As a team of benefits strategists, we work hard every day to make sure we’re exceeding client expectations and providing the most innovative and value-generating plan designs and advisory services.
A family with a dependent facing a complex health challenge
The family of the dependent was new to the company and Indiana. Their toddler had allergic reactions to almost every form of nutrition and was dependent on a high-cost formula. This formula was delivered orally, so it was not covered as a medical cost. The family was spending hundreds out of their own pocket each month just to feed their child.
Over twenty different specialists were consulted without a confirmed diagnosis. Experimenting with countless diets and medical solutions had proven fruitless. The family was still at a loss for answers.
In addition to the financial strain and challenging medical journey, the family was disconnected from vital support systems. At three years old, their child had aged out of the First Steps early intervention program, where they had received much needed assistance during their child’s development.
Sarah Michaels, RN CPBS
Solutions start with the right questions. Our nurses first wanted to find out why a three-year-old was dependent on formula. This client had the Second Opinion Program in place, allowing our nurses to connect the family with the Mayo Clinic to pursue a diagnosis. Through the referral program, the family was able to secure an in-person evaluation and lab work with industry-leading experts just before Christmas – fondly referred to by our team as the “Christmas Miracle.”
In the leadup to the appointment, Apex nurses stepped in to provide support. They identified that the specific formula the family was having delivered by their doctor could be ordered in bulk online at a fraction of the cost. This would save the family hundreds as they waited for their Mayo appointment and test results. Our team was also able to leverage local expertise and connections to get the family reconnected with the First Steps program. A local elementary school was identified that made exceptions to the age restriction for children in need.
When they first heard about the opportunity to visit Mayo, the family did not believe they could afford the visit. But since their employer had a Second Opinion Program contract in place, and they had already hit their out-of-pocket maximum, they were able to see a specialist at no cost.
The visit resulted in an official diagnosis of a rare genetic condition. Armed with this information, the child’s care team was able to develop a treatment plan, the result of which reduced dependence on formula and finally reintroduced solid food into the child’s diet.
With the first accurate diagnosis since their child’s birth, one family was given hope for the journey ahead. Instead of more visits to specialists and guesswork treatment, they had an actionable plan to begin to make progress. Instead of being disconnected and overwhelmed, they were now connected to resources like First Steps that would provide vital support. Despite a long journey ahead, the family has hope, and a new lease on life.
More Case Studies
- August 31, 2023
A family employed by an Apex were seeking answers and resources as they navigated their child’s complex health challenges. Apex’s Second Opinion Program connect them with world-renowned experts and vital local support.
- July 27, 2023
A county government with 100 employees partnered with Apex to implement reference-based reimbursement. Over the next 6 years, they experienced sustained savings on both health care spend and PEPM costs.
- June 15, 2023
A county government with over 450 employees partnered with Apex to implement reference-based reimbursement and saved millions over 7 years, decreasing their PEPM costs in the process.