Call From A Registered Nurse Case Manager With Insurance Company?

Post past **slapfish** » Mon May 22, 2017 12:30 am

Hello all,

We recently brought my son in to the hospital for some testing that required overnight admission. Fortunately, he came back with a clean bill of wellness, and while I'k a bit bellyaching that we'll need to come out of pocket for some amount, we at to the lowest degree take striking our deductible for this yr already and are but on the hook for 10% coinsurance now.

Within the by calendar week, both my wife and I have been contacted by a "case managing director" for our insurance visitor, asking about how she can assist, arranging for second opinions, and offer resource and to assistance us "better understand our benefits". Of course, we didn't inquire for any of this, and I'm a bit skeptical almost the motivations for an insurance visitor to have these folks on their payroll (I've never encountered any such offers before, and with the exception of one ambulatory surgical process about 10 years ago, I've never had much in the way of medical bills until this year).

Does this basically amount to a sales pitch on the part of the insurance company? Have any of you always worked with such a person and gotten any do good from it?

Mon May 22, 2017 1:50 am

I had major surgery at a earth renowned hospital. Since I have a multitude of medical problems, the infirmary had residents specializing in every condition that I suffer from examine me. None of these examinations were relevant to the surgery that I had. The hospital billed me for nearly $44,000 for those unnecessary examinations. My insurance company went to bat for me and eventually had the charges dropped. My example manager went the extra mile to resolve the trouble.

DMW

Postal service past **dm200** » Mon May 22, 2017 8:21 am

On the one mitt, you lot and your insurance company have competing interests: Yous want them to pay for everything and they want to pay as niggling as possible.

On the other mitt, you and the insurance company take the same interests: lower cost and/or unnecessary tests and "treatments" may be very skillful for y'all both.

Post by **livesoft** » Mon May 22, 2017 8:28 am

Ask your Case Manager to send you their blurb that summarizes the contained studies that bear witness that Case Managers lead to better outcomes for patients. Or use the internet to find those and read them.

Post by **Rupert** » Monday May 22, 2017 nine:46 am

I think most insurance companies accept these sorts of people (some telephone call them example managers; some call them other things) for certain sorts of medical situations. Assigning a case manager to you lot is typical, for instance, during pregnancy and if you accept a chronic status such equally diabetes. With respect to the chronic weather category, the example managing director's task is to make sure you lot follow your treatment regimen, which saves the insurance visitor money over the long term. In my experience, the case managers typically don't get involved in claims payment matters.

Post past **BolderBoy** » Mon May 22, 2017 10:xxx am

slapfish wrote:Does this basically corporeality to a sales pitch on the part of the insurance company? Accept whatever of you e'er worked with such a person and gotten any benefit from it?

Perhaps I'yard being naive, but the several insurance company example managers whom I've known have all indicated that 1) they work for the insurance visitor 1st and 2) they endeavour to keep an eye on costs (avoiding duplication of services such equally MRI at hospital #1, transferred to infirmary #2, etc) while assuring that the patient doesn't suffer a reduction in care quality.

Some of these case managers were RNs and others were not.

Mon May 22, 2017 ten:56 am

Perspective may be everything... your son is AOK, that's all that is important. If at that place are some charges that are in accordance with your insurance in that location is nothing to be annoyed nearly, your son is AOK.

I recently had a hip redone and lots of folks contacted me afterward I got domicile from home nurses and physical therapists to hospital folks to follow up on my recovery and meet if I needed anything. Get with the flow, your son is AOK, the rest is only part of life.

My wife was recently in the Emergency Room for a bad reaction to a couple of bug bites. We spent the night there while the meds took effect to make certain they had things well controlled earlier releasing her. I'm simply glad she's OK and am thankful I have insurance that takes care of most of information technology. I'yard not annoyed at all past the charges and glad I have insurance that handled most of it and that she is OK. She was contacted by the hospital afterwards to follow upwards too.

Mail past **Kenkat** » Mon May 22, 2017 11:14 am

I was in the infirmary earlier this year with blood clots; luckily I was only at that place for ii days. I got a call from a United Healthcare case managing director and the impression I got was that they wanted to exist sure yous had a plan for any follow up care needed - medications, doctors, etc. I recollect at that place are a lot of people that don't make the follow upward appointments, don't take the medication, etc. and finish up dorsum in the hospital which drives upward costs.

Mon May 22, 2017 11:sixteen am

Unfortunately my son has serious medical problems which accept resulted in a few hospital stays. We've had a few calls from these case managers associated with insurance and we politely decline their aid. We are vigilant in our intendance for him and are well informed on what will and will not help his condition. You would be surprised by the number of people who are ignorant and could improve their overall health with a handful of knowledge and resources. I hope the case workers tin reach these people but I'm skeptical the service saves coin or improves overall health.

Post by **slapfish** » Mon May 22, 2017 11:54 pm

Thanks everyone, you've given me some things to think about. it would make sense that the insurance company is incentivized to follow upwards on inpatient cases, even if just for observation, to make sure that post-discharge care is satisfactory and whatsoever instructions are being followed...much cheaper for them than a re-admission if the patient or their provider doesn't follow through. My mother took a more contemptuous view of the whole situation, proverb the doctor ordered the testing to "pay for her fancy new machine"...I approximate when it comes to skepticism the apple doesn't fall too far from the tree, but even I didn't take it that far.

Incidentally, I chuckled when I opened my mail service today and found a letter offering these services as well. They are definitely trying every method they can; I one-half-look to get a Facebook friend request from them in the side by side few days! Merely as 1 person indicated, this case director is indeed an RN. I may re-consider at least engaging with the case managing director, and promise that they are able to provide an objective bespeak of view.

Post by **Pajamas** » Wed May 24, 2017 12:ten am

If you need to go for rehabilitation or need abode care or equipment after beingness in the hospital, a example manager could help facilitate that. A example managing director could also speed approval for an expensive medication. Case managers can also help with chronic weather condition where you might need a specialist referral and in that location is a await to become an appointment.

Post past **spammagnet** » Wed May 24, 2017 7:58 am

I believe it has been shown that case managers better follow-up and compliance with the prescribed regimen, which improves outcome. That is particularly true for acute episodes of chronic health problems.

The benefits to the insurance visitor intersect with the benefits to you, despite their peradventure having unlike motivations. Even if you lot don't similar their (perceived) motivation, why reject those benefits to you?

Reducing duplication benefits you, as well, since you lot usually have some fiscal responsibility (co-pay, deductible, etc.). If nothing ese, it tin relieve a little of your time.

Mail service by **RNCM** » Wed Jul 28, 2021 nine:56 pm

I am a nurse case manager for an insurance company. I tin can only speak for myself and my role in my visitor. I am an advocate for my patients and do my best to meet their needs. My patients all know I would non try to put anything over on them because they are my commencement priority. I tin can accommodate and coordinate appointments with md's offices, make calls to these offices to enquire important questions. More often than not, I tin can get through to a physician's office quicker than the patients. I too call our Member Services on behalf of my patients to ask questions they may take. I have patients who reach out to me when they have questions about medications or diagnoses, and sometimes they are depressed and demand to talk. Basically, the part of an insurance company'south nurse instance managing director is to be on hand if a patient has questions or concerns of a medical nature that need to be answered. We are all Registered Nurses and have to know nigh many different fields of medicine.

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