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Customer Service: (877) 210-1719
TTY users should call 7-1-1

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Case Management

casemng

Piedmont Medicare Advantage (PPO) offers case management programs that facilitate the provision of high quality care, appropriate benefit utilization and support for our members.

Do I qualify for case management?

If you were recently hospitalized due to a major injury or catastrophic illness or struggle with an uncontrolled chronic illness. You may be unprepared or unable to deal with your health care needs. A Piedmont case manager may be able to help you. Your case manager can coordinate home care agency or outpatient services, provide you with information on community and financial resources, education, and work to improve communication between members of your medical team.

What will my case manager do?

Piedmont case managers are registered nurses who can offer added support when you need it most.

Piedmont registered nurses provide:

  • Assistance in ensuring that you receive the appropriate benefits available to you under your specific plan
  • Provider access to information that will help you manage your condition and make the appropriate choices
  • Specific education to assist you and your family with a better understanding of your condition and treatment options
  • Help to facilitate communication with your healthcare providers

 
If you have been hospitalized or have certain chronic diseases, a Piedmont case manager may contact you to discuss the programs available to you.

Our case management programs are designed to support you and your health care providers in an effort to coordinate you care, increase healthy behaviors and assure the utmost quality of care.

The case management program is strictly voluntary and confidential. It is available to all Piedmont members at no cost. Participation does not affect your policy or the premiums of your benefits plan and you may choose to stop participating at any time. If you decide not to participate, please notify us and we will withdraw your participation in the program.

If you require the services described above, you may contact Piedmont Medicare Advantage and ask to speak with a nurse in the Medical Management Department. Simply call 434-947-3671 or toll-free 1-877-210-1719, 8:00 a.m. to 8:00 p.m., seven days a week from October 1 through February 14. From February 15 through September 30, Customer Service is available 8:00 a.m. to 8:00 p.m., Monday through Friday. TTY users should call 7-1-1.

Piedmont Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in Piedmont Medicare Advantage depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Piedmont Medicare Advantage members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

 

H1659_Web2018 Approved 10112017
Updated: 10/16/2017