Making your way through the health care system can be confusing, stressful, and scary. But what if you had someone on your side to listen, stand up for you, and help make sure you get the care you need? That “someone” could very well be a case manager with your health insurance plan.

Most health plans have care management programs that coordinate care for members, especially those with complex health issues or chronic (long-lasting) conditions like diabetes, high blood pressure, and heart disease. Case managers are a very important part of care management programs.

Case managers who work for health plans often have special training in areas like social work and nursing. They are licensed professionals. While they are not doctors, they understand medical basics. Think of them as your advocate, cheerleader, and health care system guide.

The benefits of having a case manager

No two members have the same experiences and needs. That said, here are some things your health plan’s case manager may be able to help with:

• Finding providers and specialists who are in your plan’s network
• Understanding what is covered by your insurance and what is not
• Managing chronic conditions (including working with you on exercise and diet changes)
• Coordinating care among different providers and services
• Connecting you with community resources you might qualify for like food, clothing, caregiving services, and rides to appointments
• Planning for what happens after you leave the hospital

Community Health Plan of Washington (CHPW) covers care management for all its plan members, including Apple Health (Medicaid) members. CHPW has specialized care management programs for children’s mental health, diabetes care, LGBTQ+ health, and more. Visit here for details.

Tara Sol, Senior Care Manager with Community Health Plan of Washington, says many of the CHPW members she has helped appreciate the one-on-one support.

“Overall, having a case manager can help you navigate complex systems and health conditions, access the support you need, and achieve your health care goals more effectively.”

Tara Sol, Senior Care Manager with Community Health Plan of Washington

Best of all, case managers are FREE to you, it won’t cost you anything! Their services are included in your health plan.

Tips for getting the most out of your case manager

• Prepare: Before talking with a case manager, think about your health situation and where you need help. Make a list of things to discuss.
• Communicate: Tell the case manager about your health challenges and goals. Don’t hold anything back. The more they know, the better they can help you. And don’t be afraid to ask questions.
• Plan: Your case manager is your partner in health. They have your best interests in mind. So listen to their input and recommendations. Together, you will come up with an action plan and work toward improving your health.

CHPW has case managers who specialize in diabetes care management. They can help you make lasting lifestyle changes to improve your overall health. Find out more here.

How do I get a case manager?

Call your health plan. Ask about case managers and care management services. Remember, your case manager is here to help you, so don’t be afraid to reach out!

Need a CHPW case manager?
CHPW members can call the Care Management team at 1-866-418-7004.

Are you a CHPW member and need help with renewing your Apple Health coverage? Call CHPW’s Renewal Team at 1-866-907-1904 (TTY: 711), 8 a.m. – 5:30 p.m. Monday through Friday.