nosey call from BCBS case manager

[Anonymous]

Anonymous wrote:do NOT talk to them. it is not in your best interest. they are trying to gain information they can use against you for a denial later. it's a recorded call. hang up.

Yup. They're fishing for reasons to avoid paying later. It's so shameful.

[Anonymous]

Not related to pregnancy, but a specialty pharmacy called and left a message on a Friday saying they were calling on behalf of UHC (our insurer) about my son's Remicade. Given that insurance companies are always looking to screw around with coverage of expensive meds like Remicade, I was a little concerned, so I called UHC to see what it was about (the specialty pharmacy was closed for the weekend by then). UHC told me they'd have to talk to the specialty pharmacy to find out what the issue was, which makes no sense if the pharmacy's really calling on UHC's behalf. When I finally got a hold of the pharmacy person on Monday, she started asking if my son had a prior authorization to get Remicade and a bunch of other questions. I asked her why, if she was calling on behalf of UHC, she didn't already know the answers to her questions. Turns out, she was basically snooping around to find out if the pharmacy could start doing home infusions for my son.

We've also had a UHC nurse call several to offer us "help" for my son's Crohn's. I told her that what'd really help is for UHC to stop spending money on miscellaneous crap we don't want and pay people's claims without a ton of hassle.

[Anonymous]

I had forgotten about those calls but I did get a call like this with my first pregnancy. It made me wonder at the time why I was getting a support call like that. I had been handling my prenatal care responsibly and I was following medical advice from my doctor.

I also somehow got a call years later from some sort of support person when I had gained weight (25 pounds I think). They even sent me crap like a portion plate and brochures about food groups. The person was nice it just felt like I was being treated like a rather stupid, errant child who didn't know the difference between a plate of broccoli and a dish of ice cream. "Instead of that pie, eat this apple for dessert instead"......like I needed that pointed out to me.

FWIW, I think it's meant to be patient education. They offer it to everyone because some people really don't have much in the way of basic common sense.

[Anonymous]

Anonymous wrote:I don't know. CIGNA offers services like these for pregnancy and for complex health conditions. I use it for my diabetes and I find it very helpful. Yes, in part it's about the health insurer saving money--a compliant diabetic is a cheaper diabetic--but it's been really helpful to me also.

Does your average DCUM, educated, relatively wealthy mother need it for pregnancy? Probably not. But I bet it does help lots of people.

This. I’m a researcher who has studied a lot of programs like this and most health plans have pregnancy related case management. You’re not special if you’re getting these calls, you’re just pregnant and they have a vested interest in trying to make your pregnancy as healthy as possible and you/your baby’s outcomes as good as possible. Yes it’s about costs—they’re a business, that’s the way our health system is set up unfortunately—but it’s also about meeting quality targets. If you’re not showing up at appointments or if they see you have GD they’ll try to intervene. Sometimes they do things like coordinate transportation or help you sign up for WIC, or refer you to a mental health therapist willing to take pregnant patients. I’m not arguing that they’re always going to make a positive difference in your care but for people without a lot of support, resources, or knowledge about pregnancy these programs could help.

[Anonymous]

Anonymous wrote:Yes they say they are there to support you and have a hotline to call but i think it's a way to question you about the pregnancy to see if you are high risk or have issues so they can deny claims or say you have a preexisiting condition or something later! Be careful!!!

You people are full of crazy conspiracies. Knowing you are high risk wouldn’t give them an ability to deny claims. If you are high risk, there may be things you can do to improve your/your baby’s chances of avoiding complications, which in the end will reduce their costs.

It’s why they encourage you to get a flue shot and regular checkups, although it costs them money in the short term, because it saves money in the long term. Same with catching diseases/illnesses early.

[Anonymous]

Actually it can be very helpful. When my insurance called I was very honest about my situation (high-risk, self employed, etc.)

I had no idea that a benefit of my insurance includes free rides to prenatal appointments via Lyft or medical transport. Super helpful in my thirds trimester where parking is terrible in most locations I go to. I also got connected with Prepartum and post-partum mental health (therapy) benefits, along with others.

Everything is not a conspiracy.

[Anonymous]

with my BCBS plan (a PPO based out of Massachusetts) it was a preventative thing - they wanted to see if there were any risk factors they could mitigate so that my postpartum and baby's well care would not be complicated (and therefore not cost THEM a lot of money).

[Anonymous]

Anonymous wrote:with my BCBS plan (a PPO based out of Massachusetts) it was a preventative thing - they wanted to see if there were any risk factors they could mitigate so that my postpartum and baby's well care would not be complicated (and therefore not cost THEM a lot of money).

The PP above my post is the PERFECT example of why they do this. Mitigating risks!

[Anonymous]

Wow. This new strategy is VERY creepy!

[Anonymous]

Anonymous wrote:

Anonymous wrote:with my BCBS plan (a PPO based out of Massachusetts) it was a preventative thing - they wanted to see if there were any risk factors they could mitigate so that my postpartum and baby's well care would not be complicated (and therefore not cost THEM a lot of money).

The PP above my post is the PERFECT example of why they do this. Mitigating risks!

Risks are costly but they also result in poor health outcomes. So why would you argue against a program that would help try to reduce risks? I get that you’re taking issue with the health plans’ motivation but like a PP said—they’re businesses. Advocate for a single payer system. But within the system we have, it makes sense for health plans to behave this way and there are benefits to the population they are insuring too.

My niece got help through one of these programs, her care coordinator helped her get shots to prevent a second preterm birth (after her first was born at 32 weeks). Not sure that would have happened without the program and her second kid was born early term. Sure it cost the health plan less money. But it was also meant a healthier baby and easier birth and recovery for her.

[Anonymous]

Anonymous wrote:They are assholes. Don't feed them...they did this to me once to try to deny care.

This. And also don't fill out those "health surveys" they offer. Fishing for info.

[Anonymous]

Oh this is so not true! These programs are to help support pregnant who receive Medicaid that received and high school on a test regarding your health. It is scored low medium high and urgent. They call to see if they can help be another source of support during your pregnancy not monitor your prenatal visits but work with you on health goals if you need to manage a chronic health condition while pregnant and they can work with your provider as well. It is a monthly call they can help with as much or as little as you want or just decline the program it is not viscous it is to address to mortality rate that are so high

[Anonymous]

Anonymous wrote:Oh this is so not true! These programs are to help support pregnant women who receive Medicaid that received and high score on a screening regarding your health current. It is scored low medium high and urgent. They call to see if they can help be another source of support during your pregnancy not monitor your prenatal visits but work with you on health goals if you need to manage a chronic health condition while pregnant and they can work with your provider as well. It is a monthly call they can help with as much or as little as you want or just decline the program it is not scam it is to address to mortality rate that are so high.. they can help review claims answer medical questions help with resources referrals to other providers if you need it is helpful.. if you score high and are a high risk pregnancy it is actually beneficial

[Anonymous]

No case management has nothing to do with your claims plus you are receiving Medicaid which is free to you no they want to see you get support why would a nurse of any kind work with the claims department you gotta stop

[Anonymous]

Good grief- this is called population health. The idea is to maintain the health of their population. Everyone benefits. It is certainly to manage their costs and it is not really about your but your baby. Preterm birth costs are very high- one of their highest costs in a young, health population.

There is a growing body of research that supports full term - and not even 38 week C-sections- as best for the child.

Don’t answer if you don’t want to but it is not a conspiracy.