Our Members' Stories
Diagnosed during infancy with failure to thrive, baby Natalie spent eight days in the hospital with her anxious parents by her side. Because she was not gaining weight, Natalie received a feeding tube. Her parents’ only concern was their daughter’s health, so it was a relief when they received a call from a CareFirst case management nurse. Case managers assist members faced with acute or critical illness by providing personalized support and coordinating much needed resources.
Natalie’s mom, Catherine, recalls they first spoke to their case manager before Natalie was discharged. Their nurse assured them all the services, supplies and support they needed would be set up for them when they got home. She also called once they were home to walk them through how to use everything and called regularly thereafter to monitor progress. After a few months, Natalie’s case transitioned to a nurse who works for CareFirst’s Patient-Centered Medical Home (PCMH) program for longer term support.
Natalie’s Care Coordination Experience
By her first birthday, Natalie was formally diagnosed with Mowat-Wilson syndrome, a rare genetic disorder first recognized in the late 1990s. Due to its relative recent discovery, there is not a lot of research or information on the disorder. With this diagnosis came a flurry of doctor and specialist appointments.
Still processing the diagnosis, Catherine appreciated the additional support she received from her nurse care coordinator and the dedicated customer service representative (CSR) assigned to her. She says, “Once you come out of the initial shock of the diagnosis, having people who know more than you and can help you understand and deal with everything while you have so much going on, is fantastic.”
Natalie’s nurse helped coordinate the care between her numerous doctors—at her peak, she was seeing 9 different specialists—and coordinated physical, occupational and speech therapy services. Catherine says, “Our nurse was fantastic. If we couldn’t reach our doctors, we could reach our nurse and she could intervene with the doctor on our behalf.”
Catherine was also impressed with Pat, her dedicated CSR. Highly trained CSRs work individually with members participating in care coordination programs to provide prompt coverage information. These members – who rely heavily on their health plan benefits – save time and gain peace of mind by speaking with someone who is familiar with their case each time they call with questions.
Catherine says, “Having a dedicated customer service rep who worked tirelessly to find the answers to our questions was almost as important as having a nurse to talk to. Without Pat, we would have spent hours going through our insurance paperwork to try to find answers.”
Pat is equally enthusiastic about her role, stating, “I really feel I’m helping our members get better. I get to know them as a person, understand their stories and what they are going through. I hate to see anyone not feeling well and I am compassionate...I treat them all as if they were my mom.”
Building on her capabilities to make sure she reaches her optimal level of development and success is one of Natalie’s goals. Though she will face certain challenges the rest of her life, her mom says, “What’s cool is Natalie could do anything. We have no expectations.”