The Health Plan has registered nurses that are disease managers who teach self management skills to members with selected chronic conditions and/or depression. If you have a patient you believe would benefit from the Case Management Program, fill out the following form or contact one of our disease managers in our Medical Department at 740.699.6110 or toll-free at 1.800.624.6961, ext. 6110 for chronic medical conditions or the Behavioral Health Unit at 740.695.7592 or toll-free at 1.800.624.6961, ext. 7592 for depression.

Further explanation of The Health Plan's Disease Management Program can be found in the Practitioner Procedural Manual, Section 7 and Section 9.

Fields listed with an "*" are required.

Required *

Referring Physician  *

Please type the Referring Physician's Name

Physician's Phone Number

Member Name  *

Please type your Member Name

Member ID  *

Health Plan ID Number must be nine characters and begin with an H

Member's Phone Number

Physician's Email

Disease Management Program Chronic Obstructive Pulmonary Disease  Chronic Heart Failure  Diabetes  Asthma  Depression 

Comments