Earl was a decorated war veteran who was three years into a well-deserved retirement when he was diagnosed with Stage II lung cancer.
Although a former smoker, he had been a non-smoker for many years when his cancer diagnosis was given. Earl had undergone preliminary treatment in his hometown, but his family wanted additional treatment consultations beyond what was currently available.
The family reached out to Putnam Health Advocates to coordinate and manage the delivery of his care including the referral to a world-renowned facility outside of his community. One of our Cancer Nurse Navigators was assigned to help Earl and his family navigate the overwhelming intricacies of cancer treatment that also included a potential life saving pneumonectomy (removal of the diseased lung.)
We provided review and audit of medical charges; insurance and reimbursement management; coordinated post-discharge home care and helped the family with referrals to local cancer support groups.
Diabetes Care Coordination
Robert is a 64-year-old widower who now lives in the independent living area of a continuing care retirement community in the northeast and has been living with Type II Diabetes since age 58.
During this time, Robert has had to learn how to re-engineer his diet, get proper exercise and manage his insulin levels all while being the primary caregiver to his ailing wife. Additionally, Robert has 28 medications to take daily for other illnesses. His 4 times per day blood sugar checks, improper insulin management and a non-compliant diet was the catalyst for an ongoing cycle of being sick, run-down and repeat hospital admissions for pneumonia for Robert. Left on this pace, he would become worse and his progression through the retirement center would be expedited to the long-term nursing unit.
Robert’s family utilized our Care Advocate services to assess Robert’s overall living environment and develop a care plan to identify and resolve obstacles that were preventing him from living to his potential. Our diabetes assessment included: a review of his medical history, communicating and coordinating with his physicians, family members and friends; and, direct observation of how he was navigating his daily life.
We were able to identify the inefficiencies in his ability to manage his diabetes, which had a direct effect on his other health issues. We implemented RN tele-health technology and protocol for a once-in-the-morning (instead of four) blood sugar check; installed a med alert system; hired an RN to manage his “pill-box” every two weeks and hired a home care aid to visit for one-hour each morning.
As a result, Robert starts the day out with the proper nutrition, managed blood glucose and he no longer sleeps until noon and beyond. He makes his own lunch (on time) and has his evening meal in the community dining room. He has started to gain back the weight he had lost, enjoys a robust social life and gets plenty of sleep. He is now thriving.
Stroke with Care Coordination
Damon is a 51-year-old successful computer project manager for a large distribution company. Unfortunately, a history of non-compliant and untreated high blood pressure led to a Hemorrhagic Stroke.
The life he and his wife of 16 years enjoyed changed forever. While still in inpatient rehabilitation, our Care Advocates were hired by his spouse to manage Damon’s discharge and assess and coordinate services he would need. His stroke had left him with right side paralysis and almost 80% blindness. Sadly, his career as a project manager was over.
Prior to Damon’s discharge, we immediately began coordinating and applying for his Long-Term Disability benefit through his work, while also applying for Social Security Disability Insurance (SSDI); both were approved quickly. We developed a life-care plan so the family could understand and plan for the cost of care; coordinated, interviewed and hired a home care service; managed all medical bills and insurance issues; researched and obtained best pricing for needed healthcare supplies; coordinated with out-patient rehab therapists and the insurance provider for ongoing services; researched and obtained prosthesis and negotiated pricing; obtained needed in-home mental health services and researched technology to improve mobility.
Although his journey will be life-long, Damon has a direction to go in and will be ready as new technologies and therapies for stroke patients evolve.
Trauma with Case Management
Jim is a 52-year-old married father of three. On a beautiful weekend morning, he was helping his neighbor with his pool pump when it inexplicably exploded in Jim’s face.
Suffering severe facial fractures and other injuries, he was airlifted to a local hospital and placed in ICU. With his mouth wired shut and on a ventilator, Jim stayed in the ICU for five days. Jim’s family called us immediately into the case to help manage issues impeding his recovery; work with discharge planning for follow-up care; research legal professionals; liaison with financial services and provide support services to the immediate family.
Jim’s family could concentrate on his recovery and not be burdened with all of the necessary, but untimely items that needed attention. With Jim continuing on his healing journey post-discharge, we were able to position all needed resources and exit his case with comfort knowing he would be okay.
Denial and Appeal
Mary came to us because she was being penalized almost $4,200 in fees for her supposedly failure to choose a Medicare Part D Plan within the time frame set for annual sign up; Mary is under no prescriptions and enjoys excellent health for a 77-year-old.
The penalty period went back 4 years and she had been trying, for almost that long, to have the fees overturned. Clearly she had complied completely with the selection process, but somehow was not successful in communicating those points across.
Mary hired us to help and we began to put a timeline together that included documented conversations she had had with Medicare contractors going back those four years. Through our efforts and subsequent conversations, we were able to uncover documented facts that Mary did comply with Medicare regulation but, the contracting company failed in their efforts to forward Mary’s selection to the next stage; hence, Mary had fallen thru the “big crack” of government regulation and no one knew how to get her out.
Once we were able to obtain the facts on her case. we reached out and appealed the fines. It took two letters and numerous phone calls to Medicare’s contractor, but the decision was favorable and we had won our appeal.