Mateo
Relocating to a new state for a new job can cause a lot of anxiety for anyone. But when a family member has a complex condition, locating high quality providers can add extra stress.
Earlier this year, Mateo and his family relocated across the county for his new job. His 11-year-old son has autism and was receiving daily support services prior to the move.
The problem.
Mateo needed assistance locating providers for his son including a pediatrician, speech therapist, occupational therapist, and a therapist for Applied Behavioral Analysis Services (ABA). He reached out to SentryHealth for help. The SentryHealth care team went right to work, searching for in-network providers who would meet his son’s needs.
The solution.
Unfortunately, there were no in-network ABA providers so his case manager set out to locate a high-value provider to establish a direct pay contract.
The first provider quoted a fee of nearly $400 per hour. However, since Mateo’s son would receive daily services, it would cost the company almost $100,000 per year.
The case manager located a second provider that also met our high quality standards. He was willing to accept a more reasonable rate of just over $75.00 per hour, which would save the company more than $81,000 per year compared to the first provider.
Another problem the case manager came across was the health plan had an annual limit of just over 60 visits for ABA. Because Mateo’s son needs daily services, he would meet his limit within a couple of months. To remedy this problem, the case manager collaborated with the company’s benefits consultant and TPA to modify the health plan to allow for more inclusive services. By doing so, Mateo’s son was able to receive services at the same level he had before.
The result.
Because the case manager was focused on high-quality, cost-conscious care, she didn’t stop at the first provider. This emphasis on value saved Mateo’s employer nearly $20,000 a year. In addition, her close relationship with the company’s TPA and benefits consultant enabled her to advocate for Mateo’s son successfully.
As a result, Mateo’s son is thriving in Florida, receiving the high-quality care he needs without any significant interruption.
The SentryHealth difference.
SentryHealth is leading the charge in employee health and wellbeing. Integrating smart technology with personalized guidance and support, we empower employees to make more informed decisions while connecting them to quality, affordable care. The result is greater engagement, higher satisfaction, better outcomes, and lower costs.
