We understand that some members have special needs. For this reason, CeltiCare offers our members case management services to assist with members with special healthcare needs. The care is member-centered, family-focused and culturally competent. If you have special healthcare needs or are disabled, case management may be able to help you.

Our case managers are registered nurses or social workers. They can help you understand major health problems and arrange care with your doctors. A case manager will work with you and your doctor to help you get the care you need. When members have severe medical conditions, the case manager works with you, your PCP and managing providers to develop a plan of care that may include alternative treatments that are not normally covered. If the alternative treatment plan provides the most appropriate medically necessary care the CeltiCare Medical Director may authorize the care providing that:

• The member has a severe medical condition and is expected to require prolonged medical treatment;
• The alternative services are a substitute for more costly covered services that are being provided or proposed to be provided;
• The additional services are medically necessary; and
• The member agrees to the alternative treatment plan.

CeltiCare maintains the right to terminate the alternative care plan at any time when it is determined that the alternative care plan is no longer appropriate, effective, or contributing to the improvement of the member’s condition or no longer meets the above criteria.