Type of Care

Our nurses provide long term "complex case management" services to members identified as high-risk based on the presence of a life-altering diagnosis, disease or injury. We can also provide short term "care navigation" for issues like:

  • Trouble managing symptoms
  • Finding specialist care
  • Access help for substance use disorder
  • Assistance in finding a caregiver
  • End-of-life care

All care management services are holistic and developed with member input and support of a dedicated nurse navigator. Our care plans address social determinants of health, behavioral and medical needs and are specifically designed to help members better understand and manage their own health.

Behavioral Health

If you are diagnosed with a behavioral health condition, The Health Plan is here to help. Our dedicated, in-house staff of experienced behavioral health professionals provides services along the complete spectrum of behavioral health care including referral assistance, customer service, education, claims review, prior authorization, case management, disease management, outreach and screening for a variety of behavioral health conditions.

Our case and care management programs assist members living with a diverse range of diagnosis, including specific programs targeted at:

  • Depression
  • Bipolar disorder
  • Schizophrenia
  • Major depressive disorder
  • Post-traumatic stress disorder
  • Eating disorders
  • Autism 
  • Psychosis
  • Anxiety
  • ADHD
  • Substance use disorder

Most importantly, our in-house Behavioral Health Services Team ensures complete integration of behavioral health services with medical services so that the complete spectrum of needs can be addressed in the most effective and efficient manner possible. If you need assistance or have any questions regarding behavioral health, please call our office at 1.877.221.9295 (24 hours a day) and we will help you.

Disease Management

If you are living with diabetes, coronary artery disease (CAD), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), depression, or are experiencing a high-risk pregnancy, you don’t have to go through it alone. The Health Plan can provide you with educational mailings, telephone calls and counseling to help you better understand your condition.

Our in-house care team can also help by guiding you through preventive care and testing to monitor your condition. We can help answer questions related to your disease, medication or lifestyle changes to better manage your health.

If you have questions or would like more information, call our Customer Service Department at 1.888.847.7902. Members who have been diagnosed with diabetes, CHF, or COPD can enroll in the appropriate disease management program by competing and returning a Disease Management Enrollment form. After filling out the form, a nurse from The Health Plan will contact you.

Prenatal & Pregnancy

Our pregnancy program was designed to keep mom and baby healthy while reducing NICU admissions and costs associated with preterm birth and other complications of pregnancy. We provide trimester screening calls to pregnant members to support a healthy pregnancy. Expecting mothers will receive outreach calls, educational materials, and support for those identified at high-risk for premature labor and delivery. If you have concerns about your pregnancy or would like more information on this program, complete the Pregnancy Enrollment form to have one of our nurses contact them you.

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