A Case Manager who works for a health insurer is basically a coordinator that helps coordinate medical care for people with a chronic or life changing health condition. A case manager also acts as an interface with your insurance company.
Case Managers can be an important medical ally. Case Managers can:
- Help speed decisions.
- Make decisions that make sense both for the patient and the insurance company even though the service in question is not a part of a policy. For example:
- In-home care may not be authorized in the policy. However, a case manager may be able to authorize if it is cheaper than the alternative of a hospital stay which is covered.
- A case manager could authorize additional days of nursing care at home by maxing out a home-nursing benefit before turning to hospice care.
- Act as valuable advocates. Because Case Managers are usually medically trained, they can speak with doctors and other medical personnel using the necessary terminology.
- Explain medical terms and procedures.
- Help you decide which treatment to take if there are options.
- Suggest treatments or procedures that are not in general use in your local area.
Even if you don't need help now, try to get to know your Case Manager and to turn the Case Manager into a friend. Expose yourself and your concerns to the person. Stay in touch. To learn how, see: How To Make A Friend.
Don't expect miracles. Realistically, insurer hire Case Managers to help keep costs down. Fortunately, better care for you and lower costs for the insurer can often work together.
If you don't already have a Case Manager:
- Call Member Services. Ask to be connected to the Medical Case Management Department.
- Ask for the name of a person to call should you need assistance. Tell the Case Manager your situation and ask whether he or she can provide any assistance should you need it.
- Each insurer has its own rules about who is eligible for Case Management Services. If the person with whom you speak says you aren't eligible for Case Management Services, ask for his or her supervisor and try again -- and again. It's worth the effort if you can get a "yes."
To Learn More
More InformationTalking With Your Insurance Company (Make A Friend)
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