Personal Comp Member Handbook - CareFirst BlueCross BlueShield

CareEssentialsAfter your hospital admission has been authorized, aCareFirst nurse will review your admission to determine ifadditional inpatient hospital days are medically necessary.This type of review is known as Continued Stay Review.Your physician, hospital representative and the CareFirstnurse will coordinate the approval of additional hospitaldays. The CareFirst nurse can also assist with dischargeplanning as needed. If it is determined that extra days arenot medically necessary, your doctor will be notified byphone and in writing.Your policy also includes important benefits for homecare and hospice. This program allows you to receivenecessary medical services on a intermittent basis in thecomfort and privacy of your own home. Some of theservices provided include skilled nursing visits, homehealth aide assistance, physical therapy and social work.Please note that these benefits are not provided for custodialor long-term care. Refer to your policy for specific details.If you need to rent or purchase durable medicalequipment (for example, a wheelchair, a walker or someother device to aid your recovery), you can obtain moredetails on the necessary steps by calling Member Services.CareFirst wants to help you achieve the bestpossible state of health. We know that thereare many things to remember when you are living with achronic condition. That’s why our disease managementprograms can help you manage your condition and helpyou to avoid complications.We have nurses available to provide you withinformation and assist you in managing:■ Asthma■ Diabetes■ Chronic obstructivepulmonary disease(COPD)■ Heart failure■ Coronary obstructiveartery disease■ Low Back Pain■ Osteoporosis■ Hepatitis C■ Urinary Incontinence■ Fibromyalgia■ Decubitus (pressure)ulcers■ Atrial Fibrillation■ Irritable BowelSyndrome■ Acid-related disordersOnce you enroll, you will:■ Be able to call a toll-free number 24 hoursa day, seven days a week, to speak with aregistered nurse■ Receive educational materials and quarterlynewsletters with information about yourcondition■ Receive reminders and tools to help youmanage your conditionThese programs are free, voluntary andconfidential. Call (800) 783-4582 to find out if youare eligible or to enroll in one of the programs.When faced with health care decisions, youand your family may have many questionsand difficult choices to make. The Case ManagementDepartment of CareFirst wants to make sure you get allthe help you need for any health problems or concernsyou may have. The Case Management Program is part ofyour medical benefits. As a member of CareFirst, you willnot be charged any fee for this service. It’s one of the ways wecan help you to remain active and in the best health possible.Case Managers are registered nurses who play an active rolein working with your physician to help develop a plan ofcare that will ensure that you receive the best possible care inan efficient and timely manner. Your relationship with yourCase Manager enables you to receive prompt answers to anyof your questions or concerns.Please keep in mind that since this program is voluntaryyou can withdraw at any time without a penalty.When appropriate, Case Management can helpyou with conditions such as (but not limited to):■ Amputation■ AIDS■ Asthma■ Burns■ Cancer■ Diabetes■ Heart Disease■ High Risk Newborns■ High RiskPregnancies■ Multiple Fractures■ Severe Head Trauma■ Stroke■ Spinal Cord Injury10