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A new health and wellness program for UPSers and their families
 
 
Clinical Support Frequently Asked Questions
1. What is an Enhanced Case Manager?
 

An Enhanced Case Manager (ECM) is a registered nurse who typically will contact you or a covered adult family member before, during and/or after certain serious health-related events. The ECM can help you prepare for an upcoming hospitalization and assist you through a successful post-discharge recovery. He or she can help you with rehabilitation services, home health care, or durable medical equipment. Your ECM can also work with you and the member services team to help resolve claims-related issues. And throughout your experience, the nurse will help you and your doctor compare your health care options and choices, working as a team to improve your health.

ECMs are RNs employed by you health plan claims administrator, not UPS.
2. Are you a registered nurse?
 

The ECM is a registered nurse (RN) who will provide personalized assistance to meet your individual needs, to help you have the best possible medical outcome.

As an RN, ECMs have the clinical know-how to help you identify and possibly prevent any potential complications, such as a hospitalization. In addition to the education and experience that come with being an RN, the ECM has ready access to the latest information and resources about many health-related topics.

It’s important to understand that this program is not a substitute for your doctor’s sound medical advice. If you have any questions or concerns about your health, you should discuss them with your doctor or other health care provider.
3. Will ECMs help with my claims and benefit questions?
  For questions about claims and benefits, you should call your health plan claims administrator’s member services number, which is printed on the back of your medical ID card. However, the Enhanced Case Manager can help you understand the diagnosis or procedures listed on a claim. And if you are unable to resolve a claim issue, your ECM can work together with you and the member services team to reach a resolution.
4. What support and assistance can an ECM provide?
  Enhanced Case Managers have years of clinical experience helping people manage their ongoing or complex health conditions, and avoid complications. They can advise you about lifestyle changes you can make to improve your health and achieve your health-related goals. They’re also experienced in helping people get through the complexities of the health care system and take full advantage of their health benefits.
5. Why is my health care plan calling me? Is there something wrong with my health care benefit?
 

UPS has partnered with your health care plan to provide this voluntary Enhanced Case Management program to all its employees—at no additional cost to the employee.

This benefit includes the services of a professional RN to provide the support you may need before, during, and after hospitalization. When your health plan is made aware of certain upcoming surgeries or admissions to the hospital, the ECM may contact you. His or her job is to help you be prepared for your upcoming hospitalization, understand your doctor’s surgical and recovery instructions, and assist with any rehabilitation, home health care, or durable medical equipment you might need.

The goal of your ECM is to help you navigate the health care system to achieve a successful recovery and get the most out of your health care benefits.
6. How did you get my information?
 

The ECM works for your health plan and helps deliver services covered by the UPS benefit plan to you.

As part of that service, the ECM receives referrals from other UPS-related claims administrators or vendors who may have already been working with you.

7. How does the ECM know I have a complex health situation?
  Recent prescriptions, hospital stays, or health assessment data might be an indication that you would benefit from the services of an Enhanced Case Manager. The Program's health plan claims administrator, not UPS, monitors this confidential data to determine who should be contacted. The Enhanced Case Managers, who are employees of the health plan’s claim administrator, have access to technology that helps them identify people who are potentially at risk for health issues. The confidentiality of your individual health information is strictly maintained in accordance with health plan privacy policies and federal and state law.
8. Will my health information remain confidential from UPS?
  Your health plan protects health privacy in accordance with the UPS health plan privacy policies. If you’re concerned about how your health information is protected, Enhanced Case Managers can answer your questions before you decide to share your personal information.
9. If I’m experiencing health problems, will my spouse or child be allowed to speak with you on my behalf?
  In order for the ECM to discuss any health-related information with your spouse or other family member, you must first provide (verbal or written) permission.
10. If my spouse or child over 18 is experiencing health problems, why do you need to speak to him or her? I’m the policyholder.
  When the individual is age 18 or older, strict privacy laws prevent the ECM from speaking with anyone other than the person experiencing the specific health-related issue that the ECM is calling about. In addition, the individual could give us permission to speak with another individual if desired.

11. Am I required to participate if I’m contacted?
  The ECM program is completely voluntary and a benefit of your UPS health care benefits program. Your benefits will not be affected if you decide not to participate, or to withdraw from the program. Please consider this decision carefully because the ECM is here to support you and your doctor(s) to the improvement of your health including successful recovery after a hospital admission.

 


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