Strange Call from insurance company

Bizarre. I've never heard of anything like this.  Is it a scam? Based on my basic distrust of the health insurance industry, I'd be worried that they come snooping around, looking for a reason to drop my coverage. Which company is it? Through your employer or a solo policy?

I have a nurse navigaror from my ins co that did the same thing (almost - not the home visit but I think they would make sure I got a home visit if I needed it ). She didn't have all my records but had my bmx precert. Maybe they called because of the hysto.



As a matter of fact she called again the other day because my bmx was rescheduled (twice) and she thought it was done so she was calling to check in on me. Funny I was sitting in the hospital bed waiting for surgery when she called (the second date was the eleventh but the final date was the eighteenth).



I think depending on the insurance you have this would be standard for chronic health or critical health conditions.

I had this once happen with an employee of mine who was out with pneumonia.  True, the reason was to get her back to work sooner, but in this case it also meant she got well.

She wasn't being treated properly by her doctor, and I hate to think what could have happened without the intervention.

In your case Janet, I think they were checking to make sure you are progressing and to ensure you are getting the care you need.  I understand that the ultimate objective is to minimize disability, but this normally benefits the employee as well as the company.

Both before and after the BMX, I received a call from the "Breast Nurse" (I kid you not) of the insurance company.  She identified herself, then asked if I had any questions, or concerns that I wanted addressed.  After the BMX, she called again to inquire about how I was feeling, pain level, mobility issues, etc.  She then gave me her work number and said to call her if/when I had questions.  About two months later, I did call her with a question about mastectomy bras (lol).  She was most gracious and responsive and I did appreciate talking with her all three times.

The day after I came home from the hospital following my heart attack, once again I received a call from the insurance company, but this time it was the "Cardiac Nurse" who inquired about my condition, if I had help at home (I did not), medications, etc.  She then invited me to participate in a weekly phone meeting with other women who also had heart attacks (I declined).  The nurse continued to check on me by phone for the first two weeks and also gave me her number, should I need information.

Jane, I'd be suspicious about someone wanting to come to my home, though.  I'd definitely check that out.

Jelly

Yes but in my program's case  the nurse does not pay a visit. Since my tx currently consists of taking Tamoxifen and getting monthly shot + bone booster, I couldn't see how she could help.

In general, I think having these types of programs helps hold costs down--it encourages compliance, probably. I don't think they necessarily know the details of your heatlh per se. I think they probably do perceive me as a "heavy user" as I have to go to the dr. monthly. But I feel good--no issues a nurse could help with--these dr. appts. are not visits due to neglect.

I have never been denied a test/procedure.

So far the nurse has sent me a brochure that I can't believe anyone would get value from.  

I don't think I like this.  I had a nurse navigator that called me every month at BC/BC and we worked very effectively together.  I had to read your post twice to verify that "they are coming to you".  Their review of what occurs between you and your doctor smacks of interference between the doctor patient relationship and HIPAA in my opinion.  I would not go along with it.  Advice is one thing.   Determining what you should do is a decision between you and your doctor  - period.  If my doctor needs anyone second guessing her, she has me questioning her.  She does not need this!

I have not have a nurse offer to visit, but I have had nurses asssociated with my insurance company call and offer help and "navigator" type services. They called repeatedly after my lumpectomy even though I was avoiding all phone calls then and told them to stop. They started up again after my BMX but I told them again not to call. And now the latest - they must have access to my mental health records again because I got a letter from the behavioral health dept of the insurance (I'm seeing  a psychiatrist and therapist for PTSD) saying someone would be in touch soon. Sure enough, they called me at work. And once again I told them to go away.

 Yes, I suppose insome cases they might be helpful, especially if you weren't sure how to navigate the medical maze. But I am angry that so many intimate details of my private medical information are being made available to all these different people! And I can't help but mistrust whatever the insurance company's motives may be because they are sure to be in their interests, not mine.

My phone call came about a month after hyst/ooph and mastectomy. I'm sure they realize what is on the horizon after a cancer diagnosis ( chemo, rads, scans, surgery). She didn't seem to want to influence my decisions. In fact when I told her my nausea meds weren't working during chemo she told me to keep asking till I got something that worked.  However, she did mail me a packet of forms that I was to sign to "authorize" her to follow my case and make recommendations. I talked with my breast surgeon about it, she said she'd never seen anything like it before. I chose not to sign it or mail it back. I never heard anything about it. She did continue to call throughout chemo periodically. And then just called one day to ask if I still needed her service.

Maybe for someone who is all alone, with no support system, this would be good...to have an advocate. It's easy to get confused with insurance coverage if you don't understand all the terms. But I'm an avid researcher anytime I get a diagnosis, I learn all I can.  She asked me at one point if I was a nurse!!! LOL.

I do remember thinking it was odd when she first called.

I think these calls are offshoots of "wellness programs" that companies adopt.  The main tenet of which is "people with chronic conditions are obviously that way--and costing us more money--because they're ignorant of how to take care of themselves."  The other one being... let's see if we can get private health information about this employee that we wouldn't normally have.  I may be too cynical, but after signing up for a "wellness program" once I'll never do it again.  I have zero confidence that a nurse navigator could make a suggestion about treatment or recovery that I can't get elsewhere.  Now, navigating insurance... that I would welcome. 

If I were you I'd just be cautious about what medical information you give them about yourself, if you do decide to continue talking with them.  Me, I just didn't pick up their phone calls or return their messages and they eventually went away.

Cleaning for a reason..............google it. It is to help BC patients but Janet, doesn't look like it's availalbe in NY.

Jeskachi........casemanagers have to follow HIPPA guidelines and of course any professional would NOT share medical info with an employer. My members used to ask me all the time if I was going to talk to their employer...........have no idea why they would think that.............and I do understand  patients being afraid to give out info  and many many refused my services. And you certainly have the right to refuse as that is your choice. I myself found it helpful. I did cardiac outreach so this BC thing really threw me for a loop. But the insurance company that I worked for already had all my medical info as they have to pay claims and need medical coding to do it. So you really can't hide from your insurance company!

 Janet, I certainly agree and do not see why they were offering a nurse. Makes no sense to me either

 Tatina, glad you found it helpful.

Here's one story that had a good outcome. I was chatting with a member who was on both colace, a stool softener, and coumadin, a blood thinner. I was reviewing his medications with him and he got the 2 confused. Was taking the blood thinner for his constipation! (I nearly fainted). So I called his doc and he went right in for a blood test.............to check how "thin" his blood had become as he could have bled to death. That was a rewarding day for me.

Not trying to push the casemanagement thing on anyone............it's up to you to decide.

Hope this is helpful and that I didn't offend anyone! Sue