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[Health Insurance Question]
Author: Ada (---.netcarrier.net)
Date: 08-19-02 20:54
My health insurance company has evidently decided that I need a case manager. The woman I spoke to today said she is with an independent company that works with the insurance company. When she explained what her role with me would be, it seemed like a great idea. The case manager was very helpful and seemed knowledgeable, but I am a little suspicious. Anyone has any experience with this?
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[Re: Health Insurance Question]
Author: Ada (---.netcarrier.net)
Date: 08-19-02 20:55
Sorry, my fingers aren't typing very well tonight. The question I meant to ask was: Does anyone have any experience with this?
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[Re: Health Insurance Question]
Author: Sarah B--Board Moderator (---.client.attbi.com)
Date: 08-19-02 21:09
Dear Ada
When an insurance company thinks that you are going to need a lot or care or long term care or a lot of coordination in your care, they have started using case managers to help you manage your insurance needs. I know my company does this but I haven't used them myself --my company's brochure made it sound like it is mostly for people who need home health aids/care.
I'm curious to know how the case manager described her role to you.
It sounds like it will be great.
Sarah
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[Re: Health Insurance Question]
Author: Jerry Salzman (---.indy.rr.com)
Date: 08-19-02 23:22
Ada,
I have one from my HMO. It is the same person who I worked with 1 1/2 ago when I had weight loss surgery. Basically it is someone to send the paperwork to, get it all processed, and then seek approval. WHat really helps is you have a name to call when it's been awhile and you want to know what is going on. One thing though is the case manager is part of the Care Management Organization which is part of the HMO. For me it is not a seperate company.
Jerry
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[Re: Health Insurance Question]
Author: Lisa Salberg (---.dyn.optonline.net)
Date: 08-20-02 07:18
Hello,
This is one aspect of "managed" care that really does seem to work. A case manager is given to an insured person when either the diagnosis or large bills are beyond the ability of a general claims processer. Having a case manager can be nice as you do have one single point of contact, they normally tend to work as your advocate with the insurance company. Most all of my experience with case managers has been positive. I did have one case with one of my employees about 5-7 years ago where the man who was assigned to be the "case manager" thought he was the doctor and kept attempting to alter the treatment course, what was odd about that case was he was going out of his way to be "helpful" yet he did greatly interfere with the patient/doctor relationship. If you think your case manager is getting "too involved" then ask to speak to his/her manager.
I have had more than 20 cases in management in 14 years and only one was a bad experience the rest were very possitive.
Lisa
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[Re: Health Insurance Question]
Author: Julie (216.181.113.---)
Date: 08-22-02 12:06
Ada,
I was assigned a case manager after I received my ICD. She was an independant consultant hired by my insurance company. She explained that she would attempt to help me coordinate my care, deal with billing issues (if any), help me with any questions, problems, issues I had with my HCM.
I was skeptical at first, but realized that she was not trying to change or alter my care in any way.
She and I actually decided that we would close my case, as I was doing fine post-surgery. She did help with some billing issues though.
In all, I would go for it. I don't think you have anything to lose.
Julie
Author: Ada (---.netcarrier.net)
Date: 08-19-02 20:54
My health insurance company has evidently decided that I need a case manager. The woman I spoke to today said she is with an independent company that works with the insurance company. When she explained what her role with me would be, it seemed like a great idea. The case manager was very helpful and seemed knowledgeable, but I am a little suspicious. Anyone has any experience with this?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: Health Insurance Question]
Author: Ada (---.netcarrier.net)
Date: 08-19-02 20:55
Sorry, my fingers aren't typing very well tonight. The question I meant to ask was: Does anyone have any experience with this?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: Health Insurance Question]
Author: Sarah B--Board Moderator (---.client.attbi.com)
Date: 08-19-02 21:09
Dear Ada
When an insurance company thinks that you are going to need a lot or care or long term care or a lot of coordination in your care, they have started using case managers to help you manage your insurance needs. I know my company does this but I haven't used them myself --my company's brochure made it sound like it is mostly for people who need home health aids/care.
I'm curious to know how the case manager described her role to you.
It sounds like it will be great.
Sarah
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: Health Insurance Question]
Author: Jerry Salzman (---.indy.rr.com)
Date: 08-19-02 23:22
Ada,
I have one from my HMO. It is the same person who I worked with 1 1/2 ago when I had weight loss surgery. Basically it is someone to send the paperwork to, get it all processed, and then seek approval. WHat really helps is you have a name to call when it's been awhile and you want to know what is going on. One thing though is the case manager is part of the Care Management Organization which is part of the HMO. For me it is not a seperate company.
Jerry
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: Health Insurance Question]
Author: Lisa Salberg (---.dyn.optonline.net)
Date: 08-20-02 07:18
Hello,
This is one aspect of "managed" care that really does seem to work. A case manager is given to an insured person when either the diagnosis or large bills are beyond the ability of a general claims processer. Having a case manager can be nice as you do have one single point of contact, they normally tend to work as your advocate with the insurance company. Most all of my experience with case managers has been positive. I did have one case with one of my employees about 5-7 years ago where the man who was assigned to be the "case manager" thought he was the doctor and kept attempting to alter the treatment course, what was odd about that case was he was going out of his way to be "helpful" yet he did greatly interfere with the patient/doctor relationship. If you think your case manager is getting "too involved" then ask to speak to his/her manager.
I have had more than 20 cases in management in 14 years and only one was a bad experience the rest were very possitive.
Lisa
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: Health Insurance Question]
Author: Julie (216.181.113.---)
Date: 08-22-02 12:06
Ada,
I was assigned a case manager after I received my ICD. She was an independant consultant hired by my insurance company. She explained that she would attempt to help me coordinate my care, deal with billing issues (if any), help me with any questions, problems, issues I had with my HCM.
I was skeptical at first, but realized that she was not trying to change or alter my care in any way.
She and I actually decided that we would close my case, as I was doing fine post-surgery. She did help with some billing issues though.
In all, I would go for it. I don't think you have anything to lose.
Julie
