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Each day, clients tell about having to deal with insurance networks and the time and frustration involved.  Your insurance network will probably assign a case manager to you in time, but you can get an early start by requesting a case manager.
The case manager is a valuable resource to help you get the health services and benefits you need to make the best recovery possible.n cases where a patient has long term treatment that complicate the process, the case manager (CM) will act as your advocate and advisor, assisting your progress through a complex healthcare and benefit system. "Long term" can mean a month or more (i.e. chemotherapy, radiation, or chronic disorders, including alopecia or trichotillomania).  The CM will be your main contact at the  with the insurance company.
   Case managers do not make diagnoses or treatment decisions, nor do they make judgments about your eligibility for benefits. Their role is to facilitate access to timely and appropriate healthcare services, and to ensure continuity throughout the recovery process.
    Patients often find it challenging to understand and access the care and benefits they need. The CM can help you by acting as your advisor, an advocate, and a mentor throughout recovery and return to normal. The CM will:

  1. Help you understand the goals and expected outcomes of treatments, services, and benefits:

  2. Identify overall needs for recovery by assessing your diagnosis, history, treatment protocol, and progress to date. This will involve gathering information and recommendations from you and other healthcare professionals providing care;

  3. Ensure continuity of care by acting as liaison between various health professionals and services;

  4. Act as patient advocate by helping adjudicators and other parties understand your health care situation and health care needs

  5. Coordinate care and services so that you can access them easily and quickly.

  6. Evaluate your progress to recovery

  7. Will work with your physician to ensure that your treatment is going as expected.

Which patients can benefit from case management?
 In general, any patient who faces challenges regarding care and recovery is a candidate for case management. This includes (but not limited to) patients who are hospitalized, those who require care from multiple health professionals or services, and patients who have personal or psychological circumstances that may interfere with recovery.

Some factors indicating a need for a Nurse Case Manager include:
Complex or multiple injuries, or the patient is hospitalized.

  • Treatment plan is unclear or requires coordination

  • Patient's injury may permanently prevent return to the pre-injury work

  • The patient has pre-existing medical conditions that may complicate or prolong recovery

  • Patient needs assistance in accessing health care resources

  • Emotional or psychological stress may interfere with recovery

500 E. Round Grove Rd, Suite 306
Lewisville, Texas 75067
214-488-8885 1-866-383-8885
FAX 972-316-8885

Open 9:00 to 5:00 Tuesday thru Friday
and 9:00 to 3:00 Saturday
Closed Sunday & Monday.