Just assigned a Nurse Case Manager...what do I need to know?

[cherokeegal]

Oh, I'm keeping a notebook with detailed notes. I started after I got home the day I was hurt, and I journal every doctor and PT appointment, and every phone call in it. Not taking any chances there.

Just seems like a lot of this WC business is so unfair to us, the worker. Dang it, I was working when I got hurt....not sitting on my butt drawing welfare.

[hurt back]

You are correct.. I've decided that when I do get done w/ this i'm going to back to school b/c I'm going into the medical field. As maybe I can use my injury to help / inspire others.. its an unfair world in this system.. But what do you do?


Yes I write down times and all.. Just so that way if i have to go to court its a very detailed explanation of everything...

[jayne]

ahhhhh welcome to our world,isnt it just the best?Your raised to go to work and earn your way and if you had a Daddy like mine you NEVER accepted anything you didnt work for.Made your payments on time was able to put a bit aside for a rainy day and boom along came a bloody flood and all you did was get up and go to work.and now you are loosing it all..
Your NCM can help you get some medical tests faster,she can get you a different Dr faster but remember this in all herwatching sweetnes and light as she talks to like an old friend she is weeding out statements to bite you in the butt.As you are talking about finally getting out of the house as a family and going on a picnic in the country and how you were able to relax with the kids and have a good time.she is gonna write up her report that you had a outing with the kids and PLAYING with the kids...so be careful

[AQA]

AMEN.

Bottom like is this. The 80/20 rule comes into play. Bettter known as the Pareto principle. 80% of NCM's are on the bad side. While 20% are not. In my oppinion, 80% of all employee's are a waist of money. While the other 20% are well worth the money.

This is when you have to hold your cards close. Be careful what you say whether he/she is part of the 20% or not. While doing that, see if you can use him/her to your advantage. To speed up the medical process, if possible.

[hurt back]

The only thing I can say is that my case manager does get my approvals for my MRI's 7 EMG's quickly... and my appts... BUT that could also be because they are trying to get me thru asap?!?!?!

[cherokeegal]

The one who came yesterday was a "fill in" and said my actual NCM was tied up somewhere else. I didn't like this "fill in". She was nice enough, and introduced herself as "I'm your advocate" but she kept interrupting the PA when he was trying to get my history. And she once said something like, "We're going to get you back on your feet." It was the "we" inclusion of herself on my medical team that chapped my ***. She just wouldn't shut up and both my husband and I felt like the PA was getting annoyed with her.

Once I see my actual NCM, I will give her a chance, but if she is as intrusive as her partner was yesterday, she will not be allowed into the exam room with me.

[cherokeegal]

The one who came yesterday was a "fill in" and said my actual NCM was tied up somewhere else. I didn't like this "fill in". She was nice enough, and introduced herself as "I'm your advocate" but she kept interrupting the PA when he was trying to get my history. And she once said something like, "We're going to get you back on your feet." It was the "we" inclusion of herself on my medical team that chapped my ***. She just wouldn't shut up and both my husband and I felt like the PA was getting annoyed with her.

Once I see my actual NCM, I will give her a chance, but if she is as intrusive as her partner was yesterday, she will not be allowed into the exam room with me.

[hurt back]

That is one reason why I don't let mine in.. That way I can express my thoughts / concerns... I mean they talk to the dr before and after anyways normally or by phone... Mine does all the above...

I do hope that you actually case manager is nice and understanding.. But keep in mind they're hired by the insurance company, to get you better ASAP, that is their job and how they get paid!

[bronco54501]

(08-14-2012 09:02 AM)cherokeegal Wrote:  The one who came yesterday was a "fill in" and said my actual NCM was tied up somewhere else. I didn't like this "fill in". She was nice enough, and introduced herself as "I'm your advocate" but she kept interrupting the PA when he was trying to get my history. And she once said something like, "We're going to get you back on your feet." It was the "we" inclusion of herself on my medical team that chapped my ***. She just wouldn't shut up and both my husband and I felt like the PA was getting annoyed with her.

Once I see my actual NCM, I will give her a chance, but if she is as intrusive as her partner was yesterday, she will not be allowed into the exam room with me.

Fill in ncm's can be helpfull as well, the problem probably was she was called in at the last moment and didnt want to get into trouble from her peers...(all the questions she asked).. When they say we will get ya better also shows she help push for the right treatment.. But dont let your guard down for they can and will turn against you..

My ncm was allowed in some appoinments and there were some dr I wouldnt allow... But either way she still showed up and we talked before appoinments and after appoinments she wasnt allowed in.. I found it usefull to discuss if I had certain needs/problems that I was going to discuss with the dr.. She was always helpfull on getting the dr to discuss my questions... A good ncm will be helpfull but then there are some that will screw you over and twist words against you. One that tells you they wont pay for that or they will deny treatment is a waste of time and against you.. Its not thier job to decide what treatment is needed its up to the adjuster to approve them needs...

[hurt back]

Exactly Bronco..... My case manager does get my tests, MRI's approved fairly quickly and the appts.. But I my MRI's are done elsewhere and not at my treating hospital for $ reasons... But like I said watch what you say and document everything... If your case manager keeps denying approvals of treatment you can file a claim w/ the state against her. But the fill in probably wanted her to make the decision as she was probably just an office rep.. But my case manager hasn't missed a single dr visit.. she went to all so far, and the emg, just not the MRI...


Good luck..