Case Management is a program that allows for early intervention and effective management of cases involving serious or catastrophic injuries or illnesses. Case managers assess each situation and work with the claim administrator, patient and physician to make the most efficient use of health plan benefits over the course of long-term treatment. This program incorporates a balance of patient care quality and cost–effectiveness.

The impact of MedCost Case Management is significant when you consider that:

• 20% of all hospital admissions are considered catastrophic cases. Some of these cases include premature births, strokes, cancer, spinal cord injuries, debilitating diseases, and terminal illnesses.
  
• Case Management saves benefit dollars by performing the following functions:
  • Arranging alternate care in lieu of extended hospital stays
  • Negotiating rates on durable medical equipment, skilled nursing services and infusion therapy
  • Researching FDA approved treatments to ensure that the best possible treatment is being utilized
  • Determining medical necessity of services
    
• MedCost’s Health Management programs not only yield significant savings, but they also promote quality of life outcomes.

There is an additional fee for using TransReview services. The fee for this service is contingent on the level of review requested. Charges will be discussed at the time TransReview services are recommended by case management.