How Aetna care teams helped save peoples’ lives

Health insurance can be one of those things you don’t think about much, but you’re happy it’s there when you need it. That was the case for Maria, John and Dwayne, all members of a Aetna Dual Eligible Special Needs Plan (D-SNP). When these three members each faced a personal health crisis, their health plan came to the rescue.

For each member, the saving grace was an Aetna personal care team. It’s something every D-SNP member has. A care team is a dedicated group of health care workers, such as nurse care managers and social workers. They work closely with other health care teams and medical team providers to make sure members get the best care and benefits for their personal needs. Read on to see the difference an Aetna D-SNP care team can make.

A simple fix helped Maria get control of her dangerously high blood sugar

When Maria enrolled in the Aetna D-SNP program, her care manager, Carey, reached out to welcome her. During that first call, Carey flagged a possibly life-threatening problem: Maria had diabetes, but her glucometer wasn’t working. Maria couldn’t check her blood sugar levels, a major step in managing diabetes.

Carey quickly ordered Maria a new glucometer. When she followed up after it arrived, Carey learned that Maria’s blood sugar was dangerously high. Over time, high levels like this can damage organs, including the heart and kidneys.¹ They can also cause coma or even death. Maria was also down to her last test strip. So she bought more, only to find that they didn’t work with the new device.

Carey knew she had to act fast to keep Maria safe. She called an Aetna pharmacist to verify coverage and learned that a simple mistake was behind the problem: The local pharmacy entered the wrong code for the strips. Carey called Maria’s pharmacy to fix the error. Maria picked up her new test strips that day. She also got a refund for the strips she had to buy.

Now Maria has all the tools she needs to take care of her diabetes. Since she now closely monitors her blood sugar, her doctor has been able to change her medicine to keep her levels in a good range. Maria also has other heath conditions. So it’s even more important that she keep her diabetes under tight control. This goal is much easier to reach, thanks to Maria’s D-SNP care team.

Dedication and kindness helped John find a stable home and health care

John was homeless when he began working with Carrie, his D-SNP care manager, and Jenny, his D-SNP social worker. He was just discharged from the hospital. And with no place to call home, he was having a lot of panic attacks.

This made it hard for John to focus or take care of his many health issues. He suffered from congestive heart failure, chronic obstructive pulmonary disease (COPD), chronic renal failure and a history of substance abuse. On top of all that, he had no providers for follow-up care. And someone stole his medicine from the homeless shelter he was staying in.

Carrie and Jenny knew that to get John on the road to recovery, he needed two key things: stable housing and medical providers. Even as John moved from shelter to shelter, Carrie and Jenny kept in touch with him. They helped him set up follow-up doctor visits and gave him the emotional support he needed.

Today, John has a secure home and a primary care provider. He is up to date on all his medicines. And he keeps in close contact with his D-SNP care team to work on his health goals. As he tells Carrie and Jenny, “I don’t know where I would be if you guys didn’t help me.”

A routine call became a lifeline to food and key medical supplies for Michael

Dwayne has a history of diabetes and high blood pressure. He had just left the hospital when he came down with COVID-19. But all the family members he lived with had the illness too. They were isolated and alone, and Dwayne wasn’t getting enough to eat. He also didn’t have the medical supplies and medicine he needed to treat his conditions.

That’s when Stephanie, Dwayne’s D-SNP case manager, reached out. Stephanie called to talk about Dwayne’s transition from the hospital to his home and the resources Aetna could offer to help. As they talked, Stephanie learned that Dwayne needed food and vital supplies. On the list: diabetic supplies and a prescription refill. She also learned that Dwayne was not yet set up with his new primary care provider (PCP). This explained why the pharmacy wouldn’t refill his prescriptions.

Dwayne was feeling overwhelmed. So Stephanie jumped in to help. Her first step: Contact D-SNP’s meals vendor program. She quickly arranged to have meals delivered straight to Dwayne's home.

Stephanie’s next call was to Dwayne’s primary care provider. After speaking with the PCP, Stephanie set up a telehealth visit for Dwayne. That online visit meant Dwayne could now get the medicine and supplies he needed. Thanks to Stephanie’s support, Dwayne was able to rest at home and focus on what was most important: healing.

¹University of Michigan Health. Diabetes-related high and low blood sugar levels. February 2020. Accessed June 28, 2021.

Disclaimers

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our DSNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. Member name(s) and other details have been omitted or fictionalized to protect the member's (members') identity(ies). For more information about Aetna plans, refer to our website. 

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