URMBT members with certain conditions may be required to work with nurse case managers

The UAW Retiree Medical Benefits Trust may require a member to work with a Blue Cross Blue Shield of Michigan nurse case manager to ensure coverage for certain conditions that are complex, severe or rare.

This requirement is part of the Mandatory Case Management Program, which was designed to help improve care quality and coordinate health care services for URMBT members. The requirement took effect Jan. 1, 2012.

If a member selected for the program refuses to participate, the plan’s portion of the financial obligation for medical services, treatments, situations, prescription drugs or other services related to the condition may not be covered. For members enrolled in Medicare Parts A and B, we anticipate that Medicare will cover its portion of the financial obligation, regardless, since Medicare does not require case management.

Here’s how the program works:

• Members selected for the MCM  program will receive a certified introduction letter explaining the program and participation requirements.
• Physicians will receive an introduction letter notifying them of their patients who have been selected for the program.
• A BCBSM physician consultant will contact the member’s primary care physician or specialist to identify any barriers that may prevent medical stability, help to provide coordination of care and develop a plan of action to meet the patients’ health care goals and reduce unnecessary utilization.
• Designated nurse case managers will work with the members to coordinate health services, find community resources, provide information, answer questions and help members meet their established treatment plan goals.
• Members will participate in regularly scheduled calls with the nurse case managers to monitor adherence to their treatment plans.

If you have any questions about the program, please contact your provider consultant.