Improving Care and Reducing Financial Stress
Emily, the 9-year-old girl daughter of a member, was facing a challenging reality. Diagnosed with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), Emily’s life was marked by sudden and severe flares that caused depression, anxiety, and behavioral issues. Her condition led to frequent school absences and disruptive outbursts, leaving her family in a constant state of distress.
Emily’s parents, overwhelmed and desperate for a solution, reached out to Conifer’s Personal Health Nurse (PHN) program. Their call for assistance marked the beginning of a transformative journey for their family.
How Conifer’s Personal Health Nurse (PHN) Helped
The PHN quickly engaged with Emily’s parents, gaining a comprehensive understanding of their situation. It became evident that Emily’s current out-of-network provider was administering expensive infusions for her PANDAS flare-ups, placing the family in a dire financial bind. The cost of these treatments was unsustainable, adding financial stress to their already heavy emotional burden.
The PHN devised a strategic plan to alleviate both the financial and medical challenges the family faced. The nurse located an in-network provider who could offer the necessary care for Emily, significantly reducing the family’s medical expenses. By coordinating with a specialty pharmacy, the PHN ensured that Emily received her medication at a lower cost, further easing the financial strain.
The PHN helped the family create an emergency plan to manage Emily’s physical outbursts, providing them with a sense of control and preparedness during crises. Recognizing the importance of comprehensive support, the PHN encouraged the family to have Emily evaluated by the school district to identify potential wraparound services, fostering a supportive educational environment.
Member Results
Through the combined efforts of Emily’s family and the PHN, the following results were achieved:
- In-Network Care: Emily is now under the care of an in-network provider, receiving effective and affordable treatment.
- Emergency Preparedness: The family has an established emergency plan for managing Emily’s violent episodes, ensuring safety and stability.
- Educational Support: Emily is being evaluated by the school district, opening the door to additional support services that can enhance her academic and social development.
- Financial Relief: The family’s financial hardship has been resolved, allowing them to focus on Emily’s health and well-being without the constant worry of mounting medical bills.
Conclusion
Emily’s story is a powerful example of how compassionate and strategic health care intervention can transform lives. With the dedicated support of their PHN, Emily and her family have moved from a place of uncertainty and financial stress to one of stability and hope. Their journey underscores the importance of accessible, affordable health care and the profound impact it can have on the lives of those in need.
*Member’s name has been changed for privacy.
Individualized Approach
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Help members navigate the care continuum to find the right care, in the right setting, at the right time —go beyond episodic case management or chronic disease management.
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