CSN Login
Members Online: 5

You are here

Oncology case manager

KelleyTX
Posts: 11
Joined: Jan 2020

I was recently diagnosed with colon cancer and I got a letter in the mail offering the free services of an "oncology case manager"- she works for my insurance company, of course. I am wondering if anyone has had one of these and if they found them useful or if they basically are just there to keep costs down for the insurance company?

Thanks-

Kelley

Trubrit's picture
Trubrit
Posts: 5121
Joined: Jan 2013

I had an Oncology case manager call me several weeks back. Once I told her that I was five years NED, the call ended, so I do not know what was going to be offered. 

Yeah, I'm no help, but I did want to welcome you to the forum. 

Tru

KelleyTX
Posts: 11
Joined: Jan 2020

Thank you for the welcome. I'm not yet familiar with all the forum terms. What is NED?

Kelley

Trubrit's picture
Trubrit
Posts: 5121
Joined: Jan 2013

Ned means No Evidence of Disease.   

Tru

KelleyTX
Posts: 11
Joined: Jan 2020

well then, congrats!

Kelley

Steelkiwi686's picture
Steelkiwi686
Posts: 64
Joined: May 2019

I apparently have one of these. She happened to call at a weak moment so I agreed to speak with her. She just basically asked how I was doing etc and went down a list of questions. I was extremely stressed and anxious when she called due to unrelated insurance concerns and this came out in discussion. She asked if she could refer me to an 8 week counseling program I am entitled to with my coverage and I agreed. I have since started the program and it has been very positive and was needed more than I knew. I give her credit for this. 
Also helpful was discussing medications and ideas for when the best time to take diarrhea medicine is, etc based on my results. 

However this person needs sensitivity training and listening skills.

Not helpful was when she said during our first conversation that hey youre eligible to be in hospice and continue treatment and could she refer me. Not only does that not make sense to me in my understanding but nevertheless Um, what the heck, I already told her I was NED and on a chemo break and essentially stable. It felt like I got Punched in the throat and I immediately burst in to hot tears of fury and fear and confusion. This was in fact the tipping point, by the way,  that led me to accept the referral to the counseling program!

Ironic.

She also seemed to suggest a colostomy when I discussed diarrhea as routine. What is with this lady?!!!

Anyway I have tried very hard to not hold the negative things against her but got kinda angry when I looked up a medicine that she suggested I ask my doctor about getting on, that is clearly contraindicated with one of the medicines she knows I'm on!

Her stated purpose is to make sure the patient is aware of benefits they are entitled to that they may not realize so that you can maximize your coverage and have better health outcomes  I appreciate that but I'm not quite sure if I will pick up the phone next time she calls.

If I do speak to her again it will be about listening to possible coverage I have for programs that I may need right now. I just no longer trust her the way one should trust a nurse.

This has been my experience so far. Do I think it's worth talking to them? Probably yes because it could be very beneficial, but I'd be cautious.....never forget who they work for,  so take the good and use it to maximize your benefits and get the programs you are entitled to and may well not be aware of. Try to ignore the rest.

Feel free to message me with any questions.

Steel

 

 

 

Trubrit's picture
Trubrit
Posts: 5121
Joined: Jan 2013

Sage advice.  

Tru

KelleyTX
Posts: 11
Joined: Jan 2020

Thank you Steel, that was very interesting and helpful. 

Kelley

Annabelle41415's picture
Annabelle41415
Posts: 6446
Joined: Feb 2009

Welcome to the boards.  You will find a great group of people here that can help you in almost every situation, except this one for me.  I've not heard of this before so can't give you any direct knowledge, but wish there was something like that for me.  Check into it and see what it has to offer.  You might really appreciate what they can help you with.  Wishing you well going forward.

Kim

annie4145
Posts: 180
Joined: Jul 2018

My insurance company assigned me a nurse ( I believe) who checked in on me during my treatment, and was helpful even though she wasn't part of the official treatment team.   I guess it depends on who gets assigned to you and their qualifications/experience.  I don't trust insurance companies, but in my case, I liked the nurse that was assigned to me.

Real Tar Heel
Posts: 56
Joined: Nov 2019

I had a similar experience recently and it bugged me out a little. The insurance company assigned a home health nurse (a nurse practitioner) to me. I of course hadn't asked for one. They kept emphasizing it was "free of charge to you." Okay ....

I relented and made an appointment, mostly out of curiosity. When I spoke to the NP she told me during the conversation that she's usually given to people with less than two years to live. So you can imagine my reaction...well inside I was raging but I just nodded my head. I'm not in bloody hospice and my doc thinks they are going to cure me...

Other than that bit of the conversation the NP is a nice person and is concerned about my blood pressure but now she has a better understanding of her newest patient.

I believe insurance companies are going this route with patients like us to make sure they limit our hospital visits. It's cheaper to send over an NP who is on salary to deal with some side effects from treatment I guess.

Trubrit's picture
Trubrit
Posts: 5121
Joined: Jan 2013

 It's cheaper to send over an NP who is on salary to deal with some side effects from treatment I guess.

Here in rural Nevada, we pay $279 AFTER insurance for our NP.  I pay my Oncologist $86 after insurance.  I told him he was in the wrong job.  

Anyway, try figure that one out.  She's not even a Doctor. I don't know what they charge here in the rurals. I don't want to find out. 

Tru

Pamcakes
Posts: 92
Joined: Jan 2018

My husband had a OCM through our insurance for the first two years of his diagnosis. I worked as a CM for Humana for 7 years before Richard was diagnosed. i knew what to ask for and how to utilize her therefore she helped us tremendously. She helped with getting auths approved, contacted pharmacy when we had issues with the chemo pills, and checked in to Answer questions about reports and scans. She helped in getting Richard a docotor at MD Anderson ( we live in WV).She offered education. Now that Richard is NED (praying he continues to be) he no longer has the CM. We miss her!! She even helped him with non cancer medical issues. I think if you ask for help and just tell the CM what you need they will be able to offer a lot to you. When I  worked as a CM I loved for members to communicate what they wanted / needed. This allowed me to help them. I think a lot of times members were a little afraid to ask because it's the "insurance" company and they were afraid I was there to take their benefits away. once they realized the benefits they would open up. one aspect of my job now is to help / teach doctor offices how to implement CM. A good CM can really help in so many ways!!! Try it and if it doesn't work you can always stop. please let me know if you have any questions regarding CM!! 

Subscribe to Comments for "Oncology case manager"