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Care Coordination Stories: Continuing Care When Coverage Stops

March 10th, 2015

A young adult faced loss of services, but the care coordination team helped her continue coverage.

Insurance coverage was automatically terminated on her 19th birthday. Her parents worried they wouldn’t be able to get critical medications or medical equipment their daughter needs.

Specialized¬†Care for Children staff began making phone calls to the local Department of Human Services office, and to the family’s nursing agency and hospital. This team included Benefits Management & Research Specialist, Susan Fritcher, the family’s Regional Office Manager, Lisa Washington, and the Supervisor of our Home Care Compliance & Audit unit, Vickie Lund.

The group effort also included the family’s care coordination team, Maribel Cano and Amber DiGuiseppi. They drove to the local Department of Human Services office to meet face-to-face with staff and the family to discuss options. From there, they drove to the family’s home to help them complete an online Medicaid application.

While the application was pending, Maribel worked with the hospital to have the critical medications shipped to the family’s home.¬† Maribel and Amber also worked closely with the medical equipment vendor, nursing agency, and pharmacy to ensure there was no disruption in services.

After a week of extensive care coordination, the team happily reports that eligibility was re-established with no break in coverage!