Managing Logistical Details Keeps Rescheduled Surgery On Track

Cases can become complicated when surgery is postponed and hospital stays and treatment turn out to be longer than anticipated. But working together, FrontierMEDEX and the primary insurance company were able to keep the paperwork moving and the approval process on track for a 63-year-old woman living in Gaborone, Botswana.

The woman was scheduled to have knee replacement surgery in Pretoria, South Africa. Since her surgery had been postponed from an earlier date, her son called FrontierMEDEX to make sure that everything was on track for her upcoming, rescheduled procedure.

FrontierMEDEX Assistance Coordinators obtained the name of the surgeon from the treating physician and checked the arrangements. The primary insurance company confirmed coverage for the procedure and approved benefits for travel and accommodations, in accordance with the patient's policy.

Unfortunately, during pre-admission testing, it was discovered that the patient had developed a rash on her leg. A skin specialist examined her and consulted with the orthopedic surgeon, who advised delaying the surgery for at least four weeks.

Once again, the surgery was rescheduled. FrontierMEDEX Assistance Coordinators double-checked all of the details concerning the newly scheduled date. According to the surgeon, the patient would be in the hospital for about four days following the surgery, depending on how well she recovered. The primary insurance company was updated with the new information and a guarantee of payment was authorized for the surgery.

Four days after the surgery, the FrontierMEDEX Coordinator called to ask about the patient's progress. Although the surgery had gone well, the patient had not yet been discharged. She was still undergoing daily therapy and would be shown exercises to do at home. The treating facility also reported that the patient would be scheduled for outpatient follow up in Pretoria.

The patient was discharged a day later and transferred to a rehabilitation facility for another eight days until her follow-up appointment. The primary insurance company approved the cost of rehabilitation, and FrontierMEDEX reissued the guarantee of payment with the new dates of the patient's hospital stay, which was a day longer than originally predicted.

The patient's stay at the rehab facility also turned out to be a day long than anticipated, so FrontierMEDEX and the primary insurance company worked together to update the guarantee of payment for the extra day, which FrontierMEDEX then forwarded to the rehab center.

After the patient returned home, FrontierMEDEX and the primary insurance company continued to stay on top of the case until all the details were resolved.

« Back