Managed Care & Case Manager
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How might managed care limit the services a case manager is able to provide? References in APA please.
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This solution examines how managed care might limit the services a case manager is able to provide. References in APA format.
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RESPONSE:
1. How might managed care limit the services a case manager is able to provide?
Managed Care Organization (MCO) is a generic term applied to managed care companies such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) or Point of Service (POS) plans (North Carolina Institute of Medicine).
The managed care plans that are offered to patients are limited, which also limits the services a case manager is able to provide. Some services are covered while others are not, for instance. For example, a managed care plan is a "health benefit plan that creates a financial incentive to use providers that are in the health plan's network. Some managed care plans limit coverage to care obtained from network providers. Others pay more if the member obtains care from within the network, but ...
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