Sometimes, getting care isn't about finding the right doctor. Instead, it's about getting the right information in the right place.
Joe* is a Medicare beneficiary who found himself stuck in a frustrating situation. Incorrect insurance information in his records prevented him from moving forward with important medical care. Even though he knew something wasn't right, getting the problem fixed wasn't easy.
As he tried to untangle the problem, he found himself stuck between different insurance companies. Each had conflicting information. The situation became even more stressful because he had an MRI coming up. This was an important test that would help guide his treatment. Until the issue was resolved, he wasn't sure whether he would be able to get the MRI.
That's when he called Acentra Health, the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for his state, and spoke to Kim James.
Kim listened to Joe’s concerns and began working with the insurance companies and providers involved. After several talks, they found the source of the problem. Joe’s records had been mistakenly linked to his twin brother's health plan.
Once the issue was identified, Kim worked with the health plans to ensure the error was fixed. She requested that his records be flagged to help prevent the same problem from happening again. With the records updated and the confusion resolved, Joe got his MRI and his treatment progressed. For him, the biggest relief wasn't just getting the paperwork corrected. It was finally having someone help connect the dots and guide the process toward a solution.
Problems like this can happen to anyone. When they do, it can be difficult to know who to call or where to turn. Acentra Health's Immediate Advocacy service helps people with Medicare and their families work through concerns that may be affecting their care.
*Name changed to protect privacy.
October 23 Webinar: Empowering Ethical Practice and Resiliency Across Intellectual Disability & Autism Services
The Acentra Health Care Quality Unit (HCQU) is offering a free educational event designed for individuals with intellectual disabilities and autism, their families, caregivers, and support professionals throughout southwestern Pennsylvania, offering practical resources and expert guidance to improve health and quality of life.