Question:
Insurance Case Manager?
I've just gotten approval and a surgery date (last week, yay, RNY) from my insurance (Anthem BC/BS) and now this lady is calling me saying she is with my insurance and will be my Case Manager because "we want you to succeed and have all the resources you need". Now that's all well and good and I'm on board with the tone of that, but then I was sent something by my insurance to sign that I agree to be part of the Case Management Plan and how I have the right to end the plan at any time, etc. Something about this whole thing is giving me the jeebies... like this is a wolf in sheep's clothing... like this lady is going to be meddling and pushy down the line (like in a "big brother" kind of way), but I wonder if refusing it might affect my benefits or something. I need to look into it further before signing, but was wondering if anyone had any experience with "case managers" from their insurance. Thanks :o) — opheliafl (posted on February 3, 2009)
February 2, 2009
I have the same insurance, but I'm also in a long-term plan through my
surgeon. I was told by the insurance that I had to have a 6 month history
of supervised diet by a doctor, which is what I'm doing right now in order
to have my surgery in May. They haven't mentioned my having to sign with a
case manager from the insurance. The program I'm in at the hospital
requires me to regularaly check in for at least a year or two, actually as
long as I want. I'm okay with that because they will help me continue to
be successful. If you have a program at your surgeons...ask them about it.
The program director is handling everything for me...I don't even talk to
my insurance people. If you can end the plan any time you want, then I
think it's worth the risk. However, if someone else has already gone
through this and knows more...please let us know. Kathleen(Stoley)
— stoley8
February 2, 2009
I have a different insurance but went through the same scenario. It is the
gathering of data about the patients that have specific surgeries. They
can dress it up however they want to but it is collection of data. I knew
that and understood that but I didnt mind. If you think you will mnd them
calling and asking how you are feeling and how much weight you have loss,
how much and what you are eating then dont do it. My lady wasnt pushy...
she called quite a few times but she was always quite respectful. But I
knew that was what it was and since she had access to all my medical
records anyway I just went ahead with it. It is a personal choice you will
have to make. Hope this helps.
— B. Jones
February 2, 2009
— Erica Alikchihoo
February 3, 2009
My case manager is the best person to have. She takes care of any issues
with getting approvals and allof that. She can tell you what to do if you
have issues getting approved. I was sad when I reached three months post op
and her services ended.
— trible
February 3, 2009
Is this a RN or someone who helps you out with insurance issues?
— MAG
February 4, 2009
Thanks so much for your replies. It sounds like a good idea to work with
her then. She didn't state she was an RN but I assume she has at least
some medical training.
— opheliafl
February 4, 2009
My case manager is great. She just checks in to see how I am doing and if
I need anything from her. She wanted to know if I needed any extra help in
the beginning if I was getting what I was susposed to eat and drink. If I
was having any problems with pain or drainage.
— tonitoot
February 4, 2009
Hello, I actually work for an insurance company, and we also have specialty
case management that contacts our members just like this. I had surgery
done on 6/18/2008 and right from the time of approval I had a specialty
case manager assigned to me the whole time. It is almost manditory that all
Case managers who work for insurance companies to be at least RN's. Their
job is to assist with getting things done from now untill the surgery, and
then after the surgery with any questions or concerns you have and to
ensure that you received the best possible care. If you really want to look
into it, you can contact BC/BS and provide the persons name to one of their
reps and they should be able to identify that person if interal to the
company unless BC/BS uses a 3rd party company.
I would say that it is legit I get calls from people asking aobut things
like this every day, most of the time, it's just case management doing an
outreach to assist with things.
— blittlejr
February 5, 2009
I had a case manager from Anthem and she was helpful. She gave me some
suggestions and followed up with me. It didn't hurt to have another
professional checking in with me from time to time.
— SharonZ
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