Case management

If you’re enrolled in the PPO, EPO, or HDHP, your benefits include a confidential case management program, offered through Highmark Blue Cross Blue Shield.

If you have a serious health condition, the case management program can help with managing it. This program is available at no cost to you.

Your covered family members also are eligible for case management.

This program helps you when you

  • have frequent or prolonged hospital admissions;
  • require ongoing healthcare services in your home; or
  • need ongoing care in outpatient settings.

How it works

Case management helps you get the best available treatment when underlying health conditions are complex or challenging to address. The program can assist you by

  • helping you understand the care resources available to you;
  • coordinating and helping arrange medical services for you; and
  • providing education and support for you and your family.

Based on claims information, you may be contacted by a case manager (typically a registered nurse) who will work with you and your physician to facilitate approval for medically necessary covered services. Your nurse case manager will also help evaluate treatment needs and options under the direction of your attending physician.

To learn more, or if you think you could benefit from case management, call Highmark Blue Cross Blue Shield at the number on the back of your medical ID card.