Request Assistance from Case Management or Disease Management

Case Managers can help with complex medical needs (complex case management) and help with coordinating resources for care (case management). Disease Managers can assist with members who have Diabetes or Asthma and would like assistance with self-management of these conditions. If you would like to request assistance from Case Management or Disease Management, please complete the form below. A nurse will evaluate your request and call you within 2 business days. If you would like to speak directly with a nurse, please call 805-981-5060 and ask for a Case Manager or Disease Manager. If you are experiencing a medical emergency, please dial 911. Always consult your physician about your individual healthcare needs and treatment options.

Case Management/Disease Management Request Form

Request is for:

Complex Case ManagementCase ManagementDisease Management

First Name

Last Name

Health Plan ID Number

Phone Number

Email Address

Gender:

MaleFemale