Common use of Case Management Clause in Contracts

Case Management. Shall be defined as a process directed at coordinating resources and creating flexible, cost-effective options for catastrophically or chronically ill or injured individuals on a case by case basis to facilitate quality individualized treatment goals and improve functional outcomes. Case Management also includes providing any alternative medical or non-medical benefits to a Covered Person that are expected to be medically beneficial for the Covered Person but which may not be Covered Services under this Agreement. Services should be cost-effective and generally follow acceptable standards of evidence based medical practice. The Company may, in its discretion, provide said alternative benefits for a Covered Person's Illness or Injury in lieu of, or in addition to, Covered Services if: 2.1.7.1 The total cost of said alternative benefits does not exceed the total benefits payable for Covered Services; 2.1.7.2 The Covered Person’s Physician recommends that the Covered Person receive said alternative benefits; 2.1.7.3 The Covered Person’s Physician agrees that the recommended alternative benefits are expected to be beneficial for the treatment of the Illness or Injury; and 2.1.7.4 The Covered Person, or the Covered Person's guardian, if the Covered Person is a minor or incapacitated, agrees to receive the alternative benefits. 2.1.7.5 The services are prior authorized by the Company’s Medical Management Department.

Case Management. Shall be defined as a process directed at coordinating resources and creating flexible, cost-effective options for catastrophically or chronically ill or injured individuals on a case by case basis to facilitate quality individualized treatment goals and improve functional outcomes. Case Management also includes providing any alternative medical or non-medical benefits to a Covered Person that are expected to be medically beneficial for the Covered Person but which may not be Covered Services under this Agreement. Services should be cost-effective and generally follow acceptable standards of evidence based medical practice. The Company may, in its discretion, provide said alternative benefits for a Covered Person's Illness or Injury in lieu of, or in addition to, Covered Services if: 2.1.7.1 2.1.5.1 The total cost of said alternative benefits does not exceed the total benefits payable for Covered Services; 2.1.7.2 2.1.5.2 The Covered Person’s Physician recommends that the Covered Person receive said alternative benefits; 2.1.7.3 2.1.5.3 The Covered Person’s Physician agrees that the recommended alternative benefits are expected to be beneficial for the treatment of the Illness or Injury; and 2.1.7.4 The Covered Person, or the Covered Person's guardian, if the Covered Person is a minor or incapacitated, agrees to receive the alternative benefits. 2.1.7.5 2.1.5.4 The services are prior authorized by the Company’s Medical Management Department.

Case Management. Shall be defined as a process directed at coordinating resources and creating flexible, cost-effective options for catastrophically or chronically ill or injured individuals on a case by case basis to facilitate quality individualized treatment goals and improve functional outcomes. Case Management also includes providing any alternative medical or non-medical benefits to a Covered Person that are expected to be medically beneficial for the Covered Person but which may not be Covered Services under this Agreement. Services should be cost-effective and generally follow acceptable standards of evidence based medical practice. The Company may, in its discretion, provide said alternative benefits for a Covered Person's Illness or Injury in lieu of, or in addition to, Covered Services if: 2.1.7.1 2.1.6.1 The total cost of said alternative benefits does not exceed the total benefits payable for Covered Services; 2.1.7.2 2.1.6.2 The Covered Person’s Physician recommends that the Covered Person receive said alternative benefits; 2.1.7.3 2.1.6.3 The Covered Person’s Physician agrees that the recommended alternative benefits are expected to be beneficial for the treatment of the Illness or Injury; and 2.1.7.4 2.1.6.4 The Covered Person, or the Covered Person's guardian, if the Covered Person is a minor or incapacitated, agrees to receive the alternative benefits. 2.1.7.5 2.1.6.5 The services are prior authorized by the Company’s Medical Management Department.