Re: Case manager?

[Guest guest]

Hi ! I would be wary of RN case managers with a "personable demeanor." After my father had his heart attack last fall, a perky one named came by his room to introduce herself. I was a bit leery from the start and rightly so. She clearly had the insurer's interest at heart and not those of my father. I had to laugh at your reference your beeping wariness meter.

In a message dated 4/4/06 10:02:16 PM, sharon.green18@... writes:

Has anyone here ever been offered a "case manager" by their insurance company?

 

I received a letter from a woman who introduced herself as an RN case manager.  There were so many words in the letter like "maximize" and "quality" that all I could think of was a Dilbert cartoon, and my wariness meter started beeping.

 

She phoned me yesterday, and her personable manner made me a bit less guarded.  When asked, she said it was the MS that had caused my name to be flagged for her, but she did have some info about my having scoliosis, as well.  I made it clear that the MS thing is well in hand, and that I don't feel a need for any help there.  I admitted that I am contemplating surgery, and she said that once I get scheduled I'll hear from her again.  She seemed well aware that Harrington rods cause problems, and that revision is necessary for many of us.  I steered clear of any mention of my tethered spinal cord.

 

While I think that it might be nice to have someone who understands my case helping me navigate the insurance issues, I can't help feeling that she can't REALLY be on my side AND work for the insurance company.  Then again, if she had been assigned to my husband, maybe she could help clear up the issue of the company not wanting to pay for his Byetta, an injectable drug for diabetes.  Hopefully the letter of medical necessity that his endocrinologist sent will do the trick, but we could really use an ally on that one if it doesn't.  (Ironic, too, that they don't want to pay the $250 a month for the Byetta that holds great promise of making him thinner and healthier and reducing his need for oral meds, when they gave me no trouble at all over the $1500 per month for my Copaxone, for MS.  Though of course I'm thankful it isn't the other way around!)

 

Any thoughts?

 

Sharon

[Guest guest]

Thanks for your insights, Kim. I guess I'll continue to hold her at arm's length. She did say it is a voluntary program, and an included "benefit" of the policy.

Has anyone had a positive experience with a case manager?

Sharon

Re: [ ] Case manager?

Hi ! I would be wary of RN case managers with a "personable demeanor." After my father had his heart attack last fall, a perky one named came by his room to introduce herself. I was a bit leery from the start and rightly so. She clearly had the insurer's interest at heart and not those of my father. I had to laugh at your reference your beeping wariness meter.In a message dated 4/4/06 10:02:16 PM, sharon.green18@... writes:

Has anyone here ever been offered a "case manager" by their insurance company? I received a letter from a woman who introduced herself as an RN case manager. There were so many words in the letter like "maximize" and "quality" that all I could think of was a Dilbert cartoon, and my wariness meter started beeping. She phoned me yesterday, and her personable manner made me a bit less guarded. When asked, she said it was the MS that had caused my name to be flagged for her, but she did have some info about my having scoliosis, as well. I made it clear that the MS thing is well in hand, and that I don't feel a need for any help there. I admitted that I am contemplating surgery, and she said that once I get scheduled I'll hear from her again. She seemed well aware that Harrington rods cause problems, and that revision is necessary for many of us. I steered clear of any mention of my tethered spinal cord. While I think that it might be nice to have someone who understands my case helping me navigate the insurance issues, I can't help feeling that she can't REALLY be on my side AND work for the insurance company. Then again, if she had been assigned to my husband, maybe she could help clear up the issue of the company not wanting to pay for his Byetta, an injectable drug for diabetes. Hopefully the letter of medical necessity that his endocrinologist sent will do the trick, but we could really use an ally on that one if it doesn't. (Ironic, too, that they don't want to pay the $250 a month for the Byetta that holds great promise of making him thinner and healthier and reducing his need for oral meds, when they gave me no trouble at all over the $1500 per month for my Copaxone, for MS. Though of course I'm thankful it isn't the other way around!) Any thoughts? Sharon

[Guest guest]

Sharon,

I have a suggestion. When I was deciding about having surgery with

DrRand I was given the name of a patient that was almost 5 years

out...I think her name was Sharon also...but can't remember.

Anyway, she is an RN that could no longer work in a physical way

with patients so whe took a job as a case manager for an insurance

company. She was great to talk to. I am sure she could shed some

light on what it might mean to have such a person on " your case " .

I don't know which company she works for. It is possible I could

find her name and number, but if you would like to speak to her

perhaps you could call Priscilla and ask if she will coordinate a

call with her...that way you can have another reference re:Rand and

chat about your specific questions. My guess is she would be happy

to do it. She doesn't participate on Message Boards she said, but

she was willing to come meet me for lunch when I was in town to

learn more about the specifics of the surgery.

I agree you should be somewhat wary at this point, but in the end

you may find that you have an ally in your family medical needs.

Let me know if you want me to dig around in my files for the name.

Take Care, Cam

[Guest guest]

Cam, thanks for telling me about her. If it's not too much trouble to find

the info, I would certainly appreciate it. She'd be about 6 years out by

now, so it would certainly be good to hear how she is doing.

Sharon

[ ] Re: Case manager?

> Sharon,

>

> I have a suggestion. When I was deciding about having surgery with

> DrRand I was given the name of a patient that was almost 5 years

> out...I think her name was Sharon also...but can't remember.

>

> Anyway, she is an RN that could no longer work in a physical way

> with patients so whe took a job as a case manager for an insurance

> company. She was great to talk to. I am sure she could shed some

> light on what it might mean to have such a person on " your case " .

>

> I don't know which company she works for. It is possible I could

> find her name and number, but if you would like to speak to her

> perhaps you could call Priscilla and ask if she will coordinate a

> call with her...that way you can have another reference re:Rand and

> chat about your specific questions. My guess is she would be happy

> to do it. She doesn't participate on Message Boards she said, but

> she was willing to come meet me for lunch when I was in town to

> learn more about the specifics of the surgery.

>

> I agree you should be somewhat wary at this point, but in the end

> you may find that you have an ally in your family medical needs.

>

> Let me know if you want me to dig around in my files for the name.

>

> Take Care, Cam

>

>

>

>

>

>

> scoliosis veterans * flatback sufferers * revision candidates

>

[Guest guest]

Sharon,

I am obviously way behind in reading, but I can tell you I had an 'RN

case manager for both of my hospital stays (Dec & Jan). I got the

impression it was mostly a PR thing and I was told that they were

assigned as part of the agreement between my employer and Aetna. It

was a different person each month, but I received a letter and pretty

regular phone calls before and after surgery asking whether I had any

questions and if my doctor had thoroughly explained everything to me.

The first one said that she frequently speaks to patients that don't

really understand what they are getting in to. I also received calls

after surgery making sure that everything went OK in the hospital and

that I was healing well.

I, too, thought it a bit odd, but they were very nice and it was

definitely a shock to think that an insurance company would bother to

have a human call and make sure all was well.

kam

[Guest guest]

Kam's post reminds me that in a similar vein, my BC/BS plan has one of

those 24 hour " Ask a Nurse " hotline numbers that is not too dissimilar

to what Kam's experience was/is with her insurance.

I have started to use the service since having a child, and while I am

sure they offer it to reduce the cost affiliated with an emergency

room visit when it appears you can wait for normal business hours...it

is nice to have someone on the other end of the phone evaluating a

health problem in the middle of the night, expecially when there is a

sick kid. I have always liked when they call back the next morning and

see how it is going. Yeah, it's probably big business worrying about

the bottom line, but I know I have a real human being on the phone

with me!

Sharon...I have turned the house upside down looking for the

name/number of the Rand reference R.N....no go. Give Priscilla a call

and see if she can come up with it.

Take Care, Cam