My insurance gave me a Case Manager. What does that mean?

[skygirl]

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

[Patty]

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.

[Still in the hunt]

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,,

[warmwaters]

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

[jazzlover]

Has anyone else had an RN call them? One from the insurance company?

[Joe S.]

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.

[Shade]

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

[Diane54]

I have one and I am sorry I do.....I posted my experience in another post. (Letters from my insurance company post)

[Still in the hunt]

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,,

[Diane54]

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!)

[Patty]

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 .....

[4Kids]

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.

[Patty]

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.

[Still in the hunt]

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,