April 26, 2018 • Ametros Updates

Health Navigator Service Offers Peace of Mind Post-Settlement

One of the biggest reasons injured parties are hesitant to settle their claims is their fear of losing support they receive through the insurance system. That is especially true for the most severely injured.

People who have lost limbs, are bedridden, or have problems with day-to-day functions can become heavily dependent on their case manager who coordinates their care for them. Often their fear is so strong that they stay rooted in the system for years – even decades. Until now.

A new service designed for injured parties fills the need for healthcare guidance after they have left the insurance system. Not only will the injured individuals continue to have an advocate through the Health Navigator service, but they become empowered and feel confident to make decisions about their own care.

Henry’s Story

Henry* had lost both legs after a severe motor vehicle injury over two decades ago. In addition to his medical issues, he also suffers from depression, anxiety, and Post-Traumatic Stress Disorder.

The only thing stronger than Henry’s desire to settle his claim was his concern over losing the support of the nurse case manager with whom he had developed a close relationship throughout the years. She guided him through all his medical treatment – coordinating appointments, ensuring he received all the durable medical equipment he needed, and saw to it that any supplies were refilled before he ran out of them.

He learned of the post-settlement assistance he could receive through a professional administrator, and was encouraged to settle, though not fully convinced. He knew he required an extra level of support.  What ultimately changed his mind was learning about Ametros’ Health Navigator service and how its post-settlement care could impact his life.

As promised, Ametros sent a nurse, Mary, to meet Henry and to conduct a wellness assessment in-person to understand all of his wants and needs. She established a direct line with Henry, built a rapport and let him know she would be available to help him navigate the complex healthcare system.

Before Henry settled his claim, Mary gathered all the information about his conditions for his providers and the various vendors he needed. She made sure the transition would be smooth. 

Henry settled his claim last December, becoming a CareGuard member with Health Navigator support.  Mary continued to act as Henry’s dedicated Care Partner.

Since then, Mary has been working with Henry closely.  She has explained his options to him, in terms of providers and vendors, helped him understand his treatment plan, and the costs involved. She has also helped translate the advice he was given by various providers.

For instance, when Henry was advised to have surgery for a torn rotator cuff, she discussed the procedure and outcomes, along with additional options.

Rather than dictating where he had to go for medical care, Mary now shows Henry he has choices and helps him make the best decisions in terms of his medical care and protecting his settlement money.

Initially, Henry contacted Mary multiple times each day with questions and concerns she could help address. His contacts are less frequent now, but he has come to trust and rely on her to be his advocate.

The Health Navigator Service

The concierge service Henry is receiving is now available to the thousands of injured parties that want the freedom of settling their case, but fear losing the hands-on medical guidance of their nurse case managers. Helping lead the charge for this service is our new VP of Pharmacy and Managed Care, Chris Lagnese. Chris is taking that expertise and filling a much-needed gap within the post-settlement world.  

“Our laser focus is healthcare advocacy,” says Chris. “Navigating the healthcare system can be daunting and our nurse partners are ready to provide guidance and support post-settlement, allowing injured parties to make informed choices about their healthcare. The knowledge that a nurse is in their corner offers comfort that someone is listening and advocating for them. That alone is empowering.”

The service is innovative and unparalleled in the industry. Each injured person has different needs. Some, like Henry, require constant support, while others need less care, perhaps monthly contact. Some are hesitant to call, and instead depend on their Care Partner to contact them and help them through difficult situations.

Whatever the needs, each person gets one-on-one care with a full-time, in-house nurse Care Partner who is keenly aware of their many complex issues. This Care Partner will follow them through settlement, and continue to support them after the case settles and they join the Ametros platform. The injured individual will always have an assigned Care Partner for the rest of their life.

In addition to the personalized care and contact, the service includes an annual prescriptions review by a pharmacist to assess the person’s medications, along with quarterly savings analyses. And, of course, the service is coupled with professional administration that  maintains compliance with all of CMS’ requirements and other benefits.

Taking Care Further

People who are injured and need continued medical treatment throughout their lives typically find it nearly impossible to coordinate their complex care. Settling their claims may give them enough money, but it won’t necessarily provide them with critical support they need and true peace of mind.  Having a dedicated nurse available after they settle their claim allows them to focus on feeling better and living their lives.

*Name changed for privacy reasons

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