Insurance Carrier Patient Chronic Care Management Program

 

UCFA would like to offer you a program at your current doctor’s office that will help us work together to improve your health. A lot goes on at times other than during your office visits. Providers on your health team will work with each other and with you on the phone and in person utilizing our medical record system. This system helps in many ways by organizing your health information such as listing your medications, lab results and keeping track of tests and other services that you may need. Your insurance carrier and your doctors know this information is necessary to assist with keeping you healthy.

 

 

A new Insurance Carrier program starts in 2015 so be sure that you have these four things:

 

1. A phone number for you to talk to a doctor or nurse at any time. 24 hours a day, 7 days a week.

 

2. If you use a computer, tablet, or smartphone the plan offers you a way to ask your health team questions about conditions with your health such as experiencing symptoms of an earache, bladder or bowel problems, and more.

 

3. Time for you to learn from your health team how to improve your health. This can be on the phone, using your computer, or in person.

 

4. There are many people on your health team and they need time to share with you the benefits of your plan.

 

Your team is led by your primary care doctor and may also include: a pharmacist, nurse, social worker, dietitian, diabetes educator, behavioral health therapist, health coach, athletic trainer, and/or spiritual care. It depends on what you need.

 

Taking part in the Chronic Care Management Program is optional, up to you. By signing up for the program, you agree to:

 

1. Make a co-payment of approximately $8-20 for each calendar month that the services above are used. The co-payment will be billed to you. (If required - Provide proof of income and this fee can be waved)

 

2. If you do not have insurance you can enroll into our Life Blue Essential Program and you shall receive comparable services to the insured patient. The Life Blue Essential Program that also gives you 24 hours a day 365 days a year access to a medical provider to address your needs. 

 

3. Sign below that you understand and allow your health team to share your electronic medical record. I agree that I have read and understood all of the above information.

 

By signing below I agree that I want to take part in the Chronic Care Management Program. If I had any questions they have been answered. I understand I do not have to sign this or take part in this program; it is voluntary. I also swear that I am the patient or that I have authorized someone to sign for me. I can decide at any time to stop taking part in this program and the co-pay will stop at the end of the month. The plan is for me to take part for one year unless I tell my doctor’s office I want to stop.