Case Management
Case management is offered as a confidential and free program to members who are experiencing complex health issues or challenges in meeting their health care goals. Case managers can provide you with information and direction about health issues, health coverage, and available community resources, such as help with transportation to and from medical appointments. They can help make sure you are getting the best use of the covered services available to you.
Case managers (nurses and social workers) work with members, their families, health care providers, and community resources to:
- Identify members who could benefit from case management and contact them via telephone.
- Assess the member’s current health status and history by asking various health-related questions.
- Confirm if the member has case management needs and explain how Independence Blue Cross’s (IBC’s) case management programs can assist a member in managing his or her health.
- Develop a care plan designed to meet the specific needs of the individual member. The case manager may utilize home care or educate and coach the member on lifestyle changes to support independent health management.
- Follow up with the member, his or her family, and physician at the specific intervals (e.g., weekly, monthly) to review and enact the plan until all goals are met or case management services are no longer appropriate.
- Discharge the member from case management once all identified needs have been adequately met and goals achieved or when case management services are no longer appropriate. Members can continue to contact the case manager at any time.
A case manager is available to help you with your complex needs. If you feel you may benefit from this program, please call a case manager at 1-800-313-8628.
You must continue to pay your Medicare Part B premium.
The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change January 1, 2013. Members may enroll in the plan during specific times of the year. Contact the plan for more information. Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits, as well as limitations, copayments, and restrictions. Members must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
- Your State Medicaid Office.
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.”
You must use plan providers except in emergency or urgent care situations or for out-of-are renal dialysis or other services. You must use plan providers except in emergency or urgent care situations or for out-of-are renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor Keystone 65 HMO or Personal Choice 65 PPO will be responsible for the costs.
Please contact Keystone 65 HMO or Personal Choice 65 PPO Customer Service for more information.
Y0041_HM_12_300a Pending CMS Approval
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