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The amount of involvement an insurer can have in managing high cost cases depends on the structure of the benefit plan. In a tightly managed plan case management may be integral to the benefits program. In less tightly managed plan, participation in a case management program is often voluntary for patients. [5]
Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals. It is a role frequently overseen by patient advocates .
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
In either case, the HMO takes a greater level of involvement in the patient's care, assigning a case manager to the patient or a group of patients to ensure that no two providers provide overlapping care, and to ensure that the patient is receiving appropriate treatment, so that the condition does not worsen beyond what can be helped.
Case management (US health system), a specific term used in the health care system of the United States of America; Medical case management, a general term referring to the facilitation of treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals; Legal case management, a set of management ...
This clause is intended to protect the insurance company from financial risk by preventing an individual from taking out a policy with the intention of ending their life shortly afterward. The ...
In one of the earliest cases to test the law, an insurance company, Unum, sued a former employee, Timothy Loftus, alleging misappropriation after he took boxes of documents to investigate what he ...
Case management is a part of direct social work practice, it involves development and implementation of the case plan and administration of case management systems for effective service delivery. This makes the case manager involve in resource development, service management, lean leadership, cost control, resource distribution, and use of ...