The Bulletin Board

 Member Handbook - Active

Book NoMed Classic.pdf

Member Handbook - Medicare

Handbook Medicare Mem Printer Version.pdf

Member Handbook Changes

Member Handbook Changes For Web.PDF

Wal-Mart $4 Generic Program

To view a list of the $4 generic drugs available at Wal-Mart pharmacies, go to www.walmart.com/medicare  and view the printable list of all the $4 generic drugs available by clicking on "$4 generic drug program".

Chiropractic Benefit Information

For Wabash members with chiropractic benefits, if treatment is recommended with DRX 9000 equipment be advised of the following policy regarding this treatment:

1. This modality is covered by your chiropractic benefit only.

2. Any patient who desires to be considered for this modality must have a second opinion that clearly and unequivocally supports this treatment from a Board Certified Neurosurgeon or a fellowship trained Orthopedic spine surgeon.

3. Any patient considered for this, in addition to the supported required in step number 2, is required to have failed other conservative means in the opinion of the neurosurgeon or spine surgeon.  Opinions from neurologists, internists, family physicians or pain specialists will not be acceptable to approve this modality.

4. All approvals must be in advance and with the approval of the Medical Director

5. No more than 20 treatments will be approved without reevaluation by the Neurosurgeon or spine surgeon and the Medical Director.

Access My Records

AccessMyRecords.com is a new online service that will limit the possibility of medical errors.  You can store, organize and update all your personal healthcare information.  Through AccessMyRecords.com, emergency service, hospital personnel and your doctor can look up your personal identification photo; emergency contacts; family physician; allergies and medications; medical test reports; medical conditions; past surgeries; healthcare insurance providers; healthcare power of attorney and living will.  The cost of this service is just pennies a day.  Individuals may visit the website at www.accessmyrecords.com or call 1-800-796-6431 for more information about the service and learn how to subscribe.

Benefit Check

Wabash benefits do not pay for elective asbestos testing or heart screening that is being shown in television commercials.  Wabash is only authorized to pay for medically necessary testing that is ordered by a physician or other legitimate medical professional.

EHO Pharmacy Assist

There may be occasions that occur when your prescriptions may be changed, or you may require a different medicine or need a refill and still have some tablets remaining from your last order.  If your pharmacist claims to be unable to fill your order, please have them call EHO toll free at 1-800-650-1817.  If they ask for Trent and explain the situation to him, he has the authority to over-ride our rule and your prescription can be filled. 

FORMS AVAILABLE TO ORDER INTERNATIONAL MAIL-ORDER MEDICATIONS

FOR FIRST TIME USERS AND FOR REFILLS

• Go to www.expedite-Rx.com

• Click on "Print Enrollment Documents"

• Fill in your group number (from your EHO card)

• Fill in your cardholder id  (Social Security Number)

• Fill in your birthdate (mm/dd/yyyy)

• Click Submit

• For initial orders, click number 1, 2 and 3.  For refills click number 4.

DRUG DETAILS

• EHO has extended their hours for Help Desk operations.  They are now available from 7AM until 5AM CST, Monday through Saturday morning and then reopen  9AM until 5PM on Saturday.  Call 1-800-650-1817 about drug benefits, co-pays, International  imports, etc., or send an email to eho@drugbenefit.com.

• The Wabash International drug connection, Expedite Rx (through Total Care Pharmacy in Canada) has announced new guidelines for participation.  If you are already enrolled and receiving imported drugs through our source, or if you wish to enroll and start now, you need to register (or re-register) when placing your next order (or refill of an existing order).  You can do so by calling directly to 1-888-431-1166.  You can also print your own form by going to the Expedite-Rx website at www.expedite-Rx.com, scroll down and click on "print enrollment documents".

Under The Circumstances Listed Below, Members May Be  Required To Pay The Balance of Claims

• The limit of the scheduled benefit has been met for the Plan Year

• Network physicians may unknowingly refer you to physicians out of our network (call 888-800-9161 if in doubt about network status of physician)

• Your benefit may be used up during the middle of treatment and you may not be aware of it (Example: Physical Therapy, Psychiatry, etc.)

• If anesthesiologist is not part of our Network (even when the hospital is a network provider), the balance due on anesthesia charges may be your responsibility (call 888-800-9161 for clarification)

• Certain diagnostic tests

• Certain Emergency Room visits are deemed inappropriate

Each Benefit Plan Is Different ~ Check with your Personal Claim Representative Ahead Of Time To Confirm Your Coverage

How To Contact

Any questions or problems regarding claims or the Illinois Blue Cross Network may be directed to your personal claim representative at (888-800-9161). Last names beginning with: A-F ask for Denise, G-M ask for Ruthie and N-Z ask for Nona.

Tax Deductible Contributions

Tax Deductible Contributions to our Foundation provide a great way for you to say thanks and be remembered by your friends and colleagues after you're gone.  For as little as $250.00 a year (depending on your age and health), you can leave as much as $50,000 to the  Foundation through an insurance policy.  We want you to make the Wabash Memorial Hospital Foundation your favorite charity.  Please consider an annual gift to Wabash as you write checks to your other charities.  Your railroad brothers and sisters will appreciate your generosity.

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY. (HIPAA,45 CFR 164.520(1)(I), FEDERALLY REQUIRED NOTIFICATION

  The Wabash Memorial Hospital Association (WMHA) has adopted this Notice of Privacy Practices to comply with Federal Guidelines as outlined in the Health Insurance Portability and Accountability Act (HIPAA).  It is also our policy to advise each member of their rights and expectations with respect to the privacy of certain Protected Health Information (PHI). Protected health information is defined as: any 'individually identifiable health information' whether maintained or transmitted on paper, in electronic format or orally.  It may include demographic information collected from an individual that is created or received by a health care provider, health plan, health care clearinghouse, or employer, that relates to an individual's past, present or future physical or mental health or condition, or payment for that individual's health care, and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. WMHA acknowledges that during routine business transactions it is necessary to collect, receive and make use of certain personal or family medical information that is considered PHI.  This information may come from hospitals, clinics and physician providers or other insurance entities.  Without such data, we would be unable to properly process and pay medical claims on your behalf.  Since we provide either Primary or Secondary coverage for all WMHA members, we maintain Business Partner Agreements with other Providers who may be directly or indirectly involved in your healthcare.  In those instances where we also serve as a 'Provider', that data must be shared with other insurance entities to receive proper reimbursement for your treatment.  Our intent and ongoing practice is to resolutely and diligently protect the privacy of all the health information of all our members that we may be expose to in any form, from any source.  The development of this policy focuses on the following acknowledgments and assumptions.

1. Patient medical records are the property of the facility / office generating that document, however, the patient has a right to access the information in that record.
2. WMHA will obtain consent to release medical information from the members or their parent/guardian; except for those instances otherwise required by prevailing law, professional ethics, and continuity of care, billing, communicable disease reporting, etc.
3. Informed consent, i.e., with knowledge of the risks and benefits of disclosure, must be obtained for the release or transfer of especially sensitive information such as AIDS/HIV, alcohol and drug abuse prevention and treatment.
4. Any disclosure of confidential patient/member information carries the risk potential for an unauthorized redisclosure that could breach confidentiality.
5. The request for releasing patient information (copying, postage, etc.) generates cost for WMHA, which reserves the right to charge accordingly.
6. WMHA reserves the right to change or otherwise modify this policy.

Protected Information: PHI may be received from many sources via U.S. Mail, telephone, in writing or over a computer line.  Information may be oral or recorded in any medium, that relates to an individual's past, present or future physical or mental health or condition, or provision of or payment for healt6h care to an individual or: Created or received by health care provider, health plans, public health authority, employer, insurers, schools or clearinghouses.

Identifiable Information: Includes demographic data collected from an individual, created or received by a health care provider, health plan, employer or clearinghouse that may directly or inadvertently permit identification or an individual, e.g., name address, SSN, phone number.

Allowable use of data: Generally, WMHA may use or disclose PHI to 1) carry out patient treatment, 2) facilitate payment for such treatment, and 3) to carry out our own health care operations such as assisting in the settlement of member's FELA claims.

As a provider, as well as insurer, WMHA will only share a minimum level of information on behalf of a member in order to determine eligibility and covered benefits, assist with precertification or preauthorization, utilization review, billing claims management etc. Example: Your doctor may share medical information about you with another health care provider.  For example, if you are referred to another doctor, that doctor will need to know if you are allergic to any medications.  Similarly, your doctor may share PHI about you when calling in a prescription.

WMHA WILL NOT SHARE MEMBER INFORMATION FOR MARKETING MAILING LISTS OR FUND RAISING PURPOSES EXCEPT AS MAY BE DIRECTLY AFFILIATED WITH WMHA SUCH AS THE WABASH HOSPITAL ASSOCIATION FOUNDATION.

Worksite Health / Safety and Law Enforcement / Public Interest as well as certain areas of medical research are issues that allow the exchange of PHI without specific consent.  This data will normally be collective; group data/statistics unless if demanded by a court of law, specific member information related to child abuse, adult abuse, neglect, domestic violence or national security, may be demanded.

Permission:  Consent, Authorization and Oral Permission:  Consent from the patient must be granted to Direct Treating Providers giving them permission to use PHI for treatment, payment, or healthcare operations.  This can permit a One Time Event or good until revoked.  Consents must be signed and dated and may be revoked at any time.  Exceptions noted are for treatments required by law, certain emergency situations, when language barriers exist, treatment to inmates and some health plans and clearinghouses. Oral Permission is adequate for the sharing of some PHI such as notification of family members or friends involved in one's care or care payment and/or certain directory information.  Religion information may be disclosed to clergy.  Oral permission is adequate also for the ordering of prescription medications, x-rays and medical supplies.  Authorization is required for the release of PHI in situations not requiring consent: i.e. to persons/entities not directly involved in the patient's care such as Workman's Compensation claims, third party payers, life insurance inquiries, transfer of certain medical/pharmacy records, etc.

WMHA will have available upon request by a member information about who is requesting information, what, when and how that information is disclosed and by whom.  We will always satisfy the Privacy Rules by only providing the Minimum Necessary to satisfy the request.  WMHA will inform members of this Privacy Notice.

WMHA acknowledges that certain member rights exist, such as:

1. the right to amend and correct for incomplete PHI
2. the right to inspect and copy the individual's own PHI
3. the right to receive confidential communications from a Covered Entity
4. the right to request restrictions on certain uses and disclosures, and a statement that the covered entity is not required to agree to such restrictions.
5. the right to receive an accounting of disclosures
6. the right to revoke a consent

WMHA is required to:

1. Maintain the privacy of your health information
2. Provide you with a notice as to our legal duties and privacy practices regarding health information collected and maintained about you
3. Adhere to the terms of this Notice of Privacy Practices;
4. Contact and notify you if we are unable to agree to a requested restriction; and
5. Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

We reserve the right to change our practices and to make the new provisions effectively for all protected health information we maintain.  Should our information practices change, we will mail a revised notice to the address you've supplied us.

For More Information Or To Report A Problem:  Should you have further questions or wish to make a change in the protected health information, please contact Mr. Robert Kimmons, WMHA Administrator at (217) 429-5246.  If you believe your privacy right has been violated, you can file a complaint with Mr. Robert Kimmons, WMHA Administrator, PO Box 1340 Decatur, Illinois 62525 or with the Secretary of Health and Human Services.  There will be no retaliation for filing a complaint.

THE EFFECTIVE DATE OF THIS PRIVACY NOTICE SHALL BE APRIL 1, 2003