Success Story: Medical Support During a Health Care Crisis

Success Story: Medical Support During a Health Care Crisis
July 30, 2020 Erica Manhardt
Finding care during COVID shutdowns

COVID-19 has presented a difficult situation for people in need of medical care. State by state and business by business, rules to keep people safe during the pandemic and help limit the spread of the virus have varied. Some doctor’s offices have limited patient visits or closed down completely, while many hospitals have been restricting the types of services performed.

In the midst of the pandemic, Gavin found himself in need of medical care, in pain and not sure what to do. But the help of an integral member of his health care team made all the difference.

A painful accident

Gavin is an avid runner. He enjoys the freedom of the open road under his feet, and relishes his runs as a safe escape from his worries. Unfortunately, life had other plans. One day while out on a run, Gavin tripped on some uneven terrain and fell—hard. A visit to his doctor revealed he had fractured his kneecap in the accident. Every move of his leg resulted in excruciating pain. His doctor recommended outpatient surgery, but at a facility that was not in Gavin’s provider network. Seeking care in a facility outside his network would mean higher out-of-pocket costs for both Gavin and his employer..

Gavin was stuck at home, in excessive pain and unsure what to do next. He was feeling isolated and hopeless. Many doctors’ offices and facilities were closed down due to the COVID-19 restrictions. He needed to find one in his provider network that was still willing to see him.

Research and personal support

Gavin had health care coverage administered by Meritain Health®. All Meritain Health plans are supported by a team of individuals dedicated to helping clients and members address their questions and concerns as quickly as possible. The client advocate for his plan learned of his situation and got to work right away finding him a source for the care he so desperately needed.

Gavin’s client advocate began contacting orthopedic doctors in Gavin’s network to see if they had any openings, and if they were willing to treat him during all the shutdowns. Phone call after phone call, her efforts finally paid off—a facility right by Gavin’s home was ready and willing to help! The client advocate scheduled an appointment for Gavin the very next week. She contacted him with the good news, and was greeted by a big sigh of relief.

Healthy recovery

As life slowly returns to normal, Gavin is recovering post-surgery. He is thankful to have received care despite the challenges of the pandemic. He and his employer both received support that is helping him recover, plus he was able to save on the cost of that care through guidance to a network provider. This support also helped his employer save, thus reducing impact to the benefits plan and their total cost of care.

All together, Gavin will be able to get back to what he loves the most—running outdoors once again!

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 or similar outcomes in any new or future cases, as the result of each case depends upon many factors, including but not limited to the facts of each case. Any actual savings will vary based upon numerous factors, and neither Meritain Health nor its affiliates guarantees any level of savings.