Helping You with Complex Health Care Needs

Complex heath care needs may arise bringing unanticipated costs, questions about benefits or authorizations, and wondering who to turn to for safe care. Because of this, we offer a case management benefit¹ to members in this situation. We will provide individualized attention with safe, timely and cost-effective health care.

How it works:

1. Eligible members are identified based on (but not limited to) the following criteria:
   1. Complex medical care requirements²
   2. Questions about care or diagnosis
   3. Concerns about expenses incurred from a chronic/complex health condition
   4. Transition planning to new health plan¹
   5. Hospital discharge/transition planning to home
2. A Nurse Case Manager (NCM) will contact eligible members, their family and the primary and/or specialty physician within 14 days of referral. In urgent cases contact will be made within 48 hours.
3. Together, (NCM, member, member's family and provider) we will develop a plan of care and goals.

Advantages to case management

• Cost-effective quality care. The NCM will collaborate with physicians to ensure optimal health for each member.
• Patients return home faster. The NCM will help to expedite a timely case handling, which allows you to return home sooner.
• Risks of complications are reduced. Hospital-induced complications such as infection, blood clots, etc. are reduced.
• Home or hospice care benefits are managed. The NCM can coordinate your benefits, which can include purchase or rental of durable medical equipment and various types of therapy.