The time to identify and manage high-risk pregnancies, including the reduction of pre-term labor and delivery, is early in the pregnancy, not later.
Complicated pregnancies, labor and delivery can cost a benefit plan $ 500,000 or more. Preterm births or low weight births complicated by high risk factors can top or exceed a million dollars, not to mention the emotional trauma to the family involved.
A SRS Care Manager will contact the expectant mother as soon as we are notified of her pregnancy and assess her high-risk factors. If no high-risk factors are identified, SRS will pre-authorize her upcoming delivery admission as usual and follow the case upon admission to delivery. If high risk factors are detected, then SRS will issue a High-Risk Maternity Medical Care Management letter to the payor that same day. Once approved by the payor, the SRS High Risk Maternity Care Manager will contact the attending physician to obtain additional information.
All parties involved are notified by telephone and mailed information regarding the program. SRS will act as a resource center, coordinating the ongoing care of the patient in conjunction with the attending physician, to assure that all cost-effective and appropriate measures are taken to arrive at the best possible outcome.
SRS will keep in close contact with the attending physician and expectant mother to track the ongoing progress toward treatment goals and to provide informative educational materials, i.e.; from the March of Dimes. This assistance keeps the expectant Mother more involved in her own healthcare and prompts her to ask questions.
SRS can also be instrumental in negotiating reduced care fees with providers in advance of a complicated deliver and post-natal care.
Because SRS is involved with the Mother’s High-Risk Care every step of the way; the health benefit plan payor is also kept informed as to the progress of the care.