Our case management program is designed to assist members in evaluating current health care needs
Our case management program is designed to assist members in evaluating their current health care needs. A case manager will work with a member and the member's health care team to coordinate services to meet needs in a quality and cost-effective manner. Based on the member's Blue Cross and Blue Shield of Kansas contractual benefits, the case manager also will research resources that promote quality and cost-effectiveness health care.
Situations that may benefit from the case management program could include but are not limited to:
- Complex wound management
- Head injuries and strokes
- High risk pregnancies
- Multiple trauma
- Palliative and end of life care
- Premature/High risk infant
- Progressive neuromuscular diseases
- Severe burns
- Specialty drugs
- Spinal cord injuries
- Transplants
- Ventilator dependency
Making connections
Our case management approach is to make connections between our members health needs and well-being involvement. We know that everyone's needs are different, so we provide special attention to ensure case management is specific to each member. We do so by:
- Assisting members/families with concerns regarding their health care needs and benefit plan
- Identifying situations that involve unusual use of services
- Identifying appropriate sites for services
- Facilitating access to contracting providers
- Assisting with discharge planning services
- Assessing available community resources
How does the program work?
Step one
Referrals are received from multiple sources such as the member, family or caregiver, physician or other health care providers, or employers.
Step two
When a referral is received, the member’s current needs, medical history and available medical benefits are evaluated.
Step three
The case manager provides information to the member on the cost efficient use of benefits, potential alternative use of benefits and/or coordination of existing benefits.
Step four
The case manager works with the member/family, physician and other members of the treatment team in the development of a plan.
Rights and responsibilities
If you would like a copy of the program description, the rights and responsibilities in Spanish, or further information regarding the case management program, send your request/comments to [email protected] or call 1-800-432-0216, ext. 6628.
