Health & Fitness
How to Stay Flu-Free This Season | Print |  E-mail
Thursday, 13 November 2014 15:29

111314h1While flu season in the U.S. historically starts this time of year, most of us don’t think about it until either we get sick or a family member or co-worker does, and by then, it may be too late.

One of the few facts about flu season is that it’s always unpredictable and may peak at any time in the fall, winter or even spring months.

That’s why the CDC recommends that people get the flu shot each year as soon as the vaccine is available.

A notable behavioral shift over the past few years has seen many people waiting to get their shots until flu activity becomes widespread — not the wisest choice.

It takes up to two weeks for the body to build full immunity following a flu shot, and you’re significantly increasing your chances of getting sick if you wait until the last minute when the flu is already circulating in your community.

Children younger than age 5 are at high risk for flu-related complications. For school-age children, remind them of the importance of hand washing and using tissues when they sneeze. (Note that the influenza vaccine is not approved for children younger than 6 months of age.)

Pregnant women are more susceptible to getting sick, including catching the flu, because their immune systems are weaker than usual. During pregnancy, the flu can escalate quickly and be complicated by infections such as fetal distress or pneumonia.

While flu shots are particularly important for the very young, the elderly and pregnant women, the flu can be very serious for anyone, including young and healthy adults.

Last season, patients between 18 and 64 years of age accounted for nearly 60 percent of flu-related hospitalizations reported to the CDC.

An annual flu shot is the best preventive measure you can take, but there are small, everyday tips that can also help keep you healthy throughout the always unpredictable flu season:

1. Wash your hands frequently with soap and warm water for at least 20 seconds, and avoid touching your mouth and eyes. Sanitizers are also effective.

2. Cover your nose and mouth  if you cough or sneeze so that you don’t spread germs to your peers. And, wash your hands afterward.

3. Stay home if you’re sick. It’s one of the easiest ways to prevent others from catching your germs.

4. Make sure you’re eating healthy and getting enough sleep at night.

Getting the flu shot can be very affordable. Flu vaccines are now fully covered as a preventive service under the Affordable Care Act and available at no cost through most insurance plans, including Medicare Part B.

Most pharmacies (including CVS and Walgreens) offer flu shots daily with no appointment needed, and, in most states, offer a wide range of 17 CDC-recommended vaccines, including those to protect against shingles, pneumonia, pertussis (whooping cough), meningitis, hepatitis and others.

For more information on the differences in flu shots, visit cdc.gov/flu. For information on obtaining shots, visit Walgreens.com/GetAShot, or cvs.com/flu.

CAPTION: The CDC recommends that people get the flu shot each year as soon as the vaccine is available.


 
Town Hall Meeting on Mental Health | Print |  E-mail
Thursday, 13 November 2014 15:27

111314h2Robin Williams’ suicide was a stark reminder that, as a community, we must be vigilant and sensitive to the stigma which may prevent people from seeking treatment for mental illness.

In the face of the sobering statistic that one in four of us will face mental issues some time in our lives, Alameda County will sponsor a Town Hall meeting next Monday, Nov. 17, on how to navigate through the county’s mental health care services to gain access to adequate treatment.

Warning signs for mental illness include loss of appetite and loss of interest in usual activities; difficulty in sleeping, concentrating or communicating; and depression. Isolation can only exacerbate these symptoms, so reaching out and seeking treatment are essential first steps to recovery.

An interactive segment will be included in Monday’s session to answer questions related to accessing mental health care services.

The meeting is open to the public and will take place from 5 to 7 p.m. in the Council Chambers at Hayward City Hall, 777 B St. It is sponsored by the county’s Board of Supervisors, Mental Health Board and Behavioral Health Care Services.

Rochelle Elias, Chair, County Mental Health Board


 
Heartburn: What You Should Know | Print |  E-mail
Thursday, 23 October 2014 14:34

102314hIf you’ve ever experienced heartburn — also known as Gastroesophageal Reflux Disease or GERD — you know how uncomfortable it can be. Approximately 30 million people in the U.S. experience some symptoms of GERD. Besides heartburn, GERD symptoms can fall into two categories:

(1) Typical symptoms include regurgitation, bloating or an acidic taste in the back of the mouth.

(2) Less common symptoms include asthma, persistent coughing, shortness of breath and even recurrent pneumonia. These less frequent symptoms are often misdiagnosed and the root cause never recognized.

Treatments: Masking symptoms vs. treating the cause:

According to the National Institutes of Health (NIH), more than 64 million prescriptions were written in the U.S. for GERD medications in 2012, and dozens of over-the-counter heartburn remedies are available at most pharmacies — ranging from antacids and H2 blockers to proton pump inhibitors (PPIs).

“Medications don’t treat reflux, they hide it,” said Wilson Tsai, M.D., Director of Eden Medical Center’s Esophageal and Thoracic Program. “People take medications and feel better, so they think the problem is gone.

“More than 90 percent of my patients with esophageal cancer were told by their doctors to take their PPIs and they’d be fine. Meanwhile, the root cause was getting worse.”

Dr. Tsai said that people who suffer from reflux for more than a month should see their doctor for a complete workup. “PPIs should only be used to treat symptoms for a few weeks,” he explained. “Long-term use of PPIs can lead to osteoporosis and bone fractures, and they have a number of dangerous drug interactions.”

Patients are often told to reduce the symptoms of GERD by losing weight or avoiding foods and beverages that contribute to heartburn, such as tomatoes, coffee and alcohol.

Dr. Tsai agrees that losing weight can decrease the pressure in the abdomen that can cause a hiatal hernia, which is diagnosed through endoscopy or an esophagram. However, he believes that lifestyle changes only go so far in reducing symptoms of reflux.

Stopping reflux at the source:

For many years, the standard surgical treatment for GERD has been fundoplication, a laparoscopic procedure in which the top of the stomach is sewn around the esophagus to reduce reflux.

In 2012, the U.S. Food and Drug Administration (FDA) approved the LINX™ Reflux Management System. The LINX device consists of a series of titanium beads, each with a magnetic core, connected to create a ring.

The ring is then surgically implanted around the lower esophageal sphincter to prevent stomach contents from backing up into the esophagus. In clinical studies, the LINX system eliminated severe reflux in 100 percent of patients, and 93 percent of patients reported a significant decrease in the need for medications.

“LINX implantation takes about ten minutes and will be performed laparoscopically,” explained Dr. Tsai, who added that highly specialized training is required to perform the procedure.

He was careful to point out, however, that patients with esophageal changes or precancerous conditions are not candidates for the LINX procedure.

“Acid reflux is a mechanical problem, not a chemical one,” Dr. Tsai explained. “We all have stomach acids, but when they flow back up into the esophagus, it’s a clear sign that something is not functioning correctly. The problem needs to be fixed at the source, not masked with medications.”

Dr. Wilson Tsai will present a free talk about the symptoms, causes and treatments of GERD, including LINX on Tuesday, Oct. 28, at 6:30 p.m. at the San Leandro Library, 300 Estudillo Ave. Space is limited. To reserve your seat, call 1-888-445-8433.


 
Time to Review Your Medicare Coverage | Print |  E-mail
Thursday, 23 October 2014 14:33

By David Sayen • Special to the Times

Medicare’s annual open enrollment season is underway, and I want to encourage everyone with Medicare to review their current health and prescription drug coverage.

Open enrollment began Oct. 15 and runs through Dec. 7. If you want to change your Medicare Advantage or Medicare Part D (prescription drug) plan, this is the time of year to do it. Any new coverage you select will take effect on Jan. 1.

If you have Original (traditional) Medicare and you’re satisfied with it, you don’t need to do anything during open enrollment.

My agency, the Centers for Medicare & Medicaid Services, or CMS, announced recently that the average Medicare Advantage premium for 2015 is projected to be $33.90 monthly. CMS also estimated that the average basic Part D premium in 2015 would be $32 per month.

Since passage of the Affordable Care Act in 2010, enrollment in Medicare Advantage has increased 42 percent to an all-time high of over 16 million people. Medicare Advantage premiums, meanwhile, have decreased 6 percent.

The law is also closing the Part D “donut hole,” with more than 8.3 million people saving more than $12 billion on prescription drugs through last July.

Medicare plans’ coverage options and costs can change each year, and Medicare beneficiaries should evaluate their current coverage and choices and select the plan that best meets their needs. If you think your current coverage will meet your needs for 2015, you don’t need to change anything.

A variety of resources are available to help you compare your current coverage with new plan offerings for 2015. You can:

• Visit www.medicare.gov to review plans available in your area, as well as their costs, and enroll in a new plan if you decide to. Open enrollment information is available in Spanish.

• Call 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about your coverage options. TTY users should call 1-877-486-2048. Counseling is available in a wide variety of languages.

• Review the 2015 Medicare & You handbook. This handbook has been mailed to the homes of people with Medicare and it’s also online at: www.medicare.gov/pubs/pdf/10050.pdf.

• Get free, unbiased, one-on-one counseling from your local State Health Insurance Assistance Program (SHIP). Local SHIP contact information can be found:

— At medicare.gov/contacts/organization-search-criteria.aspx or;

— On the back of the 2015 Medicare & You handbook or;

— By calling Medicare (at 1-800 number above).

People with Medicare who have limited income and resources may qualify for Extra Help to pay for their Part D drug plans. There’s no cost or obligation to apply for Extra Help. Medicare beneficiaries, family members, or caregivers can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) to find out more.

Better quality in Medicare Advantage and Part D plans isn’t the only good news.

For most seniors who have Original Medicare, the 2015 Part B premium will stay unchanged for a second consecutive year, at $104.90. This means more retirement income and any increase in Social Security benefits will stay in your pocket. The Part B deductible will stay the same as well.

David Sayen is Medicare’s regional administrator for California. You can always get answers to your Medicare questions by calling 1-800-633-4227.


 
A Bit of Exercise for the Body Benefits the Brain | Print |  E-mail
Thursday, 23 October 2014 14:29

102314h2Physical activity may not be the first thing parents or teachers think about when they want to boost a child’s academic performance, but evidence supports the notion that a bit of exercise for the body is beneficial to the brain as well.

In fact, kindergarteners who participated in Build Our Kids’ Success (BOKS), a free before-school program involving physical activity and nutrition education, had significantly improved memory skills as rated by teachers, compared to their peers who did not participate.

A study of the children’s performance also concluded that those who participated in the program exhibited good behavior in the classroom.

“A sedentary life and poor eating habits can lower kids’ performance in the classroom and start a cycle of health problems later in life,” says Kathleen Tullie, Founder and Executive Director of BOKS. “Simply stated, a healthy body and a healthy brain go hand in hand.”

So how can you incorporate more healthy habits into your family’s routine?

• Active weekends: Instead of a lazy Saturday or Sunday, get outside and get moving. Take a soccer ball to the park for a pick-up game or hike a local trail. Make exercise on the weekends a regular habit for your family, and those habits will extend to the rest of the week as well.

• Fuel throughout the day: A hearty breakfast sets kids up for a great day. Follow that up with a healthful, satisfying lunch and snacks such as nuts and fruit, to help kids avoid the pitfalls of the junk food machines.

• Cook together: Take-out is great when you’re crunched for time, but be sure to cook at home at least a few times a week. Not only are homemade meals one of the only ways you can be exactly sure of what you’re feeding your family, but the act of cooking together is a great opportunity to impart some lessons about nutrition and eating right.

• Bed time: Adequate sleep is crucial for a healthy, functional mind and body. Setting a regular bedtime and sticking to it is best to ensure kids get a full night’s rest.

• Volunteer to get your school involved: Children should have one hour or more of physical activity daily, according to the Centers for Disease Control and Prevention. Unfortunately, physical education class may not be sufficient.

Investigate what other opportunities your child’s school has for physical activity, such as after-school sports.

BOKS can be run by anyone — parents, teachers, the school nurse or a community activist. To learn more, visit www.BOKSKids.org.

StatePoint

CAPTION: BOKS, founded by Kathleen Tullie, empowers parents, teachers, schools and local volunteers to give kids a body and brain boost that will set them up for a day of learning.

PHOTO © BUILD OUR KIDS SUCCESS


 
Improve Your Child’s Health | Print |  E-mail
Thursday, 09 October 2014 14:13

100914h1It’s estimated that about one-third of kids in the United States are overweight or obese. Being overweight as a child can lead to health problems later in life.

Fortunately, as a parent or other caregiver, there are things you can do to help your child consume healthy foods and beverages, be physically active, and get to — and stay at — a healthy weight.

For example, try these tips from “Helping Your Overweight Child” from the Weight-control Information Network (WIN), part of the National Institutes of Health:

Choose Healthy Foods and Beverages

• Buy and serve fruits and vegetables — fresh, frozen, canned or dried. Let your child choose them at the store. Get fruit without added sugar and vegetables without salt or added fats.

• Eat fast food less often. When you do visit a fast-food restaurant, encourage your family to choose healthier options, such as grilled instead of fried chicken.

• Don’t use food as a reward when encouraging kids to eat. For example, promising dessert to a child for eating vegetables sends the message that vegetables are less valuable than dessert.

Get More Physically Activity

• Be active together as a family. Assign active chores, such as making beds, sweeping or vacuuming. Plan active outings, like a walk through a local park.

• Children need about 60 minutes of physical activity each day, but they don’t have to do it all at once. Several 10- or even five-minute bursts of activity throughout the day are just as good.

• Activities that kids choose on their own are often best. Encourage your child to play soccer with friends, catch and throw a ball, dance, or bike (with a helmet).

Additional Information

Check out WIN’s “Helping Your Overweight Child.” This fact sheet features ideas for supporting your child, lists of healthy snacks and activities your child may enjoy, and more tips to help your child choose healthy foods and beverages and be more physically active each day. Contact WIN to get your free copy. Or go to www.win.niddk.nih.gov/publications/over_child.htm to read and download the fact sheet.

For more information, call WIN at 1-877-946-4627 or visit www.win.niddk.nih.gov. You can also like WIN on Facebook at www.facebook.com/win.niddk.nih.gov.

CAPTION: Choose healthier foods for you and your family. Serve more fruits and vegetables, and get your children more involved when selecting groceries at the store.


 
Buckle Up: Keep Your Child Safe In or Near Cars | Print |  E-mail
Thursday, 09 October 2014 14:11

By Chris Graham • Special to the Forum

It’s a fact of life in our society that cars are a convenience we take for granted and an integral part of our lives. But cars can pose many dangers to our children and teenagers.

Motor vehicle crashes are the leading cause of death for children and teens in the United States. Thousands more are injured or killed in backover/frontover incidents, child vehicular heatstroke, trunk entrapment and power window strangulation.

Motor vehicle crashes took the lives of 1,100 children under the age of 15 in 2012 and over 176,000 were treated for injuries in local hospitals.

In the U.S. at least 104 children are killed and an additional 2,400 are injured each year by being accidentally backed over by vehicles, according to the Center for Disease Control. The average age of these victims is 12 to 23 months.

These tragedies usually involve a loving parent, grandparent, close relative or care giver who don’t believe they could ever hurt their child. However, our lives today are full of demands and deadlines causing us to be rushed, stressed, distracted or fatigued.

The key to reducing the rate of dangerous occurrences with cars and children is to be aware that they do happen, how they happen and to be proactive in gaining knowledge on how to prevent them.

The good news is that there are steps we can take to provide the safest environment possible for our children when in and around cars.

Be sure all child passengers in a vehicle are buckled in a size and age appropriate car seat, booster seat or seat belt. The safest seat for your child is the one that fits properly for their weight and height. Fitted car seats reduce the risk of death in car crashes by 71% for infants and 54% for toddlers.

Children under the age of 12 years should always ride in the back seat properly restrained. Everyone in the car should be properly buckled up every time the vehicle is in motion.

Children should remain rear-facing in their child passenger safety seat until the age of two or until they reach the maximum height and weight limit for their seat when traveling in a vehicle. The middle of the backseat is the safest spot if the seat can be properly installed in this position.  Airbags can kill children riding in the front seat.

Never leave children alone in or around cars. To avoid unintentionally leaving children in an unattended and potentially hot vehicle, leave an essential item in the backseat such as a handbag, phone or briefcase. Make it a habit.

Put a stuffed animal in the car seat when the child is not there and then moving the stuffed animal to the front seat when the child is in their seat. This works as a visual reminder that the child is in the car.

To avoid backover tragedies always walk around the vehicle prior to moving the car in reverse or pulling forward. Teach your children to never play around a vehicle and keep the driveway off limits as a recreational area.

No one wants to harm the children we love and promise to protect. Now is the time to learn all that you can to keep them safe when in and around cars.

Chris Graham is the Trauma Prevention Coordinator at Eden Medical Center in Castro Valley.

Many more essential safety tips can be found on the following sites:

www.nhtsa.gov

www.cdc.gov

www.kidsandcars.org

www.safekids.org

Eden Medical Center will hold a free infant car seat inspection/installation on Thursday, Oct. 16 from 10 a.m. to noon at Eden Medical Center, lower employee parking lot off of Lake Chabot Road. First come, first served. Please allow at least 45 minutes for the inspection. Questions, please call (510) 727-3176.


 

 
WIC Program Helps Low-Income Families Stay Healthy | Print |  E-mail
Thursday, 09 October 2014 14:09

If you need nelp getting healthy food for your family and are on a limited income, Alameda County’s WIC (Women, Infants, Children) Program may be able to help.

Many local families aren’t familiar with the program or think they don’t qualify, when in fact many do.

If you are pregnant, just had a baby, or are raising children under 5, you can get free checks to buy healthy foods with the WIC Program, along with nutrition counseling and classes, breastfeeding help and referrals to health care.

You can pick up a free pregnancy test kit and get referrals to prenatal care, get painless free screening for anemia, or take nutrition classes on line.

You can get WIC whether you are unemployed, disabled, receiving government assistance, in the military, even if someone in the family is working. A family of two (pregnant woman and unborn baby) can earn up to $2,426 per month before taxes – a family of three up to $3,051. Migrant workers are also encouraged to apply for the program’s servcies.

WIC programs are available through the Alameda County Public Health offices located in the following cities:

• Hayward at 24085 Amador St., Suite 100

• Fremont at 39155 Liberty St., Suite H840

• East Oakland at 7200 Bancroft Ave.

• North Oakland at 3600 Telegraph Ave.

Call 510-595-6400 or drop in at one of the offices (best times are Mondays, Tuesday, Thursdays or Fridays at 8:35 a.m. or 1:30 p.m.).


 
County Reports Two Cases of Enterovirus D68 | Print |  E-mail
Thursday, 09 October 2014 14:08

100914h2Alameda County health officials reported two cases of the rare Enterovirus D68 last week. There were 14 known cases in the state and some 500 cases nationwide as of Friday. All of the California cases affected children between 1 and 15 years of age.

The virus generally causes symptoms similar to a common cold, including fever, runny nose, sneezing, coughing and body aches, but there have been rare cases of severe breathing troubles and, even more rarely, neurological symptoms, including polio-like muscle weakness. Only one California case, a child in Los Angeles, has suffered partial paralysis.

The State Health Department advises parents to seek immediate medical attention for children experiencing breathing difficulty.

EV D68 is spread when an infected person coughs, sneezes or touches contaminated surfaces. The season for the virus generally extends from late summer to early fall.

 

 
New Imaging Technology Boosts Breast Cancer Detection | Print |  E-mail
Thursday, 25 September 2014 21:23

092514h1By Keyvan Nouri, M.D. • Special to the Times

The best defense against breast cancer is early detection.

One of the most common tools we use to detect breast cancer is imaging, such as mammography or ultrasound. Advances in technology now allow us to produce highly detailed, multi-dimensional images, which improve cancer screening and detection.

Eden Medical Center is home to two of the most advanced breast imaging modalities available: magnetic resonance imaging (MRI) and breast tomosynthesis (3D mammograms). Physicians can now use these imaging methods to detect cancer in its earliest stages through in-depth images that were not attainable before.

Magnetic Resonance Imaging (MRI) is a noninvasive technique and does not involve exposure to radiation. Instead, this imaging test uses strong magnetic fields, radio frequency pulses and a computer monitor to produce detailed pictures of organs, soft tissues and bones.

A breast MRI is not meant to replace mammography, but is used as a supplemental tool for women at high risk for breast cancer or to help determine the extent of cancer after a new diagnosis.

Breast MRI can also be used to further evaluate abnormalities found in a routine mammogram.

Breast Tomosynthesis is another high-tech tool in the fight against breast cancer, a revolutionary technique approved by the FDA in 2011.
Also known as 3D mammography, it has enabled radiologists to view the inside of the breast layer-by-layer, helping to see fine details more closely, especially in women with dense breasts. These 3D mammograms have greatly improved cancer detection and helped to reduce false positives, which have decreased patient anxiety, expense and inconvenience.

During the procedure, multiple low-dose images called “slices” of the breast are taken at different angles. Like a regular mammogram, the patient is exposed to very low doses of radiation, well below government safety standards.

And, like breast MRIs, tomosynthesis is not a replacement for a regular mammogram. Tomosynthesis is a valuable tool for women with dense breasts because the images can minimize overlapping tissue. The technique is also used as a follow up to a mammogram because it can offer a better view of the size, shape and location of an abnormality.

Talk to your doctor if you have a family history of breast cancer, dense breasts or any concern about the health of your breasts. And, if further studies are needed, physicians at Eden now have two powerful tools available to diagnose and treat breast cancer.

Keyvan Nouri, M.D., is a board-certified radiologist affiliated with Eden Medical Center.

Dr. Nouri will speak at a symposium, “The 4-1-1 on Early Cancer Detection,” at Eden on Thursday, Oct. 9, from 7 to 9 p.m. For more information, call (888) 445-8433 or visit edenmedcenter.org.

CAPTION: Breast Tomosynthesis, also known as 3D mammography, helps radiologists see fine details more closely, especially in women with dense breasts.

 

 
A Reminder of Mental Health Services in Alameda County | Print |  E-mail
Thursday, 25 September 2014 21:22

The high profile suicide of beloved Bay Area actor Robin Williams has refocused attention on mental illness and depression. Suicide is the 11th leading cause of death in the United States, accounting for the deaths of approximately 30,000 Americans each year.

From 2006-2008, Alameda County had 362 suicides, nearly 8 for each 100,000 residents. Under the Affordable Care Act, health plans through Covered California must now cover preventive services like depression screening for adults and behavioral assessments for children.

According to the National Institute of Health, many people with clinical depression never seek the help of a professional, yet the majority can get better with treatment.

Alameda County’s Behavioral Health Care Services has an extensive local suicide prevention program that includes access to a 24-hour suicide-prevention hotline, grief counseling, senior and teen counseling, and community education at www.crisissupport.org.

The “Know The Signs” statewide suicide prevention campaign is another resource at www.suicideispreventable.org.

Teens can text “safe” to 839863 from 4 to 11 p.m. seven days a week, and correspond about mental health issues ranging from stress, anxiety, depression, relationships or suicide. Teens will be connected to a local counselor to talk about what’s on their minds via text message.  

Other resources include Mental Health Association of Alameda County (www.mhaac.org) and PEERS at www.peersnet.org.
For more information on the mental health benefits in the Affordable Care Act, visit aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm.


 
Do You Know Your Medicare Rights? | Print |  E-mail
Thursday, 25 September 2014 21:20

By David Sayen • Special to the Times

As a person with Medicare, do you have any rights and protections? You certainly do!

You have rights whether you’re enrolled in Original Medicare — in which you can choose any doctor or hospital that accepts Medicare — or Medicare Advantage, in which you get care within a network of health care providers.

Your rights guarantee that you get the health services the law says you can get, protect you against unethical practices, and ensure the privacy of your personal and medical information. You have the right to be treated with dignity and respect at all times, and to be protected from discrimination.

You also have the right to get information in a way you understand from Medicare, your health care providers and, under certain circumstances, Medicare contractors.

This includes information about what Medicare covers, what it pays, how much you have to pay, and how to file a complaint or appeal. Moreover, you’re entitled to learn about your treatment choices in clear language that you can understand, and to participate in treatment decisions.

One very important right is to get emergency care when and where you need it — anywhere in the United States.

If you have Medicare Advantage, your plan materials describe how to get emergency care. You don’t need permission from your primary-care doctor (the doctor you see first for health problems) before you get emergency care.

If you’re admitted to the hospital, you, a family member or your primary-care doctor should contact your plan as soon as possible. If you get emergency care, you’ll have to pay your regular share of the cost, or copayment. Then your plan will pay its share.

If your plan doesn’t pay its share, you have the right to appeal.

In fact, whenever a claim is filed for your care, you’ll get a notice from Medicare or your Medicare Advantage plan letting you know what will and won’t be covered. If you disagree with the decision, you have the right to appeal.

You don’t need a lawyer to appeal in most cases, and filing an appeal is free. You won’t be penalized in any way for challenging a decision by Medicare or your health or drug plan. And many people who file appeals wind up with a favorable outcome.

For more information on appeals, you can read our booklet “Medicare Appeals,” available at www.medicare.gov/Publications. Or call us, toll free, at 1-800-MEDICARE.

You can also file a complaint about services you got from a hospital or other provider. If you’re concerned about the quality of the care you’re getting, call the Quality Improvement Organization (QIO) in your state to file a complaint. A QIO is a group of doctors and other health care experts who check on and improve the care given to people with Medicare.

You can get your QIO’s phone number at www.medicare.gov/contacts or by calling 1-800-MEDICARE.

Many people with Original Medicare also enroll in Medicare Part D prescription drug plans. Here, too, you have certain rights.

For example, if your pharmacist tells you that your plan won’t cover a drug you think should be covered, or it will cover the drug at a higher cost than you think you’re required to pay, you can request a coverage determination.

If that decision isn’t in your favor, you can ask for an exception.

Ask for an exception if you, your doctor, or your pharmacist believes you need a drug that isn’t on your drug plan’s list of covered medications, also known as a formulary.

For more details, read our booklet, “Medicare Rights and Protections,” at www.medicare.gov/Publications/Pubs/pdf/11534.pdf.
David Sayen is Medicare’s regional administrator for California.

 

 

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