An Aetna member with chronic heart failure was unable to afford the copay to see a specialist after receiving a diagnosis showing a pancreatic tumor.
Aetna provided financial assistance for the member’s specialist copay and an outstanding bill for bloodwork – alleviating the financial burden and helping provide access to the care the member needed to understand their new health condition.
The efforts were a part of a new initiative called, “Nurses with No Boundaries,” which works to help remove social and economic barriers to better care for fully-insured commercial members in certain Aetna plans.
Under the program, nurse case managers can provide a small amount of financial assistance to these members annually. The initiative debuted in select states in spring 2017.
Aetna’s case managers refer cases to be reviewed by a clinical manager to make sure it fits the program’s criteria. Urgent or critical cases are reviewed for medical necessity by an Aetna medical director.
“The program empowers our nurse case managers to identify fully-insured commercial members who are struggling with extraordinary life circumstances or needs that aren’t typically included in health plan coverage,” said Debra Hicks, senior business program manager of clinical services at Aetna. “Yet we know that helping members manage these challenges will support their overall health stability.”
Nurse case managers can also help a member arrange for meal services and schedule Uber rides to a local pharmacy to pick up necessary medications.
“Based on the early success of Nurses with no Boundaries, we’ve recently expanded the program to our Southeastern Pennsylvania markets and Aetna Cares membership,” said Sherrie McNutt, head of case management at Aetna. “Nurses now have another tool to help them do the right thing for the right reason, which is a better experience both for members and our nurses.”