Each day, clients tell
about having to deal with insurance networks and the time and frustration
involved. Your insurance network will probably assign a case manager
to you in time, but you can get an early start by requesting
a case manager.
The case manager is a valuable resource to help you get the health services
and benefits you need to make the best recovery possible.n cases where
a patient has long term treatment that complicate the process, the case
manager (CM) will act as your advocate and advisor, assisting your progress
through a complex healthcare and benefit system. "Long term" can mean
a month or more (i.e. chemotherapy, radiation, or chronic disorders,
including alopecia or trichotillomania). The CM will be your main
contact at the with the insurance company.
Case managers do not make diagnoses or treatment decisions, nor do
they make judgments about your eligibility for benefits. Their role
is to facilitate access to timely and appropriate healthcare services,
and to ensure continuity throughout the recovery process.
Patients often find it challenging to understand and access the
care and benefits they need. The CM can help you by acting as your advisor,
an advocate, and a mentor throughout recovery and return to normal.
The CM will:
Help you understand
the goals and expected outcomes of treatments, services, and benefits:
Identify overall needs
for recovery by assessing your diagnosis, history, treatment protocol,
and progress to date. This will involve gathering information and
recommendations from you and other healthcare professionals providing
Ensure continuity of
care by acting as liaison between various health professionals and
Act as patient advocate
by helping adjudicators and other parties understand your health
care situation and health care needs
Coordinate care and
services so that you can access them easily and quickly.
Evaluate your progress
Will work with your
physician to ensure that your treatment is going as expected.
Which patients can benefit
from case management?
In general, any patient who faces challenges regarding care and recovery is
a candidate for case management. This includes (but not limited to)
patients who are hospitalized, those who require care from multiple
health professionals or services, and patients who have personal or
psychological circumstances that may interfere with recovery.
Some factors indicating
a need for a Nurse Case Manager include:
Complex or multiple injuries, or the patient is hospitalized.
Treatment plan is unclear
or requires coordination
Patient's injury may
permanently prevent return to the pre-injury work
The patient has pre-existing
medical conditions that may complicate or prolong recovery
Patient needs assistance
in accessing health care resources
Emotional or psychological
stress may interfere with recovery