Insurance case manager: good/bad/eh?

Florak8

We received a letter from our insurance co. offering a case manager for DS. I am kind of shocked that it has taken two years of major claims for them to ask us that, but whatever.

My question is, do you find having a case manager beneficial? Or do they try to limit you from things like second opinions, etc.? My fear is that I have been able to make our educated decisions pretty freely up til now, and I don't want some stranger at the insurance company to try to take over and limit the help DS gets. It feels a little like, "Gee, this kid is getting expensive. See what you can do to cut his costs."

We do also receive secondary coverage for DS through a Medicaid program. 

I guess I am just scared to "let someone in". Do you mind sharing your experiences? TIA. 

thefuturemrskudla

We had one, and I loved her.  She was an RN, and checked in with us each month to see whether we had new medical goals, needed help finding doctors, etc. For example, when our geneticist recommended a special test that cost 4k, our case manager got our request approved quickly. Also, she herself had a daughter with special.

suzymarie

My mom has one for her cancer.  It has been totally neutral for her.  Hasnt affected coverage.  The person tries to be helpful, but as a RN herself my mom can pretty much handle it  However for her it wasnt an option- she was getting one, period.

Jcrab

We have one but I am pretty sure she works for our hospital system and communicates with insurance as needed. We got connected with her when I was trying to get specialty services (Bowen therapy) covered under our HMO. She offered us PT and ST for feeding which has really helped. I'm glad we didn't need to wait until the pedi made the referral. Anytime I've had an issue with scheduling or getting an authorization she is able to get things straightened out with a smile in 1-2 business days. I say give it a try. GL!

IndyPRGirl

I had one when I was pregnant with DS (high-risk) and while I was skeptical at first, I loved it.  I had HG and needed an insane amount of zofran and when the insurance wouldn't approve it, I called her and she got it put through right away (like while I was standing at the pharmacy).  

catinboston

I am an insurance case manager and at the company that I work at the goal of case management isn't only to control costs, but it's to help prevent costs by ensuring that you have all the information that you need and to check in from time to time and help steer you to a doctor before an issue becomes a crisis. But yes, controlling costs is part of the goal of case management, but if your case manager is a nurse then they will ultimiately have the child's best interest in mind first. You can always tell them to stop and close the case if you're not happy with them.

Florak8

Thanks, everyone for your input.  I will call tomorrow, sign up, and give it a try. I love our public health nurse through the county, so maybe I will love this one, too. 

I also love being able to ask here! You all are great!