Allie sometimes thinks back to her younger days as an athlete on her high school track team. Back then, she loved being active and didn’t give much thought to whether her heart was healthy and working properly. She still keeps a few trophies proudly displayed on her mantel to remind her of those times and the victories she achieved while competing.
Now, getting older, Allie hasn’t felt as lucky. She’s been struggling to keep up with ongoing health issues. And today, her heart health is something she thinks about all the time.
Allie has chronic heart disease called cardiomyopathy. As part of her regular health care routine, she sees a heart specialist to help her manage her symptoms. Walking just short distances—like from the lunchroom back to her desk at work—can be enough to make her feel out of breath. And very often Allie’s heart beats too rapidly, which causes her a lot of worry.
To limit the stress on her heart, Allie’s doctor has instructed her to take it easy. She does this as much as she can by taking frequent rest breaks and always riding the elevator at work instead of climbing stairs. But her heart rhythms need to be controlled to prevent her from going into sudden cardiac arrest, which would be life-threatening. Unfortunately, due to a potential risk for too many complications, Allie isn’t eligible for an implantable pacemaker.
Instead, her doctor has recommended getting a portable defibrillator device she can carry with her. Since Allie lives 45 minutes from the nearest hospital, she could keep this machine, called an AED (automated external defibrillator), by her side at all times to save her life if her heart were to fail.
Having a solution to protect her heart helped ease Allie’s worries a lot! But finding out how much the unit could cost left her feeling lightheaded.
Thankfully, Allie’s health care benefits with her employer are through Meritain Health®. A client advocate was assigned and eager to help.
As a first step, the client advocate wanted to see if she could lower some of Allie’s future costs. She reached out to the provider in the area specializing in AEDs for homecare use. Knowing these units could be pricey, she asked if the amount could be brought down. Her efforts paid off! She was able to negotiate $700 off the original price of $3,900 for the machine—close to 20 percent savings! Additionally, the provider was willing to include the first set of defibrillator pads, valued at $75 and good for a one-time use or up to two years. This was all great news for Allie!
The next step would entail seeking approval from Allie’s employer. The AED provider was one of the only ones able to provide the kind of unit Allie needed—but they were out-of-network. However, with the new negotiated rate in-hand, the client advocate checked to see if Allie’s employer would approve purchase of her AED at the in-network rate. They agreed!
Allie could now have the life-saving machine she required. When she heard the news, she was overcome with relief—she couldn’t believe her out-of-pocket costs would be $0!
Allie’s employer was thrilled, too. Together, they were grateful for the skilled work and compassion the Meritain Health client advocate showed them, and for the money they were able to save. With her worries now behind her, Allie’s heart is beating with nothing but gratitude.
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.
