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Member success stories

Prostate Cancer
Hip Osteoarthritis
Gastrointestinal Disease

Situation

A 54-year-old male member was diagnosed with high-risk prostate cancer. The member had been seeing a local urologist, who said he would require immediate treatment. He was referred to a radiation oncologist and given the recommendation for intensity-modulated radiation therapy (IMRT).

How we helped

  • Collected medical records & pathology slides within two days of connecting with member
  • Evaluated local radiation oncologist credentials
  • Coordinated a pathology review
  • Facilitated expert second opinion with a top urologic oncology expert at a Center of Excellence (COE), and the member was seen six days later

Breaking down the member outcome

  • The expert pathology review downgraded his diagnosis to low grade disease
  • Recommended active surveillance rather than treatment, with guidance that treatment may never be necessary
  • Confidence in decision because recommended oncologist is a leading researcher and expert in their field

One-year post engagement follow up: With ongoing surveillance, the member has seen no disease progression

 

Situation

A 50-year-old female member was diagnosed with right hip moderate osteoarthritis. After describing ongoing hip pain while sitting, standing, and walking, her local orthopedist prescribed a narcotic for the pain and recommended an anterior hip replacement.

How we helped

  • Collected and reviewed her medical records and images
  • Determined local orthopedist did not specialize in hip procedures
  • Facilitated expert second opinion with orthopedic surgeon with specific expertise in hip

Breaking down the member outcome

  • The expert recommended against replacement surgery, and instead prescribed physical therapy
  • The expert second opinion also advised against a narcotic and instead prescribed an anti-inflammatory. The member relayed to the care advisor this was a relief since she did not want to risk getting addicted to narcotics

One-year post engagement follow up: The recommended nonsurgical methods are still effective for the member.

Situation

A female member reported to her physician she was experiencing a choking feeling when trying to eat. A local specialist diagnosed esophageal achalasia, a rare disorder of the esophagus, and recommended surgical intervention (Heller Myotomy).

How we helped

  • Collected medical records and images within three days
  • Identified top regional experts for esophageal achalasia
  • Expedited appointment with an identified expert

Breaking down the member outcome

  • Expert recommended against the invasive surgery and instead performed an endoscopic therapy (dilation)
  • The less invasive procedure was scheduled for two days after the expert appointment and recovery was quick and easy for the member

One-year post engagement follow up: The member remains symptom free.

Member feedback

“Thanks for taking the bull by the horns and helping me when my own doctor showed very little concern about referring me. (TWO years went by!) I was happy with your help and with the doctor/hospital you referred me to. I would definitely use your help again. Really, I am so glad I found the link on my company’s insurance page! Procedure went well and I am “cured” for a few years, if not longer.”

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