Telephonic Nurse Case Management for Blue Cross

lamazeteacher · Jul 2, 2009

amjbrick:

I was a "disease manager" in Obstetrics last year at Wellpoint, the company owned by Anthem, BCBS, and their many other insurance companies. During my interview with them I asked if it would be possible to talk about Lamaze teachniques with the pregnant women to whom I would be speaking. The answer was positive, and I took the job when it was offered.

However, once I was there, several things happened that were discouraging. The time for orientation to their computer program had been halved (much to the chagrin of the instructor, and she left the company afterward), yet the amount of material covered was the same. The other 2 nurses being trained with me, lived near the office and were able to come in very early to practise the computer formats. They supported each other, but wouldn't respond to me when I asked them questions later. I live an hour east of the office in Richmond, VA, so I got there on time, but not early.

Once we were assigned our cubicles, I wasn't allowed to call patients until my VA license (along with other "chartered states") came through. I was licensed to work in California, but I wasn't allowed to call patients there. However, the others could call California patients and others not in the "chartered" states, without being licensed there. I was very disheartened to see that we wouldn't be allowed to say anything to patients that wasn't in the "script", and that erroneous facts were to be given.

We were told a few days later that we had to fulfil educational requirements in other areas of nursing (med-surg, cardio, orth, neuro, etc.). So we had to do that instead of making calls. The others did their requirements at home, on their own time even though we were told to do the "Iris" courses at the office. Due to other time commitments, I was unable to do them at home, and they finished their educational requirements in a few days.

I got my VA R.N. license in a few days, but was still not allowed to call patients, unless they spoke Spanish (I was the only nurse who speaks that language, there). I had been assigned to an experienced nurse, to hear her make calls. She had won several monetary "awards" for calling the most patients for some weeks. It became obvious that quantity rather than quality was the standard there. That nurse spoke so fast and told patients so many things in rapid succession, never asking if they wanted her to tell them the facts they were to be force fed, or asking if they'd understood.

A week later, I was asked to complete a form to obtain BCBS health insurance (yet there was more than 2 months to go before I'd qualify for that). The other nurses didn't have to do that, as they said, as did I that they had health insurance already. HR insisted that I complete the form, which required stating my birth date. I wrote the month and day of that, but was called by my supervisor and told to place the year of my birth on it - 1939! (I don't look or act my age.)

A few hours after that, I received 6 calls from people in various departments, asking for my birth date, which I gave them. Then my supervisor asked me to go to another building a few miles away where security is housed, to write my birth date under the pictures they had taken of me. I did that, and when I got back to the office, I was told that I wasn't "a good fit" by 2 supervisors.

They offered to help me pack up my things, which I said wasn't necessary. Ten minutes later, one of the supervisors came to demand that I write my own letter of "termination" and hand it to him before leaving. I told him that I'd rather write a letter of resignation, so I could still write on applications that I hadn't ever been fired. He asked the other supervisor who said "no". I wrote the letter as one of resignation, anyway. They told me to rewrite it. I refused.

They were pretty aggitated, having told me that I could leave early and be paid for a full day, but it was getting close to the time I would have gone home anyway. I printed as many things as I could, from my computer there, emails, "Iris" certificates, etc. They came and started throwing things into the boxes they had brought, some mine, some not, reaching around and over me. It was crazy!! I asked what I did wrong, but they wouldn't answer my question. I had to turn in my badge and leave in front of many other workers, who had heard everything. It was misery!! I really needed that job.

For 14 years previously, I had been given impossible tasks at about 5 jobs, and quit all of them after being harassed in that way. A friend finally told me that the business she owned with her husband had BCBS coverage fior themselves and their 35 employees. When her husband turned 55 (over 10 years ago), BCBS wrote that $1,000/month would be added to their premium, due to his age.

They thought the health care policy was good and their employees felt secure with it, so they paid the overage. Ten years later, at 65 years of age, BCBS said that Medicare couldn't be the husband's "primary" health insurer, and wanted to charge another $3,500/month for his coverage. He retired and became the company's "consultant". Their son now runs their business.

I received a letter from a law firm in Richmond recently, that stated they had a "class action" lawsuit against Wellpoint, Anthem, BCBS for employee age discrimination. I was happy to see that, and have joined the class. However that lawsuit regards only those in VA who were fired due to age discrimination, I was told when I asked the lawyer about their instigation of other firings in many companies that had their health insurance coverage. I was told that it wasn't possible for them to handle that; and to their knowledge no cases involving companies receiving insurance from them were in litigation for their prohibitive premiums.

So, as you can imagine, I won't recommend that anyone be employed there. I do believe that Universal health care will knock private insurance companies out of business, eventually. I may not live to see that, but I'm rooting for it! The Canadian "single payer" (NOT "socialized medicine") health care program has worked very well for 47 years. The doctors from Canada have been belittled by American doctors at conferences they attend together, due to their lower incomes. However, medical students in Canada haven't entered that field to make millions. Rather, they have a passion for healing others, and very strong ethics (my niece in Toronto is a family care physician who performs palliative care).

Doctors in Canada live well, but not as lavishly as American doctors do, and they work longer hours. They're paid by the hour, in addition to getting fees for services rendered. Canadians have had a sense that they are responsible for the availability of health care for those less fortunate than they are, and have never harbored resistance to that concept. The amount they pay the government for health care isn't viewed as a tax; it is seen as a premium that also covers others unknown to them (when they happen to be asked if they mind that).

Oops, I am sliding off the topic........ well, you see what I mean......

dianabay · Aug 9, 2009

Lamazeteacher, what an awful experience. I am so sorry. SHAME ON THEM!!

I know what you mean. At the ripe old age of 45 my BCBS insurance DOUBLED!

I have no history of illness, no major surgeries, on no meds...

I have worked in the USA and Canada. While the single-payor system in Canada is far from perfect, I prefer it as a RN and as a consumer.

Not all Canadians are egalitarian, but many do consider health coverage for everyone a source of pride and worth the money paid in taxes.

If you have individual insurance in the USA (as we do), add up:

monthly premium ($700 for my family of 3) X 12 = 8400.00 /yr

deductibles ($500 each every year) =1500.00 /yr

total = 9900.00/yr

Nearly $10, 000 a year without either of us getting sick...., if one of us gets sick, add a 30% co-pay.

On top of that, BCBS tried to terminate covergae when my son was "suspected" of having autism. &@@$#$

Lamazeteacher, I hope you find an employer who appreciates your experience and wisdom. If it's any consolation, it sounds like it would have been miserable days working for those people. Best of luck!

caringchic · Aug 24, 2009

You go girls it is so inspiring to hear other nurses more seasoned than I who appear to be able to critically think be devalued by their employer!! It has been my experience that most employers really only want followers, willing to follow the script and be overjoyed while doing it!!!

Canadians health system has it's weak points, but is such a far cry better than the arrogant egotistical system we have in the States. I would like to ask some one who was at a 6+ figure income and now after this "economic downturn" is on state assistance aka (welfare) if they would value a system like Canada's??!!!! In my life time I have been both on the top and on the bottom, health care for all needs to be every ones responsibility!!!

Thank you for sharing your experience w/ us!

RN1981 · Sep 2, 2009

I am in Michigan and I had a preliminary interview for this same type of position today. My background is in Tele and OB. The "work at home" aspect of it definitely interests me though.

Anyone have any info? Did you ever take the job?

WRNconsult · Sep 4, 2009

I worked for Blue Cross and Blue Shield in Tampa Florida:

I worked both in the precert/UR department (3 months) and Case Management (3 months)

Precert Department: I have never in my life worked in such a negative environment. 90% of the employees (mostly nursing) hated every moment being there. The job was a cake walk....very easy and extremely boring. The managers were nice but again it was the co-workers and the fact that they hated every aspect of the job. Since it was a temp position, I elected not to come on permanently as a direct hire.

Case Management (Telephonic): I was a direct hire for this position and I have to say that the manager was a nut. She was constantly hugging me when she came in and all happy but then was flipping out in the next moment. I meet some really great nurses on my team which was a plus, but as far as the job itself, I did not like performing medical case management. I am not sure if it is the company itself or the job......BUT it was very depressing to interact with patients and when they do not have insurance coverage for some necessity for medical care, then I was directed "well that is all we can do". I am not that kind of nurse. I would research other resources in the community but I was told not to spend time on that.

The whole company attitude was extremely poor. The attitude for medical director reviews was "well, how many denials have I had this week".

I am sorry, but I don't agree that the mentality there.

As far as telephonic case management in general (I went on to accept a work comp telephonic nurse position) and I have been with the company for over 5 years. I truly love my job. And yes, you can be very effective working telephonically.

Case Management is a wonderful and instrumental field if you are with a company that truly values what it is that you can offer.

Good Luck

rmicu, MSN, NP · Sep 9, 2009

I work for BCBS in NY as a telephonic CM , I work from home and have been with the company for over 2 years. It took about a year for me to begin working from home.

My manager is great, coworkers are great. I do case management for the senior population, it is not medical management. My patients are in their homes and we call to offer education, arrange services, give them resources related to their health isues.

Wellpoint (parent co) is really into telecommuting, most of my coworkers, including managers, work from home.

It will be a matter if the job fits your expectations. There have been some nurses who resigned because they didn't like the job or the job requirements.

Why not take a leave of absence from your current job? Give the BCBS job a try for 2-3 months, if it doesn't work out, you can return to your current position.

I hope this is helpful.

lamazeteacher · Sep 9, 2009

I believe that after the Health Care Bill passes, within the first few years there will be ethical, non money related, good telephonic nursing to do - if HHS stays away from former companies' programs.

I resented having to keep to a script when I worked in Richmond, VA for BC/BS (much of which was wrong, wrong, wrong!) after being told in the interview that I could utilize my extensive experience when talking to patients.

I'd worked there about 3 weeks, when they discovered I was 69 years old, and 6 people from various departments (including HR) actually called to ask my birth date (illegal), and upon becoming convinced that I really was my age, I was fired, as "not a good fit"! It was completing the application for health insurance, that gave that away (I was told to do that despite my saying that I didn't need their insurance (I had Medicare); and when I left the birth date part undone, was told to fill it in, then I left the year of my birth off, was told to include that.......).

I've joined an age discrimination class action lawsuit against them! :yeah:

lamazeteacher · Sep 9, 2009

I work for BCBS in NY as a telephonic CM , I work from home and have been with the company for over 2 years. It took about a year for me to begin working from home.
My manager is great, coworkers are great. I do case management for the senior population, it is not medical management. My patients are in their homes and we call to offer education, arrange services, give them resources related to their health isues.
Wellpoint (parent co) is really into telecommuting, most of my coworkers, including managers, work from home.
It will be a matter if the job fits your expectations. There have been some nurses who resigned because they didn't like the job or the job requirements.
Why not take a leave of absence from your current job? Give the BCBS job a try for 2-3 months, if it doesn't work out, you can return to your current position.
I hope this is helpful.

Don't they call it DISEASE Management in New york? That's what the job is in VA..........

How are you dealing with patients who became convinced by their church, Republicans, or others, that their lives will be prematurely ended when the Health Care Bill is passed (go to those sites if you want to argue about that)?

Perhaps you get smarter patients than those persuaded that the Q5year interviews to determine end of life issues, are not in their best interests. I'll appreciate having that done, as I know I should have prepared a living will by now, but haven't gotten to it yet. I'm too busy living!

rmicu, MSN, NP · Sep 10, 2009

No, for my dept it is called case management. There are other depts that do disease management within BCBS, mine is one of them. I have not had any members express concerns regarding end of life issues, some have qeustions, as we all do aboutthe future of Medicare and health care in general.

Overall, I enjoy my job and it allows me time to work in the ICU PRN.

It is important to do what works for you and your family.

I am sorry to read about the tremination of the 69 yo poster. It is unfortunate and I hope you have found a job that fits your needs.

jimsnurse · Oct 16, 2011

I have been employed by BCBS of Fl for more than 5 years; I now work from home as a telephonic case manager working with a variety of members/plans. As far as insurance? I have a HD plan, but BCBS deposits $2000 every January into an HSA which I also contribute to. My premium is less than $200 month. Granted, I have a $6000 deductible, but I also have a $6000 OOP max and all preventative visits and screenings are covered at 100%. Whoever you are, you aren't telling the truth. BCBS of Fl is one of the better companies to work for; in the insurance industry. I certainly appreciate my job, and don't envy those that have to risk their lives and their licenses working in an understaffed and overworked hospital setting. Negative environment? only if you make it that way.

Pamela Schinke RN · Nov 1, 2011

Did it take you

long to be able to work from home?