Aetna Member Story
New Hope For A Member In Need
Steven*, a member of Aetna Better Health® of Illinois, called the health plan expressing serious frustrations about his health and his need for health care. He told the call center team member that his health was failing him all at once. Steven had been scheduled for cataract surgery a month earlier, only to learn when he went to the appointment that the provider was not in network and wouldn’t perform the procedure. Steven couldn’t reach his assigned PCP and didn’t see any specialists. He was overwhelmed by the process of trying to find the health care he needed.
Because Steven was expressing harmful thoughts, a behavioral health care manager was assigned to speak with him. Toni* was able to deescalate the situation, assuring Steven she would help connect him with the providers he needed. Steven expressed relief that someone was listening and providing information that made sense.
Toni enrolled Steven in care management. She called his assigned PCP and scheduled an appointment for Steven. She scheduled a next-day visit at a CVS® Minute Clinic so Steven’s blood pressure could be checked. Finally, Toni scheduled an appointment with an ophthalmologist.
After each appointment, Toni followed up with Steven. He was very satisfied with his PCP visit, getting a full exam, a prescription for blood pressure medication and referrals for other care. He was scheduled to have the cataract surgery he needs.
Steven was extremely grateful for Toni’s help, stating “for the first time in a long time, I have hope.”
*Names changed to protect privacy
