Care Management Program

We want to inform you about our Care Management Program, under which we work with the population that suffers from chronic, catastrophic, degenerative and disabling conditions.

Through this clinical program,

• We coordinate and facilitate the care and services related to the participant's condition by following up on the treatment plan established by your primary care physician or specialist.
• We direct our efforts to improve the quality of health care through an individualized care plan.
• You will have nursing staff and care management specialists who will contact you periodically by phone to monitor the progress of your treatment, identify your individual needs, and help you achieve the goals and objectives developed in accordance with the treatment plan defined by your doctor.

The Care Management Program is free of charge, voluntary, and available to any member who qualifies. You can apply directly for program services by contacting the Customer Service Call Center. Your call will be confidential. Once your voluntary participation in this program begins, you may opt out at any time.

Eligible Members

If you have any of these conditions or situations, you may qualify for the Care Management Program:

• Member with end-stage renal disease (ESRD), without fistula coordination
• Members eligible for organ and/or bone marrow transplantation
• Members who need to receive services in the United States because they are not available in Puerto Rico.
• Members with multiple chronic or end-stage illnesses
• Members who need skin care due to chronic ulcers
• Members who use specialty drugs
• Complications related to chronic conditions, such as congestive heart failure, kidney disease, and stroke.
• Members dependent on mechanical ventilator

If you meet any of these conditions or situations, you may join the Care Management Program. You can do it in two ways:

• By referral from your doctor: Ask your doctor to complete the referral and send us your information.
• By direct request from the member: You can request your enrollment directly to the program by contacting the Customer Service Call Center by calling 787.281.2800 (metro area) or 1.888.758.1616 (toll-free), Monday through Friday from 8:00 a.m. to 8:00 p.m. and Saturdays from 8:00 a.m. to 4:30 p.m. Individuals with hearing impairments (TTY) may contact 1.866.627.8182. We are ready to help you get the care you need.