Case management good or bad?

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Wainwright
Wainwright Member Posts: 7
edited January 2016 in Managing Side Effects of Breast Cancer and Its Treatment

Hi all,

My insurance (BCBS) has been blowing up my phone (from unknown numbers, which I do not pick up as a general rule) letting me know about my exciting benefit of a Case Management Nurse. I can't help but think this is purely a way to manage their costs, not my well being, and trip up my treatment. Does anyone have experienced good or bad with having a case manager?


Tx

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  • Beatmon
    Beatmon Member Posts: 1,562
    edited January 2016

    I found the one from my insurance to be ok. Hasn't done anything helpful, nor harmful. Wanted to talk with her and keep her in my back pocket as a contact if I did need help.

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  • Kicks
    Kicks Member Posts: 4,131
    edited January 2016

    My first thought is - are you sure this is really BCBS that is calling you and not some 'Scammer/Spammer' who has gotten some of your information and is trying to get you to give out other information to 'steal' your identity. I know sounds strange but there are many who represent themselves as all sorts of 'things' to try to get one to give them information that is then used illegally.

    The Facility you are going to should have a Nurse Navigator to help you through TX is needed who will be looking out for you - with you being the important one - not some company if this is really BCBS, not a nefarious character.

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  • luvmygoats
    luvmygoats Member Posts: 2,942
    edited January 2016

    Wainwright - I too have BCBS thru DH's work. I had many calls and letters from case management during 2013 when I had some extra PT problems. Not so much during my original diagnosis year that I recall. I never availed myself of the service. I am an RN and did not see I needed their services that might have served someone else better. BUT had I had a more complicated course or worse initial diagnosis I surely would have. If you have doubts about the authenticity of the call you can always go thru your main provider # esp since they always left a name on my voicemail. I might have been more willing if I were not tuned into the medical community and not in a rural area. BCBS at least with my experience has been very good and has never denied a claim or even jacked around with one.

    Like Beatmon said it's good to keep the option open. I still have some of the letters with the phone#. What bugs me the most is BCBS and Express Scripts calls. Yes it would save me some but not enough for the inconvenience. Also not sure they would guarantee that I get the same generic Femara brand every month that my grocery pharmacy is great about. Am on lots of eyedrops for glaucoma just to clarify. The cost of one cheapy Femara RX would surely not make me go Express Scripts way.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited January 2016

    luv - I did Express Scripts initially on Femara, and they were very cooperative about the specific brand I wanted - my MO just had to write the prescription that way.  What was good was that I could get a 90 supply with no co-pay (so a $15 savings for 90 days) rather than the 30 day supply I get from CVS.  My CVS does procure the specific brand I like, I just have to give them a week notice. I found Express Scripts to be easy to work with and it was nice to have the med come in the mail at first because I was still receiving Herceptin infusions and kind of ragged out from chemo, more surgery, and newly diagnosed LE.

    As for the OP's question, I have military related insurance and definitely use an individual in referral management, so she functions like a case manager. I do this because I have had a long and complicated series of events related to breast cancer.  I have a good friend that uses Cigna and she also used a case manager - it can make it easier to have a go-to person who can oversee the coordination of the many moving parts involved, and expedite when necessary.  A nurse navigator would have been useless for me because my original surgery was in a facility local to my breast surgeon, but my plastic surgeon was in private practice on the other side of town, and my oncologist in another private practice elsewhere.  I have had 14 surgeries in 4 different hospitals locally with three different surgeons - all in private practice.  I receive lymphedema treatment in yet another separate cancer center.  My insurance company is the only entity with 100% of the info.

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  • sandcastle
    sandcastle Member Posts: 587
    edited January 2016

    I had BCBS from my husbands company and yes there were many calls from a Case Manger/Nurse.....I was not interested.......my Husbands Company engaged this to oversee what they thought would be helpful......after about 5 years they dropped all of this.....seemed NO ONE wanted their privacy invaded....Liz

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  • Wainwright
    Wainwright Member Posts: 7
    edited January 2016

    Thanks all. My nurse navigator has been amazing but since I'm also being treated for thyroid cancer, maybe some extra coordination would be helpful, especially if I have to go out of the Inova system, where all of my treatment is now. And I'll verify that it is indeed BCBS and not some spammer!

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  • sandcastle
    sandcastle Member Posts: 587
    edited January 2016

    I...really do not think this is a Spammer.....very common today with Insurance/Company contracts.....Liz

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