Presbyterian Health Plan, Inc. P.O. Box 27489 Albuquerque, NM 87125-7489 www.phs.org Important plan information TC Standard U.S. Postage PAID Presbyterian Health Plan INSIDE Pregnant? Try virtual care 4 Live well during the holidays 7 Your Winter 2025 for Turquoise Care members En español: Si usted desea obtener este boletín en español, llame al (505) 923-5200 o al 1-888-977-2333. Help kids cope with chronic conditions A chronic condition is a serious illness that requires ongoing medical care. It can last a year or longer or throughout a lifetime. Managing a chronic condition is more than physically exhausting. It’s hard on your mental health too. Children and teens can be born with chronic illnesses or develop them during childhood. Some of the most common are: • Diabetes • Asthma • Attention-deficit/ hyperactivity disorder • Cystic fibrosis • Down syndrome • Spina bifida • Cancer • Food allergies It isn’t easy for anyone to cope with a chronic condition day in and day out. But there are often special concerns for kids. Children and teens may miss school and other activities because of their condition. Their illness may make them feel different and isolated from other kids. Other kids may tease them or exclude them from activities. All these things can hinder kids’ ability to form friendships, which can make them feel insecure, anxious, or depressed. What parents can do to help As a parent, you likely want to shield your kids from all bad things. It may be tempting to avoid talking about your child’s condition or specifics about medical treatments. But experts say it’s best to be honest and open with your child in an age‑appropriate way. Here are several ways you can help your child cope. Encourage learning. Help your child find out everything they can about their condition. That way, you can both learn together. Empower them. Kids often feel more in control when you take time to explain why they have certain treatments or need to miss school and other activities. When possible, allow your child to have a say in these care decisions. Teens especially may want more control over their own care. — Continued on page 2
2 Communicate openly. To build trust, talk with your child frequently. Ask them how they feel, and listen actively. Remind them about the ways you are helping them get better or stay healthy. Tell them often that you love them and are there to support them in any way they need. Involve their school. Tell the school about your child’s illness, special needs, and medications. Give school officials an emergency plan so they’ll be prepared. Check in regularly with teachers to see how your kid is doing. Get help. If your child or teen shows signs of depression, extreme stress, or ongoing behavior problems, talk to their provider. Your child might benefit from talking to a mental health counselor or attending family therapy. Sources: American Academy of Child and Adolescent Psychiatry; American Academy of Pediatrics; Child Mind Institute; Merck Manual Help kids cope with chronic conditions — Continued from front page Did you know that there is no amount of lead in the blood that is considered safe? Lead poisoning in children can cause serious health risks. Risks for affected children can include: • Slow growth • Learning disabilities • Behavioral, hearing, and speech problems Early detection is key to prevent lead poisoning. Prevention and testing There are several ways to reduce your child’s exposure to lead before they are harmed. • Ask your landlord or real estate agent when your home was built. Some homes built before 1978 have lead paint on the walls. • Get a professional to inspect the home. • Repaint with newer, environmentally friendly paint. • Keep painted surfaces in good condition to minimize chipping or cracking. If you suspect your child may have ingested lead paint chips or been exposed to lead in the home, contact your healthcare provider right away. Children enrolled in Medicaid are required to get tested for lead at 12 and 24 months old. They are also required to get tested if they are between 24 and 72 months old and have no record of ever being tested. Treatment If a child has lead in their blood above the blood lead reference value from the Centers for Disease Control and Prevention (CDC), their provider may recommend follow-up services like: • Finding and removing lead from your child’s environment • Feeding your child a diet high in iron and calcium • Connecting your child with early educational services • Scheduling follow-up blood testing If you need help finding a provider or scheduling a visit with your child’s provider, please call the number on the back of your Presbyterian Health Plan member ID card. Lead screening for children Early detection of lead in the blood is key to lessen the longterm effects of lead exposure.
www.phs.org/Medicaid 3 Dental care is important for every kid Did you know that baby teeth are at risk for decay as soon as they first appear? To avoid tooth decay, kids should have one dental visit every six months from 6 months old to 21 years old. What can you expect at a biannual dental checkup? The dentist will check your child’s teeth and gums. There will also be a dental cleaning to remove the buildup of plaque (a sticky film of bacteria that coats teeth). At certain visits, X-rays may be taken of your child’s teeth. If you have trouble finding a dentist or scheduling an appointment, you can call the number on the back of your Presbyterian Health Plan member ID card. NeuroFlow is a digital tool that connects you to health information, self-guided exercises, tailored resources, and support services. It’s offered through Presbyterian Health Plan (PHP). NeuroFlow is available at no cost and is easy to use. Eligible PHP members can use it online or by mobile phone app. NeuroFlow users will be able to: Presbyterian Health Plan’s digital wellness tool Take charge of your health and well-being with NeuroFlow Get started with NeuroFlow today! Visit neuroflow.app.link/PHP123 or use the QR code to the right to sign up for NeuroFlow. For assistance with signing up or if you have questions, please email NeuroFlow at support@neuroflow.com or call 1-855-296-7711. Receive customized health content. Topics include healthy living, emotional well-being and mental health, recommended screenings, and more. Manage your overall health with personalized wellness journeys on topics such as: • Mental health • Lifelong health and wellness • Women’s health • Pregnancy • Chronic conditions • Smoking cessation Track and monitor your progress and health patterns in focus areas like: • Mood • Sleep • Stress • Pain Achieve your goals and feel your best through daily tools and activities.
4 Virtual maternity care with Ouma Health To schedule your first virtual visit with Ouma Health, have your Presbyterian Health Plan member ID card handy and visit www.ouma.me/phs. Presbyterian Health Plan (PHP) has partnered with Ouma Health. We’re determined to make it easy for you to get virtual, highquality, focused maternity care wherever you are in New Mexico. Ouma’s providers work directly with your in-person provider as a member of your care team. They provide support and guidance throughout your pregnancy. Ouma has appointments available in 200-plus languages. When needed, Ouma can monitor your pregnancy progress remotely using 3G cellular-enabled devices from Marani Health. They can check on your weight, blood pressure, and blood sugar. Presbyterian Turquoise Care members can have virtual visits during pregnancy or up to one year postpartum for: Prenatal care. Get your pregnancy off to a healthy start with a prenatal visit in the first trimester. Or use the prenatal safety net to access maternity specialists throughout your pregnancy. Never miss a visit due to transportation issues or bad weather. Postpartum care visit. Stay connected to a provider after you deliver. The most common postpartum problems are mental health conditions, heart conditions, bleeding, and infection. Having virtual visits can help find issues early. Ouma supports you during this exciting but often challenging time. Lactation services. Visit with a board-certified lactation consultant. They will help with your breastfeeding and pumping concerns. Behavioral health. Get screened for mood disorders during and after pregnancy. They can help with anxiety, depression, obsessivecompulsive disorder, and more. Tailored treatment may include therapy and medication management by specialized providers. Appointments are typically available within one to three days. Substance use program. Start your recovery journey with a caring and customized approach. Your plan may include medication, counseling, and regular virtual check‑ins.
www.phs.org/Medicaid 5 The “Food as Medicine” benefit is now offered in New Mexico to pregnant Medicaid members with diabetes (Type 1, Type 2, and gestational). The program offers healthy meals to support well-being during and after pregnancy. Presbyterian Health Plan aims to address food insecurity and diet-related diseases during pregnancy. Focusing on your health during pregnancy is crucial for the wellbeing of both you and your baby. Uncontrolled diabetes during pregnancy can lead to complications for both mom and baby. Uncontrolled diabetes during pregnancy increases the risk of: • Preeclampsia, or high blood pressure • Needing a cesarean section • Potential worsening of existing diabetes-related complications, like eye or kidney problems Babies are at risk of: • Developing birth defects • Being born larger than average • Having low blood sugar and breathing problems • Jaundice, which is excess bilirubin that causes yellowing of the skin and eyes All these risks to babies increase the chance of hospitalization after birth. Give your baby the best start with the Food as Medicine benefit Uncontrolled diabetes puts both mom and baby at extra risk of obesity and Type 2 diabetes later in life. Managing diabetes through diet, exercise, and prescribed medications is vital to lessen the risks and ensure a healthy pregnancy, delivery, and baby. The Food as Medicine benefit will provide: • Home-delivered meals that are healthy, tasty, and ready to heat • Grocery boxes that include food you can use to prepare your own meals (as availability allows) Presbyterian Health Plan offers this benefit to Turquoise Care members. Members who qualify must enroll during pregnancy. They are eligible for up to two months postpartum. Speak to your provider for a Food as Medicine referral. Talk with them for more information on diabetes during pregnancy, risk factors, and prevention. If you have questions, please call the Presbyterian Customer Service Center at the number on the back of your member ID card. We’ll help you make appointments, get transportation to provider visits, and have 24/7 access to a PresRN phone advice line. Available to Turquoise Care members. I’M DETERMINED TO STAY STRONG AND HEALTHY FOR MY BABY.
6 Speak with a Presbyterian nurse at any time You have access to PresRN, a nurse advice line, 24 hours a day, seven days a week, even on holidays. PresRN is an easy way to speak with a Presbyterian nurse if you are not feeling well and need advice or just have a general health question. A PresRN nurse will help you and your family, whether you require a trip to the emergency room or urgent care, a virtual visit with a provider, or self-care at home. The best part is, all you need is a phone. Presbyterian nurses are happy to answer any questions. Please call even if you are healthy but need some advice. As part of your Presbyterian healthcare team, we let your provider, care coordinator, and health coach know of your health concern so that you will have continued care and follow-up. We are here when you need answers! Start breast cancer screening at 40 Breast cancer is one of the most common cancers among women. Regular screenings can help detect breast cancer early, when it is most treatable. Catching breast cancer early can make a big difference in outcomes and survival rates. How screenings work A mammogram is the most common breast cancer screening. This X-ray procedure is used to detect issues in breast tissue. Mammograms are so effective that they can detect breast cancer before you have symptoms. They can even see breast changes or lumps that are too small to feel. When you get regular screening mammograms, your healthcare provider can track changes in your breast tissue over time. This helps with early detection and gives you more treatment options and better health outcomes. According to the latest recommendations from healthcare professionals, women should begin breast cancer screenings at age 40. They should also continue screenings at least once every two years. This change highlights the importance of regular screening and early detection. Call PresRN at (505) 923-5677 in Albuquerque or toll-free at 1-888-730-2300. If you are having a medical emergency, please call 911. Why early detection matters Rewards for you Did you know that Turquoise Care offers an incentive for completing breast cancer screenings? Members who complete their breast cancer screening will receive 150 points — a $15 value — as part of the Turquoise Care Rewards program. These points can be redeemed for various items. For more information on Turquoise Care Rewards, visit www.turquoiserewards.com. For more information or to schedule your breast cancer screening, please contact your healthcare provider.
www.phs.org/Medicaid 7 4. Add a source of lean protein to each meal. Protein helps you feel full. It also slows down blood sugar spikes and reduces sugar cravings. Lean protein sources include eggs, fish, chicken, turkey, beans, tofu, lentils, Greek yogurt, and low-fat cottage cheese. 1. Move your body. Exercise is a great way to keep your blood sugar down, even when enjoying holiday foods. Try walking, biking, stretching, weightlifting, or yoga. 3. Add some fiber to your plate. Fiber helps you feel full. It can help lower cholesterol and aid weight loss. Try adding more salads, roasted vegetables, nuts, seeds, and whole grains to your meals. 5. Avoid skipping meals. Ditch the mentality that you need to save up all your food for one meal. This can lead to overeating, high blood sugar, and heartburn. Instead, have protein- and fiber-rich meals throughout the day, before the main holiday meals. Living well during the holiday season You can get more ideas for healthy eating when you join the Path for Wellness Prevention Program. This program offers healthy weight management and diabetes prevention to eligible Presbyterian Turquoise Care members at no additional cost. It is designed to help members: • Build healthy habits • Lose or manage weight • Be more active • Reduce their risk of Type 2 diabetes It’s easy and fun to participate! The program is available online or by phone. The classes are also available in Spanish. 2. Stay hydrated. Consuming 16 ounces of water prior to eating can help you eat less, feel full, and lose weight. Limit holiday drinks. Avoid ones that may have sugar, such as punch, eggnog, sweet wine, or mixed cocktails. Managing your health and wellness during the holidays can be stressful. When you add in travel, holiday meals, extra desserts, time change, and bad weather, it can become overwhelming. Here are five tips for enjoying the holidays and staying on track. To learn more about the program and get more information about how to sign up: • Visit www.phs.org/preventionprogram. • Call 1-855-249-8587.
8 Important tests to get When you have diabetes, it’s recommended to get these tests regularly: A1C test every three months. This test shows your average blood sugar level over the past few months. It helps your provider see how well your diabetes is managed. Kidney tests once a year. Diabetes can hurt your kidneys. A simple blood and urine test can show how well your kidneys are working. Eye exam once a year. Diabetes can affect your eyes. A special eye doctor can check for early signs of damage before you notice any changes. Foot check every visit. Diabetes can make it harder to feel pain in your feet. Your provider should check your feet for cuts, sores, or other problems. Cholesterol and blood pressure checks. Keep these levels in a healthy range to help protect your heart and blood vessels. Diabetes care and recommended tests Living with diabetes means taking care of your body every day. Planning ahead and staying on top of your health can help you feel better and avoid serious problems later. Healthy habits matter too! Along with regular testing, healthy daily habits can keep you feeling your best. • Check your blood sugar as often as your provider recommends. • Take your medication every day. • Eat healthy foods. • Stay active with fun exercises. • Don’t smoke or vape. • Limit sugary drinks and alcohol. Make a plan Keep a list or calendar of when your next tests are due to help you stay on track. Bring questions to your provider and talk about how you can stay healthy year‑round. For more tips, visit www.diabetes.org or ask your healthcare team. Taking small steps today can make a big difference tomorrow. PLAN AHEAD
www.phs.org/Medicaid 9 Presbyterian Health Plan’s Ombudsman Program helps members learn how their insurance works and get the care they may need. How the ombudsman (awm-budz-muhn) can help members: • Aid them with issues or problems (before they go through the grievance or appeal process) • Assist with learning about Presbyterian Health Plan • Help with referrals and resources • Refer or recommend members to care coordination • Teach members about their rights under Turquoise Care What is an ombudsman? An ombudsman is someone who looks into problems and helps to resolve them. They do this without taking anyone’s side. What is the role of the ombudsman? The Presbyterian Turquoise Care ombudsman works for the member to help with member issues through advocacy, support, and research. When should the ombudsman be contacted? Members can contact the ombudsman if they’re having a problem with getting the care they may need or have questions about their care. How can the ombudsman help me? The ombudsman works for the member on issues and is not part of the grievance or appeal process. They work with the member to guide them through the processes. The ombudsman works with the care team to be a voice — to talk about the member’s needs. What does an ombudsman not do? The ombudsman does not take the place of established processes, such as appeals or grievances. The ombudsman will not make final decisions about the member’s care. To reach the Turquoise Care ombudsman: • Phone: (505) 923-5780 • Fax: (505) 923-8159 • Email: ombudsman@phs.org • Address: Presbyterian Health Plan 9521 San Mateo Blvd. NE Albuquerque, NM 87113 Communication is important to you and to us. That’s why we offer translation services if you need them. We want to make sure you have the information in the language or format you use so you can take charge of your own healthcare. We have bilingual staff and certified translator services, if you want to use these services. These services are available to help you talk with providers, nurses, and caregivers; learn about your health plan; and much more. Our translation and interpreter services include: • Language translation • Written materials translation •Telephonic interpreters • In-person interpreters •American Sign Language interpreters •Video remote interpreters It’s easy to request these services. Call the Presbyterian Customer Service Center at the number on your Presbyterian member ID card. Our ombudsman is here to help Presbyterian’s translation and interpretation services
10 The flu and RSV — why it’s important to get vaccinated Getting vaccinated against RSV (respiratory syncytial virus) and the flu (influenza virus) is very important. When you get vaccinated, you are less likely to get sick from diseases like RSV and the flu. About RSV RSV is a virus that can cause lung infections. It is especially risky for babies, older adults, and people with weak immune systems. Getting the RSV vaccine can help protect you from this virus. It helps your body recognize and fight the virus if you come into contact with it. The RSV vaccine is important for babies and older adults. Here are some guidelines for those who should get the vaccine. Pregnant people. An RSV vaccine is recommended for mothers during pregnancy to protect their baby from getting RSV. Babies. The RSV vaccine is recommended for babies, especially those born early or with health issues. Talk to your pediatrician for more information. Older adults. People 75 and older should consider getting the RSV vaccine, especially if they have health problems. Others at risk. Adults 60 to 74 years of age who have a weak immune system, lung or heart problems, certain medical conditions, or who live in a nursing home should talk to their provider about the RSV vaccine. Only a single dose of the RSV vaccine is needed. It is not needed annually. About the flu The flu is a virus that can cause fever, cough, body aches, and other symptoms. The flu can be very dangerous for some people. Babies, older adults, and those with health problems are at higher risk. The flu vaccine helps your body fight the flu virus and can prevent you from getting really sick. • Everyone over 6 months old should get the flu vaccine every year. • Pregnant women should get the flu vaccine to protect themselves and their babies. • Older adults are strongly encouraged to get vaccinated, because they are at higher risk of complications. • People with health problems like asthma, diabetes, or heart disease should consider getting the flu vaccine.
www.phs.org/Medicaid 11 Paperless delivery available for people 14 years old and older Did you know electronic delivery (e-delivery) is available to people as young as 14 years old? This means they can get email notices when important health plan or medical documents are ready. This makes it easier, faster, and more secure for you to stay up to date with your healthcare. Don’t have a myPRES account? Signing up is easy. Go to www.phs.org/myPRES to create a user ID and password. Please make sure you have an active email address. Already have a myPRES account? Make sure your email address on the “Contact Information” page is correct and has been verified. This will make sure you don’t miss any notifications. Review the Joint Notice of Privacy Practices It’s important to understand how medical information about you may be used and disclosed. We want to make sure you know how you can access this information. Review Presbyterian Health Plan’s Joint Notice of Privacy Practices. Visit www.phs.org/privacy-security#. On the “Privacy & Security” page, select the link for “Joint Notice of Privacy Practices for Presbyterian Healthcare Services.” You can also find it in the back of your member handbook. Keep these numbers handy The Presbyterian Customer Service Center (PCSC) is available for members Monday through Friday, 8 a.m. to 6 p.m. Members can reach the PCSC at the following numbers: (505) 923-5200 or 1-888-977‑2333, TTY: 711 Children in State Custody: (505) 923‑8417 or 1-844-233‑4887, TTY: 711 Navajo/Diné members: (505) 923‑5157 or 1-888-806‑8793, TTY: 711 Other important numbers PresRN: (505) 923‑5677 or 1-888-730‑2300, TTY: 711 New Mexico Crisis and Access Line (for a behavioral health crisis): 1-855-662‑7474 (1-855-NMCRISIS) 988 Suicide & Crisis Lifeline (available 24/7): 988 or 1-800-273‑8255 Presbyterian Turquoise Care Ombudsman: Phone: (505) 923‑5780 Email: ombudsman@phs.org Modivcare Transportation Services (24 hours a day, seven days a week) — you can call at any time for a reservation or for dischargerelated requests: (505) 923‑6300 or 1-855-774‑7737 How to start receiving email notifications: • Log in to your myPRES account. • Select your account drop-down menu in the upper right of the page, and select “My Account.” • Select “Communication Preferences” to set or change your delivery and language preferences. We continue to make more documents available online. Don’t miss out — sign up today.
Yourstory Your Story is published for members of Presbyterian Health Plan, Inc., and Presbyterian Insurance Company, Inc. P.O. Box 27489, Albuquerque, NM 87125-7489 www.phs.org Managing editor: fluentqc@phs.org Information in Your Story comes from a wide range of medical experts. Models may be used in photos and illustrations. If you have any concerns or questions about specific content that may affect your health, please contact your healthcare provider. Such services are funded in part with the State of New Mexico. Presbyterian complies with civil rights laws and does not discriminate on the basis of protected status including but not limited to race, color, national origin, age, disability, or sexual orientation or gender expression. Free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. Call 1-855-592-7737 (TTY: 711) or speak to your provider. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. También están disponibles de forma gratuita ayuda y servicios auxiliares apropiados para proporcionar información en formatos accesibles. Llame al 1-855-592-7737 (TTY: 711) o hable con su proveedor. SHOOH: Diné bee yáníłti’gogo, saad bee aná’awo’ bee áka’anída’awo’ít’áá jiik’eh ná hóló̜. Bee ahił hane’go bee nida’anishí t’áá ákodaat’éhígíí dóó bee áka’anída’wo’í áko bee baa hane’í bee hadadilyaa bich’į’ ahoot’i’ígíí éí t’áá jiik’eh hóló̜. Kohjį’ 1-855-592-7737 (TTY: 711) hodíilnih doodago nika’análwo’í bich’į’ hanidziih. For more information, visit www.phs.org/nondiscrimination. 2025 © Coffey Communications, Inc. All rights reserved. MPC082509 Medicaid #TC7223 Like us on Facebook: Facebook.com/PresHealth Makes 4 servings. Ingredients 2 boxes (16 ounces each) frozen pureed winter (butternut) squash 2 medium apples (try Golden Delicious or Gala) 1 tablespoon olive oil ½ teaspoon pumpkin pie spice 2 cans (12 ounces each) fat-free evaporated milk ¼ teaspoon salt ⅛ teaspoon ground black pepper Directions • Place the frozen squash in a microwave-safe dish. Cover loosely. Defrost in the microwave on medium power for 5 to 10 minutes, until mostly thawed. • Meanwhile, peel then shred the apples using a grater or food processor, or peel and finely chop apples into thin strips. Set aside ¼ cup. • Warm oil in a 4-quart saucepan over medium heat. Add all but ¼ cup of the apples. Cook and stir until apples soften, about 5 minutes. • Stir in thawed squash and pumpkin pie spice. • Add the evaporated milk about ½ cup at a time, stirring after each addition. • Season with salt and pepper. • Cook and stir over high heat just until soup is about to boil. • Ladle into individual soup bowls. • Top each with a tablespoon of the unused apples. Sprinkle with additional pumpkin pie spice, if desired. Tip: For chunkier soup, try two bags (14 ounces each) frozen diced butternut squash. Or cut a fresh butternut squash into small chunks, and place in a microwave-safe dish covered with 1 inch of water. Microwave on high for 5 to 10 minutes or until squash is tender and can be easily pierced with a fork. Remove skin. Place squash in blender, and blend to desired consistency. Nutrition information Serving size: 1½ cups. Amount per serving: 334 calories, 4g total fat (1g saturated fat), 7mg cholesterol, 62g carbohydrates, 18g protein, 5g dietary fiber, 370mg sodium, 1,142mg potassium. Source: U.S. Department of Health and Human Services with shredded apples squash soup CREAMY
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