Common use of CASE MANAGEMENT PROGRAM Clause in Contracts

CASE MANAGEMENT PROGRAM. If you have injuries or an illness that may extend for some time, the Plan provides for services through case management. For example, if you are facing an extended period of care or treatment and these services may be accomplished in a skilled nursing facility or in your home, the case management program may be helpful in facilitating and coordinating this care. This can be beneficial to you because these settings may offer cost savings as well as other advantages to you and your family. When reviewing claims for the case management program, the case management provider always works with you, your family, and your physician so you receive close, personal attention. Through case management, the case management provider can consider recommendations involving expenses usually not covered for reimbursement. This includes suggestions to use alternative medical management techniques or procedures, or suggestions for cost-effective use of existing Plan provisions such as home health care and convalescent facilities. In order to be considered for payment under the Plan, the alternative care must result in savings without detracting from the quality of care. You, your provider, and the Plan must approve alternate care before it is provided in order to be covered by the Plan. Case management is voluntary. There is no penalty for not participating in case management or for leaving the case management program during its course. If you have questions regarding case management and its possible application to you, call the Administrative Office.