I was talking to a friend the other day. She was recently diagnosed with lymphoma. She was scared worried and felt she needed to speak to someone about finding a specialist and what she should expect to encounter as she started on her journey.

She told me she decided to call her insurance company and asked to talk to a case manager. She is a case manager herself, so she thought she could depend on another case manager to listen to her and point her in the right direction. Instead, she was told that she was not sick enough to have a case manager. Yes, you read that right – she was told that she was not sick enough to have a case manager. As we talked, I asked myself – why was she told this? I was disappointed and angry that my friend could turned away and told she was not sick enough. My question is: how sick do you need to be to talk to a case manager?

As a nurse case manager/nurse advocate, I tell people to call their insurance company and talk to a case manager when they need help as they know the network and can give the patient choices. I tell people in the hospital to ask for a case manager when they are unsure of what is going on. I don’t expect them to be told, ‘you are not sick enough’. Case managers are resources for people, patients, caregivers, and healthcare team members. They are in place to proactively help people break down barriers and find resources to meet their needs. If they can’t help them – they find someone who can.

Case Managers are supposed to be a resource, someone whom a patient, a member, an injured worker can ask a question, depend on to help find a resource, say they have a problem, and be directed to the one person who can help them. If we are not doing this – what are we in place for?

As a nurse case manager/nurse advocate, I want people to know that they can depend on us when they need a trusted voice to help them. I don’t want to hear ‘you are not sick enough. I know we can’t help everyone – that there are things beyond our control, but we can provide direction to give suggestions for questions a person could ask to clarify things for them. We must provide help – especially when people ask us – Not be told ‘You are not sick enough.’

If you are ever told you are not sick enough to talk to a case manager, please share the Case Management Standards of Practice with the person telling you this. They say; Case managers are recognized experts and vital participants in the care coordination team who empower people to understand and access quality, safe, and efficient health care services. 

Here is a link to the Case Management Standards of Practice. https://pmg.joynadmin.org/documents/1054/602c251cef0d263a52749741.pdf

Case managers are in place at every entry point of the broad healthcare system. They should be available to listen and provide direction to those in need. In my mind, everyone should be able to talk to a case manager when they are in need, or why are we in place?

We need to close the disconnect between theory and practice? 

Thoughts? Reactions?

Thanks for reading…..have a good week.

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