So I got a call from my insurance today from a "case manager". She asked a lot of questions about my diagnosis, doctors and prescriptions as well as how my daily living is affected. She also offered to help me manage my prescriptions and told me some other useful information. She said she will call me once a month and I can contact her anytime. Apparently they have noticed my great multitude of drs, prescriptiions and procedures. She was very informed on autoimmune and helpful so it would be nice to have access to someone like that.
What do you think? Is this a good or a bad thing?
I receive calls every few months from an RN associated with my insurance company. She is very helpful, but sometimes I worry that I will say something that can be used against me. Anxious to see what others say.
I know it could be bad if you are not doing what they think you should be doing in order to take care of yourself.
Over the last six years, I have received 2 phone calls/year from a case manager from my insurance company.
It is always a different person, and frankly, I tire of explaining my "case" each time when I know information is available to them.
Usually, I end up listening respectfully, answering the questions I want to, and explaining that I had a long career as an RN and am currently comfortable managing my own care. A few times, I have learned something new.
I think these calls are an attempt at cost-controlling by the insurance company, and I understand the need for that.
Turned 65 in August, have Medicare now, so they are secondary. Hope there are no more calls:)
A few weeks ago I was told by someone connected to my insurance that I needed to call a number and ask for a case worker, because they can help more by hearing concerns, making sure I am getting full use of my benefits, and they can get me and my husband in touch with specialists we need.
I hope this helps.
susanep :)
I was admitted to the hospital on September 12th, on the 13th, my new Case Manager called me in my room at the hospital. She told me she would follow up when I was discharged and she has called several times since I was released. Asked LOTS of questions about my condition and current treatment, as well as plans for further tests and referrals. Then she asked if I would like to be referred to the "Compassionate Care Program". I did not like the sound of that at all, and told her I did not think so. She said she just wanted me to know it was available "when" I need it. I finally found our plan description, and it is for patients with 12 months or less to live!! I think NOT! It seems like Case Managers turn up whenever I have a major flare or an admission to the hospital. They seem very helpful, but I also worry if something I tell them could come back to haunt me. It's hard to tell.
My sisters insurance had one call her too. They told her about a class called "Living Well With Chronic Illness". She went to it and learned quite a bit. I got the number for the person who put it on and called to see if there was one in my area. At the time there was not. About a month ago they called to let me know they are going to do one here. I go on Thursday.
Well it sounds like this is a positive thing. I have thought before that it would be nice to have some help with this mess - too many doctors and too many medications to keep track of. She is the one that will always call and it will be monthly. She did ask me if I have a living will and do not resuscitate order - LOL! Everyone always thinks I am going to keel over - they underestimate my ornery determination to keep trudging along!
That is some one who is paid to make false reports to the insurance company so they can cut you off.
Get a copy of every thing they send to the insurance company and cross check it with your doctor for accuracy.
Joe - I don't believe that to always be the case. The one who calls my sister has helped her in many ways. I think sometimes we tend to be over suspicious.
I am just saying, be careful. I ran into one that did just what I said.
Interesting, and it's good for you folks to post your experience. So many times we are on a "list" and don't know it. We may not even know such a "list exists." I worked for an insurance company for 4 years about 15 years ago. We had a "medical services RN" who would work with things that fell outside the norm and were hard to be decided. Sometimes a decision would be made and then the patient might fight the decision. Often, people who resisted and put their case together won and the bill would be paid. It might have been a case of good information gathered by the patient.
It has been awhile ago and they change names of departments all the time and what was a Medical Services nurse a long time ago could be a gunnery squad now. (kidding) I do believe that some people could be helped and your case comes to the manager because of your diseases, or costs, things that stand out. Perhaps they can help and we all know what it's like to find information when no one will cooperate.
Like Joe S. though, I would be leary of this type of "help." You might want to call the hospital for patient advocacy or something like that for information. I wonder sometimes even about the religious contacts at the hospitals and how they might help people. Thanks for posting this on here, everyone. Lucy
Yes, these are some very good thoughts - thank you all.
I feel cautiously optimistic.
Hello Patty:
I've had a great deal of experience with LTD and disability insurance companies and in my humble opinion, I don't share the same perspective as some of the previous posters.
The first thing I would say is to be aware that Case Managers are not your friend. They will often take a sympathetic approach to try and obtain the most amount of information that they can from you in order to later use it to try and expose the chinks in your claim. Remember, the insurance co is in the business to make money not pay out claims. Please know that when you have a conversation with your case manager on the phone, everything you say is being logged and noted in a way that benefits the insurance company. If you have to eventually go to court, you would have a he said/she said situation and even if your words had been completely distorted, you would not be able to refute the insurance co's story since you have no proof and they do because they have "logged" your conversations. So you would want to be very aware of what is being said at all times and if possible, do not have phone conversations with your insurance company at all. Have them send any questions to you in writing and respond in kind. That way you have proof to present a judge if need be should a dispute arise.
Also I would strongly suggest that you get a copy of your disability insurance plan or policy (the master plan document) asap which is attainable from your work's HR if it is a group plan or directly from your insurance co if it is a private policy. Read it thoroughly as all of your obligations to the insurance co are listed therein in order to continue to receive benefits. Each plan or policy is different and you need to know what the rules and obligations are in yours.
Best of luck,
Daisy
Yes, my experience with a short term disability was the same as Daisy and Joe stated. (Yes, I'm your friend. Oh, I feel so sorry for you. Oh, that's terrible.) Baloney!! >:(
What I told her and what she reported were two different things. When they were going to decline my claim based on what I said (supposedly) and I told them that was incorrect. They didn't care...Too bad, it's declined and you'll have to file an appeal.
So now, no money. Having to use an attorney and give him a third of what I collect. (I'm not SS so there is no limit to what an attorney can charge me.)
All I can say is be careful. I don't intend to talk to them again. As Daisy said, they can write and ask any questions they have.
Good Luck Everyone,
Shade
The last 3 posters have stated something that also applies to your employer and their HR Department. When you have problems, HR to the rescue and that couldn't be further from the truth. They work for the MAN, not you and their interest is in keeping the MAN happy.
That's why we often urge people who have SJS or other issues to keep quiet at work and not spill their anxieties to friends, co-workers. It all comes back to bite you. In the case of Co-managers at the insurance company, it sounds like the same. Beware.
Hi
I'm not sure if I'm understanding this thread...
Is this about health insurance, or disability insurance ???
Are you saying that the health insurance has some case workers that may contact someone if the person is "using the insurance too much"?
That sounds scary guys.
Hey guys, does your insurance has a lifetime benefit limit? One day I was looking into the one I get through my hsuband's work...I can't remember how much, but it was something about lifetime benefits, some number $$$ I can't recall. Then I got thinking about it...
Monica
My post is about health insurance not disability insurance. I haven't worked in almost 2 years. When I was working, I was careful not to talk about my health, even when I had to take FMLA. Likewise, we do not discuss it with my husband's co-workers since I am on his insurance.
what it means is tread lighty when you talk to her or him,,they record everything,, and arent afraid to use anything you say against you,,but on a happier note,, at least yours call,, mine say i;ll call you the next day,, she called three weeks later and told me that she is seeking a psych referral,, i told my ID doctor about it,, she called teh case manager and told her to back thehell off,, this man has some serious problems and teh last thing he needs is you telling him he needs psych help right now,,
Ok - big distinction between Disability and Medical insurance. In disability, let me assure you the Case Manager is NOT your friend - as others have stated, your statements may be taken down and used against you if the insurer chooses to.
In medical insurance, it may well be that the Case Manager really is there to help you, or not. Why don't you ask them? I would do this by asking them to send you a statement about how the information you discuss with the Case Manager is used? Does it go into the claims related information, and does it have any effect on your premiums?
In some cases, the Case Manager really is there to help. For example, let's say that you've got a disease that is helped by taking a hot bath every day (silly, but just an example). It's really cost effective for them to educate everyone with that disease, so that at least some people will take a hot bath, and reduce the number of times they need a doctor or a costly medicine. Similarly, it's really helpful for them to help coordinate your care so that you don't end up going to a lot of different doctors to look at the same problem. So it's there to help you, but, in the background, they are hoping to reduce costs.
On the OTHER hand, sometimes the Case Manager is really investigating whether you are really as sick as you say you are, and whether you really need all the visits, treatments, drugs etc. And there is no easy way to tell the difference. So that's why asking them for a statement as to how they use the information that they collect is very important.
Good luck
Has anyone else had an RN call them? One from the insurance company?
Yes. Okay, here is the insurance part of my story. After about two years with Fibro, multiple spinal injuries and severe migraines the insurance company assigned an RN "case worker" to monitor my case and help me get off the insurance company roles. In short succession I was forced into an appointment with an adverse chiropractor and an adverse neurologist. The chiro said there was nothing wrong. I went into his office with two canes and the aid of my wife and daughter. I came out the same way. He collected a large check for his opinion. I went in to the adverse neuro with just my wife and the QRC nurse. After the chiro, I filed legal paperwork to have copies of everything put into my file at the insurance company. What the nurse said and what the neuro said were two different things. I took a copy of what she said the neuro had said back to the neuro. He told me it was common for them to lie. He took her report apart word by word as lies and sent in a copy of his report again since they had pulled his report from my file. He gave me copies for my own files and to give to my attorney he was so mad at her. You decide who she was helping. I know that it was not me.
Hi Patty,
So you're not on disability and don't plan to be?
If that's the case, then if you find the Case Manager helpful you could listen to what knowledge she has to offer. I would still tread very carefully, though. If you have specific questions then ask, but I would not volunteer anything.
The questions that she asked you are the same questions that the RN Case Manager from my disability insurance company asked me. So that causes me concern for you.
I don't know that this is the case with your insurance company, but at one time my insurance company got very involved in the medications doctors were allowed to prescribe to us...which was all about the almighty dollar, of course. And they're still doing it now. It took my psychiatrist several months to get the antidepressant she wanted to prescribe me okayed by my insurance company.
All that being said, I don't know your exact situation. Certainly, those of us dealing with filing for disability/continuing disability payments have a more sceptical view of this situation.
Wishing you the best,
Shade :)
I have one and I am sorry I do.....I posted my experience in another post. (Letters from my insurance company post)
case workers are exactly what the name implies,, now with that said,, read Joes experience with them,, read mine,, there employed by the insurance company for one reason, to see if they can save the insurance company any money,, I have got no help from mine other hten to hear her say,, no one is co-ordnating your care,,,i asked if thats soemthng she could do sinceshe was a (case Worker),, that caught her off guard and I never got a call back other then the one that said I;mgetting you a psych referral, its easier for them to send you to a shrink,, less money they have to put out,,(testing),, and its easier to toss a few antidepressents at you and hopefully you never come back looking for treatment,, expecially if you have cost thema ton of money because yo dared to get sick,, lie we asked for this train ride,,
For sure! The last time I talked to my Case Manager she sugguested a therapist for me also.....I have been on antidepressants for years for a low seratonin level...........what more do they want from me other than maybe to keel over so that I will be off their books! Too bad....I am here to stay for a long time! (At least I hope so!)
I am trying to get Social Security Disability but was laid off 2 years ago so I am not getting disability from an employer. Is that what you mean?
I got a letter today from medical insurer wanting me to sign a form "authorizing any physician, hospital, or other professional involved in my treatment to disclose my personal health information to those healthcare professionals, agencies, or payers involved in the provision of necessary healthcare services."
Hmmmmm .....
In Canada we have privacy laws that make that illegal. I am not aware of the laws in the US but I would refuse that one.
Yes, my answer to their request is "No Thanks!" It might be helpful, but I worry they will start trying to direct my care and my case is really complicated. I don't have disease markers and we need to treat based on my symptoms.
Thank you all for the valuable advice.
When your health information starts getting spread all over the place a lot of things can happen,, and most arent good,, some people or companies get ahold of this information and the next thing you know your getting emails about different antidepressents you might be interested in,, now how did they get that information, I suspet doctors share this info with vendors , call me a conspiricy buff,, but I am not above believeing that everything isnot on the up and up when it comes to our medical information,
Now, when applying for social security disibility,, you will have to have that info shared, but not with everyone,, only social security,, they send the forms to teh doctors, you sign a release, they fill them out and send them back,
its people like us that dont show markers, yet we know were sick as a dog, , we are hte people that get sent these letters so that insurance can compare everythingand make a decision that,, there is nothing wrong withthis person, and were wasting our time treating him or her for something they dont have, sothe word goes out,, and we get that call from the case manager,, we think you might benefit from some therapy,
My case is this,, Ihave stuff pouring out of my sinuses constantly,, I stilll cant eat without choking, my enat threw me under the bus andwants me to see another ENT after 4 years of being with him, when i stand up I almost fall over,, I KNOW for A FACT something is wrong with my spine,, but I cant get that point across, and now that my COBra has run out, I have a horrible insurance plan and one stay in the hospital will ruin us,, but in my case,, I suspect eventually my body will just collaspe from the compression in my spine and i;ll be in some sort of rehab for a person thats paralyzed,, all becasue I cant get my point across, I guess they will tell me to get therapy, for the love of God,, I am barely walking, and they just refuse to listen, but,, what can I do, i;m just one person,, and like all of us, we are fighting a system that is madeto gt rid of us if we start costing them to much money, thats just my take on it,