True Story Story #3 Case Managers Are Member Advocates
True Story 3 | July 2016 | Prairie States News |
A member’s 18-year-old son became very ill and required helicopter transport to a qualified hospital. The teen was diagnosed with a brain tumor and a surgery was scheduled. Prairie States’ Case Manager was able to authorize the surgery, but meanwhile the helicopter transport was billed to the member at a cost of $54,000.
The Director of Claims at Prairie States stepped in and negotiated a rate with the helicopter transport company. The member did not have to pay the $54,000, only his health plan deductible.
Following the surgery, the teen’s care plan was extensive. The Case Manager quickly got to work to ensure all the pre-certification requirements, national standards and benefits plan guidelines were met. Through her work, every single treatment, overnight stay and prescription sought by the physicians was approved.
Continuous Support for the Member and Great Result the Bottom Line:
When a loved one is seriously ill, and especially when that person is a child, healthcare benefits are not always top of mind. Our Case Managers are in our members’ corner, continually advocating for them from both a clinical and financial standpoint.
The good news about coverage throughout the stages of care was not only a financial relief for the member, but an emotional one as well. He wrote a letter to his company’s Human Resources Director pointing out the “level of genuine care and concern” they got from their Prairie States representative and how “touched we are” over the attention they’ve received from diagnosis to recovery.
Prairie States Enterprises, Inc. is a third-party health benefits plan administrator that brings industry expertise and a clinical focus to self-insured companies. Our in-house claims administration, health management services, wellness programs, plan analysis and predictive modeling tools result in remarkable and unprecedented cost control for employers. We also provide the most compassionate and personalized level of service for plan members.