Frequently asked questions

Pathwise helps you manage your healthcare more easily. We work with your doctors, hospitals, and health plan to make sure you get the care, resources, and follow-up you need. Our goal is to help you stay healthy, avoid unnecessary hospital visits, and connect you with support in your community.

Pathwise Case Management LLC partners with your health plan to provide care coordination and case management at no additional cost to you.

If you are a CareSource or Humana Healthy Horizons member, these services are part of your existing benefits. You will not receive a bill from Pathwise for our services.

Your health plan covers:

• Coordination of your care between providers

• Post-discharge follow-up and support

• Help understanding your doctor’s orders

• Assistance finding community resources

• Help managing chronic conditions

• Support with scheduling and transportation

We bill your health plan directly for these covered services.

Members with certain health plans, such as CareSource or Humana Healthy Horizons (Medicaid), are automatically eligible for our case management and care coordination services. We may reach out if your health plan identifies you as someone who could benefit from extra support, or you can refer yourself.

If you're health plan isn't listed we can reach out to them to obtain a contract to service you as well.

You can get started in three ways:

1. Click the Referral Form on our website.

2. Ask your doctor, nurse, or hospital case manager, family member or yourself to refer you.

3. Call us directly at 404-806-4301 and one of our Care Coordinators will assist you.

Our Care Coordinators and Case Managers can help you with:

• Scheduling doctor or specialist appointments

• Reviewing discharge instructions after a hospital stay

• Clarifying medications or doctor’s orders

• Finding community or in-home care resources

• Communicating with providers and insurance plans

• Managing chronic conditions (like diabetes, asthma, or heart disease)

• Arranging transportation or home health services

• Connecting with mental health or substance use support

Yes. With your consent, we communicate with your doctors, hospitals, and your health plan to make sure everyone is on the same page. This ensures your care is coordinated and you don’t miss important follow-ups.

Absolutely. Pathwise Case Management follows HIPAA privacy laws to keep your health information confidential. We only share information with your permission and as allowed by law for your care coordination.

That depends on your needs. Some members receive weekly check-ins, others monthly or as needed. You can always call us anytime for assistance — we’re here when you need us.

If you move or change insurance plans, let us know as soon as possible. We’ll help you stay connected to care and, if needed, transition your case management to your new health plan.

Your doctor provides medical treatment, and home health delivers care at home. Pathwise bridges the gap — we coordinate all parts of your care, help you understand your plan, and support you between visits so nothing falls through the cracks.

Yes! We encourage family involvement. With your permission, family members or caregivers can join care calls and help support your health goals.

📞 Phone: 404-806-4301

🌐 Website:www.pathwisecasemanagement.com

📧 Email:pathwisecm@pathwisecasemanagement.com

⏰ Hours: Monday–Friday, 8:00 AM – 5:00 PM EST

Not yet — but Medicare is coming soon! Pathwise Case Management is in the process of expanding to serve Medicare members in addition to our current Medicaid population. Once approved, we’ll be able to assist seniors and other Medicare beneficiaries with care coordination, discharge follow-up, and chronic care management — just like we do for our Medicaid members.

Stay tuned for updates on our website and social media as we announce when Medicare coverage becomes available.

Pathwise Case Management is committed to ensuring individuals receive the support they need, even when insurance coverage is not available. We proudly accept private pay for clients who do not have insurance or whose current health plan does not cover our services. If you prefer to move forward with care on an out-of-pocket basis, we are happy to work with you to arrange services that fit your needs.

For questions about rates, service options, or getting started, please contact us by completing our referral form on the website.

Referring yourself or someone else to Pathwise Case Management is simple. We accept referrals from physicians, hospitals, rehabilitation centers, social workers, counselors, family members, caregivers, and self-referrals.

To begin, please complete the referral form available on our website. Once submitted, our team will review the information and contact you to discuss next steps.