A 2-year old patient came to VMC with an uncontrolled nose bleed. His father brought his family with him to Greenville so that he was able to interview for a Physics Professor position at ECU. The patient was admitted to the Children's ED and then transferred to PICU with abnormal blood work. Labs and other tests revealed that he was in renal failure and needed dialysis. He was on the ventilator, sedated, and received CRRT (continuous renal replacement therapy).
After he was stabilized, the family wanted him transferred to CHOP since the father was to be back at Penn State to work. Prior to calling the patient's private insurance, the case manager met with the father and the father stated he would not be able to financially pay out of pocket for patient transport. The patient's private insurance denied the transfer since our facility was able to provide the care that he needed.
The father and the nursing case manager (NCM) reached out to the private insurance company pre-authorization department. The nephrologist was in the process of writing a letter for medical necessity but awaiting kidney biopsy results. The NCM made a referral for the benevolent fund but the patient was not eligible to utilize these funds.
The letter for medical necessity was sent and received by the insurance company. A received a call from the insurance company and air transport to CHOP was denied. At this time, Dr. L initiated the peer to peer MD review with the insurance company. While awaiting a call back from the insurance company, A reached out to East Care regarding cost for both helicopter and ground transport to UNC/Duke. She called the insurance company to make them aware of these costs. The ground transport cost to UNC/Duke was comparable to the fixed-wing to CHOP. The peer to peer physician review was completed and the fixed-wing transport was formally denied.
Throughout this process, the family was becoming more frustrated, as they needed to be back in Philadelphia for dad to return to work. The health care team felt helpless and had to explore more options to assist the family. With much thought, it was suggested by Jonanna to call Angel Med Flight to see if they could offer assistance. A called them in the morning and received a call back early in the afternoon confirming that they were able to do the transport without any cost to the patient's family. Arrangements were made to transfer patient. The patient was transferred to CHOP via Angel Med Flight. If it were not for the persistence of Jonanna, A, and the PICU team, the patient would not have been able to be transferred. The family was very grateful for the team not giving up on trying to get them back home to Philadelphia. The PICU team's compassion, Jonanna's suggestion, and A's hard work made this possible. Besides providing quality care, we were able to make the patient experience memorable and a great one.
Also wanted to let everyone know that during those days where the insurance companies denied the transport, it was all Jonanna could think about and it laid heavy on her heart. She brainstormed during those days of being denied. Her research into children's hospital transports led her to Angel MedFlight.