Acentra may perform medical case management for those participants who have a complicated, catastrophic or chronic condition. Through medical case management, Acentra may elect to (but is not required to) extend covered benefits beyond the benefit limitations and/or cover alternative benefits for cost-effective health care services and supplies that are not otherwise covered under the Plan. The decision to provide extended or alternative benefits is made on a case-by-case basis for participants who meet Acentra criteria.
This article describes the medical case management program for participants with complicated, catastrophic, or chronic conditions, including the potential extension of covered benefits or coverage of alternative benefits.