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Health Care Management Unit

HealthChoice is pleased to offer a staff of dedicated medical professionals in our Health Care Management Unit (HCMU). Our mission is to assist our members in navigating the complex world of health care. HCMU is staffed by licensed, certified registered nurses seeking to promote the best possible outcomes in the most cost effective manner.

Some of the services HCMU provides:

Case Management

Our case managers are licensed, certified registered nurses with emphasis in various medical specialties. Examples of when to call a case manager are:

  • Out-of-state emergencies
  • Cancer
  • HIV/AIDS
  • Transplants
  • Rehabilitation
  • Terminal illness
  • High-risk pregnancy
  • Premature infants
  • Mental health/substance use disorder
  • Specialty Durable Medical Equipment

Advantages of Utilizing a Case Manager:

  • Individualized, personalized, on-site visits to ensure the highest quality of care, attaining the maximum level of independence possible.
  • Case managers help decrease the fragmentation of care while increasing quality and cost efficiency.
  • Case managers help maximize your benefits through early intervention and by offering access to specialized treatment and services which complement traditional therapies.

We are here to help. To speak with a case manager, please call 405-717-8879 or toll-free 800-543-6044, ext. 8879.

Certification

For a listing of services which require certification, refer to healthchoiceconnect.com. To obtain certification, please contact Customer Care at 800-323-4314. TTY 711.   

Life Insurance Underwriting/Disabled Dependent Status Review

The Health Care Management Unit (HCMU) is responsible for review of all requests for life insurance requiring a Life Insurance Application.

HCMU reviews all applications for disabled dependent status.

If you have any questions concerning this process, please contact our office at 405-717-8879 or toll-free 800-543-6044, ext. 8879.

Specialty Services

Emergency Rule:

Members may have additional benefits available for medical emergencies when non-Network services occur.  This benefit is available only upon request. You must notify a case manager at HealthChoice by calling toll-free 800-543-6044, ext. 8879 for consideration.

Services Not Available in Network:

In the event a member requires services not available in network, additional benefits may be allowed only with prior approval through HCMU. Please contact our case managers toll-free at 800-543-6044, ext. 8879 or, in the Oklahoma City metro area, 405-717-8879.

Utilization Review / Quality Assurance

HealthChoice is licensed by the Oklahoma Insurance Commission to provide utilization review services. Our Utilization Review Plan is updated on an annual basis to reflect changes in policies and procedures.

This plan also addresses provider and/or member concerns relating to utilization and quality issues. To discuss any concerns, please contact our office at 405-717-8879 or toll-free 800-543-6044, ext. 8879.