How to Be Your Own Case Manager

Charles E. Roberts, MSW/CSW

Plan Organize Lead Control

These are the Keys to Management

Planning – The process of establishing a set of meaningful Goals, Objectives and Action Steps.

Organizing and Organization – The structuring of Material, Resources, Time, and People.

Leading and Leadership – The taking on of responsibility and the manipulation of decision making, problem solving, Communication, Motivation, Advocacy, and Politics.

Control – The process of setting standards and implementing the regulation of time, material, resources, budgets, audits, reports, diaries, and follow-up.

ALL PHASES OF CASE MANAGEMENT REQUIRE PLANNING, ORGANIZING, LEADING AND CONTROLLING

I. ORGANIZING YOURSELF – NOTEBOOKS – FILES WITH TABS

1. SUMMARY SHEET. Basic data about your case.
2. RELEASES – Notarized.
3. PRESCRIPTIONS – All Rx’s; Keep copies if possible. A record of prescriptions for medications, tests, services, treatments, and equipment makes it harder for insurance companies, Medicare, and Medicaid to reject or deny.
4. MEDICAL REPORTS
5. REPORTS – Medical, Doctor, Hospital, Specialist, Laboratory, Psychological, Neurological, and Insurance Company, misc.
6. TESTS – Psychological, Vocational, and misc.
7. CORRESPONDENCE – Miscellaneous. Some correspondence may need to be filed under captions.
8. SOCIAL SECURITY – All kinds of information, determinations, and correspondence.
9. DEPARTMENT OF SOCIAL SERVICES – All kinds of information, determinations, and correspondence.
10. BILLS – With some kind of organization so they can be found and understood.
11. BUDGETS – Anticipated and actual spending.
12. PRICE QUOTES – Develop your own forms for shopping around for equipment and supplies.
13. BROCHURES – Keep them in a file.
14. RESOURCES – Names, addresses, phone numbers of agencies, professionals, contacts, and vendors with comments.
15. MEDICAL PROVIDERS – Physicians, nurses, Nursing Companies, Nurses Aides, Pharmacists, Nursing Homes, and others with notes and comments.
16. INSURANCE POLICIES – Auto, life, health, disability, travel, homeowners, others.
17. POLICE REPORTS – Including detective reports.
18. PROFESSIONAL PROVIDERS – Attorneys, Physical Therapists, Case Managers, Speech Therapists, Psychologists, Treatment Programs, Hospital Programs, and Consultants, etc.
19. OFFICIAL DOCUMENTS – Birth Certificates, Medicare, Medicaid Blue Card, Social Security Card, and other documents.
20. HOUSING ALTERNATIVES – Group Homes, Apartment Buildings and Complexes that are sensitive to TBI or their handicaps, Section 8, Special Mortgage Arrangements particularly through the Michigan Housing Development Authority.

Remember: In the medical and insurance arena it is DOCUMENTATION AND MORE DOCUMENTATION. Documentation is what makes things happen for you and your family.

II. GOALS – Written long term goals – What do YOU want to see happen

1. Intermediate goals – could be 100 or more
2. Objectives
3. Action Steps
4. A written treatment plan – A care plan

III. MEDICAID – Dealing with DSS (Michigan Department of Social Services).

1. Don’t give out originals of anything, use photocopies, use the notebooks and let others photocopy from your records.
2. Be very persistent with DSS workers. They feel overworked, overwhelmed, and
3. Develop a table of organization.
   1. Your worker
   2. Worker’s Supervisor
   3. Regional Medical Worker
   4. Regional Medical Worker’s Supervisor
   5. Lansing Coordinator
   6. Prior Approval Desk
   7. Exceptions Division
   8. And so on, up through the current State Director
4. WRITE LETTERS – If you are not getting what you want. Don’t keep the issues in the dark. Nothing happens until you get the issues up and in view.
   1. Write the letter to the authorized person with copies to: (as appropriate)
      1. Governor – particularly if issues involve state agencies like Social Services and Vocational Services.
      2. Attorney General (can act as an Ombudsman)
      3. Director of The Department of Social Services
      4. US Senators
      5. US Congressman
      6. State Senator
      7. State Representative
      8. Ombudsmen or Oversight Agency (Citizen’s for Better Care, MHIA)
      9. Supervisor of the person you are writing to
      10. Judge – Particularly if in probate and a guardian is involved
      11. Concerned others
   2. Content of the letter
      1. Make the letter brief, intelligent and readable (this is not soap box to cure all ills)
      2. Typed is preferred but legible hand written will do
      3. Present your issues logically, factually, and in sequence. Keep to the issues – stay away from asserting personalities. What will happen if you assassinate personalities is a backfire. Your legitimate issue will be switched from what you want to your attack behavior and the real issue will be lost.
5. Appeal any adverse decision.

IV. SOCIAL SECURITY

1. Keep originals and submit photocopies.
2. Know the organization the way you know DSS.
3. Appeal, appeal, appeal any adverse decision.
4. You may want to use a Social Security specialist attorney, but they should be interviewed and fee arrangements discovered. They will take their fees, which are regulated, out of settlements and are generally 25% up to $4,000.
5. Get to know the programs: SSI, DSS, Medicare, Work Incentives, etc. Rules, handbooks & brochures are available at any Social Security Office.

V. INSURANCE COMPANIES Auto No-Fault, Worker’s Compensation, 3^rd Party Liability, Homeowners, Health and Disability

1. KNOW THE ORGANIZATION IN THE SAME WAY YOU KNOW SOCIAL

SECURITY OR DSS.

1. Agent who wrote the policy.
2. Claims Adjuster/Case Manager.
3. Claims Supervisor.
4. Claims Manager.
5. Branch Manager.
6. Home Office Claims Vice-President.
7. Law Firm representing the Insurance Company.
8. Bureau of Labor, Worker’s Compensation Division.
9. Insurance Commissioner.

1. Remember that an insurance company is in the money business. An insurance company does not fix cars, bodies, or homes. It pays to fix them. You may have to make the decision of what to buy, which doctor to use, and/or which facilities or treatment programs to use. The insurance company may balk and not pay because they think that the decision you made is not reasonable or within the scope of the policy. But YOU are in control.
2. Remember DOCUMENTATION is what justifies insurance company payment.

VI. HOSPITALS AND OTHER HEALTH CARE INSTITUTIONS

1. Hospitals are really just another bureaucracies. Often inefficient and mistake prone.
2. You need to know the table of organization just as you would an organization. The
3. Billings can sometimes be negotiated. Particularly if there are items which are not
4. Discover what hospitals accept for Medicaid and negotiate.
5. Collection Agencies

VII. RESOURCE AGENCIES

1. MHIA
2. Citizen’s for Better Care
3. Catholic Social Services
4. Jewish Vocational Services
5. Michigan Rehabilitation Services
6. Intermediate School Districts
7. Michigan Housing Development Authority
8. Area Agency on Aging
9. Services for Senior Citizen’s

VIII. CONTRACTS – SHOPPING

You can make contracts with vendors, providers of service and professionals.

1. Design your own forms for shopping comparisons.
2. Buy in case lots, if possible.
3. Pay in advance – vouchers for later delivery.
4. Ask for discounts – make deals.
5. Shop around –
   1. Durable Medical Equipment (the mark-ups are incredible).
   2. DRUGS – Make the best deal with the best buy. Consider generic replacements. Work with your physician to prescribe and dispense for longer periods of time so that you can ask for discounts. Consider writing to the manufacture for direct payments or free medications.
   3. Disposable. This will also reduce co-pays. Shop for case lots and yearlong supplies. Rite-Aid, CVS, and K-Mart are in keen competition. Again, consider buying from the manufacturer. Work unusual sources that might sell to you wholesale.
6. Professionals – Don’t take just any referral, ask around. Interview and check references.

1. Attorneys – Make sure they knows their specialty – Probate Court, Social Security, or Head Injury, etc. The first meeting should be free.

IV. BUDGET-BUDGET-BUDGET CONTROL-CONTROL-CONTROL

1. Design your own budget forms. Go to the library and research budgeting. Find a way that works for you. You won’t succeed at budgeting unless you do it your own way. Just be organized about it (Plan, Organize, Lead, and Control). Budgets are supposed to be realistic estimates but really try and live by a budget. Most of us don’t, but try anyway.
2. Seek help from state agencies. Pick peoples brains for ideas.
3. Avoid debt reconcilers, if possible. They often charge an arm and a leg for things that you can do yourself.
4. Keep receipts and bills in a system. Try using a computer. There are many financial programs that can help you organize your bills and payables.
5. Keep logs of both time spent and mileage. You must have documentation; there is no other way.
6. If you can, try to use family meetings to make decisions. If your get consensus, then there is likely to be more cooperation and commitment.
7. Communicate with family members about plans. Listen to ideas, but don’t jump on the bandwagons.

X. EAT RIGHT – STAY FIT – BUILD ENERGY – YOU’LL NEED IT!!!