Anthem Blue Cross and Blue Shield is dedicated to simplifying healthcare and making it less daunting for our members. A key part of this commitment is our Care Management Program. Our care managers are specialized professionals who act as guides, helping you navigate the complexities of healthcare, understand the services available to you, and actively participate in your own health journey.
What is the Anthem Blue Cross Care Management Program?
The Anthem Blue Cross Care Management Program is a personalized support system designed to assist members in effectively managing their healthcare needs. It connects you with a dedicated care manager, often a nurse or social worker, who provides individualized guidance and resources. This program is a valuable benefit of your Anthem Blue Cross and Blue Shield coverage, offered to eligible members at no additional cost. Think of your care manager as your personal healthcare advocate, working with you and your healthcare providers to ensure you receive the right care at the right time.
Who are Anthem Care Managers and What Do They Do?
Anthem care managers are experienced healthcare professionals, typically registered nurses or licensed social workers, who possess a deep understanding of the healthcare system and available resources. They are trained to provide compassionate and effective support, acting as a central point of contact to coordinate your care.
Their role is multifaceted, encompassing:
- Personalized Support: Getting to know you, your health situation, and your specific needs and goals.
- Education and Empowerment: Helping you understand your health conditions, treatment options, and benefits.
- Care Coordination: Facilitating communication between you, your doctors, specialists, and other healthcare providers.
- Resource Navigation: Connecting you with relevant Anthem programs, community resources, and support services.
- Problem Solving: Assisting in overcoming barriers to care, such as appointment scheduling, transportation, or access to medications.
How Can an Anthem Care Manager Help You?
Care managers offer a range of services tailored to your individual circumstances. They can assist with various aspects of your healthcare journey, including:
- Setting up Necessary Healthcare Services: Helping you arrange appointments with doctors, specialists, therapists, or home health agencies.
- Navigating Referrals and Prior Authorizations: Streamlining the process of obtaining necessary referrals and pre-approvals for treatments and procedures, reducing administrative burdens.
- Understanding Your Plan of Care: Reviewing your treatment plans with you to ensure you understand your medications, follow-up appointments, and self-management strategies.
- Post-Hospital Discharge Support: Providing crucial support after a hospital stay to ensure smooth transitions, schedule follow-up appointments, and prevent readmissions.
- Chronic Condition Management: Offering ongoing support and education for managing chronic conditions like diabetes, heart disease, or asthma, empowering you to live healthier.
- Behavioral Health Support: Connecting you with behavioral health specialists and resources if you are experiencing mental health challenges or substance use disorders.
- Emergency Room Utilization: Working with members who frequently visit the emergency room for non-urgent issues to find more appropriate and effective care solutions with their primary care providers.
When Might an Anthem Care Manager Contact You?
Anthem care managers proactively reach out to members who may benefit from their services. You might receive a call from a care manager if:
- You or your doctor believe care management could be beneficial: If you are facing health challenges, managing a chronic condition, or simply feel overwhelmed by the healthcare system, either you or your healthcare provider can request care management services.
- You have recently been discharged from the hospital: To ensure a smooth recovery and prevent complications, care managers often contact members post-hospitalization to assist with follow-up care.
- You frequently visit the emergency room for non-emergency care: Care managers can help you access more appropriate and consistent care through your primary care physician, reducing unnecessary ER visits.
- You have contacted the 24/7 NurseLine and require further support: If your needs extend beyond the immediate advice provided by the NurseLine, a care manager may follow up to offer ongoing assistance.
- You are managing serious physical health issues: For members with complex medical conditions, care managers provide extra support to coordinate care and improve health outcomes.
- You are experiencing behavioral health concerns: Care managers can connect you with mental health professionals and resources to support your behavioral health needs.
Verifying Calls from Anthem Care Managers
It’s understandable to have questions or concerns when receiving unsolicited calls about healthcare. When an Anthem Blue Cross and Blue Shield care manager contacts you, they will always:
- Clearly identify themselves: They will state their name, title (e.g., Registered Nurse, Social Worker), and that they are calling from Anthem Blue Cross and Blue Shield.
- Explain the purpose of the call: They will clearly describe the Anthem Care Management Program and the services offered.
- Discuss your health needs confidentially: They will ask questions about your health and well-being to understand how they can best assist you.
If you have any doubts about the legitimacy of a call, you can always ask for the care manager’s contact information and independently verify their identity by calling Anthem Blue Cross and Blue Shield Member Services directly using the number on your member ID card or the official Anthem website.
Conclusion
The Anthem Blue Cross Care Management Program is a valuable resource designed to empower you to take control of your healthcare journey. By providing personalized support, guidance, and coordination, care managers help simplify the healthcare experience, improve health outcomes, and enhance your overall well-being. If you think you could benefit from the support of a care manager, don’t hesitate to contact Anthem Blue Cross and Blue Shield Member Services to learn more about the program and how to get started.
