Case Manager Conversations

Hi @m1 and @Jeanne C. 

I believe Jeanne is saying that the social/case worker with whom she is scheduled to meet is actual through her husband's insurance plan. She's not referring to the state grant program providing hours of in-home help. If I'm understanding Jeanne correctly, a good analogy would be medicare or other private health insurance except this is via the medicaid program through the state. In most states, the state has private contracted out medicaid services to private insurance companies to manage them. Thus, the managed care part... very succinctly.

I wish I had some specific advice for you. I have the same basic general suggestions that I'm sure you've already thought of:

-- keep answers to the point

-- someone who is out to help you will ask questions that will benefit you; someone who is out to screw people will find a way to do it if you give too much information with the questions they ask.

-- come with a few questions of your own, though that may be hard if this is routine

-- accept any information they have to provide on any programs or resources even if you think you don't qualify or already have the pamphlet

-- the squeaky wheel thing is often true

I work for managed care insurance. Please don't take the below as defending manage care, because that is far from what I'm trying to do here.

People have this idea that the main goal of managed care is to deny services. While it's true that one way manage care saves both insurance and patients money is to put prior auth requirements in place for expensive, invasive, or possibly frivalous services. Another far more helpful way managed care companies cut costs is to provide some guidance and/or case management to help patients make the best treatment decisions for them. This might mean helping someone research or locate treatment for a specific condition or educate on benefits around a particular thing. The company i work for is small and so does these services well and ultimately to the benefit of patients. Rarely do I see managed care limiting access or harming people's ability to access care. But that's not the companies that contract for medicaid, although the model is similar.

I don't know if anything of this helps. I hope others have other suggestions for you.

Take care of yourself.

I want to validate your anxiety. As anyone who has ever engaged with a large bureaucractic system can attest, there's always the very real fear of being just a number instead of a real person, a family, with real needs and concerns. These systems enact real changes when they work well, and thus can due real harm when they fail as well.

All we can do is our best to understand our rights and responsibilities as recipients/consumers.

I read a little further down and am glad to hear the meeting went relatively well. Hang in there, and hopefully you will be less worried about your next meeting now that you know what to expect.