Complex Case Management by Health Insurance RN

I am in complex case management by a registered nurse at the health insurance.

I really adore her, and she works very hard on my case.

However, we both are befuddled on what I am supposed to be doing (and have been for 8 months).

My physician is immature (first year out of training, works at a medical school) and remarks that he hates health insurance, and does whatever he can to not deal with them (he gets supremely upset when given a denial and won’t appeal, remarking, “I hate health insurance…”). He does not answer phone calls easily, and he always forgets to get back with me. Sadly, my network is small, and I needed this specialized care; and he is all there is.

My health insurance now is trying to nail jello to a tree by calling him to set up for a physician at the health insurance company to ask him what is my care plan and health goals from it.

My questions are… Does he have to participate with this meeting? If not, does he get in trouble for not participating?

What is the meeting like and entail? Is it as it sounds like? “What are we planning to do with the patient’s care…?”

Or is the health insurance generally frustrated with the situation (for me) and somehow going to punish the provider organization for what’s going on, this way?

submitted by /u/PharaohOfParrots
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