In January of 2016, Brad was referred by his Primary Care Physician (PCP) to have an MRI done due to some unusual symptoms he had been experiencing. When his wife called Quantum Health to see what the benefit was for an MRI, the Care Coordinator discovered there was no authorization on file for the procedure. She immediately reached out to the PCP and put an authorization on file to ensure it would process correctly. The Care Coordinator then shared with the nurse in her pod what was going on and provided a real-time intercept for Brad and his wife. The nurse answered some preliminary questions they had and helped to ease some of their anxiety.
When the results of the MRI came back, it was what they feared most—brain cancer. But, because we were involved from the beginning of Brad's journey, we were able to put in a referral for a top neurosurgeon in Brad's area who was in-network so that he could start on chemotherapy right away. Because of Real-Time Intercept, we were not only able to arrange the best possible care for Brad, we were also able to save him money on his copay.
Shortly thereafter, Brad started radiation—five days per week for an entire month. Then chemo...again. Throughout all of this time, we worked closely with him and his wife, answering benefit questions, processing claims, providing referrals and setting up hospital visits for testing and treatment along the way. And because Brad and his nurse at Quantum Health developed such a great relationship, they touched base often to share the ups and downs of his treatment.
In 2017, after doing some digging, we discovered that Brad's health plan at the hospital where he worked had changed—for the better. It was SO good, in fact, that now any care and services done at the hospital were ENTIRELY free. By using Real-Time Intercept and some particularly good sleuthing, we've saved Brad over $17,000 this year alone...and that number continues to grow.
Along the way, it was a full team effort—Brad's Care Coordinators answered all benefit and provider questions; the clinical and oncology teams assisted with healthcare, treatment, chemo and radiation concerns; and the claims specialist looked into claims when the member's providers were processing for payment. Had it not been for Brad's dedicated team from Quantum guiding him every step of the way, his claims may not have been reprocessed and he may not have been redirected in-network, which would have cost him over $12,000!
Although Brad's unchosen healthcare journey isn't over, he can rest easy knowing his Care Coordinators are fighting for him every step of the way.