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

[Patty]

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?

[jazzlover]

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.

[susan]

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:)

[susanep]

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

[newtosjs]

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.

[Jozee]

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.

[Patty]

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!

[Joe S.]

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.

[Jozee]

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.

[Joe S.]

I am just saying, be careful. I ran into one that did just what I said.

[eyeamdry]

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

[Patty]

Yes, these are some very good thoughts - thank you all.

I feel cautiously optimistic. 

[Daisy1234]

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

[Shade]

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

[eyeamdry]

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.