Why this program
Describe the patient’s care need, the role of the device or outreach, the named care-team contact, and how the program connects with their existing clinician.
Talk with us PAYER GUIDE
Patient cost share and consent are part of a respectful program—not an afterthought.
A care-management program works best when patients understand why they are being offered it, what contact to expect, how to pause non-urgent outreach, and any potential financial responsibility.
Design a patient-ready workflowWHAT TO EXPLAIN BEFORE ENROLLMENT
Clarity protects trust—and prevents avoidable drop-off.
Do not make the patient discover a recurring program, unfamiliar caller, or possible cost after enrollment. Explain the clinical purpose, who is contacting them, what changes in their care, and what the actual benefit check shows.
What it may cost
Give the member-specific benefit result—not a universal amount. Explain deductible, coinsurance, copay, supplemental coverage, or uncertainty in plain language.
How they stay in control
Record preferred language, channel, calling hours, frequency, caregiver involvement, and a simple way to decline or pause non-urgent outreach.
COST-SHARE PATHWAY
Use the coverage type to start the conversation—not to finish it.
These are communication prompts for the practice. They are not an individual coverage determination.
| Coverage type | What may affect the patient’s cost | What the practice should do |
|---|---|---|
| Original Medicare | Part B deductible and coinsurance can apply to covered care-management services. Medigap, Medicaid, or other secondary coverage may change the amount. | Verify the current service, assignment status, and secondary coverage; communicate the patient-specific estimate before starting. |
| Medicare Advantage | Copay, coinsurance, deductible, authorization, and network rules depend on the member’s exact plan and benefit. | Use the plan’s current member benefit information; do not project an Original Medicare amount onto the plan. |
| Medi-Cal / Medi-Medi | Coverage combination, plan, county, eligibility, and secondary-payment rules affect what the member may owe. | Confirm the actual member and plan pathway; do not assume that a coverage label alone eliminates cost share. |
| Commercial insurance | Plan benefit, deductible, copay, coinsurance, authorization, and employer-plan design can change patient responsibility. | Perform a member-specific benefits review and explain any uncertainty before enrollment. |
A RESPECTFUL ENROLLMENT SCRIPT
Make the invitation feel like care, not another campaign.
“Your care team is offering this because of your ongoing care needs. We will explain who will contact you, what information we will use, how often we plan to reach out, and what your benefits check shows. You can ask questions or choose not to participate.”
Explain the clinical purpose and how the program fits the patient’s existing care team.
Verify coverage and communicate any potential patient responsibility before enrollment; do not quote a universal amount.
Capture the required consent and a patient’s preferred language, channel, contact timing, and frequency.
Offer a clear way to ask questions, decline, or pause non-urgent outreach while preserving clinically necessary escalation.
MEDICARE EXAMPLE
Use the actual approved amount—not a marketing estimate.
Medicare.gov notes that chronic care management is a monthly Part B service and that, after the Part B deductible, beneficiaries pay coinsurance. Other coverage and plan arrangements can change patient responsibility.
Read Medicare’s chronic care management coverage informationDESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
Send us a message
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