Get extra help
for a serious illness or injury

Case management can help you with a life-changing health event

If you ever face a serious illness or injury, you shouldn’t have to worry about how to get the right care. At Moda Health, we have a special team ready to support you.

Dealing with a health crisis can feel like too much. There’s a lot to remember, many appointments to schedule and a long to-do list. Our case management team works with you, your family or your caregivers to help manage it all.

Case managers are skilled at breaking down barriers to care. They can connect you with the services and supplies you need, such as home health support, medical equipment, rehabilitation or other specialty services. Case management is included in your Moda Health benefits at no extra cost, is completely voluntary and is available for as long as you have your plan 

When can case management help?

Case management is designed for serious, life-changing illnesses or injuries, like a new cancer diagnosis, a traumatic brain injury or heart failure. You can ask for case management for yourself or a family member, or your health care team might refer you if they think it would help.

The team may also reach out after a long hospital stay to make sure:

• You understand your discharge instructions
• Medications are correct
• Services have been ordered
• Supplies have been delivered

Case managers are also especially helpful when you hit roadblocks in your care:

• Need medical equipment, like a wheelchair or oxygen? They can help get it
• Can’t travel due to pain or mobility issues? They can arrange home health services
• Facing financial challenges? They can connect you to community resources
• Need support for tough conversations? They can help you plan or connect with a counselor

They can also explain how different benefit services, like physical or occupational therapy, fit into your treatment. With a clinician advocating for you, you’re more likely to get the right care, at the right place, at the right time – while lowering your chance of being readmitted to the hospital.

For questions about eligibility, costs, prior authorizations or appeals, call medical customer service at the number on your ID card.

An inside look at the team

Our case management team is small but mighty, with six licensed registered nurses (RNs) and two licensed clinical social workers (LCSWs). Their focus is providing personal support to patients with the most complex health needs.

• Some patients may only connect with their case manager once or twice after a hospitalization
• Others may talk every week, depending on their needs
• Complex cases remain open for at least 60 days, but support is available for the life of your plan

Parents of pediatric patients may work with their case managers for years. Some patients may step away and return when they need help again.

Even though they’re called “case managers”, these clinicians don’t manage patients. They help patients and caregivers manage the situation they’re in. You’re always in control of your care.

It’s easy to ask for help

Case managers act as your advocate, with your whole family’s needs in mind. Their goal is to solve problems so you can focus on your health and recovery.

If you think you or a family member might benefit from case management, you can submit a referral. The team will reach out, ask a few questions and let you know if you qualify. If you sign up, your case manager will work with you to decide what kind of support you need.

Get started:

• Call 800-592-8283 (TTY users: dial 711)
• Email casemgmtrefer@modahealth.com
• Or log in to your Member Dashboard

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