is medically necessary. Coverage decisions
are based on:
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Medical policies.
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Nationally recognized clinical guidelines.
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Your health benefts.
You should know that:
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We make decisions based on care and services you need
and the benefts you have.
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We do not reward doctors, providers or decision-makers
who work with us for not approving requested care
or services.
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We do not provide fnancial incentives for those who make
UM decisions to encourage decisions that result in less
care given.
To learn more about the UM process, call us toll-free weekdays
except holidays from 8 a.m. to 5 p.m. at
1-888-285-7801
.
We have a free interpretation service at this number as well.
When you call, just ask for an interpreter in your language.
If you call before or after hours, you can leave a private message
and a member of our staff will return your call on the next business
day during the hours above, unless you request a different time.
Any staff member who calls you about a UM issue will give you
his or her name and title and the name of the company.
If you have hearing or speech loss and want to reach UM, you
can call the TDD/TTY line at
1-888-757-6034
.
What all mothers,
daughters and sisters need
Women’s health tests
and checkups for you
Finding cancer early is the best way to treat it and
beat it. And the simplest and most efective way to
fnd cancer before it spreads can be a screening or test,
depending on the type.
Some breast and cervical cells may grow faster than
other cells. Tis uncommon cell activity can become
a mass of cells called a tumor. Not all tumors are
cancerous. Some are benign (not cancerous). However,
cancerous cells can spread to other parts of your body
and can cause other problems inside your body.
Here are three important steps every woman should take:
1
Know your risk factors (the things that put you at
greater risk for cancer).
2
Change things
you
can control in your lifestyle
(lifestyle factors, like what you eat and do).
3
Get regular screenings and women’s health tests
(see “Tests”).
Breast cancer screenings
Cervical cancer screenings
TESTS
RISK FACTORS
LIFESTYLE FACTORS
Breast self-exam
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Women 19 and over: every month
Exam by physician
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Women under 40: every 2 to 3 years
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Women 40 and over: every year
Mammogram
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Women 40 to 49: talk with your
doctor about when you should
have a mammogram
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Women 50 and over: every 2 years
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Gender – being a woman
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Aging – as you age your chance of breast
cancer increases. Most breast cancer is
found in women over 60.
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Genetic risk factors (e.g., inherited
changes to the BRCA1 and BRCA2 genes)
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Family and personal history of cancer
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Race and ethnicity
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Dense breast tissue and certain benign
breast conditions
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Having children at an older age
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Never having children
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Using oral contraceptives
(birth control)
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Hormonal therapy use for
many years
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Drinking high amounts
of alcohol
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Being overweight and having
a lack of physical activity
TESTS
RISK FACTORS
LIFESTYLE FACTORS
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Pap test: women within 3 years of
sexual activity or age 21, whichever
comes frst
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Women ages 19 to 39: every year
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Women ages 30 to 69: every 2 to
3 years for women with 3 normal Pap
tests in a row
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Women ages 70 and older: with 3 or
more normal tests in a row and no
abnormal tests in the last 10 years,
women may stop having this
screening exam
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HPV infection
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Immunosuppression (such as HIV that
causes AIDS)
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Chlamydia infection
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Birth control use for 5 or more years
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Multiple full-term pregnancies (3 or more)
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First pregnancy at a young age (under 17)
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Poverty
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Chemical exposure to DES (a drug
prescribed to pregnant women from the
1940s to 1970s)
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Family history of cervical cancer
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Smoking
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Diet low in fruits and vegetables
What Utilization Management (UM) is and how it affects you
Source: American Cancer Society website: cancer.org
Donate your organs
The good news: one organ donor can save up to eight lives.
The bad news: there are more than 100,000 people still
waiting for an organ. They need your help. Become an organ
or tissue donor. To learn more, speak with your doctor about
it. Or visit
organdonor.gov
to sign up online.
Source: U.S. Department of Health and Human Services’ organ donation
website: organdonor.gov