Blue Medicare HMO Blue Medicare PPO

Case Management Programs

In certain health situations, members of Blue Medicare PPO and Blue Medicare HMO are eligible to work one-on-one with a case manager. A provider's patients may be eligible for a case manager if they:

  • Have a qualifying complex, chronic or rare condition
  • Are at risk for developing a complex and serious medical condition. This may be determined by the patient's answers to the Health Risk survey that he/she completed during enrollment.
  • Have been involved in an accident or other catastrophic health event
  • Need assistance managing accute or chronic health care needs

Case Management programs are available at no additional cost, but copayment and coinsurance for covered services may apply. Case managers can help patients

  • Navigate the health care system
  • Identify, implement and monitor their health care needs
  • Learn how to prevent falls
  • Eliminate barriers to receiving care
  • Learn more about their condition, benefits and medications
  • Find resources in their community
  • Learn about hospice and palliative care, advanced directives, and provide support
  • Coordinate services such as home health, skilled nursing facilities, inpatient rehabilitation, hospice, durable medical equipment, transplants and more.

Blue Cross and Blue Shield of North Carolina is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.