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 the best care is given 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 completion of treatment, coordinates all aspects of your care and provides additional 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 proceed in fully enrolling 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 and the implications of such refusal relating to benefits eligibility and/or health outcomes
- Use end of life and advance care directives
- Obtain information regarding 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 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 individually specific health care decisions
- Work collaboratively with Aetna representatives in developing goals and implementing interventions to manage their condition
- Work collaboratively with health care providers in developing and carrying out agreed-upon treatment plans
- Make a good-faith effort to maximize healthy habits, such as exercising, eating a healthy diet and not smoking Abide by the administrative and operational procedures of our case management program
If You Have Questions
Please refer to your Official Plan Brochure or call toll free at 800-638-8432.
Official Plan Brochure
Download a copy of our Official Plan Brochure to learn more.