Case management professionals work with both health insurance companies and health care providers to coordinate the care of patients. Their role is to make sure that hospitals and physicians are being appropriately paid by a health plan provider and that patient care costs are kept down to a reasonable level. However, another major role of case management professionals is to make sure that patients are being fairly treated and that they're receiving an appropriate amount of care. A health care case manager makes sure that the right diagnostics are being performed, that the right treatments are being administered and that special services can be fairly and appropriately applied where necessary. Ultimately, this leads to lower costs for insurance providers and lower health insurance quotes for all of the individuals in a health plan.

It's easiest to see the role of a case manager when a major health condition or illness needs to be diagnosed and treated. In an HMO without management, physicians would have an incentive to try to keep their costs as low as possible, since as a health care provider, they would be paid the same regardless of whether the patient received fair treatment. This is obviously problematic, as it could mean that a patient's illness wouldn't be properly treated. A blind focus on lowering costs could also lead to misdiagnoses, which eventually leads to higher costs for all parties involved, including the patient, the health care provider and the health plan company. A case manager has the necessary financial and medical knowledge to ensure fair and accurate medical treatment. For example, if the patient has a catastrophic illness, the case management professional would work to find specialized services, to obtain counseling, and to look into effective treatment options. The case manager would also perform some post-case follow up, which prevents re-occurrences of diseases and conditions.

Case management services can drastically reduce health insurance quotes for all of the insurance policy holders in an HMO or other health plan while keeping the quality of care high. The role of a case manager is indispensable, as without case management, costs can unintentionally increase, particularly in the case of misdiagnoses. Health care providers might attempt to take every possible step to lower their costs, which would lead to low-quality care.

Health plan members should read about their plan's case management services. Understanding the system can make it easier to obtain the right services, particularly with specialized services, tests and procedures that may be essential for proper care. Working with a health care case management professional makes it easier to obtain treatment under a health plan and keeps costs down for all involved parties.