Case Manager
My insurance company through my employer was CIGNA. RUSH was my approved primary center per my insurance. Every potential living donor can only be evaluated at the primary center. I had the option to be evaluated and listed at multiple centers (my choice) but the insurance would cover services only at the primary center. CIGNA appointed a case manager, Caryl Taylor, who stayed in touch with me the entire time I was on a transplant list until dialysis or a new kidney. A case manager becomes a very significant resource for you in many ways:
1. She is a nurse and an insurance employee. She knows the insurance rules
2. She is a patient advocate at the insurance and will guide you to avoid the pitfalls.
3. She has the resources at her fingertips and will guide you through the process and requirements for multiple testing. She'll guide you to find wait times, Organ Procurement zone, in-network dialysis or transplant centers.
4. She is the one to consult before you gets tests done- some tests require prior auth else you foot the big bills when the claim is processed.
5. She is the one to approve your primary and secondary listing status or change.
6. She also help you with 'additional insurance benefits'. My insurance plan has Travel Benefits where it pays certain benefits to both th patient (recipient) and the donor if the transplant were to take place over 60 miles from your home. Caryl approved this benefit and sets the $ limits and sends out the credit card.
My insurance company through my employer was CIGNA. RUSH was my approved primary center per my insurance. Every potential living donor can only be evaluated at the primary center. I had the option to be evaluated and listed at multiple centers (my choice) but the insurance would cover services only at the primary center. CIGNA appointed a case manager, Caryl Taylor, who stayed in touch with me the entire time I was on a transplant list until dialysis or a new kidney. A case manager becomes a very significant resource for you in many ways:
1. She is a nurse and an insurance employee. She knows the insurance rules
2. She is a patient advocate at the insurance and will guide you to avoid the pitfalls.
3. She has the resources at her fingertips and will guide you through the process and requirements for multiple testing. She'll guide you to find wait times, Organ Procurement zone, in-network dialysis or transplant centers.
4. She is the one to consult before you gets tests done- some tests require prior auth else you foot the big bills when the claim is processed.
5. She is the one to approve your primary and secondary listing status or change.
6. She also help you with 'additional insurance benefits'. My insurance plan has Travel Benefits where it pays certain benefits to both th patient (recipient) and the donor if the transplant were to take place over 60 miles from your home. Caryl approved this benefit and sets the $ limits and sends out the credit card.
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