Nurse Case Manager through the ins.company

[triples15]

Hi everyone,
I changed to United Healthcare through my husband's employer in January. Yesterday I got a letter from a Nurse Case Manager saying she had been assigned to my case and is available to help me "manage my disease". Ha. It also said she has been trying to reach me by phone, which she hasn't. Neither my husband nor myself have received any calls/messages from them. I guess that's neither here nor there, but I guess the point is the letter just kind of irked me. <img src="i/expressions/face-icon-small-smile.gif" border="0">
Anyway, as we know the insurance companies are all about the bottom line and trying not pay for anything they don't have to. I'm certain this is another attempt to for them to save a buck while trying to make it look like they're "helping". I guess my question is, have any of you worked with a nurse case manager through the insurance company? Has it actually helped in any way? I guess the only possible way I see it helping is by having one contact that I could call when I have questions regarding billing/coverage instead of a different person every time. However, I'm wondering if that's even within her scope of duties.
After 31 years with CF I doubt a nurse with very little to no knowledge of CF is going to help me manage it! I feel like it would just complicate things but I'm tempted to call her and see what it's about. The letter sounded almost threatening, but the way I'm reading it it's an optional service. Please let me know if any of you have thought/opinions or experiences with a nurse case manager.
Thanks!

 

[triples15]

Hi everyone,
I changed to United Healthcare through my husband's employer in January. Yesterday I got a letter from a Nurse Case Manager saying she had been assigned to my case and is available to help me "manage my disease". Ha. It also said she has been trying to reach me by phone, which she hasn't. Neither my husband nor myself have received any calls/messages from them. I guess that's neither here nor there, but I guess the point is the letter just kind of irked me. <img src="i/expressions/face-icon-small-smile.gif" border="0">
Anyway, as we know the insurance companies are all about the bottom line and trying not pay for anything they don't have to. I'm certain this is another attempt to for them to save a buck while trying to make it look like they're "helping". I guess my question is, have any of you worked with a nurse case manager through the insurance company? Has it actually helped in any way? I guess the only possible way I see it helping is by having one contact that I could call when I have questions regarding billing/coverage instead of a different person every time. However, I'm wondering if that's even within her scope of duties.
After 31 years with CF I doubt a nurse with very little to no knowledge of CF is going to help me manage it! I feel like it would just complicate things but I'm tempted to call her and see what it's about. The letter sounded almost threatening, but the way I'm reading it it's an optional service. Please let me know if any of you have thought/opinions or experiences with a nurse case manager.
Thanks!

 

[JustDucky]

Before I went on Medicare, I had United as well and was assigned a case manager too. She was actually a godsend, she made sure I got every medication, necessary equipment, tests, flawless coverage from lengthy hospitalizations etc. This was all before my CF dx, I was very sick nonetheless and required frequent hospitalizations, several procedures, and ultimately was vented. It was a very stressful, confusing time for me but she made it easier because she dealt with the insurance end totally and did a fantastic job. She advocated for me on more than a few occasions. She also called me just to check up on me and see if I needed anything.

I hope that you wind up with a case worker like I had, someone who will fight for you if the insurance company balks and who actually seems to care. I was actually sad to go on Medicare because I knew that I would lose this wonderful advocate.

Good luck...

Jenn 40 wCF

 

[JustDucky]

Before I went on Medicare, I had United as well and was assigned a case manager too. She was actually a godsend, she made sure I got every medication, necessary equipment, tests, flawless coverage from lengthy hospitalizations etc. This was all before my CF dx, I was very sick nonetheless and required frequent hospitalizations, several procedures, and ultimately was vented. It was a very stressful, confusing time for me but she made it easier because she dealt with the insurance end totally and did a fantastic job. She advocated for me on more than a few occasions. She also called me just to check up on me and see if I needed anything.

I hope that you wind up with a case worker like I had, someone who will fight for you if the insurance company balks and who actually seems to care. I was actually sad to go on Medicare because I knew that I would lose this wonderful advocate.

Good luck...

Jenn 40 wCF

 

[JustDucky]

Before I went on Medicare, I had United as well and was assigned a case manager too. She was actually a godsend, she made sure I got every medication, necessary equipment, tests, flawless coverage from lengthy hospitalizations etc. This was all before my CF dx, I was very sick nonetheless and required frequent hospitalizations, several procedures, and ultimately was vented. It was a very stressful, confusing time for me but she made it easier because she dealt with the insurance end totally and did a fantastic job. She advocated for me on more than a few occasions. She also called me just to check up on me and see if I needed anything.

I hope that you wind up with a case worker like I had, someone who will fight for you if the insurance company balks and who actually seems to care. I was actually sad to go on Medicare because I knew that I would lose this wonderful advocate.

Good luck...

Jenn 40 wCF

 

[MCGrad2006]

I had that before. At the risk of sounding snobby....I hated it. Like you said, I am 28 years old and I am pretty sure I know how to take care of myself. And I am VERY good about meds and appointments and whatnot. I felt like I was being babysat. They called me once every three months basically to make sure I was taking my meds and refilling the scripts on time. The problem with that is, my doctor often writes the meds for more times per day, so I don't have to refill all the time...or if I need to up a dose, I can very easily (if I am sick, I need more of something...or more enzymes with different meals).

There was one time I had a question and I can't remember what it was now, but I was able to call her and she figured it out. But for the most part, for me, I am independent and felt as though I didn't need the help. Besides the one time, it was like a phone call every once in a while.

 

[beleache]

Hi Autumn,
I agree w/ everything that Jenn said. Have you had a change in your health recently ?
I also have United Health Care & after I had renal failure , due to Tobramycin, I was assigned a nurse case manager.
She was helpful at that time, but like you I was leery due to the fact that she worked for the ins. co. In the end though I think she was helpful.
I was taken off her case after some time & me getting better. Like Jenn said, I hope you get a good one. T
he one thing you said that I didn't like was that the letter seemed threatening ?? Dont care for that.
Take care <img src="i/expressions/face-icon-small-smile.gif" border="0"> joni

 

[Mistyjo]

We did with Jasey and loved her. She was very compassionate and helpful. If you do it hopefully you will have the same experience. Our nurse use to work at Cincinnati children's so she was familiar with some of Jasey's med problems.

 

[Beccamom]

We had a nurse case manager and had a great experience. She helped when we were traveling out a state for various tests and second opinions. She explianed that the way she helped the insurance company was speeding up the approval process for needed tests, appointments, and medications because these "preventative" items save the insurance company a ton of money if hospital stays etc. could be avoided. She handled all of our referrals, billing questions, etc. I did always feel like I had to be cautious about what I said, but the experience was only positive. It really helped when it took more than one phone call to get a referral approved because I never had to start the story over again. She also told me about programs my insurance company offered that I don't think I would otherwise know about such as assistance traveling to clinical trials. I hope you also have a great experience.

 

[SIcklyhatED]

I had a case manager (not a nurse though) through CIGNA for a few months when they were being horrible and a typically stingy insurance company (they DENIED my Creon! for Pete's sake, how am I supposed to eat?!). My case manager was very kind and helpful and straightened out things super fast and always called to see how I was doing.

I'm sure there's some bad ones out there but I think for the most part case managers are there to smooth things over and be a direct line to your insurance company. Lord knows my mother works way too hard dealing with CIGNA and trying to teach me how to take on that role now...

 

[Ratatosk]

We had one -- actually, still do, but we refuse to deal with them. Basically she'd call and ask us stupid questions regarding our knowledge of CF, if we did vest and neb treatments... DH pretty much told them to quit calling us and wasting our time. Got a weird vibe and they didn't help us when insurance stopped covering DS' actigall suspension and refused to cover Pancreaze...

 

[Jenica]

We had a nurse case manager when we were insured through Harvard Pilgrim and I LOVED her! Cheryl was actually trained specifically for CF, and through the four years or so that we were there, she was amazing. She took care of every insurance-related issue for us, and was incredibly proactive. I never once had to actually request anything ... she would see that we needed more physical therapy visits, or that we'd be moving to a new enzyme program, etc, and let me know that she would be taking care of it. And she did!

When my husband's company was purchased and we moved to Blue Cross Blue Shield, I was so sad to leave her. After several years, we had developed a really great relationship.

I suppose like anything, you might get a nurse with a heart for her job and for her patients, or you might get something just looking to cross you off her list. Hopefully it's the former, because Cheryl made my life so much easier and more pleasant!

 

[MamaDee]

My mom has been a nurse case manager for over 20 years now, and they are typically very helpful. But you have to want and need the help. If insurance denies something, they advocate for you and do all they can to help you get it approved. If they don't do that then they are not doing their job. Best of luck!

 

[triples15]

Thanks so much for all of your replies!

I'm really glad to hear several of you had positive experiences. I didn't figure someone who worked for the insurance company would ever go to bat for me, so I'm glad to hear they did for you.

Jenn, that is great that you had someone so helpful! I'm sorry you had to lose her! I'm hoping since you and Joni both had good experiences and were both with United that I might find it beneficial as well.

It's the negative experiences that scare me though. Caitlin and Liza's experiences are exactly what I pictured, being babysat and asked stupid/obvious questions. Just like Caitlin, I am 100% compliant with meds and office visits so I certainly don't need the extra hassle of someone looking over my shoulder and having to report to her.

Joni, nope no recent changes in my health. I did just join this plan in January though. I'm thinking it just took a few months to raise the red flag on me? <img src="i/expressions/face-icon-small-wink.gif" border="0"> I was a little surprised though because I've really not had many claims (for a CFer anyway) since being on this plan. I've only had one 3 month office visit (in March) and then my monthly prescriptions. No IV's, hospitalizations, etc. It must be the prescriptions that tripped their trigger. It's a little concerning that I'm already on their radar since I've actually been relatively "cheap" up to this point. What in the world will they do when the big bills start rolling in? LOL. Yes, I thought the letter kind of had a threatening undertone but my husband tells me I tend to read too much into things. <img src="i/expressions/face-icon-small-wink.gif" border="0"> It was just that it said she had been trying unsuccessfully to reach me by phone-which she had not. I looked at all of our benefits/human resources info online and it has our correct phone number so I know she has not called. I don't have it in front of me but it basically says I need to contact her asap. There was another thing or two that rubbed me wrong but I can't think of them right now.

Anyway, I didn't call them today. I might call if I get the chance tomorrow. I guess I can just see what it's all about. I think like Jenica said, it's probably also kind of a crap shoot as to who you get!

Well I better run but thanks so much again everyone!

Autumn

 

[concernedmom]

In the early 2000s, our Anthem policy had a voluntary case management program for various chronic illnesses. If you participated, you received up to $300/yr in gift cards for various places such as pharmacies, athletic wear stores, etc. We participated solely to get the rewards. In our case, I had the initial screening call and she determined that my knowledge was comparable to hers so she signed us off with only one more call (the exit call.) OTOH, some of my coworkers used the CM services for high bp, asthma, etc. They apparently did not have as thorough knowledge about their chronic health issues because they received monthly calls for six months before being signed off and receiving the rewards. Our CM services did not help with insurance issues. THey discontinued the rewards a couple years later. I would not have done it if it hadn't been for the rewards.

 

[Ratatosk]

This is the program we have -- called Accordant and IMO there's really no benefit for us to participate.

https://www.thorconnect.org/Physician-Clinician/AccordantCare/WCMD_014342.htm