Meredith was happy just to stand.
This simple movement that seemed so unremarkable for many was a huge accomplishment for her. She had developed a chronic condition as a teenager that at first made her feel a little clumsy. But eventually, it robbed her of her ability to walk. Probably most terrifying was its progression, and the fact that there presently isn’t a cure.
Luckily, Meredith’s doctor recommended a medication that could be infused directly into her spinal column. After a few treatments, she was able to stand, and sometimes even take a few steps. This increased mobility made her feel more alive. She hated the thought of being confined to a chair for the rest of her life. Just being able to grab a glass of water or something off a shelf was life-changing. And the medication also helped slow the progression of her disease.
However, it came with a price.
Meredith lived in a remote area where treatment centers were hard to find. She needed to drive more than seven hours each time she needed an infusion. On top of that, the medication itself wasn’t cheap. It cost her and her employer more than $300,000 per year.
Meredith has Meritain Health® benefits through her employer. A Meritain Health account manager reviewed her case and set out to find a solution that would make her treatments easier for her to get and afford.
Working closely with Meredith’s employer, their broker and other Meritain Health team members, the account manager began her research to find a new treatment facility. This included working with a specialty pharmacy advocate from the High Cost Drug Management Program, included in Meredith’s benefits. Her home state was pretty vast, and the account manager needed to do some investigating. She was able to find a facility that was a much shorter drive. It would shave about five hours off Meredith’s journey for her injections.
The new facility was also in her provider network. This meant savings to both Meredith and her employer through network discounts.
The account manager contacted Meredith to share the good news. She was beside herself with relief. The travel and cost of her injections were adding stress and worry to an already difficult situation. By visiting this new facility, she would be able to save herself valuable time and also money.
Meredith continues with her injections at her new facility and is hopeful for freedom of mobility for as long as possible. She’s grateful for the efforts of her account manager, who made it much easier to get the treatments that are helping to sustain her quality of life.
This story is based on an actual member experience. Names and information have been changed to protect the member’s privacy. This communication is intended for informational, promotional purposes only. The reference to previous outcomes made as a part of this communication does not guarantee success in any new or future case(s), as the result of each case depends upon many factors, including the facts of each case.
Case savings include managed savings and negotiated savings and follow guidelines prescribed by the Case Management Society of America (CMSA). Managed savings reflect avoidance of potential charges that are realized through the intervention/actions of the case manager. Negotiated savings reflect savings off actual charges that are negotiated by the case manager with an individual provider.
This material is for information only and is not an offer or invitation to contract. Health benefits and health insurance plans contain exclusions and limitations; see your plan documents for complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary and are subject to change.