Insurance assigns a Case Nurse....nice or a trap?

[dlp712 11]

I have United Healthcare Choice Plus - I have a Case Manger assigned to me. She is very helpful has also informed me the surgery has been approved As soon as they get 6 months of diet weigh in. I don't see it as a trap !!

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[jea(n__n)ette 98]

I might be paranoid but I can't help but worry is there some way my insurance is trying to get this info and then trip up my process and find a reason to deny me?

Maybe this is a nice benefit, I don't know. My husband works for a pharma company and we typically get great healthcare plans offered to us, so this might be legit. Or it could not be, I don't want to misstep accidentally and ruin my coverage.

Am I paranoid? Or should I cancel this phone intake appt, and not get a case worker til I am approved?

Thx

The nurse case manager's job is two-fold, to advocate for the patient, and to coordinate your care. I was self-pay and had no case manager, but if I had one, she would have saved me all the headaches (and bodyaches) I went through trying to coordinate faxes between my doctors' offices and my work's short term disability program; this was not pleasant to do while I was still recovering post-op. Luckily the hospital where I had my procedure at has a Bariatric Coordinator that served as my advocate. I got regular phone calls checking up on how I was recovering and she offered to personally call my surgeon on his cell if I needed any antibiotics or additional pain medication.

Another way to look at a nurse case manager is this, it's their job to be your coach, to monitor that you stay on track and continue to benefit (healthwise) from your surgery. The insurance company is investing money into you. A healthier you = less obesity-related medical costs down the road for them. If you end up not being compliant with the necessary WLS lifestyle changes, then the insurance company is at a financial lost from the cost of your procedure and then has more obesity-related expenses as you stay overweight.

Definitely take advantage of having a nurse case manager if it's offered!

[WantToBe 77]

Sorry. I am going to be very negative. RUN do not walk AWAY from anything a health insurance offers for FREE! You will end up paying for it later. Seriously I do NOT trust insurance companies with anything. Their purpose in existence is to MAKE money by not paying claims. Please do not think that an insurance company ever has your best interest at heart. You have your surgeon and his staff for support and guidance. Good luck

[brandimarie123 1]

I also have united health care and had my phone interview 3 months ago. The nurse basically was there to answer any questions I had about the surgery. Like which Dr. and hospitals were approved the approval process and support. I will do my 3 month weigh in on June 24th and have met with the surgeon for my consult. I still have to get blood work to monitor my Vitamin intake, the np suggested asleep apnea test. Which I am waiting on. I also have my phyc. Evaluation and the surgeon wants to do a endo something.(check my insides before surgery) then 3 more weigh ins and then waiting on approval. I was told by my nurse it only takes a few days.

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[IrishGermanRN 151]

I would do it... I actually work for UHC and an RN for one of the programs. Don't be afraid of the 45 minute call. Mine usually last 10-15 min and we are great with follow up and working with Mds. Remember we are RNs. Always helpful in any case.

[IrishGermanRN 151]

Sorry. I am going to be very negative. RUN do not walk AWAY from anything a health insurance offers for FREE! You will end up paying for it later. Seriously I do NOT trust insurance companies with anything. Their purpose in existence is to MAKE money by not paying claims. Please do not think that an insurance company ever has your best interest at heart. You have your surgeon and his staff for support and guidance. Good luck

Absolutely wrong and false. We are RNs first regardless of how you feel about insurance company's. These programs are offered to keep people out of the ER and Hospital.

Feel how you do with Insurance but I took my RN oath to help people.

Edited June 17, 2016 by IrishGermanRN

[gary5862 208]

I have united and was assigned a case worker. They mostly just want to make sure that you are on track. You only speak with them 3 times.

[IrishGermanRN 151]

I might be paranoid but I can't help but worry is there some way my insurance is trying to get this info and then trip up my process and find a reason to deny me?

Maybe this is a nice benefit, I don't know. My husband works for a pharma company and we typically get great healthcare plans offered to us, so this might be legit. Or it could not be, I don't want to misstep accidentally and ruin my coverage.

Am I paranoid? Or should I cancel this phone intake appt, and not get a case worker til I am approved?

Thx

The nurse case manager's job is two-fold, to advocate for the patient, and to coordinate your care. I was self-pay and had no case manager, but if I had one, she would have saved me all the headaches (and bodyaches) I went through trying to coordinate faxes between my doctors' offices and my work's short term disability program; this was not pleasant to do while I was still recovering post-op. Luckily the hospital where I had my procedure at has a Bariatric Coordinator that served as my advocate. I got regular phone calls checking up on how I was recovering and she offered to personally call my surgeon on his cell if I needed any antibiotics or additional pain medication.

Another way to look at a nurse case manager is this, it's their job to be your coach, to monitor that you stay on track and continue to benefit (healthwise) from your surgery. The insurance company is investing money into you. A healthier you = less obesity-related medical costs down the road for them. If you end up not being compliant with the necessary WLS lifestyle changes, then the insurance company is at a financial lost from the cost of your procedure and then has more obesity-related expenses as you stay overweight.

Definitely take advantage of having a nurse case manager if it's offered!

Well said

[WantToBe 77]

I stand by what I said. I do NOT and would never suggest anyone accept any program offered by insurance company.

[grandmaofone 411]

I had a case worker through my insurance company and it was a third party and didn't work for my insurance company but for me!!! It was awesome having someone that was trained and could answer any questions I had. She would also talk to me about my diet and workouts and suggest other things. This was helpful when I couldn't get the doctor to answer my questions. Also I actually only had to talked to her 3-4 times over a 4 month period to get me through to the time of surgery, I am still talking with her to this day(one and half years later). Plus as an added bonus my insurance company mailed me a $300 gift card to Target where I spent it on new clothes to fit me once I got to the size I wanted to be!!!! I will also continue talking with her until I get to my newest goal, she is one of my biggest supporter and I can question her about anything and NEVER has it affected my insurance in any way!!!!!

[WantToBe 77]

Super. Glad it worked for you

[higher 966]

I have UHC Choice plus and when I started looking into VSG it was one of my plan requirements for approval to enroll in the Optum Health program and engage with the RN they assigned me. So I didn't even think I had a choice and I really wanted to dot all my i's cross my t's etc.

That said, the RN I've engaged with has been wonderful and helpful. For example, she explicitly laid out the steps to insurance approval for me and emailed me a copy. This was a huge assist since my surgery program has their own set of requirements and it was very confusing.

We spoke, I believe, 3 times total and each time I felt like I got something out of it.

[kmorri 1,689]

I retired from BCBS after 29 years and currently work for UHC. Nurse case managers are there to help you navigate all your requirements and ensure you know what to expect...and get all the proper follow-up care......They can answer all the questions you have about the pre and post op diets......I know you hear people say all the time that insurance companies are just trying to find reasons to not pay claims...............but it just isn't true. Now they do absolutely want to reduce the costs, but how they do that is by trying to ensure patients are educated and providing them with information that will help them make educated and informed decisions.....and hopefully prevent unnecessary cost due to a patients not being properly educated.

I would absolutely take them up on the offer.

[daniotra 298]

I used to have UHC. They offered this to me due to my asthma. They would also call and check in with me every six months or so for my son (he's special needs and medically fragile). They also had a nurse call any time we had a hospital admission. It's intended to be a "nice benefit" as it costs the company less money to ensure you are compliant with your treatment programs than to let you get sick and require pricey treatments or hospitalizations.

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[daniotra 298]

Sorry. I am going to be very negative. RUN do not walk AWAY from anything a health insurance offers for FREE! You will end up paying for it later. Seriously I do NOT trust insurance companies with anything. Their purpose in existence is to MAKE money by not paying claims. Please do not think that an insurance company ever has your best interest at heart. You have your surgeon and his staff for support and guidance. Good luck

Yes, the insurance companies are in the business of making money. By assigning the nurse care coordinators, the company saves money by helping patients stay compliant with the less expensive ongoing treatments instead of requiring pricey emergency care or developing complications.

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