Complex medical conditions can be very stressful and confusing. Our Case Management program is designed to help members cope with a variety of complex conditions by working closely with them, their families, and their doctors. Each member is assigned a specific nurse to help coordinate care, help obtain specialized medical equipment, provide information, or even just listen to their questions and concerns. A participant in our Case Management program can expect to be treated with the highest care and respect, and receive quality services like the following:

• Identification of Preventative Measures - Our Nurse Case Managers are able to identify preventative measures, such as medical equipment, medication, or alternative services, which can help members control their condition before serious complications arise.
  
  
• Patient Advocacy - In every situation, we want members to receive the treatment they need. We make a strong effort to help members know what questions to ask their doctor, encourage communication between their care providers, and even help coordinate care so that members receive the treatment and medical equipment they need, when they need it.
  
  
• Care Coordination - When dealing with a complex condition, a member often will receive care from a number of doctors and facilities. The Nurse Case Manager helps coordinate the care between these care-givers to ensure that the best treatment is provided.
  
  
• Patient Stabilization - If members are experiencing serious complications or are hospitalized, their nurse will follow their progress closely, and make sure that the most appropriate care is received. The nurse will also coordinate alternative treatments such as home health, where the necessary care is provided in the comfort of the member's home, while at the same time saving on costly hospital stays.
  
  
• Medical Necessity Determinations - Through our review process, we are able to make certain that expensive procedures and services are the most appropriate treatment for a member to receive, and that there are no better alternatives.
  
  
• Preferred Provider Verification - As a part of the process, we always confirm that a preferred provider is being used if possible. Most benefit plans have a preferred provider network that could help the member by providing a discounted rate for services and possibly a higher benefit rate if used.
  
  
• Plan Exclusion Identification - A number of benefit plans have exclusions for certain procedures, and as a part of our review process, we can check on the member's benefits, and give notification prior to a procedure of any potential problems with coverage.
  
  
• New Technology Research - In cases where new or experimental procedures or technology are requested, we will research information and determine if it is medically appropriate and covered under the benefit plan.

• Cancer
• Congestive Heart Failure
• Traumatic injuries
• Organ failure
• Transplants
• High-risk pregnancy
• Complex medical diagnoses
• Complex psychological issues
• And more…