Aetna Member Story

Turning Frustration Into Progress

Chris* is an Aetna Better Health® of Illinois member who was assigned to care management. He refused to engage in care management planning and assessments with his care manager, Melanie*. She was able to determine that Chris needed to see a dentist and ophthalmologist but didn’t have the information he needed. He was frustrated and asked for Melanie’s help.

Melanie advised Chris that he needed to select a primary care physician (PCP), who could refer him to an ophthalmologist. Chris refused to speak further and insisted that Melanie email the resources to him. Melanie compiled a list of dental providers, ophthalmologists and PCPs in Chris’ zip code. She called each one to make sure they were in network and emailed the list to Chris. But Chris called and was unhappy. He insisted that she do another provider search.

Melanie placed Chris on hold and called an ophthalmologist office he had selected. The staff stated the need for a PCP referral. Melanie then reached out to a network primary care provider to get an appointment for Chris. The provider’s office contacted Chris, enrolled him in their system, assigned a PCP, and scheduled an appointment — even getting him in for an earlier visit.

Working through Chris’ frustration, Melanie was able to help achieve a positive outcome. With the collaboration of the network provider, he was able to see his new PCP and get a referral to an ophthalmologist.



*Names changed to protect privacy