What is Care Management?
The care management team consists of medical social workers and licensed registered nurses. Your care manager, typically an Appalachian Regional Healthcare System social worker, will work together with you, your physician, and healthcare team to ensure the best care for you during and after your stay.
Your care manager is your advocate and is available to help you with any questions you may have about your treatment, insurance plans, and community resources. You can speak freely with your care manager about any questions or concerns you may have.
A care manager will be paired with each patient admitted into our facilities. You may meet your care manager in the Emergency Department or during the pre-admission process if you are having a scheduled procedure. If not, s/he will come by and meet you shortly after your admission to go over the care plan and treatment goals from your doctor.
Your care manager will be available to
- answer any questions you may have
- contact your insurance company for approval of your stay
- begin the process of discussing your plans for care after your hospital stay
- make referrals to other healthcare providers you may need when you leave
What is discharge planning?
Discharge planning is a service that allows your care manager to work with you, your family, nurses, therapy team, insurance company, and doctor to identify your needs and provide options for your continued care after your hospital stay.
The care manager takes the preferences you and your family have into consideration when working with you to develop the discharge plan.
Care Managers can help you with the following arrangements:
- Admission at a specialized rehabilitation therapy center
- You must be able to participate in a minimum of 3 hours of intensive rehabilitation per day
- May be covered by insurance, but requires pre-approval and extensive clinical information that will be provided by your care manager
Skilled Nursing Facility
- Admission at a nursing home
- Treatment is less intensive than inpatient rehabilitation, but physical therapy is still provided daily
- Includes Nursing & Certified Nurse Assistant Care
- Medicare pays for first 20 days, and it may also be covered by private insurance with prior approval
- Admission at a facility or apartment complex that provide daily assistance with meals, housekeeping, and transportation
- Not covered by private insurance or Medicare and requires private payment on a monthly basis
Durable medical equipment (DME) may be ordered by the doctor. Not all DME is covered or paid for by insurance, and you may have to pay out-of-pocket. Durable medical equipment includes items like:
- Bedside commodes
You and your family or caregiver need to have a plan for your transportation after discharge from the hospital. Transportation to the skilled nursing facility, inpatient rehabilitation or home is not covered by Medicare or private insurance if you are medically stable to ride in a car. Ambulance services for transport can be arranged, but these require payment up front.
Appalachian Regional Medical Associates Health Navigation
Patients of Appalachian Regional Healthcare System may be contacted by a Patient Care Advocate upon discharge from a hospital stay or after an office visit. The Patient Care Advocate’s goal is to ensure patients understand their care plan and give patients a point of contact within the healthcare system for future questions. Patients can get help with their questions, schedule appointments and obtain medication refills.