Peach State Health Plan is pleased to let you know that we have a case management program. The case management program helps you or your child learn more about their health care condition. You can learn more about:
- Congestive Heart Failure (CHF).
- Coronary Artery Disease (CAD).
- Non-mild Hypertension (high blood pressure).
- Chronic Obstructive Pulmonary Disease (COPD).
- Severe Mental Illness.
- Severe Cognitive and/or Developmental Limitation.
- High-risk or high-cost substance abuse disorder.
- Frequent hospital admissions.
- Frequent emergency room visits.
- Chronic debilitating disease.
Who is eligible?
All covered members are eligible for case management services. You or your doctor can refer for case management services. Call the Case Management Department at 1-800-504-8573 for information on the services offered. TTY users should call 1-800-255-0056. The case management staff will talk with you and find out if you need case management services.
How can you use case management?
You can use it to:
- Help you find doctors and other providers, such as mental health, you may need.
- Help you get services, such as medical equipment or home health, within your plan benefits.
- Work with your doctor to help you stay healthy.
- Provide resources in the community you may not know about.
Our Case Management team is made up of nurses, social workers, pharmacists, and outreach workers. They work with members to help them maintain good health. They also assist you and your doctor to arrange services that you may need to manage your health. The goal of our Program is to learn what information or services members need in order to become more independent in meeting their health care needs.
When you are in the hospital and well enough to get visitors, a Peach State Health Plan nurse or social worker may come to your hospital room. They will discuss with you:
- Your discharge care.
- Answer any questions.
- Tell you about our benefits and services offered.
- Provide information to you about our case management program.
Our staff will always check with the hospital staff first before entering your room. We want to make sure the timing is right for us to visit you
- You may receive a call from one of our case management staff members. They may request you to participate in our Complex Case Management Program. Complex Case Management is a high level of case management services. This is for members who are seriously ill and need help with finding their way through our health care system. Finally, we know that everyone may not want to take part in this program. You can choose to not participate in the program at anytime. Just call your case manager.
- Peach State Health Plan staff will talk to your PCP and other service providers to coordinate care.
- Peach State Health Plan staff will provide information to help you understand how to care for your self and how to get services.