The commission for case management certification defines case management as a collaborative process that assesses plans, implements, coordinates, monitors, and evaluates the options and services required to meet and individuals health needs using communication and available resources to promote quality cost effective outcomes.

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Case Managers and Medical Professionals are independent contractors who are not employed by the insurance companies or other entities.

We are hired by the client.

 

Case Management Role

 

• Make objective assessments and coordinate a plan of care.

• We are impartial advocates for our clients. We empower clients/families to have a greater understanding of their health concerns related to injuries sustained in an Motor Vehicle Accident (MVA).

• We follow the doctor’s plan of care.

• Our goal is to help you to return to your maximum medical potential.

• We only assist with services related to the auto accident. All other health concerns should be managed by your family physician.

• Our services are non-emergent/all emergency calls should be directed to the local Emergency department (call 911).

• Our services include the following:

• Scheduling and attending medical appointments

• Communicating treatment recommendations between providers

• Requesting medical records for care coordination

• Arranging medical transportation

• Communicating your current status with the adjuster and attorney as directed.

 

Client Rights/Responsibility

• The client will attend appointments as scheduled, which includes:

• Physician office visits

• Therapy

• Diagnostic Testing

• If the client is not able to attend scheduled appointments, the client will notify the Case Manager in a timely manner.

• The client will communicate with the Case Manager any changes in the current status which includes:

• Changes in health condition

• Living situation

• Safety concerns

• Treatment plan

• Client has a right to participate in the care delivery

• Client will allow the Case Manager to coordinate care related to accident

• The client has the right to cancel services at any time

• Client agrees to work with Case Manager to schedule appointments and coordinate care. Client understands that if he/she schedules doctor appointments without working with Case Manager to schedule. The Case Manager may not be able to attend the appointment.

• If client/caregiver takes over care coordination and appointment scheduling, the Case manager will discharge the client to take over his/her own care

 

Payment/Authorization of Services

• The Case Manager will submit request for payment to the insurance company and not the client.

• In the event that the insurance does not provide reimbursement, Pristine Case Management Services exercises the right to stop providing services immediately.

 

Office Hours

Monday-Friday 10am-4pm

 

Contact information

Contact number: (248) 595-0322 

Fx/Ph: (248) 595-0322 Ext. 101

 

Health Information Protection

All information is private and protected. A release must be signed by the client/representative in order for us to disclose information.

The client agrees to allow for Pristine Case Management Service to obtain records for the purpose of coordination of care.