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Complex Case Management

Positioning people to make the care choices right for them.

Ms. V was diagnosed with diverticulitis, an inflammatory disease of the digestive tract, and underwent surgery. Pathology results confirmed that she had malignant peritoneal mesothelioma, a rare type of cancer that occurs in the membrane lining of the abdominal cavity. 

Soon after receiving this diagnosis, Ms. V was contacted by a MedCost Case Manager. Through research, the Case Manager verified that peritoneal mesothelioma is an aggressive cancer and is regarded as universally fatal. Treatment options included surgery and intra-operative or early postoperative chemotherapy. 

Ms. V’s local physician told her that no specialist within the MedCost network could treat this rare type of cancer and referred her to a specialist in Washington, D.C. Ms. V went to Washington for a consultation, paying the costs out-of-pocket since no coverage was available for out-of-network care. She expressed her concern to the Case Manager because she did not want to go out-of-network and to another state for her treatment. 

The Case Manager located a MedCost Network provider who treats patients with the same type of cancer and could offer an opinion on treatment options. Initially, Ms. V’s local physician resisted and did not want to refer her to the in-network specialist for evaluation. At the urging of both the Case Manager and Ms. V, the doctor relented and made the in-network referral. 

I’m so pleased that I will be closer to home for my treatment and will save money. I’m so lucky you helped me find this physician.

The in-network specialist’s main goal was to evaluate the treatment plan that Ms. V received during her D.C. consultation. His recommendations for her treatment were exactly the same as the original plan, so Ms. V was able to remain at home and in-network for the medical services she needed.