Case manager with your insurance company

I had one for a little while, but found her to be of no value, so after a few weeks quit calling her back.  My onc, onc nurse and even onc pharmacist were very available to answer questions.  And the few times I did talk to her she had nothing worthwhile to add.  Plus I figured that my medical team was looking out for my health, whereas an insurance company employee would be looking to cut costs.  I didn't trust her.

Right after I finished chemo, I had a mastectomy with a fairly involved reconstruction that made upper body movement very limited.  She called to let me know that my insurance benefits would pay for a home health aid for a couple weeks.  And then told me there was no way I would be able to find one (left unsaid was that I wouldn't be able to find out at the measly rate the insurance company was willing to pay).  I didn't need one any way.  I figured it was a ploy to get me out of the hospital sooner.  My PS was very good at dealing with whoever makes those decisions - I was not rushed out at all.  Telling me about a "benefit" that in practice doesn't exist was just aggravating. 

I am probably a little paranoid, but I figure despite what they may tell you, insurance companies objectives only goal is to cut costs.  Don't arm them with more information to use as ammunition.

OK, you guys are in BIG TROUBLE now. (smile please). I had just retired 6 months previously as a casemanager RN for a nation wide insurance company. Sheesh. As soon as I was diagnosed with BC (in both breasts, long story......) I called one of my buddies who was ONC CM. I had no clue about my ER/PR HER2 status and definitely wanted someone to guide me thru the whole awful dreadful process. And I worked for this company, knew how they liked to deny or postpone paying for services ,etc......but the casemanager that I got was absolutely invaluable as I was a cardiac casemanager and knew diddly about BC.,

In my experience as a CCM (certified casemanager, took the exam when I was 55 for goodness sakes) , I called and inter acted with  a lot of skeptical folks. I think they wanted to know just what I was all about. Well, I was all about helping people as we nurses tend to be "givers" rather than "takers."  Some were afraid that I was going to report their status to their friends and employers, etc. I needed to sign a release, BOO, so that my CM could coordinate all my care, educate me, suggest what to say to the doctors, what questions to ask, etc. I found someone just like myself.  (She eased me thru the whole awful terrible(insert swears here)  horrifying experience. She talked me down when I was ready to lose it. She encouraged me. She offered valuable community resources. She was wonderful. She approved a MRI which was invaluable to me, hence the second BC dx)..To this day I feel I am blessed to have such a kind and caring person. 

Read up on HIPPA. No one can disclose your medical info without your written consent. No one is going to know what is happening to you......except for your invaluable CM. And if you don't like her or him, request a new one.

Casemanagement is the NEW THING for insurance companies. They truly are priceless. I will admit some are truly useless; we all have slugs who we work with......but CMs are available to help their members, coordinate care, do education, soothe you when you need soothing, and generally help you.

I live in central MA and opted for treatment in Boston. VERY expensive. My CM applauded my decision. Wanted nothing but the BEST for me. Please please please re think your decision and feel free to contact me with any concerns. 

OH and if they call you 3 months after you have had surgery.......double BOO to them. We were always "right on it" and even called our members when they were in the hospital. 

Sue

I can say I used my case manager.  If I hadn't contacted her, I never would have gotten a copy of my insurance plan so I could make sure that I knew what was covered.  (can u believe HR didn't even have a copy of the previous years plan let alone the current plan) 

The doctors and nurses were definitely the best sources of info but the case worker was invaluable for me as a sounding board when I was trying to coordinate some non cancer doctors with the cancer folks.

I guess it really depends on each individual mangager and patient.

Hugs to you all.

I requested a CM at the beginning. I thought it would help me coordinate everything through the insurance company. In my case, she seemed most concerned with me washing my vegetables thoroughly so I wouldn't catch something if I became neutropenic and end up in the hospital. She may have said more but that's all I remember.

We spoke twice or three times and then I never called back and she never called me either. So it wasn't much of anything for me.

The best advocate I had during my roller-coaster ride of BC and MRSA was my insurance company nurse/case-manager. She was a wonderful compassionate listener - she encouraged me to get my operative reports; when I was questioning why the doctors gave me such strong antibiotics, SHE looked up the information and told me I had MRSA in my abdominal incision (none of my many doctors EVER said the word mrsa to me). When I was unhappy with the nasty personality of the nurse practitioner at my original onc's office, she empowered me to find a new oncologist where I would be treated with more respect. She was an amazing person! After we switched insurance companies (to cover the hernia repair with out-of-network surgeons) - the new nurse/case-manager called to check up on me, but she was not as bright nor as personable. I felt she was just "doing a job". To this day, I miss my first nurse case-manager - someday I plan on digging through my old papers and calling her up to say "THANK YOU!"