denial was actually the best thing that could have happened. Without it, we would not have discovered the cancer when we did, and I wouldn’t be getting the care I need now.
Linda
A.,
Network Health Medicare Advantage member
EDITORIAL STAFF
V ice President Marketing David Sengkhammee
Strategic Mar keting Julie Buchanan and Communications Laura Lopez Coor dinators
Super visor Creative Design Debra Sutton
EDITORIAL BOARD
Michael Jurmu, Jennifer Quadracci, Kristy Yarcho, Stacy Schwandner, Ted Regalia, Susan Wendt
ASK NETWORK HEALTH
If you have questions about anything you read in this issue of Concierge, call the member experience team at 800-378-5234 (TTY 711) Monday–Friday, 8 a.m. to 8 p.m. We're available every day, 8 a.m. to 8 p.m. October 1–March 31.
At Network Health, we understand that navigating health care can be challenging, and we are here to make it easier for you. We take the extra steps to make health insurance understandable, so you are comfortable with your coverage. With your personalized, secure member portal, you can easily manage your plan by accessing important plan documents, benefits, claims updates and more. Access your portal at the times most convenient to you. The portal works great on your mobile phone and is built to be viewed on any smart device. Either scan the QR code with your smart device or type login.networkhealth.com into your favorite internet browser.
Go Paperless. Get it Faster.
Want less clutter and faster updates? You have the freedom to choose the way you’d like some items sent to you. Going paperless to receive information via email is fast, secure and does not clutter your mailbox. In fact, this newsletter is one of the items you can choose to receive electronically. If there are communications you’d still rather receive as hard copies through the mail, you can select that preference.
To select your preferences, simply log in to the portal, click your name in the upper right corner and select Change My Communication Preferences. From there, you can choose email for some or all the available categories. Make sure to click Next to save your choices. For plans with a pharmacy benefit*, to receive explanation of benefit (EOB) statements electronically, click the EOB tile and select View Pharmacy EOBs. Once redirected, change your communication preference under the Account menu.
Plan Information
The member portal is your one-stop shop for information specific to your health plan.
• Benefits and coverage overview
• Claims detail and status
• Access your mobile Network Health member ID card
• Out-of-pocket expenses tracker
• Important plan materials
• Select or update your personal doctor (or request replacement hard copies)
• Monthly EOB statements
More Resources
The member portal also provides seamless connections to other valuable resources.
• Pharmacy benefits and claims information *
• Your health questionnaire
• Virtual visits
• Wellness programs and tools
To keep your information safe, we use multi-factor authentication. It’s easy to set up and gives you peace of mind when accessing your important information wherever you go – the pharmacy, doctor’s office or even on vacation. Just visit login.networkhealth.com.
*Not all Network Health plans have pharmacy benefits. Check your plan documents for details.
SCAN ME
POA, Guardianship and Protected Health Information. Start Planning Now
Advance Directives are legal documents that allow you to express your health care preferences in advance, in case you become unable to make your own decisions in the future. While navigating the various forms can seem complex, taking this simple step today can provide peace of mind for you and those closest to you.
by Katrina G., CSW, social work care manager special needs plan and Lexi F., BSVR, CSW, social work care manager special needs plan at Network Health
What is a Power of Attorney (POA)?
A POA is a legal document designating a person (your “agent”) to make decisions for you when you are no longer able. The document gives you the opportunity to express your wishes relating to end-of-life care.
A POA for Health Care specifically addresses health care matters. The person you designate as your health care agent only has authority to act on your behalf if you are declared incapacitated by two health care providers. Incapacity means you are unable to receive or process information, or unable to communicate your medical decisions. Those 18 and older should have a POA for Health Care in place. In Wisconsin, a family member (“next of kin”) is not automatically authorized to make health care decisions for you.
A Durable POA is for financial matters. This POA becomes effective immediately unless you specify a future date or occurrence that will activate the powers expressed in this form.
Where Can I Find Advance Directive Forms?
You can access free advance directive forms, including the POA for Health Care and Durable POA, through the Wisconsin Department of Health Services website dhs.wisconsin.gov/ forms/advdirectives/adformspoa.htm. Your personal doctor may also have forms available to you.
What is Guardianship?
Guardianship is needed when someone is deemed incompetent, meaning the person’s impairment is likely permanent and prevents them from understanding information or expressing their wishes. Unlike a POA, the court system will appoint a guardian. An individual may require a court-appointed guardian of the person, a guardian of the estate, or both.
Protected Health Information (PHI)
A PHI form allows you to designate someone to receive information on your behalf. Your designation can be a spouse, relative, friend, advocate, attorney, doctor, organization or
another person you trust. The form gives permission to share your PHI with those you designate but does not authorize them to make decisions on your behalf.
You can submit this form to Network Health through your member portal. You can also contact the member experience team at the number located on the back of your member ID card, to request the form be mailed to you.
Key Takeaways
1. Think about what is important to you.
2. Learn about options for end of life – what you want and don’t want.
3. Choose the agent you trust to make decisions on your behalf.
4. Engage in open communication with your agent and your doctor.
5. Document your wishes by completing your POA.
6 Ensure your POA is shared with your doctor, local hospital and agent. Keep a copy for yourself in a safe place.
7. Review your POA regularly to make sure it is up to date.
Don’t wait; start planning your future today to ensure your wishes are known and respected.
Other Helpful Resources
Your local Aging and Disability Resource Center (ADRC)
Greater Wisconsin Agency on Aging Resources, Inc. at gwaar.org/guardianship-resources
Fox Valley Advance Care Planning Partnership at fvacpp.org
Network Health Care Management team at 866-709-0019 (TTY 711), Monday-Friday from 8 a.m. to 5 p.m.
By Sam Clark, community wellness supervisor
Network Health Diabetes Prevention Program
Network Health is the first health plan in Wisconsin to offer the Medicare Diabetes Prevention Program (MDPP). This free program is led by the Centers for Disease Control and Prevention (CDC). Classes are offered every other month.
This program consists of a one-year series of facilitator-led group sessions for individuals with prediabetes. There is no cost to the program if you are enrolled in Medicare Parts A and B.
The program focuses on dietary changes, increased physical activity and behavior change strategies. MDPP classes are designed to help individuals make small changes that lead to big differences in their overall health. Program participants may also learn to manage other conditions like high cholesterol or high blood pressure with fewer medications.
The Network Health MDPP program delivers incredible results. To be included in future classes, email NHpreventT2@networkhealth.com or pre-register at networkhealth.com/wellness/ prevent-t2-ma and a Network Health Wellness Coordinator will follow up with you.
Network Health also offers a diabetes prevention program, Prevent T2, to our commercial, individual and family plan members as well. Virtual classes are offered twice a year. To learn more, visit networkhealth.com/wellness/prevent-t2.
Know someone who is enrolled in our commercial or individual and family plans and could benefit from this program?
SCAN ME
What is the Medicare Health Outcomes Survey?
By Kristy Yarcho, manager of quality health integration at Network Health
Each year, Medicare sends a survey to some people in each health plan. This survey is called the Health Outcomes Survey or HOS. The survey asks questions about your health, how you feel and how well your health plan is helping you. Responding to the survey gives you the chance to improve health care overall. Here’s what you should know.
The Survey is Simple
• It’s not a test, and there are no right or wrong answers.
• Your answers are private and will not change your Medicare benefits.
• It only takes a few minutes to complete.
Medicare Sends the Survey
The objective is to learn about the following.
• How people feel about their health.
• If their health is getting better or worse.
• If their doctors and health plans are helping them stay healthy.
Your
Voice Matters
How the Survey Works
• Beneficiaries are picked randomly.
• Questions are asked about their mind and body.
• Two years later, they answer the same questions again.
• This helps Medicare see how their health has changed.
Why Your Answers Matter
• They help doctors and health plans improve care.
• They help beneficiaries get better services.
• They help Medicare see which health plans are doing a good job.
Take a few minutes to fill out the survey. Your voice helps make health care better for everyone.
Addressing the Opioid Crisis
by Ted Regalia, RPh, vice president of pharmacy benefits and Beth Coopman, PharmD, pharmacist at Network Health
A nationwide effort to address the ongoing opioid crisis has made some progress, however, challenges still exist. The good news is, according to the Centers for Disease Control and Prevention (CDC), the national opioid dispensing rate has been steadily declining since 2019. Despite this progress, opioid-related deaths still reach over 100,000 people.
Opioid use disorders can happen to anyone. These disorders include opioid addiction, which can interfere with a person’s health, well-being and quality of life, not to mention the hardship and strain it can cause loved ones.
Working Together to Address the Opioid Crisis
The scale of this crisis underscores the need for comprehensive solutions. Here are the ways our members, providers and Network Health all play a role in keeping our communities safe.
Opioid Prescribers
The State of Wisconsin requires doctors to consult a website every time they prescribe an opioid. This displays prescriptions from other doctors and pharmacies across the United States, so the prescriber has a full picture of the medications a patient is receiving. Additionally, Wisconsin doctors are required to take continuing education classes on safe opioid prescribing.
Pharmacies
Naloxone is an opioid antidote and is a life saver in cases of opioid overdose. Wisconsin allows naloxone to be sold over the counter without a prescription and it can even be found in some specialized vending machines. We strongly recommend you discuss naloxone with your personal doctor or pharmacist.
Network Health
We have quantity limits on new prescriptions for members who have not had an opioid in the last six months. This is to prevent unintentional intake, overdoses or the unused opioids getting into the wrong hands. We have put a prior authorization in place for cases where high-dose opioids are medically necessary.
Protecting Yourself and Others
You play the most important role. If you need pain control, talk to your doctor about alternative treatment options to help minimize your opioid use, including non-opioid medications, physical or behavioral therapy, counseling and other interventions. Also, store your pain medication in a secure place, do not share your medications with others and dispose of unused medications either at your pharmacy or follow disposal instructions provided by the Food and Drug Administration (FDA) at fda.gov. Finally, teach those around you about naloxone and how to use it.
Working Together to Preserve Great Benefits
By Beth Coopman, PharmD, pharmacist at Network Health
The Inflation Reduction Act (IRA) brought big changes to Medicare Part D, which is great news for affordability, however, it also puts pressure on health plans. To keep the benefits you love, we need your help.
Smart Choices = Big Savings
Choosing lower-cost options like biosimilars, lower cost pharmacies and special programs helps us control costs and maintain your coverage.
• Biosimilars are safe, effective alternatives to brandname biologics that are approved by the Food and Drug Administration (FDA) and often up to 90% less expensive. Once you hit your $2,000 out-of-pocket maximum on Medicare Part D in 2025 ($2,100 in 2026), you pay $0. However, even at this stage, the price difference between using the original product versus the biosimilar greatly impacts the cost to your health plan. This is a similar concept to using generic medications.
• We’re actively adding biosimilars to our prescription drug list, which is the list of covered medications. Humira® and Stelara®, for example, have biosimilars on the formulary. Our pharmacy team is here to help you switch to a biosimilar with ease and confidence.
Save More with Mail Order Options
• Mark Cuban Cost Plus Drugs (Cost Plus) offers deep discounts on select generics. For example, members on Abiraterone for prostate cancer can save hundreds of dollars and the plan up to $60,000/year by using Cost Plus. Visit costplusdrugs.com to explore options.
• Need help getting started? Our Wisconsin-based pharmacists are ready to assist. 888-665-1246 (TTY 711), Monday-Friday from 8 a.m. to 5 p.m.
Local, Trusted Delivery
• Froedtert Pharmacy Home Delivery is a great choice, especially for Tier 1 and Tier 2 medications. You’ll get excellent service, SeniorCare® billing and may speak directly to pharmacy representatives. Call 844-249-4235 or visit froedtert.com/pharmacy/home-delivery to learn more.
How You Can Help
• Opt for cost effective solutions without sacrificing quality.
• When we call you for a medication review, actively participate to ensure you continue to have access and affordability to your medications, all while helping us with our quality rating.
• Stay healthy by taking your chronic condition medications, like diabetes, high blood pressure and cholesterol medications, as prescribed.
Together, we can keep your benefits strong even as costs continue to rise.
From Denial to Diagnosis
By Laura Lopez / Photography by Kyle Halter at Network Health
Linda A., a Network Health Medicare Advantage member, had been going to physical therapy for neck pain for months when Network Health denied coverage for additional sessions. The denial turned out to be a blessing in disguise. Because another round of physical therapy would not be covered, Linda's physical therapist recommended further diagnostic testing to determine the root cause of her pain. An MRI uncovered an unexpected and life-changing diagnosis: metastatic cancer.
“That denial was actually the best thing that could have happened,” Linda shared. “Without it, we would not have discovered the cancer when we did, and I wouldn’t be getting the care I need now.”
After the MRI, Linda’s medical team recommended further imaging to determine the cancer’s origin. While a mammogram didn’t show any abnormalities, an ultrasound revealed breast cancer.
With this diagnosis, Linda turned to Network Health Care Manager Rosanne R. for support. “When you’re newly diagnosed, there are so many questions,” Linda explained. “Who do I go to? Where do I go? What do I do next? Rosanne was the one I called every time.”
When you’re newly diagnosed, there are so many questions,” Linda explained. “Who do I go to? Where do I go? What do I do next? Rosanne was the one I called every time.
When Linda’s doctor sent her to an oncologist who wanted to move forward quickly with a mastectomy, she contacted Rosanne. The doctor’s plan didn’t sit well with Linda. She wanted to get a second opinion but wasn’t sure if it was okay to do so, or which doctors she could see.
Rosanne reassured her that seeking a second opinion was her right as a patient. “She told me I didn’t need a referral for a second opinion. It was covered by my plan,” Linda recalled. After speaking with Rosanne, Linda was able to get an appointment with a leading breast cancer specialist at Froedtert within days. “That was on a Friday, and by Monday, I was sitting with one of the top doctors in the field. The information I received was lifesaving.”
That was on a Friday, and by Monday, I was sitting with one of the top doctors in the field. The information I received was lifesaving.
The second opinion confirmed Linda’s doubts about surgery. Because the cancer had already spread to other parts of her body, the oncologist at Froedtert recommended a different approach that was focused on managing the cancer while maintaining her quality of life.
Throughout her treatment, Linda has relied on her Network Health Care Team for not just medical coordination, but emotional and practical support. From helping her understand which health plan was best for her changing medical needs, to calling monthly to check in, care managers Rosanne and Shannon C., who took over when Rosanne retired, have been a steady source of support during her journey.
“I appreciate that they care so much. I get a monthly call from them. They listen and take notes, and then they always follow up to make sure I get what I need. What insurance company does that?” Linda said.
As Linda continues to navigate her health journey, she encourages women with dense breast tissue to advocate for a breast ultrasound in addition to their regular mammogram screening. She also wants everyone to know about the care management team at Network Health. “Rosanne was right by my side. To have that kind of individual attention when you have a life-changing diagnosis is so helpful to people who are really sick. I love my Network Health and I love my people there.”
Rosanne was right by my side. To have that kind of individual attention when you have a life-changing diagnosis is so helpful to people who are really sick. I love my Network Health and I love my people there.
What is Care Management?
When a member is facing a difficult diagnosis, complex medical condition or behavior health condition, having an experienced and compassionate care manager like Rosanne and Shannon by their side can ensure that the member gets the care they need, when need it.
Network Health Care Managers provide personalized care and advocate for members in the following ways.
• Review medications and treatment plans
• Identify signs that a health condition is worsening so the member understands when to act, including when to contact their health care provider
• Work with a member’s health care provider to ensure they are aware of changes in the member’s health
• Include the member and their caregivers in health care decisions
• Share helpful community resources
If you or a loved one are navigating complex health needs, Network Health’s care management team is here for you, whether you need help coordinating appointments, navigating treatment plans or finding someone to talk to.
Accessing the care management services is easy.
A Network Health care manager may contact you during a transition of care, such as returning home from the hospital. You can also ask your personal doctor for a referral to care management or you can contact the them directly at Network Health to explore your options. Call 866-709-0019 (TTY 711) Monday–Friday, 8 a.m. to 5 p.m. or visit networkhealth.com/wellness/care-management.
From helping members understand their condition to coordinating timely care and being there to answer questions, Network Health’s care management team ensure no one has to navigate their health care alone.
Your health journey matters to us. Our dedicated RNs and social workers are here to listen with compassion and help you navigate the path that’s right for you.
– Katie M., manager of care management at Network Health
Earn Rewards with Our Member Referral Program
Love your Network Health Medicare Advantage Plan? As a member, we reward you for telling others about Network Health.* To refer somebody, they must meet the following criteria.
• Have Medicare Parts A and B
• Not cur rently enrolled in a Network Health plan
• Live in our ser vice area
If your friend or family member meets these criteria and is looking for a Medicare Advantage plan that goes above and beyond, have them call our Medicare advisors at 844-850-5284 (TTY 711), every day from 8 a.m. to 8 p.m., to let us know you referred them.
You can earn up to four $15 gift cards for a variety of stores each year. Once your referral calls us, we will contact you to choose the gift card you prefer.
*Licensed agents who are appointed with Network Health are not eligible for these gift cards
Living and working in the areas we serve allows us to focus on our mission of building healthy and strong Wisconsin communities. Members from across northeast and southeast Wisconsin can learn more about the 2026 Medicare Advantage plan benefits at our Experience Network Health events from October 7 through November 5. If you cannot attend, a pre-recorded version will be placed in your member portal. Just one of the many ways that Network Health provides members with the personalized support they need to make informed decisions about their health care.
Here's what you can expect from this year’s events.
• Meet your Network Health Pharmacy, Member Experience and Care Management teams
• Lear n what’s new for Network Health’s Medicare Advantage Plans in 2026
• What your benefits are and how to use them
• Answers to common Medicare Advantage plan questions
• Lear n about resources available to you
• The oppor tunity to receive your flu shot* To register for one of these events and to receive your flu shot* , visit networkhealth.com/ experience. Don’t miss this opportunity to meet and engage with your Network Health team and learn more about your Network Health Medicare Advantage Plan.
* register and attend a member experience event to receive a flu shot.
Join Us in The Community
Network Health is a Wisconsin-based health plan with deep roots in the communities we serve. Whether it’s a farmer’s market, local health fair or volunteer experience, you can find your Network Health team at events throughout Wisconsin, all year long.
SCAN ME
1570 Midway Pl.
Menasha, WI 54952
Health and wellness or prevention information
Required Information
NE/SE/SNP/EGWP
There are several organizations that exist to help improve the quality of health care across the United States, including the National Committee for Quality Assurance (NCQA), the Wisconsin Office of the Commissioner of Insurance (OCI) and the Centers for Medicare & Medicaid Services (CMS). They use a variety of performance measurement tools and regulations to help ensure consumers are protected and receive quality health care services.
These organizations also require health plans to provide information to their members on these specific topics.
• Access to Network Health Care Management Employees and Services
• Ensuring You Receive the Service You Deserve
• Evaluating New Technologies
• Falls/Osteoporosis
• How Do Health Plans Make Decisions?
• Keep Yourself Safe from Medicare Fraud
• The Impor tance of Exchanging Information
• Member Rights and Responsibilities
• Networ k Health’s Focus on Quality
• Submitting a Claim for Reimbursement
• What’s the Difference Between Emergency Care, Urgent Car e and Virtual Visits?
• What is Population Health Management?
You can download this information at networkhealth.com/required-info. If you do not have access to the internet and need a hard copy, please call our member experience team at the number located on the back of your Network Health member ID card.
What You Should Know About Fraud
Network Health takes health insurance fraud seriously. Insurance fraud costs millions of dollars each year, and it results in higher health care costs. Network Health investigates all reports we receive. Tips from our members are critical in helping us identify fraud, waste and abuse. We urge you to contact us if you feel you’ve been impacted.
Here are some examples of possible fraud.
• A health car e provider bills for services you never received.
• A durable medical equipment (DME) supplier bills for equipment different than what was ordered and provided or was unsolicited.
• Someone uses another per son’s member ID card to get medical car e, supplies or equipment.
• Misr epresenting alternative medicine or cosmetic pr ocedures as covered plan benefits.
If you suspect fraud, here’s what you can do.
• Call your health care provider to make sure the bill is correct.
• Call the member experience team at the number located on the back of your Network Health member ID card.
