75 Year Old Patient with Lung Cancer
Specialty Care Management (SCM) Proactively Improves Patient and Health Plan Experience
Upon evaluation for case management, a 75-year-old patient undergoing chemotherapy for lung cancer was found to be suffering from prolonged constipation. Unable to self-administer an enema, the patient had attempted various OTC remedies without relief. Despite being in this condition for eight days, the patient was reluctant to visit the ER due to the cost of his $500 copay and indicated that he would simply wait until his next scheduled oncologist appointment, which was two weeks away.
Thanks to the intervention of SCM, the patient was able to avoid bowel surgery and possible colostomy. Additionally, the patient’s health plan was spared the exorbitant expense of additional hospital days, surgical costs and the potential long-term costs of colostomy supplies, greatly improving the overall experience for all parties involved.
After educating the patient about the potential health risks associated with allowing prolonged constipation to continue, SCM notified and discussed the situation with the patient’s oncologist. The oncology office called him and saw him that day for an unscheduled appointment. He was admitted directly from the oncology office to the hospital, where a partial obstruction was identified and resolved without surgery.
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About Specialty CM:
We’ve designed a new way to manage catastrophic claims—one that brings costs back under control and delivers a complete risk solution. Plus, with double the savings compared to typical network discounts, we deliver maximized savings every time.
Exclusive Program Features:
No Set-Up Fee or Cost Until Utilization so you don’t pay until you have a claim
Medical Expense Protection safeguards you from extraneous medical expenses or legal fees
Flat Case Rate that protects you from inflation while saving you more off provider billed charges
Renal Claims Defense provides access to legal counsel and support for provider appeals while accepting fiduciary risk to eliminate exposure
100% Success Rate on challenges and appeals