Aetna Member Story

Aetna’s Care Coordination Team Helps Family Beat the Clock and Avoid Hospitalization

"As a nurse, I used to think that insurance companies were only out for themselves, but today I’d like to present a story that gives me my real why, my why I wake up and love going to work every day and how impactful my team is,” said Lisa-Jasmin Ford, Clinical Manager at Aetna Better Health.

Last year brought with it many challenges. Along with a nationwide pandemic, Illinois grappled with severe storms. Aetna Better Health Member, Linda Velazquez, called Aetna in a panic the day after one of these severe storms. Linda’s daughter Vanessa, also an Aetna member, was born with a very rare and complex genetic disorder, which results in profound weakness, chronic lung issues and malnutrition.

Linda was in a panic because she had lost power in her home which directly affected Vanessa’s medical needs. Vanessa had extreme failure to thrive, a form of malnutrition, and suffered from many nutritional imbalances and had to be fed through a stomach tube. Without continuous and proper nutrition, Vanessa was at a high and immediate risk of developing a seizure condition which could potentially become fatal. The battery for the stomach pump used to feed her only had a lifespan of a few hours without being plugged into a power source.

Aetna’s care coordination team:

• Outreached ComEd and was able to escalate the case for faster restoration.
• Signed Linda up for text alerts so she could track when the power would be back on.
• Established a safety plan checklist with Linda so she could safely travel to a family member's home while her power was being restored.

With the help of the care coordination team, Linda and Vanessa were able to beat the clock and safely settle into her aunt's house. Her feeding was uninterrupted, she suffered no life-threatening seizures, and she was able to return home and sleep in her own bed that night once the power was restored.

“Aetna believes in prevention, we work with all different agencies and treatment teams to ensure the safety and best health outcomes for our members - We are prevention,” said Ford.