Patient advocate success stories demonstrate reduced medical costs and improved outcomes for patients

Warehouseman agrees to get second opinion and gets wonderful news

The wife of a 52-year-old warehouseman called us to ask for help persuading her husband to get a second opinion after being diagnosed by CT scan with lung cancer.  After some discussion, and promise to set up the appointment and "do the heavy lifting," he agreed to see another oncologist at an NCI Center of Excellence.  Our nurse advocate went to work getting all the previous diagnostic testing sent ahead to the consulting physician.  She then met the patient and his wife in the lobby of the hospital and accompanied them to the appointment.  It was there that she heard the 2nd doctor said, "I don't think you have cancer, but let's do some more tests."  Two weeks later, after additional testing and a lung biopsy, the trio returned again to the consulting physician's office to hear more definitively, "It's not cancer." 

Denial of child's cleft palate repair is overturned

One of our broker clients referred a case of a child whose cleft palate repair was surprisingly denied by the parents' insurance company.  After exploring the denial and getting nowhere, the broker turned it over to Guardian Nurses.  One of our nurse advocates got to work reviewing the paperwork, the clinical notes, and all the accompanying documentation.  She was able to build a case which the insurance company was unable to turn down!  Since the family was looking at a $23,000 bill, you can imagine their joy at hearing that the denial was overturned!  

With emergent admission to ICU, family reached out for support

A family's matriarch, a 72 year old woman with 5 children, was admitted emergently to the ICU for acute onset of shortness of breath and chest pain.  Having always been in good health, her children were overwhelmed with all of the information and conversations they were now needing to have with the hospital staff.  The eldest son, a Teamsters' truck driver, called Guardian Nurses to ask for help.  Within two hours, a nurse advocate showed up in the ICU waiting room.  She got the family's approval to speak with the clinical staff to find out exactly what was going on so she was then able to help the family understand what was happening to their mom and what they could expect in the next couple of days.  "We never would have been able to get through those first three days without her," they wrote, after mom was stable and doing well.

$192,000 in hospital charges eliminated after infant's hospitalization

Working on behalf of a family in California, our nurse advocate was able to eliminate $192,000 in hospital charges that the family owed from their infant son's recent hospitalization. "Baby Jones," a one-week old infant developed acute respiratory failure and was rushed to the in-network hospital where he stayed in the intensive-care-unit for one month. The nurse advocate coordinated billing and claims issues with two insurance companies and was instrumental in having the entire balance eliminated!

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