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Staying Healthy

Individual Health & Wellness Programs

As your health plan, our goal is to put you in control of your health care choices. We give you the resources you need to make intelligent health care decisions that will keep you healthy or make you well.

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Utilization Management

Inpatient Approval

When you need to go into the hospital, your doctor will work with the Utilization Management team to ensure you receive the right care in the right place at the right time. While you are in the hospital, one of our nurses will review your case and assist with discharge planning or approve additional inpatient hospital days, if necessary.

Disease Management

You have many things to keep track of when you are living with a chronic condition. Our disease management programs can help you manage your condition and help you to prevent or delay complications. Our nurses are available to provide information and assist you in managing asthma, diabetes, chronic obstructive pulmonary disease (COPD), heart disease and other conditions.

Once you enroll, you will receive:

  • Access to a toll-free number to speak with a registered nurse 24 hours a day, seven days a week
  • Educational materials and quarterly newsletters with information about your condition
  • Reminders and tools to help you manage your condition

These programs are free, voluntary and confidential. Call the CareFirst Care Support Program (800) 783-4582 to find out if you are eligible or to enroll.

Case Management

When faced with a serious diagnosis or condition, you and your family have many tough choices to make. The Case Management program can help you navigate the complex health care system and provide support during your time of need.

Case managers can help members with a variety of conditions and diseases including (but not limited to):

  • Serious trauma
  • Rehabilitation
  • High risk pregnancy
  • Cancer
  • Special needs

Our case managers will:

  • Work closely with you and your doctors to help you follow your treatment plan
  • Coordinate necessary services
  • Contact you regularly to see how you are doing
  • Answer your questions
  • Give you a list of community resources

This program is free, voluntary and confidential. To enroll or to find out more information, call 888-264-8648. You can also enroll online.


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