Success Story: Top Patient Care Saves a Life

Success Story: Top Patient Care Saves a Life
November 20, 2020 Lisa Winter
What is Case Management?

“We’re sorry to inform you, your son has been shot.”

This is a call no mother wants to receive. But this is what happened to Lydia one evening.

Now her worst fears were confirmed. The hospital had just called with news that her son Daniel had been shot and was in the intensive care unit. He was paralyzed from the thighs down. She raced to the hospital in a panic.

Lydia and her son have Meritain Health for their health care benefits. Meanwhile behind the scenes, Lydia’s employer had reached out to their Meritain Health client advocate for help with Daniel’s situation. For the best possible outcome, he would need immediate air medical transport to a facility that specialized in spinal injuries—but unfortunately, this service had been quoted at over $80,000.

This would be an enormous expense to the both the group, and to Lydia, who would be responsible for a portion of the cost. She was already beside herself with grief and worry. Figuring out how to provide her son with the care he needed would be too much. There had to be another way.

The client advocate knew what she needed to do. Working together with a specialty flight nurse through the Meritain Health Case Management Program and other team members, they negotiated a much lower rate: just over $17,000. This was less than a quarter of comparable air transports in that area. The transport would include advanced life support and ambulance attendants, plus Lydia would be able to ride along.

Less than 24 hours later, Daniel and Lydia were on their way to the spinal care facility.

Once there, Daniel was treated by top-rated specialty providers for the best possible care. This facility provided care unique to most rehab facilities and was in a value-based network. This meant Daniel received top-rated, life-saving treatment, and at a lower cost to Lydia and her employer.

Daniel survived his ordeal and today has a bright future. He’s in school and working towards his career. Though paralyzed, he feels fortunate he made it through a life-threatening situation. His story is not over; in fact, it’s just beginning. By getting the care he needed just when he needed it most, he’s still able to live his dreams.

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.