Español
Navigate to Facebook Navigate to Twitter
Log in or Register as new user  

Members

CLINICAL PROGRAMS

As our customers’ trusted partner in health, their well-being is our first priority. More than insurance, we offer a full range of clinical programs to help them manage their care needs.

Preauthorization Requirement

Our authorization procedures involve the evaluation of requests for services prior to the delivery of care. When conducting preauthorization activities, network providers work with specially trained clinicians to ensure that the coordination and provision of medically necessary health care services occurs in a timely and efficient manner. 

Case Management

Experienced registered nurses and licensed social workers provide support, education, and coordination of services for customers in need. For more information, call 888.320.2583.

 Programs within case management include:

  • Catastrophic and Complex Condition Management — Our multidisciplinary team works with customers, their families, caregivers, and providers to coordinate care throughout treatment for and recovery from catastrophic and/or complex medical conditions.
  • Oncology Case Management — This program provides guidance to customers diagnosed with cancer to help them understand their benefits, coordinate services, manage treatment-related symptoms, and develop a plan to support their immediate and long-term well-being. For more information, call 888.320.2583.
  • Transplant Case Management — A case manager will work closely with the customer and the transplant facility to plan pre- and post-procedure care. For more information, call 888.320.2583.
  • Precious Baby Prints® — We offer services for high-risk pregnancies to help reduce premature births and complications, and support low-risk pregnancies through automated outbound education calls. For more information, call 800.892.3033.
  • Automated Communication Outreach — We conduct telephonic outreach to educate customers about their care management options, emergency department utilization, and the transition home from an inpatient facility.

Chronic Condition Management

This program provides free educational resources and personalized phone support to customers with chronic conditions, such as asthma, coronary artery disease, depression, diabetes, and congestive heart failure. For more information, call 800.892.3033. Our hours of operation are Monday through Friday from 8:00 am to 6:00 pm.

Behavioral Health (Mental Health and Substance Use)

  • For customers experiencing problems with alcohol or drug use, this program assists with and coordinates referrals to a certified addictions counselor.
  • For customers experiencing problems with depression, anxiety, mood swings, or any other emotional issues that may impact quality of life, this program assists with and coordinates referrals to a mental health specialist.

For more information, call 866.322.1657.

Social Services

Experienced clinical staff provide assistance, education, and resources to help customers:

  • Pay for prescription drugs.
  • Deal with loss of income and/or housing.
  • Find transportation to health care appointments.
  • Deal with loss of health insurance coverage.

CarePlusSM

A home-based care program for chronically ill BlueJourney PPO and BlueJourney HMO customers who have complex needs. Nurse practitioners provide chronic, acute, preventive, and 24/7 urgent care to address medical issues most likely to result in hospitalizations and emergency room visits.

Program availability is based upon the customer’s benefit plan. For assistance with any of these services, including additional information and program availability, please contact us at 888.340.3978 (TTY: 877.244.0842).
 

Other Information

Members who suffer an emergency event are encouraged to call 911 in the event of a life threatening emergency or contact their primary care physician.

Please review the member rights and responsibilities for more information. 

While participating in a chronic condition management program, member expectations include:

  • Follow care advice offered by Capital BlueCross
  • Provide Capital BlueCross with the information necessary to provide and carry out Disease Management services.
  • Notify Capital BlueCross and your treating practitioner if you decide to dis-enroll from the program.