Case management

Empowerment through case management

Aetna Better Health Premier Plan offer an evidence-based case management program to help our members improve their health and access the services they need. Case managers typically are nurses or social workers. These professionals create comprehensive care plans that help members meet specific health goals.

All members are assigned their own case manager. The amount of care management a member receives is based upon an individual member’s needs. Some of the reasons you may want to ask the health plan to have a case manager contact the member are:

  • Does the member frequently use the emergency room instead of visiting your office for ongoing issues?
  • Has the member recently had multiple hospitalizations?
  • Is the member having difficulty obtaining medical benefits ordered by providers?
  • Has the member been diagnosed with Congestive Heart Failure (CHF) diabetes, asthma, or Chronic Obstructive Pulmonary Disorder (COPD), yet does not comply with the recommended treatment regimen?
  • Does the member need help applying for a state-based long-term care program?
  • Does the member have HIV?
  • Is the member pregnant with high-risk conditions?
  • Is the member pregnant and over 35 years of age?
  • Has the member received a referral to a specialist, but is unsure of the next steps?
  • Does the member need information on available community services and resources not covered by Medicaid (e.g. energy assistance, SNAP, housing assistance)?

 

What happens to your referral?

After you make a referral, the member's case manager contacts the member. The case manager might also contact the member's caregivers or others as needed.

What will a case manager do?

To help the member learn how to manage their illness and meet their health and other needs, a case manager contacts the member to schedule a time to complete an assessment. The case manager asks the member questions about his or her health and the resources currently being used. Answers to these questions help the care manager determine what kind of assistance the member needs most.

Next, the member and the case manager work together to develop a care plan. The case manager also educates the member on how to obtain what they need. The case manager also may work with the member’s health care providers to coordinate these needs. The amount of case management and frequency of contact with the member and others will vary based upon the individual needs of the member.

To make referrals for case management consideration, please call Provider Services at 1-866-600-2139.
A case manager will review and respond to your request within 3-5 business days.