Re: HMO- ??how should you go about getting a case manager???

[Guest guest]

In a message dated 1/18/00 6:03:43 PM Pacific Standard Time,

whyten@... writes:

> I would

> definitely suggest that anyone who does not work with a case manager for

> insurance look into this option.

,

We requested a case manager for the boys 2 years ago and were denied. The

gentleman that I spoke with over the phone seemed to be as stunned about it

as I was but said that the ruling from the main office was that a case

manager was not needed. Can you think of any " tips/tricks/options " that we

should take in order to change that ruling?

Here's what happened back then:

I called the Cous. Service numbers and requested that the boys have a case

manager and the gentleman took our information (the ID numbers, names/numbers

of the current 17 specialist) and said that he'd put the request in and that

we should hear back from him in about a week. Two weeks went by and then he

called telling me of the decision.

What do you think I did wrong or not quite right ??? Thanks for any

suggestions that you may have on this!!!

TTYS

Romona

http://members.aol.com/elf808

[Guest guest]

Romona,

What about an appeal?? I CAN'T bleive they denied you a special needs case

manager...I am the squeakiest of squeaky wheels when it comes to stuff like

this. Sometimes as much as I hate confrontation that is what is called for.

Just a thought..

ruth

[Guest guest]

romona;

i don't understand why you were denied... i thought that was something

patients were entitled to (silly me)... did the man give you a reason for the

denial?

orion had a case manager at keystone mercy. we didn't even request one

(never thought of it, i guess). the lady (who was an RN) just called my house

one day and said she was assigned to orion's case. she came out to my home to

meet us and discuss orion's special needs, meds, etc. and what the insurance

would cover. when she found out we didn't have a car, she said she could

arrange for an ambulance to transport orion and me to the hospital for tests

or dr's appointments. she explained to me that this service was only for pts

who couldn't walk, and since orion was only 4 months old, he couldn't walk

yet, so she could get around the rules. i even requested (expecting her to

say no) that an RN come out to my house maybe once or twice a week for a few

hrs, so that i could go food shopping or do anything else that needed to be

done. i was surprised when she said yes, that she thought it was a reasonable

request and she thought it would be approved.

orion died shortly after her visit, so i can't say if any of this would

actually have been approved-- just going by what she told me... here i go

rambling again.

julia

orion's mommy

9-18-98 to 2-3-99

familial erythrophagocytic lymphohistiocytosis and mito

In a message dated 1/20/00 9:44:09 AM Eastern Standard Time, Elf808@...

writes:

<< We requested a case manager for the boys 2 years ago and were denied.

The

gentleman that I spoke with over the phone seemed to be as stunned about it

as I was but said that the ruling from the main office was that a case

manager was not needed. Can you think of any " tips/tricks/options " that we

should take in order to change that ruling?

Here's what happened back then:

I called the Cous. Service numbers and requested that the boys have a case

manager and the gentleman took our information (the ID numbers,

names/numbers

of the current 17 specialist) and said that he'd put the request in and that

we should hear back from him in about a week. Two weeks went by and then he

called telling me of the decision.

What do you think I did wrong or not quite right ??? Thanks for any

suggestions that you may have on this!!!

TTYS

Romona

http://members.aol.com/elf808

>>

[Guest guest]

Same with us. Once we got out of Aetna(aarrgg) our new insurance

assigned us a case manager. She has been a gift. If i have any problems

, I just call her! But they are trying to be very accomidating, because

Aetna was our companies NIGHTMARE!!And that word is not allowed in our

home! But you do need to keep fighting, Aetna taught me that. Noone else

will be your childs advocate.

Good Luck,

Gloria

[Guest guest]

Romona,

Gee, this one really has me stumped. Our insurance automatically

assigned a case manager for Matty once we received his diagnosis...as a

matter of fact, it was the case manager that called me to tell me about

herself and her role concerning Matty. Maybe you could request again,

and this time try to point out how having a case manager will benefit

the company..i.e. time spent processing claims and (maybe) avoiding

double billing. I think that's what caused our ins. co. to provide a

manager for Matty, they were afraid that with all of the docs involved,

that they would end up paying for bills more than once...

Sorry I can't help more.

Elf808@... wrote:

> From: Elf808@...

>

> In a message dated 1/18/00 6:03:43 PM Pacific Standard Time,

> whyten@... writes:

>

> > I would

> > definitely suggest that anyone who does not work with a case

> manager for

> > insurance look into this option.

>

> ,

> We requested a case manager for the boys 2 years ago and were

> denied. The

> gentleman that I spoke with over the phone seemed to be as stunned

> about it

> as I was but said that the ruling from the main office was that a case

>

> manager was not needed. Can you think of any " tips/tricks/options "

> that we

> should take in order to change that ruling?

> Here's what happened back then:

> I called the Cous. Service numbers and requested that the boys have a

> case

> manager and the gentleman took our information (the ID numbers,

> names/numbers

> of the current 17 specialist) and said that he'd put the request in

> and that

> we should hear back from him in about a week. Two weeks went by and

> then he

> called telling me of the decision.

> What do you think I did wrong or not quite right ??? Thanks for any

> suggestions that you may have on this!!!

> TTYS

> Romona

> http://members.aol.com/elf808

> -----------------------------------------------------------------------

> [