Members with certain diagnoses may benefit from our Case Management program.
If you’re identified to participate, a health care professional specially trained as a case manager will work with you and your doctors to plan quality care by:
- Identifying options in health care delivery
- Identifying and coordinating appropriate plan benefits
- Finding available community resources
- Preserving plan benefits by negotiating costs
The case manager works directly with you and your doctor to help guarantee that you get the best care in the most appropriate setting. This works towards eliminating unnecessary medical expenses and reducing out-of-pocket costs. The case manager is dedicated to each case through the end of treatment, coordinates all aspects of your care and provides other support as necessary.
Participation in our Case Management program is completely voluntary. However, an authorization to release medical information form must be completed before we can enroll you into the program.
Member Rights and Responsibilities
As a participant in Aetna's case management program, members have the right to:
- Be educated about their rights
- Be informed of choices regarding services
- Have input into the case management plan
- Refuse treatment or services, including case management services
- Use end of life and advance care directives
- Obtain information about the organization’s criteria for case closure
- Receive notification and a rationale when case management services are changed or terminated
- Obtain information on alternative approaches when the consumer, family and/or caregiver is unable to fully participate in the assessment phase
- File a complaint regarding the case management program by contacting Customer Service by phone at 1-202-833-4910 or by writing to Foreign Service Benefit Plan 1716 N Street NW Washington, DC 20036
Members have the responsibility to:
- Accurately and completely disclose relevant information and notify Aetna of any changes
- Become involved in individual health care decisions
- Work with Aetna representatives to develop goals and implement interventions to manage their condition
- Work with health care providers to develop and carry out agreed-upon treatment plans
- Make a good-faith effort to keep good healthy habits, such as exercising, eating a healthy diet and not smoking
- Follow case management program procedures
If You Have Questions
Please refer to your Official Plan Brochure or call toll free at 1-800-593-2354.