Managing benefits key to keeping members happy
July 1, 2002
Managing benefits key to keeping members happy
Case managers help them negotiate health care maze
Families facing a serious disease or catastrophic injury often need help getting through the complex maze of medical care, and the case managers at Blue Cross Blue Shield of Arizona are there to lend a hand.
"Medical care is so complex today. One of the big advantages of having a care manager is to help you work through the maze," says Barbara Guerriero, RN, MA, vice president of medical services at the Phoenix-based insurer. "A lot of times, people are not aware of their benefits until they need them and they’re trying to sort through them in time of crisis."
The care managers work with the patients and families to determine the benefit limits and how best to utilize the benefits they have purchased. The members get assistance finding community resources that can help them make the best use of their benefits. "We work as an advocate for the patients. We try to work with them to make management of their condition as successful as possible," Guerriero says.
For instance, a person with multiple trauma is likely to need rehabilitation when he or she is discharged from the hospital, but benefits may be limited to 60 days. If the patient is being discharged from the hospital and is too sick to actively participate in rehab, the case manager may suggest that the patient go to a skilled nursing facility until he or she can fully benefit from rehab.
"We are helping them manage the benefits they’ve purchased to help them get well. Members may not understand their benefits in the context of their own condition. We want to help them find the best way to gain functionality," Guerriero says.
The case managers work with the families proactively to help preserve the benefits for when they are needed most.
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