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Service Coordination

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All Health Plan members with current coverage can have Service Coordination. The program is an added benefit for our members. Service Coordination is at no cost to the member. Our program is completely voluntary so members may opt in or out at any time.

What Service Coordination Can Help With

The nurses and social workers are here to help you:

  • • Get care, services, equipment and medications.
  • • Understand and manage your health conditions.
  • • Understand and get the most out of your benefits.
  • • Understand the healthcare system and get needed authorizations and referrals.
  • • Help you find programs and community resources for things your insurance does not cover.

What to Expect

After being referred to Service Coordination, one of our team members will call you and complete an assessment over the phone. You can expect this call within four (4) days. This assessment will help us identify what needs you have. We will work with you to create a plan of how to meet your needs. We will work with you on your plan until your needs are met, you no longer have coverage with us, we can no longer reach you or you decide you no longer want help.

You will be linked with a nurse or social worker who you can call directly anytime you need help. Your nurse or social worker can also work with your doctor or pharmacy to help you. Health information is confidential and protected. Having Service Coordination does not affect your plan coverage.

How to Request Service Coordination to Help You:

To request Service Coordination, call 1-855-897-4448 and ask to speak with a member of our team. You can also email us to request Service Coordination at: CaseManagement@BSWHealth.org.

Our Service Coordinators are available between 8 AM and 5 PM CT weekdays (except for state-approved holidays). TTY users can call 711.

RightCare’s Disease Management Program

The disease management program provides specialized help from registered nurses for members with conditions such as: Asthma, Diabetes and Musculoskeletal Conditions (injuries or disorders of the muscles, nerves, tendons, joints, cartilage and spinal discs).

The program offers education and coordination of care between your doctors and benefits. You can talk and work with a nurse who has been certified and licensed by the state. We want to help you get information and the support you need. Please call us at 1-855-828-1013 if you would like the extra help. Our disease management programs are at no additional cost to you.

Special Health Care Needs

If you have special healthcare needs — such as chronic conditions, serious ongoing illness, or a disability — your service coordinator can:

  • • Help you get specialized care and services, including scheduling appointments
  • • Develop a plan of care with you and your doctor
  • • Answer your healthcare questions

Behavioral/Mental Health and Substance Abuse

Your complete well being is important. Your service coordinator can help you get care if you:

  • • Feel very sad, stressed or worried
  • • Can't deal with daily life
  • • Aren't sleeping or eating well
  • • Have thoughts about wanting to hurt yourself or others
  • • Are troubled by strange thoughts (like hearing voices)
  • • Are using drugs or drinking alcohol more
  • • Have problems at work or at home
  • • Have a child with problems at school

Our Service Coordination team may reach out to invite you to join these programs and services after looking at your health claims. You may also sign up or opt out at any time. You can email or call the number listed on your member ID card.

Farm Workers and Migrant Workers

Children of migrant workers have special health care needs. Our service coordinators will help members get the care they need right away. They will also help with scheduling doctor visits and getting checkups sooner if you are leaving the area.

Call us at 1-855-TX-RIGHT (1-855-897-4448).

Healthy Pregnancy Information

Expecting the Best® Maternity Program

Scott and White Health Plan is pleased to offer Expecting the Best® for our members. This program is focused on helping mothers enjoy a healthy pregnancy. Expecting the Best® members will receive helpful tips and assistance during pregnancy and for one year after birth.

Pregnancy/Delivery
  • • Planning for delivery, including individual support during and after a pregnancy
  • • Access to a nurse 24 hours a day, seven days a week
  • • Coordinated efforts to promote full-term birth in women who previously delivered pre-term
  • • In-home support for high-risk conditions such as diabetes, hypertension and severe nausea
  • • Early enrollment in Service Coordination support program
Postpartum
  • • Depression screening following delivery, including postpartum resources
  • • Parental education for newborn health during the first year
  • • Immunization reminders
  • • Planning for returning to work

Sign up by calling the customer service number on the back of the member's insurance card or email us. Please include:

  • • Name
  • • Preferred phone number
  • • FirstCare member number
  • • Brief description of needs or risk factors

A Service Coordinator may invite you to enroll when we receive a doctor’s referral or pregnancy claim. You can opt-in or out of this program at any time through a Service Coordinator or customer service.

View informational flyer.

 

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Quality Improvement Program

We want to get better at helping you get better. Our RightCare Quality Improvement (QI) Department helps us do that. Using data to measure your health needs, we can create better programs for diabetes, asthma, heart disease, immunization (shots) and women's health. To learn more about our QI goals, processes and outcomes, call us at 1-855-TX-RIGHT (1-855-897-4448).