From Denial to Diagnosis

By Laura Lopez, strategic marketing and communications coordinator at Network Health
Photography by Kyle Halter, multimedia content coordinator at Network Health

Linda A., a Network Health Medicare Advantage member, had been going to physical therapy for neck pain for months when Network Health denied coverage for additional sessions. The denial turned out to be a blessing in disguise. Because another round of physical therapy would not be covered, Linda's physical therapist recommended further diagnostic testing to determine the root cause of her pain. An MRI uncovered an unexpected and life-changing diagnosis: metastatic cancer.

"The denial was actually the best thing that could have happened," Linda shared. "Without it, we would not have discovered the cancer when we did, and I wouldn't be getting the care I need now."

After the MRI, Linda's medical team recommended further imaging to determine the cancer's origin. While a mammogram didn't show any abnormalities, an ultrasound revealed breast cancer.

With this diagnosis, Linda turned to Network Health Care Manager Rosanne R. for support. "When you're newly diagnosed, there are so many questions," Linda explained. "Who do I go to? Where do I go? What do I do next? Rosanne was the one I called every time."

When you're newly diagnosed, there are so many questions," Linda explained. "Who do I go to? Where do I go? What do I do next? Rosanne was the one I called every time.

When Linda's doctor sent her to an oncologist who wanted to move forward quickly with a mastectomy, she contacted Rosanne. The doctor's plan didn't sit well with Linda. She wanted to get a second opinion but wasn't sure if it was okay to do so, or which doctors she could see.

Rosanne reassured her that seeking a second opinion was her right as a patient. "She told me I didn't need a referral for a second opinion. It was covered by my plan," Linda recalled. After speaking with Rosanne, Linda was able to get an appointment with a leading breast cancer specialist at Froedtert within days. "That was on a Friday, and by Monday, I was sitting with one of the top doctors in the field. The information I received was lifesaving."

That was on a Friday, and by Monday, I was sitting with one of the top doctors in the field. The information I received was lifesaving.

The second opinion confirmed Linda's doubts about surgery. Because the cancer had already spread to other parts of her body, the oncologist at Froedtert recommended a different approach that was focused on managing the cancer while maintaining her quality of life.

Throughout her treatment, Linda has relied on her Network Health Care Team for not just medical coordination, but emotional and practical support. From helping her understand which health plan was best for her changing medical needs, to calling monthly to check in, care managers Rosanne and Shannon C., who took over when Rosanne retired, have been a steady source of support during her journey.

"I appreciate that they care so much. I get a monthly call from them. They listen and take notes, and then they always follows up to make sure I get what I need. What insurance company does that?" Linda said.

As Linda continues to navigate her health journey, she encourages women with dense breast tissue to advocate for a breast ultrasound in addition to their regular mammogram screening. She also wants everyone to know about the care management team at Network Health. "Rosanne was right by my side. To have that kind of individual attention when you have a life-changing diagnosis is so helpful to people who are really sick. I love my Network Health and I love my people there."

Rosanne was right by my side. To have that kind of individual attention when you have a life-changing diagnosis is so helpful to people who are really sick. I love my Network Health and I love my people there.

What is Care Management?

When a member is facing a difficult diagnosis, complex medical condition or behavior health condition, having an experienced and compassionate care manager like Rosanne and Shannon by their side can ensure that the member gets the care they need, when they need it.

Network Health Care Managers provide personalized care and advocate for members in the following ways.

• Review medications and treatment plans
• Identify signs that a health condition is worsening so the member understands when to act, including when to contact their health care provider
• Work with a member's health care provider to ensure they are aware of changes in the member's health
• Include the member and their caregivers in health care decisions
• Share helpful community resources

If you or a loved one are navigating complex health needs, Network Health's care management team is here for you, whether you need help coordinating appointments, navigating treatment plans or finding someone to talk to.

Accessing the care management services is easy.

A Network Health care manager may contact you during a transition of care, such as returning home from the hospital. You can also ask your personal doctor for a referral to care management or you can contact them directly at Network Health to explore your options. Call 866-709-0019 (TTY 711) Monday-Friday, 8 a.m. to 5 p.m. or visit networkhealth.com/wellness/care-management. From helping members understand their condition to coordinating timely care and being there to answer questions, Network Health's care management team can ensure no one has to navigate their health care alone.

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