He was standing on a ladder to clean out a roof drain when the unthinkable happened.
Kevin*, a 47-year-old man from North Florida, lost his balance and fell to the ground, fracturing both elbows, his left shoulder, and left kneecap upon impact. The injuries were so severe that he spent 19 days hospitalized at a local trauma center and rehab hospital and required five surgeries.
Kevin’s wife and father, John*, immediately became his caregivers—and realized they would need help navigating the complexities of the health system.
Thankfully, their health insurance Health Advocate R.N. Nancy Byers was ready to step up.
In her role, Nancy is the dedicated personal health advocate for employees of one of our largest insured employer groups. As such, she handles a wide variety of issues every day—from answering quick, one-time questions about prescriptions or claims to providing ongoing guidance related to a chronic condition. Sometimes, as in the case of Kevin’s accident, she becomes a lifeline for a family in need.
Nancy reached out to Kevin’s family to see how she could help.
She reviewed Kevin’s treatment plan and made sure that home health care had been arranged for him after discharge. Upon learning that Kevin and his wife would be temporarily moving in with John to make caregiving a little easier, Nancy reviewed what equipment John already had at home and what was still needed.
She determined that, in addition to a wheelchair and adaptive bathroom equipment, Kevin would need a special hospital-grade bed delivered.
Nancy went over Kevin’s coverage with the family so they knew that home health and durable medical equipment were 100% covered under their plan. That news was met with genuine relief. It was one less thing for them to worry about. She also suggested things the family hadn’t even thought to consider—and took steps to make them happen. Because Kevin would be wheelchair bound for a while, special transportation arrangements were made for appointments and a wheelchair ramp was installed at John’s home. Nancy reached out to community assistance programs to help the family with the cost.
Once the initial plans were in place for Kevin’s care, Nancy continued to follow up with the family weekly. When another surgery was planned, she helped coordinate pre-operative care. And when Kevin was able to transition to outpatient occupational and physical therapy, she again reviewed benefits with the family and explained costs.
Every month, Kevin achieved a new milestone in his recovery, giving the family hope and a reason to celebrate. Six months after the accident, he began his return to work, using a cane for mobility and attending physical and occupational therapy after hours.
Eventually, it was time to close Kevin’s case—but Nancy made sure he knew that if he ever needed help again, she was simply a phone call away. In the meantime, John wrote a letter to the health insurer to express his gratitude:
“Nancy, your communication and your knowledge of my son’s plan benefits were a lifesaver to his wife and to me as we communicated with hospital personnel, his orthopedic surgeons, and the rehab hospital personnel regarding his stay and his ongoing therapy sessions. Your consistent monitoring and your frequent and clear communication as to what we needed to do to access all of his benefits and services will always be ingrained in this family’s heart. We will be ever thankful for you and the services that you provided to us!”
Nancy says the appreciation goes both ways. “I love my job. When I am able to truly be there for a member, it is incredibly fulfilling for me,” she said. “It warms my heart to be able to help our members and they inspire me every day. This is what I was meant to do.”
*Names changed to protect the member’s identity.