What is Care Management?
Care Management at Appalachian Regional Healthcare System is part of the on-going commitment we make to provide optimum quality care and service to our patients.
The care management team consists of Licensed Registered Nurses and Medical Social Workers. Your care manager will work together with you, your physician and health care team to ensure optimum care for you during your stay and as you transition back into the community and health. Your care manager is your advocate and is available to assist you with any questions you may have regarding your treatment plan or your insurance plan. Please feel free to speak freely with your care manager about any questions or concerns you may have.
Who is my Care Manager?
Each patient is assigned a care manager to assist them during their stay. 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, your care manager will come by and meet you shortly after your admission to go over the plan of care and treatment goals that your physician has determined will best address your needs.
Your care manager will be available to answer any questions you may have, will contact your insurance company for approval of your stay and will begin the process of discussing your plans for care after your hospital stay to include any discharge planning needs you may have.
What is discharge planning?
Discharge planning is a service that your care manager starts as soon as possible; it may even begin prior to your admission if you are having a scheduled procedure. 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.
Frequent discharge arrangements include:
- Involves a stay at a specialized rehabilitation therapy center
- You must be able to participate in a minimum of 3 hours of intensive rehabilitation on a daily basis
- May be covered by insurance, but requires pre-approval and extensive clinical information that will be provided by your care manager
Skilled Nursing Facility
- Involves a stay at nursing home
- Less intensive than inpatient rehabilitation, but physical therapy is 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
- Includes facilities and apartments 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 may require payment from you. Durable medical equipment includes items like:
- Bedside commodes
- You and your family or coach 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 companies require payment up front.