A little prevention goes a long way.

Which is why Security Health Plan encourages members to take steps to prevent illness and live healthier lives. When you get sick less often, your life is richer and you can keep your costs down, too.
 

Added services with Security Health Plan

• Care management

  • Personal support and health care guidance

  • Access to nurses, social workers and physical therapists

  • Assistance with coordination of care following a hospital or nursing home stay

• 24-hour Nurse Line

• Information on how to live with and manage chronic illnesses such as diabetes and asthma

• Wellness and healthful living programs

• Health risk assessment

• Tobacco cessation help and drug coverage

• Advocare Connection member newsletters

• Toll-free number for customer service

In addition, members may enroll in any health and wellness program offered by Security Health Plan:

Case Management Program - Registered nurses help members understand their health care needs and match them with the appropriate health care professional or community services. This service is for members who have complex health care needs and frequent hospitalizations.

Asthma Management Program - Members with asthma receive educational information and tools to assist them in controlling their asthma. Through discussions with the nurse care manager, members will better understand their condition, medications, how to manage asthma triggers and how to create a self-monitoring plan.

Diabetes Management Program - Members with diabetes receive educational information and tools to assist them in managing their diabetes. Through discussions with the nurse care manager, members will better understand their condition, medications and the importance of physical activity and healthy eating.

High blood pressure and cholesterol program - Members diagnosed with high blood pressure, high cholesterol or heart failure are provided support, tools and education related to cardiovascular disease so they can take an active role in maintaining good Health and managing their condition.

Utilization management - Security Health Plan employs doctors, nurses and other staff to perform utilization management for its members. This helps ensure that members receive appropriate care in the appropriate location and at the appropriate time.

Precertification is the process of obtaining authorization for inpatient admission to a hospital. Security Health Plan does not require its members to precertify admissions. However, members’ doctors are expected to notify Security Health Plan of admissions.

Concurrent review is the process of reviewing the care that is received while members are in the hospital, nursing home, or skilled nursing facility. When the care that members are receiving can be safely obtained in a place other than the hospital or nursing facility, Security Health Plan staff will discuss other options with member’s doctors. These options may include continuing care in a skilled nursing facility, or at home with the help of a home care nurse.

Retrospective review is a process of reviewing medical treatments after the service has been provided. The review process includes eligibility verification, review of medical necessity, status of admission and other criteria as appropriate. Security Health Plan staff review clinical information when making decisions about coverage. They do not receive financial compensation for denying benefits for health care services, nor is their performance measured on such denials.

Members with an Advocare plan may speak to a Health Services Department staff person regarding a specific utilization management case or utilization management processes by calling customer service.

24-hour Nurse Line (1-800-549-3174) - Wondering if your condition is serious enough to visit your provider or go to urgent care? Check with a registered nurse first. Security Health Plan’s 24-hour Nurse Line, available 7 days per week, connects you with a registered nurse who can answer your health care questions.

Nurse Navigator service - Confused by health care? Don’t know where to turn for answers? One call to Customer Service puts you in touch with our nurse navigators, who can answer your health care questions. A nurse navigator is a registered nurse who works across the health care system to ensure you receive the right care at the right time. You can expect to receive one-on-one, personalized support for your specific health care issues.