Insurance Case Managers can either
- make things infinitely easier (OMG Jump on it!) as they effectively cut through all the red tape & ou don’t have to go through multiple approval/denial/appeal shenanigans. Once you’re approved? You’re approved. I’ve spent literal years fighting for payment or preapproval of services, that a case manager has stepped in and not only across the board approved all of them, but upped my coverage in some things (as it fell under some obscure clause), in the space of 30 minutes. And then made the next year and a half of rehab (accident with complicated medical care to follow) a BREEZE as far as payment went.
- make things infinitely harder (OMG don’t agree!) as they represent the insurance company, not you, and if they disagree with any of your care can flat out deny you benefits to things that’s would have gone wholly unchallenged without them, or insist on alternate treatment (like because my son is a teenager, the case management people through the insurance didn’t want him seen by the specialist at the expensive children’s hospital, but any old doctor should do at the dirt cheap state hospital. Fortunately my son’s case manager through the Children’s hospital eviserated them :D Up to and including having Legal threaten major lawsuits, serious bad publicity, and all sorts of other fun and excitement. Billion dollar attorneys? Meet billion dollar attorneys! = Insurance case manager sent a very carefully worded letter that she’d personally made a mistake, that it wasn’t company policy to discontinue payment, blah blah blah :rolleyes: But that was very clearly only the result of having a really badass case manager through the hospital, with a rockstar legal department.).
So I’ve personally seen this go both ways, and very much depends on the personality you get as your insurance case manager. You get someone who understands what you’re doing & why & agrees? Easy street. You get someone who thinks you’re just malingering, choosing fancy pants options, and that there’s no difference between top flight care and bottom of the barrel garbage? You’re screwed, unless you’ve got someone to go to bat for you.
Don’t you just love 6 of 1, half a dozen of another, answers? :wtf:
My advice would be this : Unless they’ve put a clock on it (respond by such and such date), I would hold off on agreeing with the intent TO agree (probably)... But first to
- run it by the hospital you’re going to (if they have any experience dealing with XYZ insurance company case managers, as XYZ wants you to agree to one, and you don’t know if that’s a good idea)
- run it by med pros in your life (therapist, Pdoc, etc.)
- call and speak with the case management person directly to get a feel for them & how they think of your case (and if they go through everything & are awesome? Make sure to get their name, and write that you spoke to Susie Derkins with CM & would be thrilled to take her on as your case manager... because that means that either your case goes to their desk, or if it goes to someone else’s you haven’t legally agreed to CM by them & have a bit of legal wiggle room).
