Tip
Confirm in writing what was discussed in a phone call. This is a great way to follow-up on phone conversations.
The Role of Health Insurance Care Managers
The Role of Health Insurance Care Managers
Often parents only think of their child’s health insurance provider as the organization to call about paying for mental healthcare. Although that is the primary role of health insurance providers, these companies also offer care management services.
Health insurance care managers can also be valuable partners in your child’s treatment. In addition to explaining your insurance benefits, health insurance care managers can offer assistance with finding mental health specialists for your child, coordinating care among different healthcare providers, and offering referrals for community services. These services are voluntary. A family can self-refer or have a provider or other community agency working with the child make the referral with the permission of the parent.
Managing Care for Children with Special Needs
Neighborhood Health Plan of Rhode Island offers a specialized care management program for children with special healthcare needs. Some of the benefits include:
- A care manager assigned to your family
- A comprehensive needs assessment completed within days of enrollment
- An integrated care plan including medical, behavioral health, social, and dental care services
- Assistance in understanding and adhering to provider’s treatment plans
- Facilitated access to all needed healthcare services and providers
- Communication and collaboration with other healthcare providers (for example, physical therapists, occupational therapists, speech-language pathologists) and care coordinating organizations
- Referrals to non-healthcare related services, such as transportation services and interpreters
Types of Professionals
Health insurance care managers have expertise in health insurance issues. Many of them have mental health or medical expertise and may be social workers, licensed mental health counselors, or nurses.
Evaluations
Health insurance care managers can help you find a mental health specialist to evaluate your child’s mental health. They will also check to see which mental health specialists and evaluations are covered by your insurance.
Services Offered
Some examples of support services that care managers can offer are:
- Help finding a mental health specialist
- Referrals to community services and family support networks
- Assistance with hospital discharge planning
- Assistance with residential treatment planning, if needed
- Communication and follow-up with pediatricians, mental health specialists, and community service providers
- Problem solving with providers to overcome barriers to accessing services
Some insurance providers have appointments reserved specifically for their members in the event of a crisis or emergency to prevent hospitalization.
How Health Insurance Care Managers Work Within the Mental Healthcare System
Health insurance care managers can help you coordinate all the different aspects of your child’s care. In particular, they can help you overcome any barriers you may come across in accessing certain services. For example, they can connect you with transportation resources if lack of transportation is getting in the way of you accessing treatment for your child.
Limitations
Health insurance care managers are only available for those individuals who are covered by certain insurance plans. In addition, the health insurance plan that you have may limit the providers and services that are covered.
Resources
The three primary insurers in Rhode Island offer care management services:
Blue Cross Blue Shield of Rhode Island (BCBSRI)
If your child’s insurance provider is BCBSRI, call BCBSRI Case Management Program:
Phone: 401-459-2273 or 800-637-3718, ext. 2273
TDD: 877-232-8432 or 401-831-2202.
Website: https://www.bcbsri.com
Neighborhood Health Plan of Rhode Island (NHPRI)
If you child’s insurance provider is NHPRI, Optum is the behavioral health management company for NHPRI.
Phone: 800-963-1001 x6681 (Care Management Services)
Website: https://www.nhpri.org
Unitedhealthcare
If your child’s insurance provider is Unitedhealthcare, United Behavioral Health is the behavioral health management company for UHP.
Phone: 800-888-2998 (Care Management Services)
Website: https://www.uhc.com