Care Insurance Benefits

What Is a Managed Care Insurance Benefit?

Have you heard the term “managed care” before and wondered what it was? Simply put, a managed care insurance benefit is a plan that contracts with healthcare providers to provide care at a reduced cost. As a result, managed care insurance benefits can help control costs while ensuring a high quality of care.

physical therapy with nurse

Understanding Your Managed Care Insurance Benefit

Suppose you have a managed care insurance plan. In that case, you might want to know what coverage it provides for independent living, assisted living, skilled nursing, or a rehabilitation stay.

The type of plans and the benefits vary widely, so it’s important to learn the ins and outs of your insurance benefit before needing it. We highly recommend contacting your insurance provider directly for those details, but we can also help you navigate your benefits. By providing your insurance policy number and date of birth, our director of admissions can help determine what benefits are available to you at our communities.

Types of Managed Care Insurance Benefit Plans

Managed care insurance benefits include plans that you participate in through your employer, often referred to as commercial insurance or group-sponsored health plans. Common examples of these plans include health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

Medicare Advantage plans are another type of managed care insurance benefit. Under these plans, Medicare-approved private companies typically offer coverage for services that your original Medicare plan doesn’t cover.

Ohio’s Medicaid Managed Care Insurance Benefit includes therapy services, respite care, skilled nursing services, and more.

Doctor holds a woman's hand for her therapy program

Frequently Asked Questions About Managed Care Insurance Benefits

We accept many managed care insurance benefit plans at Optalis. We’re here to help you determine what covered services are included in your plan. Contact us anytime with specific questions, or refer to some frequently asked questions below.

How do I know what benefits my plan covers?

To determine your managed care insurance plan benefits, you can contact your insurance provider directly, or you can reach out to the director of admissions at the Optalis community of your choice. They’ll use your policy number and date of birth to determine what benefits are available to you. You must meet an identified skilled level of care for your insurance benefit to provide coverage.

Is Optalis a provider of managed care insurance benefits?

Yes, Optalis communities accept most managed care insurance benefits. However, it does vary by plan and insurance company, so it’s important to contact your insurance company directly or reach out to us to determine your coverage.

How long will my plan cover my stay?

Once we submit prior authorization and your managed care insurance company approves it, the Optalis community team will complete weekly continued stay reviews. When the managed care insurance company determines your stay is no longer necessary, they will let us know, and we will notify you and coordinate a discharge plan.

What happens if I don’t feel ready to return home when my managed care insurance company provides a discharge date?

If your managed care insurance company feels that your skilled nursing and rehabilitation stay is no longer necessary, you have the right to appeal this decision. Your Optalis community team can help you with this process and also help you find an appropriate next level of care, such as outpatient rehabilitation or our assisted living rehab and recovery program.

Still Have Questions?

If you have any other questions, feel free to contact us. One of our experts will help you with questions specific to your individual needs and financial situation.