How A Nurse Case Manager Can Help With Your MS

Nurse Case Manager

NURSE CASE MANAGER Can Assist You With Difficult Issues

I would like to say Happy Multiple Sclerosis Month! While I work hard to bring awareness and information about MS with my blog, there is a role of a nurse that may be of assistance to you now or sometime in the future. This role is called a nurse Case Manager. These individuals are usually employed by Insurance companies and Medicare. The function of a CM is mainly to provide individualized service to someone needing special assistance through their program to help find, negotiate, and help get approved specialized treatments for a disease or disorder. They work closely with your physician’s office and you to get his orders or treatment plan initiated.

A Case Manager can also be assigned by your insurance company if you have a high dollar disease in which to save money. They are in a position to negotiate prices through different providers to help make benefit dollars go a long way. Most people don’t realize that most insurance plans have a maximum dollar benefit number such as 1,000,000 lifelong. In these times where medicine and treatments costs are skyrocketing, it wouldn’t take long to max out your benefits. The CM also helps to obtain approval through your insurance company for any specialized treatment in which they may not cover ordinarily. For instance, say you have a spastic bladder and need Botox as a treatment. Your doctor has ordered it but insurance may not cover this medication for this particular treatment. A Case Manager can research your medical records for other treatments you may have tried that haven’t worked and go to a significant person within the company and plead your case and obtain the approval. They are also good at helping assist you in finding specialized physicians in different areas, or coordinate with all your physicians in obtaining care if having multiple health problems. Say you need long term care, need specific long term equipment such as a hospital bed, wheelchair, oxygen, or even catheters; this would be a service they could help find and even set up. You may have spoken with one through a pharmaceutical company about your MS medication. They often call me to see how my medication is working or if I have any questions. I also worked as a CM with BCBS in the past and was able to help several individuals with ongoing health problems.

I have even been fortunate to get approval for payment by my insurance company for an experimental treatment in the past. Because their help is so individualized, the nurse case manager’s assistance is almost limitless and it costs you ZERO dollars to use. It reduces the headache and frustration of dealing with all the different people you have to talk to within your insurance company when trying to get a treatment approved. To get a Case Manager assigned to you is very simple; by calling the 800 number on your insurance card and making a request to speak with a nurse or asking specifically for the case management department. Be prepared to answer a lot of questions and be specific with what you are wanting. If your care is assigned a CM, you will only have that one person that you will communicate with for treatment needs. Understand that it is not their job to fix a bill or handle insurance billing issues in which they have not been involved with. Your doctor’s office can also advise you if a case manager will be beneficial for you. I encourage you to give these specialists a try if running into issues getting type of treatment set up or approved. With everything else we have to deal with, fighting with an insurance company doesn’t need to be one of them.

MS Blogger and Multiple Sclerosis Activist shares her journey living with MS, tips for others living MS and her husband, Steve, offers his insight as a caregiver for MS.