Why Medical Case Managers hired by Insurance Companies May Not be the Best Patient Advocates…

While medical case managers hired by insurance companies may provide valuable services to patients, they may not always be the best patient advocates for several reasons:

1. Conflicts of interest: Medical case managers who are employed by insurance companies may have competing interests. Their primary responsibility is to manage costs for the insurance company and ensure that the company pays out as little as possible for medical care. This may sometimes conflict with the best interests of the patient.

2. Limited options: Medical case managers may only be able to offer care options that are covered by the patient’s insurance plan or that are the preference of the insurer or adjuster for a variety of conflicting reasons. This could limit the options available to the patient and potentially lead to suboptimal care.3. Lack of autonomy: Medical case managers who work for insurance companies may not have complete autonomy when it comes to making decisions about a patient’s care. They may be required to get approval from the insurance company before certain services can be provided, which could delay or prevent necessary care.

4. Inadequate training: Medical case managers who work for insurance companies may not have the same level of training and expertise as other healthcare professionals, such as long-serving psychiatric or geriatric focused nurses or advanced degreed medical social workers. This could limit their ability to provide comprehensive and effective support to patients.

5. Pressure to save costs: Medical case managers who are assigned by insurance companies may be under pressure to save costs and reduce the amount of money the insurance company or a quasi-public claim servicing organization pays out for medical care. This could lead to decisions that prioritize cost savings over the patient’s best interests.

While medical case managers employed by insurance companies may provide valuable services and support to patients, it is important for patients to also have access to independent patient advocates who can provide unbiased support and guidance in navigating the healthcare system.
Another Blog Post by Direct Care Training & Resource Center, Inc. Photos used are designed to complement the written content. They do not imply a relationship with or endorsement by any individual nor entity and may belong to their respective copyright holders.
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