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Members

Case Management

A comprehensive plan of care for members with complex medical needs

Your Recovery is Our Top Priority

Capital BlueCross recognizes that Members with complex medical needs often require a wide variety of resources and specialized information to help manage their health and improve their quality of life. Our Case Management program can help you and your family to get the special attention you need when you are not sure where to turn, and Case Management services are part of your insurance coverage so there's no extra charge for the service.

Case Manager's Role

A Case Manager is a specially trained professional - generally a registered nurse or occasionally, a social worker - who works with you, your family and your doctors to help coordinate your care. Your Case Manager provides you with information about your care options so that you can make informed decisions about your own health care needs. Your Case Manager encourages your involvement and assists you as you make important choices and carry out the plan of care you have helped to design.

Your Case Manager will work with you to develop a customized plan for the complex array of services your special case requires. Our efforts are focused on making sure that your care is administered in an efficient and effective manner. Your Case Manager can assist in identifying the services available to you and provide options to maximize your covered benefits.

Plan of Care

Your Case Manager will consult with you and your medical team to develop a Plan of Care tailored to your needs. Your Plan of Care will include an evaluation of the anticipated medical procedures, your expected recovery time and the medical, family and community resources available to you. Communication between your Case Manager and others involved in your treatment is very important as you begin your recovery.

Who Qualifies for Case Management?

You may benefit from Case Management if:

  • You have been diagnosed with a serious medical condition
  • You have multiple injuries or medical problems
  • You may be at risk for a future adverse health event due to an existing medical condition
  • You are undergoing an extended hospital stay
  • You are seeing several doctors
  • You have had recurring re-admissions for a single diagnosis
  • You may need an organ transplant
  • Your condition renders you incapable of performing daily independent living activities

Communication is Key

Your Case Manager knows what questions to ask, where to find answers to your questions and how the pieces fit together. Generally, your Case Manager may contact you and your doctors by telephone and in writing, but can also arrange to visit you at home or at the hospital. Case Managers are available by phone during regular business hours, and have voicemail for you to leave a message if they aren't available when you call.

All this adds up to one thing: sensitive, caring professionals helping you or your loved one through the treatment and recovery process.

Contact Us

Your recovery is our top priority. If you would like to benefit from the Case Management program, you or your physician may contact the Capital BlueCross Case Management staff at 1.888.320.2583.