Managed care patients

  1. I am a full-time salaried Home health nurse. Our agency just recently combined our managed care and medicare divisions. Now my patients are a mix of Medicare and Managed care. I find managed care to be very confusing at times and very, very frustrating when I cannot get needed visits authorized for my pts. I have a hip replacement patient that has been waitng for 5 days for her approval for more PT, the eval only was approved. No HHA and when she fell in the home they would not approve an assessment visit so she went to the hospital which ended up costing more! Is it always like this and what are WE going to do about it! Ellen in FL
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    About Ellen

    Joined: Jan '70; Posts: 21; Likes: 3
    Cardiac/Telemetry RN


  3. by   LEK 3547
    I have been in managed care for some time now, and you are right, it can be very frustration. We have established relationships with most of the companies we deal with, and they have been pretty good with giving authorization, even when we contact them several days after the initial visit. It seems that we leave messages on voice mail more often then we get to speak to a real person, but they always call back sooner or later, We have not been denied any reasonable visits
  4. by   Bridget
    Managed Care can be frustrating. I have learned to give case managers what they want to hear ie. specifically what skill I am doing with the client, what am I teaching, what are my goals...sometimes if I feel that if someone needs a little more attention, monitoring, I will embelish a bit about their condition.
    As you are aware, sometimes there is something wrong that you can't put your finger on, and managed care believes you should know everything there is to know after one visit.

    Sometimes the case manager will still give you a hard time, in that case I notify the MD and tell him who I spoke with, first and last names, phone number and extention.

    Home Health is not a babysitting service, nor do I go to client's homes merely to hold their hands and offer reassurance, I understand this. I have had case managers imply that we were doing just that and robbing them of there paltry reimbursement rate, but as long as my goals are clear and skill is noted I usually get what I need.