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Referrals to our Complex Case Management program


Program goal


Our Complex Case Management program is a collaborative process of assessment, planning, facilitation, care coordination, monitoring, evaluation and advocacy for options and services to meet an individual’s and caregiver’s comprehensive health care needs. The program assesses population needs and uses evidence-based practices in managing complex illnesses and chronic conditions. We help members understand their health care needs, benefits and how to access available community resources for which the member may be eligible.


How it works


The overall goal and objective of the Complex Case Management program is to help members regain optimum health or improved functional capability, in the right setting and in a cost-effective manner.




Referrals for the program may come from the following sources:


  • Primary care physicians
  • Specialists
  • Facility discharge planners
  • Member or caregiver(s)
  • Medical management programs
  • The member’s employer
  • Other organization programs or through a vendor or delegate
  • The 24-Hour Nurse Line

Referrals can be submitted through the toll-free phone number on the member’s ID card.

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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