What Is a Managed Care Insurance Benefit?
Have you heard the term “managed care” before and wondered what it was? Simply put, a managed care insurance benefit can be described as a type of plan that contracts with healthcare providers to provide care at a reduced cost. As a result, managed care insurance benefits can help control costs while ensuring a high quality of care.
Understanding Your Managed Care Insurance Benefit
Suppose you have a managed care insurance plan. In that case, you might want to know what coverage it provides for independent living, assisted living, long-term care or a skilled nursing and rehabilitation stay. The type of plans and the benefits vary widely, so it’s important to learn the ins and outs of your insurance benefit before needing it.
We highly recommend contacting your insurance provider directly for those details, but we can also help you navigate your benefits. By providing your insurance policy number and date of birth, our director of admissions can help determine what benefits are available to you within our Optalis Healthcare communities.
Types of Managed Care Insurance Benefit Plans
Managed care insurance benefits include plans that you participate in through your employer, often referred to as commercial insurance or group-sponsored health plans. Common examples of these plans include health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Medicare Advantage plans are another type of managed care insurance benefit. Under these plans, Medicare-approved private companies typically offer coverage for services that your original Medicare plan doesn’t cover.
Ohio’s Medicaid Managed Care Insurance Benefit includes therapy services, respite care, skilled nursing services and more. These are optional services that Ohio has elected to provide in addition to Medicaid’s covered benefits under the federal plan.
Frequently Asked Questions About Managed Care Insurance Benefits
We accept many managed care insurance benefit plans at The Optalis communities. Our director of admissions is here to help you find out what covered services are included in your plan. Contact us anytime with specific questions or refer to some frequently asked questions below.
Managed Care Insurance Benefit Questions
To determine your managed care insurance plan benefits, you can contact your insurance provider directly or you can reach out to the director of admissions at The Optalis community of your choice. They will use your policy number and date of birth to look up what benefits are available to you. You must meet an identified skilled level of care in order for your insurance benefit to provide coverage.
Yes, The Optalis communities accept most managed care insurance benefits. However, it does vary by plan and insurance company, so it’s important to contact your insurance company directly or reach out to us to determine your coverage.
Once we submit prior authorization and your managed care insurance company approves it, The MacIntosh community team will complete weekly continued stay reviews. When the managed care insurance company determines your stay is no longer necessary, they will let us know, and we will notify you and coordinate a discharge plan.
If your managed care insurance company feels that your skilled nursing and rehabilitation stay is no longer necessary, you have the right to appeal this decision. The MacIntosh community team can help you with this process and also help you find an appropriate next level of care, such as outpatient rehabilitation or our Assisted Living Rehab & Recovery program.
Do you have additional questions about your managed care insurance benefit?
If you have additional questions, feel free to contact us. Our team of experts is here to help you with your individual questions and concerns.