Disease Management (DM) is all about you
The BlueChoice HealthPlan Medicaid Disease Management (DM) programs give you a choice and a voice in how to care for your health. With the help of licensed nurses and social workers, called DM case managers, you will learn to better manage your condition and improve your quality of life.
How it works
DM case managers work with you by phone to create health goals and develop a plan to reach them. They educate you about your condition and help you take more control of your care.
Who is eligible?
Any BlueChoice HealthPlan Medicaid member with any of the following:
- Behavioral health conditions, such as depression, schizophrenia, bipolar disorder and substance use disorder
- Heart conditions, such as congestive heart failure (CHF), hypertension and coronary artery disease (CAD)
- Lung conditions, such as asthma and chronic obstructive pulmonary disease (COPD)
BlueChoice HealthPlan Medicaid also assists with weight management services.
BlueChoice HealthPlan Medicaid includes you in these programs unless you choose to opt out. You can choose to opt out at any time.
If you take part in a DM program, you will get:
- Personal assistance from a case manager to help you manage your health
- Help to make sure you have the right medical equipment for your health condition
- Screenings for other problems
- Information about local caregivers
- Information about the most up-to-date treatment for your condition
- Help with coordinating care between your primary care provider and other specialists
To serve you better, we also:
- Monitor your progress with any health condition for which you are being treated
- Give your doctors information on the latest treatment options for your condition
- Give you and your doctor updates on your health
- Ask you about how we can help you
- Ask you for your ideas to find ways to make the program even better
How to participate
Call us toll free at 1-888-830-4300 (TTY 711) or email your name and phone number to
email@example.com, and we will be happy to help you. Please be aware that although emails exchanged over the Internet are usually safe from unauthorized interference, there is some risk third parties may access these emails without your permission or knowledge. By sending your information by email, you acknowledge that the email might be accessed by an unauthorized third party.
Call your case manager
- 8:30 a.m. to 5:30 p.m. Eastern time, Monday through Friday
- Toll free at 1-888-830-4300 (TTY 711)
- Leave a private message for your case manager 24 hours a day
Other health care resources
- For routine health questions, call your primary care provider
- In an emergency, call 911
- For help anytime, 24 hours a day, seven days a week, call our 24-Hour Nurseline toll free at 1-866-577-9710 (TTY1-800-368-4424)
Rights and responsibilities
As a member enrolled in a DM program, you have certain rights and responsibilities.
You have the right to:
- Get details about your plan, including:
- Programs and services provided on behalf of BlueChoice HealthPlan Medicaid
- Our staff and staff qualifications
- Any contractual relationships
- Opt out of DM services
- Know which case manager is handling your disease management services, as well as how to request a change
- Get support from us to make health care choices with your providers
- Be told about all disease management-related treatment options mentioned in clinical guidelines (even if a treatment is not covered), and to discuss options with treating providers
- Have personal data and medical information kept confidential
- Know who has access to your information and know our procedures used to ensure security, privacy and confidentiality
- Be treated politely and with respect by our staff
- File complaints to BlueChoice HealthPlan Medicaid and receive guidance on how to use the complaint process as well as know our standards of timeliness for responding to and resolving issues of quality and complaints
- Receive information that is clear and easy to understand
- Formulate advance directives
- Access medical records in accordance with applicable state and federal laws including the ability to request the record be amended and corrected
- Refuse treatment
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, in accordance with Federal regulations
- Receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness, or medical condition
- The right to have honest talks with your doctors about the right treatment for your condition, in spite of the cost or your benefit coverage
You also have a responsibility to:
- Follow the plan of care you and your case manager agree on
- Provide us with information needed to carry out our services
- Tell us and your provider if you decide to leave the program
For a written version of your DM rights and responsibilities or information on this website, please print this page or call your case manager.
DM does not market products or services from outside companies to our members. We do not own or profit from outside companies on the goods and services we offer.
For general Medicaid questions, contact Healthy Connections at 1-877-552-4642 or TTY 1-877-552-4670.
We can translate this at no cost. Call the Customer Care Center number on your member ID card.
Podemos traducir esto gratuitamente. Llame al número del Centro de Atención al Cliente que aparece en su tarjeta de identificación (ID card).
To report waste, abuse or fraud, contact the South Carolina Medicaid Fraud Hotline at 1-888-364-3224 or email at firstname.lastname@example.org.
For more information, please call BlueChoice HealthPlan Medicaid Customer Care Center at 1-866-781-5094 (TTY 1-866-773-9634).