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CASE STUDY 1
CASE STUDY 1
$19,000 Denial Solved in 24 Hours
$19,000 Denial Solved in 24 Hours
The Challenge
After a job change, a patient was denied life-critical medication by their new insurer. Their new specialist filed prior authorization requests and formal appeals for two months to no avail. The out-of-pocket cost? $19,000 per month.
Care Champions in Action
Conducted an immediate weekend audit of the insurer's submission protocols and written communications, identifying communication errors.
Discovered the physician’s office was using outdated fax protocols, delaying insurer reviews by up to a week. Directed the office to the online submission portal and how to mark the request as urgent.
Facilitated live, three-way calls between the patient, past specialists and pharmacies, the insurance plan, and the new specialists' office to speak "the language" of the authorization department in the urgent submission.
The Result
The medication was approved within 24 hours. Care Champions trained our All Star on how to monitor their own portal to prevent future lapses.
CASE STUDY 2
CASE STUDY 2
Logistics and Dignity at the End of Life
Logistics and Dignity at the End of Life
The Challenge
A family was simultaneously navigating a complex new diagnosis for one member while managing the final weeks of an elder family member's life. They were overwhelmed by the physical and emotional weight of caregiving.
Care Champions in Action
Acted as the central communication hub, updating friends and family so the family could focus on being present.
Arranged transportation for the newly diagnosed family member and acted as the "professional note-taker" during a treatment session.
Provided emotional and spiritual anchoring, ensuring that medical decisions remained centered on the family’s values and the patient’s autonomy.
The Result
The family was able to focus on comfort and connection during a terminal illness, knowing the logistics and treatment research were in expert hands.
CASE STUDY 3
CASE STUDY 3
Treatment Decision Informed by Research
Treatment Decision Informed by Research
The Challenge
A specialist talked with their patient about switching their treatment from one medicine to another. The patient did not yet have a clear diagnosis, making it harder to know if this was the right choice for them. They wanted to understand if the treatment would be effective for all of the conditions they were being checked for and the potential downsides for their way of life.
Care Champions in Action
Conducted a review of the scientific literature of the new treatment being offered. As a quality control measure, reviewed the output from a narrow AI prompt to make sure nothing was missed in the manual review.
Provided an easy to read research report in table format and a link to the AI summary used as a quality control measure in 2 hours. The table offered facts about the treatment's results, side effects, and how the treatment would be given. Each fact was categorized as a pro, con, or neutral based on the fact itself and the patient's personal preferences. In addition, the source of each fact was listed and a link to that source was provided as proof.
The Result
The now informed patient engaged in more discussions with their specialist armed with scientific evidence. They shifted from "uncertain" to "empowered," feeling more confident in making the best treatment decision for themselves.
CASE STUDY 3
CASE STUDY 3
Preventing Delays in Care Caused by Pre-Authorization and Scheduling Mistakes
Preventing Delays in Care Caused by Pre-Authorization and Scheduling Mistakes
The Challenge
Due to a scheduling error, a patient arrived at the wrong hospital for a pre-authorized CT scan. With the correct facility 30 minutes away, they faced a missed appointment and a weeks-long delay in preventive care.
Care Champions in Action
Negotiated with the front desk staff in real-time to determine if a "walk-in" was possible.
Researched the specific insurer's "transferability" rules for pre-authorizations.
Coached the patient through a high-impact 10-minute call to the insurance line to successfully move the authorization to the current location.
The Result
The scan was completed that same day. No rescheduling, no extra driving, and no delay in critical health data.
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