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This article is intended for HMO members enrolled in an employer health insurance plan.
These may include diabetes with heart disease, for example, but may also include chronic pain, medicine intolerance and cognitive problems.
If one or more conditions or diagnoses happen to you or a family member, ask for Complex Case Management (CCM). Extra help to coordinate care, recovery or managing your health issue is part of your HMO plan. There is no added cost to you for this service. You just pay your normal copay amounts.
A case manager from your Individual Practice Association (IPA) or medical group arranges your care. Your case manager will:
Often, the IPA or medical group will call you if you are having complex health problems. You also can contact your primary care provider, IPA or medical group for help. Just tell them you would like to be considered for CCM.
Originally published 3/6/2020; Reviewed 2022, 2023, 2024
I have been denied on critical care needed for my kidney transplant. My immune Globulin treatments were approved by BCBS in May 2019 then denied and payments rescinded from Alexian Brothers Medical Center, Elk Grove, IL in February 2020. I did not receive a denial notice until February 2020 and nothing was explained in the notice. I requested the plan documents from BCBS and our Third Party Administrator, Benefits Management Group Inc. months ago and have not received any response. Please provide me with these documents.
Adrian Kamide