Mrs. V. was lucky that she had health insurance in today’s growing world of the uninsured. Her unemployment status had left her with a COBRA policy. The policy seemed comprehensive enough to her at the time that had she purchased it. An in-patient deductible and coinsurance were reasonable. Additionally, the policy contained skilled nursing benefits. But how were the policy’s pharmacy benefits? So far the Wal-Mart $4 Prescription program had been able to take care of her needs. When a serious post-op infection left her with the need for long-term intravenous (IV) antibiotics, Mrs. V. found that she was underinsured. There were no pharmacy benefits.
As the hospital based case manager, my task was to help Mrs. V. make plans to transition out of the hospital. The cost of the IV antibiotic was nearly $170 per day. Our infectious disease physician anticipated the need for four to six weeks of therapy. Calculating the cost, the antibiotics would cost a minimum of $5,100. Additionally, the infusion company wanted the money prior to delivery of the medication. We asked the question: “Can a less expensive medication be used?” “Yes, maybe,” was the physician’s answer. However, the infectious disease specialist wasn’t comfortable with changing from a medication that was known to work. This option must be the last resort.
Financially, planning discharge for Mrs. V. was a challenge. She was in a Medicaid-pending status and there was no guarantee that she would have this benefit. When I presented the cost information to Mrs. V. she began to cry. Mrs. V. was 50-something and the thought of going into debt, or possibly using her skilled nursing facility benefits (SNF) and still going into debt appeared to be her only choices. Fortunately for Mrs. V., her husband was emotionally supportive. With his encouragement and a personal call from an administrator at the skilled nursing facility where she had been an employee and had now chosen to be referred, Mrs. V. decided SNF would be her best financial option. This option also helped to support her need for ongoing surgical wound assessment and care. After nearly three weeks of being hospitalized for what began as a respiratory illness and having undergone two surgeries to manage the wound infection, Mrs. V. was discharged.
In today’s world of health care, scenarios such as Mrs. V.’s are not uncommon. Although her choices were limited, we were able to offer her options. At the time of discharge Mrs. V. was comfortable with her decision and looking forward to moving to a facility that was closer to home and was familiar to her. Even though we would have liked for her to be able to return to her home, as her case manager, I was proud that I could help her find the best possible solution to both her financial and her healthcare needs.
