CMGT-BC Practice Questions - CMGT-BC Nursing Case Management Exam

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A case manager is advocating for a patient with a rare disease who requires an expensive experimental treatment not covered by their insurance. Which of the following actions best demonstrates the case manager's role as an advocate?

Informing the patient that the treatment is not covered and exploring alternative, less effective treatments. Contacting the insurance company to appeal the denial and providing a detailed letter of medical necessity from the patient's physician. Suggesting the patient start a crowdfunding campaign to pay for the treatment out-of-pocket. Advising the patient to switch to a different insurance plan during the next open enrollment period.

Correct Answer:

Contacting the insurance company to appeal the denial and providing a detailed letter of medical necessity from the patient's physician.

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