Reasons your health insurance company may call you (that aren’t scary)

When the Capital Blue Cross care management team calls, members are often surprised—and sometimes skeptical. But Nicole Ridolfi, one of Capital’s care management team leaders, says there is no need to worry.

“Sometimes when we tell members why we’re calling, they ask, ‘Is this real?’” she says.

That’s because her team isn’t calling with bad news – they’re calling to help. Whether it’s checking in after a hospital stay, helping coordinate care for a health problem that won’t go away, or connecting members with resources, these calls are meant to be supportive – not scary.

Why a care manager would call you

While you can request a care manager, you don’t have to be the one to ask for help. Sometimes, a care manager will reach out to you first.

There are many reasons why you might get a call, and all of them are meant to make your health journey easier. Here are a few ways you might be referred to Capital’s care management program:

• Your health needs. If Capital sees that you’ve had a lot of doctor visits, hospital stays, or certain types of treatments, a care management representative may connect with you to offer extra support.
• Your doctor or hospital. Sometimes your healthcare provider will ask Capital to get a care manager involved to help coordinate your care.
• Your group health plan. If you get healthcare coverage through work, your health plan might offer care management as a helpful resource.
• Someone close to you. A caregiver or a family member can also ask for help directly.

No matter how the connection happens, the goal is the same: to make sure you have the support, resources, and guidance you need to feel your best.

What can a care manager do for you?

Capital’s care management team – made up of skilled nurses, social workers, and behavioral health specialists – is here to help you get the support and resources you need to feel your best. Here are just a few ways Capital Blue Cross can help:

After a hospital stay:

• Make sure you have the medical equipment, medications, and follow-up appointments you need for a smoother recovery.
• Review your medical history and treatment plan with you and answer any questions you may have.

Navigating the healthcare system:

• Talk with you about ways to save money on prescription medications.
• Help you find in-network doctors and schedule appointments with shorter wait times.

Connecting you to additional services:

• Help apply for community resources or find free and discounted services that could help improve your quality of life.
• Talk through life stressors and get connected to behavioral health support, including:
• A case manager who helps coordinate your care and connect you to services.
• A peer recovery specialist, who is someone with lived experience who offers guidance, encouragement, and support on your recovery journey.

Trained medical professionals

Capital Blue Cross’ care management team includes medical professionals with backgrounds in nursing, counseling, and social work. They bring clinical training and real-world experience to help members navigate health services with confidence and compassion.

Whether you're recovering from surgery, managing a health problem that won’t go away, or facing emotional stress, these care managers are here to walk alongside you.

Each one plays a unique role in helping members overcome barriers and access the care they need. Here are just a few members of the team: