randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
i got a letter from bc/bs saying they are assigning a "case manager" to me.
i called wasn't able to get in touch with her but her message was pretty clear about her trying to reduce the number of office visits and prescription costs. you could just tell by her voice that i was considered a "high risk" and she was out to "get me". (paranoid)
this is what the letter said pretty much:
Case Management With our Case Management program, you never have to face extensive, long-term illnesses and injuries alone. Case Management is a voluntary program, provided at no additional cost to Blue Cross customers as part of their health care contract.
Benefits of Case Management A registered nurse case manager to research, assess, coordinate and monitor health care needs and provide information about community resources Specialty services for individual needs, such as complex medical conditions, burns, high-risk pregnancy, pediatrics, organ transplant, physical rehabilitation, psychiatric and substance abuse Information about using benefits effectively
WTH does coordinate and monitor mean??? i have a feeling that they are getting ready to cancel my insurance. even tho i'm pretty sure they can't because i'm a federal retiree....at least i don't think they can.
she was sort of condescending...like i was abusing the system or something.
anybody know anything about this??
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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quote:Originally posted by randibear: Case Management is a voluntary program, provided at no additional cost to Blue Cross customers as part of their health care contract.
Since bc/bs is stating that this is a voluntary program, tell them that you are not interested in participating in that service. You don't need nor want a case manager.
They're just trying to cut costs and have someone from bc/bs ration the medical services you consume. They do this under the guise of "offering bc/bs customers the services of a medical professional/RN, free of charge," yada yada yada.
Posts: 503 | From Maryland | Registered: Oct 2007
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posted
I agree. Tell them you don't want one. It's voluntary. My guess is they can't force it on you.
-------------------- sixgoofykids.blogspot.com Posts: 13449 | From Ohio | Registered: Feb 2007
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feelfit
Frequent Contributor (1K+ posts)
Member # 12770
posted
Randi,
I am also a retired Federal Employee. Tell them to take a hike. It clearly states that it is a voluntary program...they just want to poke their nose where it doesn't belong and mascarade it as kindness.
Throw the letter out. Do you pay a portion of your health ins.? I have to pay like 89 dollars a month.
feelfit
Posts: 3975 | From usa | Registered: Aug 2007
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feelfit
Frequent Contributor (1K+ posts)
Member # 12770
posted
Oh and I am fairly sure that you cannot be cancelled.
Posts: 3975 | From usa | Registered: Aug 2007
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posted
I had a case manager assigned to me - I was worried at first - but she was quite nice, said that her job was to try to help me find services etc. and she did send me some info and found me some support groups etc. - didn't do anything particularly useful but didn't do anything problematic either. I got on the case manager list from what I can tell because I had a number of visits in a short time to the emergency room but she never made me feel like they were unjustified or anything. After things settled down for me they sent me a letter saying they didn't think I needed a case manager and that was the end of it. I still needed a fair amt of medical attention and they never gave me problems with any claims. I only wanted to tell you this so you don't get too nervous about it. I don't know if others had bad experiences with it, but I really don't think it means they are going to cancel your insurance or anything drastic. Good luck to you. Ellie
Posts: 34 | From Saratoga Springs, NY | Registered: Jun 2008
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lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
I agree with Six and Fuzzy! Tell them politely that you are dealing with this without a problem and do not have a need for their services.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
i pay over 100 bucks a month, well, about 150 i think.
i just panic when i get letters like this.
mike never goes to the doctor and he didn't get one.
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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posted
And I forgot to say this...... I suppose it really goes without saying... but...
It is a huge conflict of interest for a bc/bs "case manager" to try and manage a customer's care. Since the entire motive is to cut costs for the insurance company and limit the amount of medical services the customer is consuming -- they're not going to be advocating for you in the health arena by doing this.
They will not have your bests interests at heart. They will have their employer's best interest at heart, i.e., bc/bs.
And anyway, the chances are extremely high that you know more about your illness then any case manager they might try to assign to you.
Bc/bs has canvassed customers in other regions with letters like this. Patients who don't understand the letter or intent, think they are required to use the service. That is not so. It is, as they say, voluntary.
Posts: 503 | From Maryland | Registered: Oct 2007
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feelfit
Frequent Contributor (1K+ posts)
Member # 12770
posted
no worries Randi. It is more for them than it is for you. They are trying to cut some costs.
Posts: 3975 | From usa | Registered: Aug 2007
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posted
My husband got a letter like this when he got a cancer diagnosis. We just ignored it, and I don't believe anyone ever contacted us, although we had the option of initiating contact. It didn't seem to affect his coverage.
So I wouldn't go out of my way to initiate contact with the case manager...and I agree with the advice to politely decline any services offered.
Viva
Posts: 532 | From southeast US | Registered: Oct 2005
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randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
yeah, i just finished researching this. bc/bs in new mexico had a suit filed against them because of the things the case manager did.
i think this is just the beginning to interfere with us getting treatment. pretty soon they will decide who' ill enough to see a doctor and what tests you can have done.
geez, i wish there were some magic pill to make this all go away....
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Trust your instincts here.
My advise is RUN, don't walk to the nearest exit.
Think about it... they didn't hire case managers to help YOU.
I've seen the most wicked of the wicked.... and can't believe how they have lied, how stupid they were and how they could manage to destroy someone's life with no care at all on their part.
There MAY be a good one out there somewhere...
But NOT if you have Lyme and TBD's and NOT in a world where there are SO many IDIOTS trying to prevent you from getting treatment.
posted
I have BCBS insurance and rec'd a ltr like this once before.
I was having a lot of MRI's and x-rays, then ended up having major back surgery, so I knew exactly why they wanted to "manage" me.
The nurse called me a couple of times, but I never even called her back (rude, I know, but oh well).
Finally, I called BCBS and told them that I wasn't interested. They said okay and that was it.
Nothing else ever came of it.
My advice: don't worry about it. You need your energy to concentrate on getting better.
take care -kelly
-------------------- Take care -kelly --------------- Posts: 330 | From TX | Registered: Mar 2009
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Leelee
Frequent Contributor (1K+ posts)
Member # 19112
posted
My husband got a letter like this too after his heart attack and emergency angioplasty in September 2007.
He never responded and so BC/BS started calling our house about once a week looking for him. They just wouldn't give up. Then they asked for his work or cell phone number and asked when the best time to reach him was.
Eventually they tracked him down at home. I advised him not to talk to them because, really, they aren't his doctor and I am suspicious of insurance companies. But, he spoke to them and they still call periodically. I wish he would quit talking to them.
They ask him tons of questions and I can't help but feel they are using this as ammunition to cancel our policy at some point.
He's been hospitalized three more times since the heart attack and they keep calling and he keeps talking. It's not a good thing.
-------------------- The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. Martin Luther King,Jr Posts: 1573 | From Maryland | Registered: Feb 2009
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beths
Frequent Contributor (1K+ posts)
Member # 18864
posted
I was a case mananger once..I was one of the good ones, I tried to help my patients navigate thru the maze of healthcare, and get to the right doctor and streamline treatment.
We did try to cut costs, by streamlining care, and managing small issues before they becam emergency issues.
However, that said, there are a lot out there, who just want to cut costs,
If you feel you can manage the system fine by yourself, politely decline their offer.
Posts: 1276 | From maryland | Registered: Jan 2009
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JillF
Frequent Contributor (1K+ posts)
Member # 5553
posted
after my gastric bypass bc/bs decided i needed a case manager
actually a really nice lady. she told me i'm entitled through my insurance to things like 6 free (no copay) visits to a nutritionist of my choice and reimbursement to gyms, free bicycle helmet, etc, which i did not know about
other than finding out the above, it was pretty pointless and useless. alot of questions about my recovery, etc... i was also supposed to fill out and sign something that they sent me concerning the case manager - which i did not do
she has only called twice. last conversation she said it would be about 6 mo or so before she'll call again
i would be nervous if bc/bs had given me a case manager for any other reason tbh. i don't trust insurance companies at all
bc/bs is always sending me surveys to fill out to better help them manage my health - never fill them out. too worried about them using it against me somehow/somewhere down the line
Posts: 1485 | From USA | Registered: Apr 2004
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posted
We have a case manager now for my son, and she has actually been quite helpful. That being said, I do not have the BC/BS plan that you have, I may even have the same plan as EllieP50.
She has helped me navigate through the mountains of paperwork for in-network, out of network, ER trips, inpatient hospital admissions, etc. She actually has gone so far as to (indirectly - wink, wink, nudge, nudge) suggest when to file claims and not to based on whether they will show up as a "red flag" in their account systems.
Posts: 263 | From Capital Region, NY, USA | Registered: Jun 2008
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